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FOR THE PEOPLE
THE AMERICAN MUSEUM
AMERICAN MUSEUM OF NATURAL HISTORY
HANDBOOK OF HEALTH
IN WAR AND PEACE
A MANUAL OF PERSONAL
ISSUED AT THE
OPENING OF THE HEALTH AND FOOD EXHIBITION
AMERICAN MUSEUM OF NATURAL HISTORY
MAY 23, 1917
PRICE 25 CENTS
HANDBOOK SERIES, NO. 6
AMERICAN MUSEUM OF NATURAL HISTORY
HANDBOOK OF HEALTH
IN WAR AND PEACE
A MANUAL OF PERSONAL
C-E. A. WINSLOW
WITH FOREWORD BY
HENRY FAIRFIELD OSBORN
PREPARED AND ISSUED BY
departments of public health and public
education of the american museum
of Natural History
NEW YORK, 1917
There has never been a period in American history when
diffusion of knowledge of the laws of nature was a more im-
mediate and a more imperative duty than at the present
time. Hundreds of thousands of young men and young
women are ready to offer their services and, if need be,
their lives for their country and for the great principles of
loyalty, truth, justice, humanity and liberty for which our
President has enlisted us in this world war. But let not a
single life be lost needlessly. Let no constitution be broken
by disease through ignorance. The patriotic opportunity of
all men of science is to spread the truth, and to spread it as
quickly as possible. Let us speak plainly of all the dangers
and enemies which surround the soldier and the sailor, of
those that kill the soul as well as those which destroy the
body. The loss to the world of the finest strains of manhood
is the most awful curse of the many curses attending this
war. Every young man, if single, must think of his future
wife, of his future home, of his future children and so live
that, if his life is spared, he may some day give to his coun-
try one of the greatest gifts it is in a man's and woman's
power to give — healthy and patriotic offspring. It is a
scientific, no less than a religious principle, that to serve
one's country one must be sound in body, sound in mind,
and sound in spirit.
In opening a food and health exposition, the American
Museum is in cooperation with the Council of National
Defence and especially with its Medical Board, also with
the National Food Commission under Herbert C. Hoover.
Henry Fairfield Osborn,
HEALTH AS A NATIONAL DUTY
War is no longer a conflict of armies but a struggle be-
tween nations. Behind the gallant bat- n „
talions in the field there must be other , ... . J^
battalions in the munition factories and on _ T J t « . .
. . . , j. „ National Cnsis
the farms whose devotion is equally essen-
tial to national victory. Success demands the coordinated
individual efficiency of the whole people; and individual
efficiency rests upon health.
As the United States enters upon a great war for liberty,
for justice and for humanity, there arises in all of us a new
sense of common responsibility, a new determination to
reach the highest level of effectiveness. There is no place
any more for carelessness, for meddling, for self-indulgence.
There is no place for preventable disease.
Health is to-day, as never before, a national duty —
health not merely in the sense of freedom „ . , -
from acute sickness, but in the sense of full Vff * .
abounding vigor and vitality and power.
The maintenance of such vigor and vitality depends on
simple principles of hygiene and sanitation. It has been
truly said that "within natural limitations, a community
can determine its own death rate." It is equally true that
"within natural limitations, an individual can determine his
own physical efficiency."
It is in the belief that thousands of men and women in
training camps and in munition factories, on farms and in
homes, are determined in this hour of trial to give their best
to their country that this Handbook of Health and Efficiency
has been prepared by the American Museum of Natural
History and dedicated to an awakened and a reborn America.
FUEL FOR THE LIVING MACHINE
The food is the fuel which runs our living machine, just
p , p . as truly as coal is fuel for an engine. Ex-
periments in physiological laboratories have
shown that in a man, as in any other well-made machine,
you get out an amount of work and heat that corresponds
directly to the amount of fuel put in.
Our first food need, then, is for a sufficient supply of
energy. Food energy is measured in calories, one calorie
being the amount of heat energy necessary to raise the
temperature of one kilogram (about two pints) of water
one degree on the centigrade thermometer. Three large
lumps of sugar, one large banana, one very large egg, one
chop, two thin slices of bread, two apples, one pat of butter,
two-thirds of a glass of milk — each of these food portions
contains about 100 calories. The average adult needs about
2,500 calories a day if leading a sedentary life, 3,000 calories
if engaged in active physical work.
The individual soldier has his dietary needs cared for by
those in authority. For the civil population and for the
nation as a whole, however, the question of the food supply
is a vital one in war time, and particularly at the present
moment when the food supplies of Europe are exhausted and
the whole allied world depends on America to preserve it
The attainment of proper national dietary standards de-
_ . « pends partly on the available food supply
Q 1 . f and partly on the intelligent selection and
TV t use °^ f°°d s - The cost °^ 100 calories in
different forms varies enormously; and by
learning to make an intelligent selection every individual
purchaser and every individual householder can help in the
great task of food conservation.
The following table, from "The Fundamental Basis of Nu-
trition/ ' by Graham Lusk, shows the cost of 1,000 calories in
the form of various staple foods. The actual prices would
be higher now than in 1913, but the figures are significant
of more or less constant relative differences. The economy
in such foods as cornmeal, wheat flour, beans and pork as
compared with mutton, beef and codfish is worthy of special
Cost in Cents of 1,000 Calories
Glucose 1% Butter 10
Cornmeal 2 Milk 10
Wheat flour 2 l / 2 Smoked ham 10%
Oatmeal 2y 5 Cheese 11^
Cane sugar 3% Loin pork 12%
Dried beans 4 Mutton (leg) 16%
Salt pork (fat) 4^ Salt cod 19^
Rice 5 Sirloin beef 24
Wheat bread h\i Turkey 40
Oleomargarin iy 2 Codfish steak (fresh) . . .42
Potatoes iy 2
The supply of a sufficient calorie allowance is, of course,
only a part of the problem. The body not _> , , ....
i + f - + t a u / i Body-building
only gets energy from its food but also „ .
builds up out of the foods its own substance
which is constantly being consumed as a result of the life
process. Muscle and brain and all the other tissues of the
body are wasting away minute by minute and second by
second, and the waste must be made good from the sub-
stances in the food. Some of the elements in living tissue
are present in almost all food substances and are sure to be
supplied in sufficient amounts in any diet which will furnish
2,500-3,000 calories of energy. Other building stones of the
body are found only in certain foodstuffs.
The most important of these building stones are found in
the nitrogen-containing foodstuffs known as proteins, of which
white of egg and lean meat are examples. So important are
these substances that many authorities have divided foods
into two main groups.
(1) Body-builders and repairers. (Protein, chiefly con-
tained in meat, eggs, milk, peas, beans, kernels, grain, etc.)
(2) Energy-producers, yielding heat and work. (Fats,
and oils [hydrocarbons] with sugar and starch [carbohy-
A definite proportion of protein food (10-15 per cent.) is
an absolute essential of the diet, and people who fail to get
a sufficient amount of such food quickly show the result in
diminished vigor. Pellagra, a serious disease which occurs
particularly among the poor population of our southern
states, is closely connected with a diet poor in protein, and
can be cured by the substitution of one rich in meat, eggs and
The table below, showing the classification of certain com-
mon foodstuffs according to their richness in proteins and
fats, is taken from the excellent handbook on "How to Live/'
by Prof. Irving Fisher and Dr. E. L. Fisk. Foods low in
both proteins and fats are composed chiefly of carbohy-
drates (sugar and starches).
Common Foods Classified
Poor in Fat Rich in Fat
White of eggs
Poor in Fat
Rich in Fat
Yolk of eggs
Mineral salts, such as lime, iron, etc., are also essential to
the body and there are peculiar substances T f
called vitamins present in certain foods, v .
such as fruits, unpolished rice, etc., which .
are necessary for its normal development.
The disease beri-beri among the Philippine scouts was due
to the lack of such substances in a diet made up largely of
polished rice, and was cured by a change in diet. As wide
a variety of foods as possible should be included in the diet,
and fads as to the avoidance of certain foodstuffs frowned
upon. A certain proportion of hard, bulky and indigestible
foods, such as crusts, fibrous vegetables and nuts, is essen-
tial to the proper working of the bowels. Ample protein,
salts and vitamins will be secured by the normal instincts
if unhampered by economic limitations, so that the whole
question comes down to one of costs. Professor Lusk esti-
mates that the average cost of a group of staple articles has
increased from 11 cents in 1916 to 18 cents in 1917 for an
amount that would supply 2,500 calories. To help meet
the problem of this increased cost of living he has prepared
the following low-cost meatless dietary of high caloric value,
designed for a family of five persons, the father at work
and the mother doing household work. Potatoes, with
their valuable alkaline salts, had to be excluded from the
diet because of their prohibitive price. The cost amounted
to SI. 16 daily for 14,400 calories, or eight cents per thousand
calories, which is not a high price:
Low-Cost Meatless Dietary of High Efficiency Value
for a Family of Five Persons, Father at Work
and Mother doing Household Work
Essentials. — Do not buy meat until you have bought
three quarts of milk a day. Milk contains valuable tissue-
building food, valuable salts and invaluable vitamins which
help toward sound health.
If you buy bread remember that day-old bread is much
cheaper than freshly baked bread and is just as good a food.
The menus may be arranged as follows:
Cornmeal mush, fried (-fmilk for children and corn syrup for
adults), or oatmeal, or hominy, or farina, or buckwheat
Bread (or toast).
Orange juice for baby.
LUNCHEON OR SUPPER
Pork and beans (bean soup for young children), or creamed
dried beef on toast.
Tea with milk and sugar, for adults.
Milk for youngest children.
Cereal, coffee or cocoa for older children.
Sliced bananas with sugar, or stewed dried peaches. (The
bananas may be boiled in their skins.)
Lentil soup (or potato, or bean, or pea soup).
Boiled rice (or spaghetti, or macaroni with cheese, or
baked split peas with bacon).
Tea for adults.
Milk for youngest child.
Dried-apple pie with cheese, for adults.
Dried-apple sauce for others.
The Approximate Cost per Day and the Nutritive
Values in Calories Appear Below
Amount Calories Cents
Coffee 23^3 ounces 3
Tea l /2 ounce 2
Milk 3 quarts 1,800 27
Bread 2 pounds 2,500 9
Cereal Y 2 pound 800 4
Oleomargarin % pound 2,500 19
Corn syrup 3^ pound 650 2
Sugar J4 pound 450 2
Rice or macaroni 1 pound 1,600 8
Dry navy beans 10 ounces 1,000 7
Fat pork 6J/2 ounces 1,000 6
Dry fruit (prunes) 1 pound 325 12
Flour, lard, etc., for pie or
other extras 1,800 15
As cheaper meats, pork sausages, braised chuck rib of
beef, salt cod or herring may be added if finances allow.
The amount and hence the cost of food available for the
poor depend directly on the amount wasted _. ,
by the well-to-do; and it is the duty of _ . ,
. Rule for
every American to give serious attention F
to this question. A diet containing a sur- _ .
plus of meat, fish and eggs is not only
wasteful but positively harmful, since proteins in excess
decompose in the intestines and poison the body. An ex-
cellent general rule in this connection has been suggested
by Prof. H. C. Sherman, who advises that the average
family should spend as much for fruits, vegetables and milk
as for meat, fish and eggs, and as much for vegetables and
fruits as for milk and eggs.
Wastage in purchasing and preparation of foods is another
ox xt. -rrr important cause of dietary deficiency. The
Stop the Waste f . . . f J ,
,i , following suggestions indicate some of the
special ways in which the housewife can
Go to the store yourself and select the food, with a view
to quality and cost. Be sure you get full weight and take
home for soup or stew all bones and trimmings.
Buy the cheaper cuts of meat. They are in many cases
more nourishing than the more costly ones, and can be made
tender by proper cooking and seasoning. The cheaper cuts
of meats cost only one-half as much as the round and sirloin.
Buy in quantity if possible.
Use fish instead of meat as much as possible.
Milk, cheese and beans are cheaper than meat and con-
tain all necessary nutrients.
Use a fireless cooker, which saves time, fuel and food value.
Buy fruits and vegetables only when in season.
Buy foods in bulk, not in packages.
Omit luxuries and foods of low-energy value.
PURE FOODS AND CLEAN FOODS
In war time we should welcome the introduction of cheap
food substitutes or the marketing of second-
A grade foods if they are really valuable and
" if they are sold as such. Cold-storage
products are usually not as palatable as
fresh meats; but cold storage has vastly increased the food
resources of the world by conserving the excess of one season
and one locality for use at other times and places. Skim
milk is a highly valuable food material which should be sold
freely if properly labeled. There are butter substitutes on
the market which are as valuable for food as real butter
and cost but half as much.
The purity in foods is mainly a question p, •♦«■ h
of honesty. Clean food, on the other hand, ~. ..
u i +• i f \ uu Cleanliness
is a vital essential of health.
Polluted water in the past has been a common cause of
disease both in the camp and in civil life. n -
All surface water supplies, lakes and streams _. „ . , — T ,
.. ,. . n x. , t Polluted Water
are liable to pollution from sewers or from
material washed in from the banks, and wells and springs
may be polluted through crevices in the soil. No water
should ever be drunk if there is any uncertainty as to its
quality. The water for troops in the field should be purified
by filtration or disinfection, and it is one of the first duties
of the soldier to avoid the use of any unauthorized supplies.
Water of doubtful quality may be made safe by boiling or
bj' the addition of chloride of lime. Dissolve a teaspoonful
of chloride of lime in four pints of water and add one teaspoon-
ful of this solution to a gallon of the water to be purified
(one tablespoonful to four gallons, ten tablespoonfuls
to a barrel). The water should stand for half an hour
Milk is another food which often carries the germs of
disease, germs of tuberculosis from the cow, n f
or germs of typhoid fever, sore throat, M ..^
diphtheria, etc., from human beings who
have handled it. Milk should always be pasteurized or
heated to 140 Q -145 C F. for 20 to 30 minutes before it is used,
and on no account should uncooked cow's milk be given to
The best way to pasteurize milk in the home is to set the
bottles in a deep pan of water on the stove, put a milk
thermometer into the water, heat to about 145° F. or
Pj. a little over, and then set the pan on
p . the back of the stove, moving it back and
M .„ forth now and then to keep the tempera-
ture, for half an hour, as near 145° as
possible, say between 140° and 145°. If no milk thermometer
is at hand it will be almost as well to heat the pan till
the water boils and then let it stand on the back of the
stove for half an hour, although this may give the milk a
slight cooked taste.
Foods of all sorts should be carefully protected from dust
Oth ^ f an( * ^ es ' wn * cn ma y carr y disease germs,
- f and from unnecessary handling. It is im-
~, - portant that foods should not be handled
by those who are "coming down" with any
communicable disease; and foods to be eaten raw should be
purchased only from careful and responsible dealers. The
greatest care should be taken to avoid tainted meats and to
keep perishable foods from spoiling.
EXERCISE AND REST
The heart, the lungs, the blood vessels, the bowels de-
generate if they are not given their proper
Value of work to do, and on the other hand they
Exercise suffer if too heavy a burden is placed upon
The muscles make up more than one-half the total weight
of the human body, and their proper use is essential, not
only for their own growth but on account of the inter-
relation between the health of the muscles and that of the
rest of the organs. Vigorous physical exercise not only de-
velops the muscles themselves, it stimulates the heart and
the blood vessels, it deepens the breathing, it keeps up the
tone of the digestive system, it frees the tissues from the
accumulation of harmful waste products.
The physique of the recruit is systematically developed
by setting-up exercises, marching, rifle and . . , M
\ & . . ' ?.' Avoidance of
sabre exercises, applied gymnastics, swim- _ .
ming and athletic games. It is overstrain
which the soldier must avoid, and " soldier's heart" has been
a common complaint in Europe during the present war.
Exercises should be varied so as not to overtax any one
group of muscles and they should never be carried to the
point of exhaustion. Breathlessness is a valuable danger
signal of overload of the heart.
It is not hard work that kills. It is prolonged strain at
dull tasks without variety, on the one hand, p ,
worry and excitement on the other. With __ .
a proper variety of work it is marvellous
what the human mind and hand can accomplish, but they
cannot endure too long a pull without interruption. The
operatives in the Zeiss Optical Works at Jena actually did
more work in an eight-hour day than in one of nine hours.
They could keep fresh and vigorous for the shorter period,
while they began the nine-hour day in poor condition be-
cause imperfectly rested from the day before.
The studies made in the English munition factories dur-
ing the present war have shown clearly that a limitation of
hours of labor may often lead to such an increase in pro-
duction; and this is a lesson we must bear in mind in this
country in the present crisis.
The first rule of the hygiene of rest, then, is to avoid so
far as possible overstrain due to prolonged w -
work of a similar kind. People vary a p ti
good deal in their rest needs. Some men
are rested by a change of work, some by active play and
some by complete rest. Nothing, however, can take the
place of necessary sleep, and the average individual needs
about eight hours of sleep out of the twenty-four. No one
can work hard all day and play half the night. Nervous-
ness and irritability are danger signals. They mean that
the strength is being overtaxed and that some change in
habits should be made.
Cultivation of mental poise is a great help in conserving
vital force. Worry is as bad as monotony and a fit of anger
poisons the whole system and is more exhausting than a
hard day's work.
POSTURE AND RESPIRATION
Standing still properly is one good form of exercise.
p Posture depends on the muscles which con-
v f trol the position of different parts of this
. framework. With the same equipment of
bones, one body may be stoop-shouldered
and slouching and another may be erect and well-knit.
One of the most immediate good results of military training
is correct posture, which involves the exercise of all the
hundreds of muscles which help to hold the body well.
The backbone, as we have seen, is meant to be slightly
^ m r « j curved, so as to give elasticity. In people
Evils of Bad , ' , ., & , , ; . ,. *7u*
p who do not sit or stand straight, these
curves become greatly exaggerated, leading
to round shoulders and a drooping head. Such bad posture
is not only ungraceful but unhealthy. If the back and
shoulders and abdominal wall are not held properly the
lungs do not get sufficient aeration and the internal organs
are crowded together and their blood supply hampered.
Many and grave disorders are traced to faulty posture and
are cured by improving it.
When standing correctly, the head, body and legs should
_ be poised one above the other so that a
line dropped from the front of the ear falls
within the forward half of the foot. "This
is the position of the long-distance walker, the mountain
climber, the best all-round athletes; it is the position of
command and authority, and is found predominant in the
great leaders of commerce and public life. On the other
hand, collapsed positions are characteristic of both physical
and mental weakness. They constitute a distinct aspect
of weakness and illness, from the tuberculosis patient to
the feeble-minded." *
In sitting, the body should be bent only at knees and
hips, and the head, neck, and trunk should be kept in one
Another important element in hygiene is the exercise of
the organs of breathing. In ordinary breath- _
ing only about ten per cent, of the lung R . .
contents is changed at each breath, and the
remoter air sacs of the lungs which are not properly exer-
cised are peculiarly liable to disease. The high mortality
from tuberculosis among clerks, bookkeepers, telegraphers
and other indoor workers whose tasks require or invite a
stooping posture are examples of such harmful effects.
"A hundred deep breaths a day" is one physician's recipe
for tuberculosis, according to Fisher and Fisk. Deep
breathing should be slow and not forced.
Variations in the chemical composition of the air are of
little practical moment, except for the pres- „„ „ « A .
r r j j j Why Bad Air
ence of poisonous fumes and dust under T tt c i
special industrial conditions. Even in the
worst ventilated room the proportions of carbon dioxid and
oxygen never change sufficiently to produce harmful physi-
ological effects. The discomfort and injury to health that
come from living in badly ventilated rooms are due not
primarily to any chemical changes but to the rise in tem-
perature that obtains under such conditions.
This does not mean that fresh air is unimportant, but
quite the contrary. A badly ventilated room is generally
* Jessie H. Bancroft, in The Teaching of Hygiene.
an overheated room. In such a room the blood vessels
■pft f * °f the skin are dilated, the body tempera-
~ . . ture rises, the pulse increases, the blood
pressure falls. The brain and inner organs
are robbed of blood. One feels dull and listless and disin-
clined to exertion. The New York State Commission on
ventilation showed that when there was a powerful incentive
exertion was possible for short periods at high temperatures,
but that under ordinary conditions 6 per cent, more work
was done at 68° than at 75° and 15 per cent, more than at
86°. Prof. Ellsworth Huntington, from exhaustive studies
of the effect of season and climate upon physical and mental
work, finds a mean outdoor temperature of 60°-64° most
favorable for efficiency, summer and winter both showing a
marked falling off as compared with fall and spring. It
cannot be doubted that the excessive temperatures main-
tained in many factories (often combined with high humid-
ities, which accentuate the effect by checking evaporation
of perspiration) militate very seriously against industrial
efficiency. In military life the important influence of climate
upon bodily vigor should be borne constantly in mind in
the selection of training camps.
The avoidance of gross overheating (temperatures above
v , f .. 68°) is not the only factor to be considered.
M The body must be protected against the
debilitating effect of heat on the one hand
and against the shock of excessive chilling on the other.
Within reasonable limits, however, variations in tempera-
ture, and particularly movement of the air, are important
factors in promoting health. The body owes its marvellous
power of maintaining its own temperature constant through
a wide range of outside temperatures to the reaction of the
skin blood vessels, which contract to keep the blood out of
the skin when it is cold and expand and bring the blood to
the surface when a more rapid heat loss is desired. The
tiny muscles in the walls of these blood vessels must be ex-
erased like any other muscles if they are to be kept in good
condition. In a person who lives habitually in an even
high temperature the blood vessels do not respond readily
to sudden change. In such people, the mucous membranes
of the nose are constantly congested (filled with blood and
lymph) as the blood vessels dilate to keep the body at the
proper temperature. As a consequence, these membranes,
instead of shrinking and drying promptly as they should
when they come in contact with cold outer air, lose their
quickness of response and stay moist and swollen even after
the blood vessels themselves have contracted; this makes
them an excellent breeding place for bacteria. People who
have been weakened in this way are very sensitive to the
cold air and are easily subject to chills. Benjamin Franklin
once said, "People who live in the forest, in open barns, or
with open windows, do not catch cold, and the disease called
a cold is generally caused by impure air, lack of exercise,
or from overeating." Science has amply confirmed these
observations of our great natural philosopher.
Fresh air, then, means air that is not too hot, or too cold,
or too even in temperature, — air that is w « „ ,
pleasantly cool and in moderate motion. .. T
If the thermometer reaches 70° (except in the
case of elderly people, who may require a higher tempera-
ture) it is a sign that the window should be opened. It is
particularly important to have plenty of fresh air in the
sleeping room and windows should be kept well opened at
night even in cold weather.
HYGIENE OF CLOTHING AND BATHING
The clothing should protect against extremes of cold, and
this is particularly necessary after exercise n ... -
when the skin blood vessels are dilated and /£ f| , .
the body bathed in perspiration. Woolen
clothes may be desirable under such conditions because
wool being porous is a poor conductor of heat and also be-
cause it takes up moisture readily and so absorbs and holds
Cotton, and particularly linen, are rapid conductors of
_ .- , T heat and do not absorb moisture, so that
"R ri tV ^ e Y are niore suitable for warm weather.
It is quite as undesirable to wear clothes
that are too warm as to expose the body to undue chill. If
the skin cannot get rid of its heat fast enough as a result
of too heavy clothing the dull and sleepy feeling associated
with "bad air" results. The habit of wearing too many
clothes weakens the power of the system to respond quickly
to changes in temperature, and renders one susceptible to
colds. Most people wear too heavy underclothing in winter.
Cotton or linen underwear is generally better than woolen;
and up to the age of fifty or even sixty years it is wiser to
wear underclothing of the same weight both winter and
summer, relying on an overcoat for warmth when out of
doors and not exercising.
The first object of bathing is to wash off the dirt and soot
w - which soil the body and to remove the waste
r ih "R fh* materials deposited on the skin by per-
spiration. Warm or tepid water is most
effective for cleaning the hands or body. Bathing in warm
water increases the size of the blood vessels in the skin and
draws the blood away from the brain, making one feel com-
fortably sleepy. This is the reason why a warm bath is
usually taken at bedtime. After every hot bath cold
water should be applied to the entire body. A cold bath,
on the other hand, contracts the skin blood vessels and
drives the blood to the internal organs and the brain, mak-
ing one feel alert and keen. Cold bathing is a powerful
tonic to the skin, since it trains these blood vessels to re-
spond quickly to changes in temperature. People who take
cold baths regularly are likely to be hardy and little subject
In the matter of bathing, however, we must again re-
member that the body should be stimulated . . . .
by cold water, but not chilled too severely. _,
A cold bath should be followed by a re-
action ; that is, the surface blood vessels should enlarge again,
so that the skin becomes warm and glowing. Brisk rubbing
with a rough towel helps to secure this reaction. If no re-
action follows, or if one feels tired after bathing, the bath was
too cold or too prolonged, or the body is not strong enough
to endure the shock. In such cases cold baths may do
No bath of any kind should be taken within an hour after
eating. The blood is needed in the intestines for the process
of digestion, and it is harmful to disturb the circulation, as
any bath must do at such a time.
The cleanliness of underclothing is of specially vital im-
portance to the soldier. The suppuration _ ,
of wounds is frequently due to germs _,
coming from dirty clothing, and the terrible
disease " trench-foot," w T hich has afflicted the French troops
in the present war, has been shown to be due to neglect in
this regard. Molds from damp and dirty socks get into cuts
and cracks in the foot, stop up blood and lymph vessels,
and gangrene follows in the tissues thus deprived of the
protective action of the body fluids.
Shoes of proper shape and material are also primary mili-
tary essentials. Colonel Keefer says, "No _. „ . .
one article of the soldier's clothing plays so _.
large a part in his efficiency as the shoe.''
As the result of an exhaustive study made by a special
army board created to study this subject, the problem of
army shoes has been satisfactorily solved. The civilian,
however, still often suffers from improper footgear. The
deformity known as flat foot, often accompanied by pains
reaching far up the back, may be caused by the resulting
strains. A hygienic shoe should be everywhere as wide
as the sole of the foot, and wide enough in front to permit the
toes to move freely. The inner edge of the shoe should be
straight, so that a line drawn back from the middle of the
great toe touches the heel. The heels should be low and
broad. The sole and uppers should be flexible, so that the
foot may be bent freely at the point where the toes join the
instep. A high shoe should not be so tightly laced at the
top as to interfere with circulation. A porous shoe, like one
made of russet leather, is much better than an enamel or
patent-leather shoe, because it allows the escape of moisture
and prevents overheating of the foot.
CARE OF THE TEETH AND BOWELS
Many obscure maladies of the joints, the heart and the
kidneys are traced to bacterial infections arising from de-
cayed teeth, and the care of these strong but delicate struc-
tures is a primary essential of personal hygiene.
The enamel is the natural protection of the teeth, and it
T , r f is very important that it should not be in-
, t +h jured by cracking hard nuts with the teeth
or picking the teeth with hard objects which
might splinter them.
On the other hand, thprough chewing of the food, and
particularly of fairly hard foods like crusty bread, helps to
polish the surfaces of the teeth and to prevent deposits on
them. The coarse food which savage people eat helps to
keep their teeth in good condition, but since civilized man
eats few hard foods, especial care is necessary to prevent
tooth decay and keep the mouth healthy.
The most important help in keeping the teeth in good
Th T +h condition is, of course, the toothbrush. It
. - - has been said that in an army the soldier's
toothbrush should be inspected every morn-
ing as systematically as his gun. The teeth
should be brushed regularly night and morning at least.
It is well to brush them after each meal, because the sooner
deposits of food are removed, the better. Once a day a good
tooth powder may be used to aid in cleaning the teeth. For
soldiers in the field, where no tooth powder is available, wood
ashes or wood charcoal has been recommended.
The toothbrush should not be too large, and the bristles
should be of medium hardness and so shaped that they will
get between the teeth. Both sides and the top of the teeth
should be thoroughly brushed. It is much better to brush
down or up from the gums to the cutting edge than side-
ways across the teeth, because when the brush passes side-
ways the bristles do not get in between the teeth. The most
effective method is to place the bristles of the brush firmly
against the teeth, apply pressure as if trying to force the
bristles between the teeth, and then give the brush a rotary
or scrubbing motion. Care should be taken to go over
both the back and the front of the cutting teeth in both
jaws, as well as the flat crowns of the grinding teeth. The
gums above and below the teeth and the surface of the
tongue should also be cleaned.
When the brushing is finished, lukewarm water should
be taken into the mouth and forced between ^ A ., £ xf _
, , , , i-i Details of the
and around the teeth several times by — M . — .- .
. ., r , , , , J Tooth Toilet
means of the lips, cheeks, and tongue.
This is as important as the proper use of the toothbrush
itself. The tooth toilet should take from three to five
Even the best use of the toothbrush will not always keep
the spaces between the teeth entirely clean. If food par-
ticles collect in these spaces, a bit of dental floss may be
passed up and down between the teeth, care being taken not
to injure the delicate gums.
With all precautions tooth decay is likely to begin in
places; and the teeth should be regularly examined by a
competent dentist twice a year to detect such troubles in
Another common cause of obscure ailments, headache,
TT a -j dullness and feeling of oppression is decom-
How to Avoid ... , , , & *T ■ , . ■ ..
r . . position of food wastes in the intestines.
If the bowels are not emptied regularly,
bacteria form poisonous products of decay, which are ab-
sorbed along with the food and produce far-reaching
It is important to form the habit of cleaning out the in-
testines regularly at least once a day and perhaps oftener,
so as to keep the intestinal tube clean. If this does not
happen naturally, the remedy should be found, not in medi-
cines, but in drinking plenty of water and eating more fruit,
green vegetables, and coarse foods, or in more exercise, sleep
and fresh air.
Too frequent loose movements of the bowels (diarrhea)
_. . are often due to the growth of special kinds of
harmful microbes in the digestive tract. The
best remedy is cut down the food, particularly meats and
eggs, and to take a dose of castor oil or some other medicine
which will help the body to get rid of both microbes and
poisons. If the trouble continues, a doctor should be
AVOIDANCE OF DRUGS AND STIMULANTS
Among the influences which work to deprive the body
ai 1, i °f ^s maximum efficiency, none is more
. n important than certain dangerous drugs,
among which alcohol is the chief offender.
Alcohol, like many other drugs, acts chiefly on the nervous
system; it does not serve to make any part of the nervous
system work more readily, but numbs or puts to sleep certain
parts of it. It acts first of all on the inhibitions, with the
result that some of the nerve actions which would ordinarily
be inhibited or held in check are allowed to go on more freely.
This seems like a stimulation or increase of power, but it is
really only a breakdown of the system of control. The situ-
ation is somewhat similar to the case of a runaway horse.
The horse is no stronger, but is much more dangerous,
when it is running away than when it is held firmly by the
reins in the hands of a skilled driver.
A long series of experiments, of which the most recent
have been carried out by Prof. F. G. Bene- .. , . «
diet, in the Carnegie Nutrition Laboratory, Fffi .
have made it abundantly clear that even
very moderate doses of alcohol tend seriously to interfere
with the working of the nervous machinery of the body and
to make its reactions slow and clumsy. Of eleven different
tests of efficiency made by Professor Benedict, all but two
showed a decrease in quickness or accuracy of from 3 to 46 per
cent, in the persons who had taken alcohol. The relation of
the use of alcoholic liquors to industrial accidents is well rec-
ognized; and the attitude of public service corporations and
other large employers of labor toward alcohol offers eloquent
testimony to its harmful influence. No one who has ever
been a steady user of alcohol is accepted as a member of an
arctic expedition, and alcoholic drinks are never used by
those engaged in these enterprises. Such persons have been
found by experience to be lacking both in efficiency and in
the ability to endure the necessary hardships.
Xor are the results of the use of alcoholic liquors limited
to a temporary interference with mental and A1 , 1
physical powers. Exhaustive studies of the , ,
death rate among abstainers and non-ab- n , p
stainers conducted by English and American
life insurance companies have yielded most significant results.
One such recent investigation made by forty-three American
life insurance companies showed that the death rate of those
who used alcohol steadily and freely was 86 per cent, above
the normal, while the rate among steady moderate drinkers
(persons taking the equivalent of two glasses of beer or
one glass of whiskey a day) was 18 per cent, above the normal.
It is evident that alcohol does a great deal of harm to
certain individuals and a certain amount of harm to all who
use it habitually. No man who wants to do anything diffi-
cult, and to do it well, uses alcohol beforehand. No sur-
geon about to perform a difficult operation would dream of
taking a drink. No athlete would think of drinking before
running a race. When a person wants to be at his best, to
have his nerves and muscles and his whole body working
most smoothly and effectively, he does not use a drug.
So it is with nations. The evil effects of alcoholic drinks
upon national efficiency, and the wastefulness involved, were
strikingly recognized in the European War. The Russian
government stopped the sale of vodka (the Russian strong
drink), and the governments of France and England passed
laws to restrict drinking. As soon as the European nations
wanted to be at their best, to meet a great crisis, they laid
aside the burden of alcohol.
Now that the United States has entered the world con-
flict the policy of "down glasses till the war is over,"
should be the slogan of every man determined to give his
country his best service in an hour of crisis.
It is important to remember that both alcohol and many
„,, ^ . other harmful and often habit-forming
The Patent , .. , , , . , .
■** j- • t- -i drugs are often taken unknowingly in van-
Medicme Evil & , . , . j- • a *
ous kinds of patent medicines, borne 01
the commonest and most widely advertised "tonics" and
"spring medicines" owe any effect they have to the fact
that they are composed largely of whiskey. Remedies sup-
posed to cure catarrh, tuberculosis, and other diseases often
contain opiates that may lead to a drug habit. Medicines
advertised to soothe babies usually contain morphine or
opium, and headache cures frequently contain deadly
poisons, such as acetanilid. The use of such preparations,
except on the order of a physician, is most unwise. Patent
medicines and their misleading advertisements do immeasur-
able harm by arousing a false sense of confidence and de-
laying the medical or surgical care, prompt use of which is
essential in such diseases as cancer and tuberculosis. The
well person has no need of drugs of any kind, and if one is
ill enough to need drugs, he is ill enough to benefit by medical
HYGIENE OF ADULT LIFE
Statistics show that at ages over 45 the death rate in the
United States is apparently increasing and _, _^ .
not decreasing, as is the case at earlier age p .
periods. The increase is manifested almost _, -J fi
wholly in the degenerative diseases of the
heart and blood vessels and kidneys, and in cancer. Most
of the degenerative diseases cannot be cured in the sense
that diseases of early life are cured. Old age prevails in
time. The important fact is that in too many cases old
age comes on prematurely and without the victim suspecting
its insidious onset.
The premature onset of old age, when not due to specific
congenital defects, is usually the result of _ f
unhygienic living and particularly excesses p
of various kinds. Under the unnatural con- , .
ditions of modern life too many of us suffer
from too little air, too little exercise, too much work and
too much food.
The degenerative diseases of adult life are gradual in
their onset and could generally be checked v t ,
if the enemy were detected in time. When
disease of the heart or arteries or kidneys . ..
, u c ,, .. animation to
or any other organ first sets in, the ordinary _^ _ .
mm ii* i i i .Detect Disease
rules of personal hygiene must be supple- . T .
mented by special rules of daily living
which take into account the particular defect. Even can-
cer, one of the most deadly of the diseases of adult life, can
be curod in a large proportion of cases by a surgical operation
if the condition is recognized early in the disease, while if
treatment is delayed, there will be little hope.
The only way in which these physical defects can be de-
tected early enough to check their course is through a com-
plete examination of the whole body by a competent physi-
cian. It is the conviction of public health authorities that
every person over forty-five should consult a physician at least
once a year, for a complete examination of the whole body,
to learn in time of the beginnings of disease and the precautions
necessary to prevent it from extending. Such a course would,
it is conservatively estimated, add five years to the average
life of persons between forty-five and fifty years of age.
MAN AND THE MICROBE
Good and Bad
There are many different kinds of microbes (or little living
things, which is the meaning of the word),
some of them classified by the biologist as
animals and some as plants. Most microbes
are harmless and some are actively beneficial to man, as, for
example, the bacteria which ripen cream and make vinegar
and those which fix the nitrogen of the air and make it avail-
able for the food of higher plants. A few of the microbes,
however, are parasites which live in the tissues or on the
surface of the human body as a mold grows in jelly. As the
mold forms chemical products which give the jelly a musty
taste, so the microbes form chemical substances called toxins,
which poison the body and produce the symptoms of disease.
Disease germs are normally propagated only by transfer
from one human being (or animal) to an-
other. They may survive for a time out-
side the body, but with rare exceptions they
do not multiply under such conditions, but
gradually and progressively perish. In an experiment by the
English bacteriologist Houston, of 470,000 typhoid germs
placed in ordinary tap water, only 480 were alive after one
week, 31 after two weeks, 5 after three weeks, and none after
four weeks. The danger against which we must guard is the
rather direct transfer of infectious material from one person
to another (or in a few instances from one of the higher
animals, such as the cow, to man).
The source of disease germs is then the human (or in a few
cases, the animal) body. An important „. ~
part in the spread of communicable disease . f
is played by early cases (not yet displaying .
any characteristic symptoms of illness) and
by "carriers," persons who have recovered from their illness
or may never have themselves suffered from a particular dis-
ease at all, and yet are cultivating in their bodies and spread-
ing to others the germs which are capable of causing the
malady in question. An outbreak of over three hundred
cases of typhoid in New York City was caused by a milkman,
a typhoid carrier, who had had typhoid in Michigan forty-
six years before and had been cultivating the germs in his
body ever since. One or two out of a hundred well persons
in a given community may be cultivating the germ of diph-
theria in their noses or throats, and one or two out of a
thousand may be cultivating the germ of typhoid fever in
gall bladder or intestines. In such diseases as pneumonia
and epidemic cerebro-spinal meningitis, the proportion of well
carriers may be much higher, and infant paralysis appears to
be chiefly spread in this manner.
Bacteria are solid particles not easily detached from moist
surfaces. Quietly expired air is germ-free, w n .
and disease microbes are not transmitted by r
the atmosphere except where there is gross Q ,
local pollution by the spray thrown out in
coughing or sneezing or by clouds of infected dust. Cloth-
ing, books, toys, or other objects handled by the infected
person play a much smaller part in the spread of disease
than was thought a few decades ago. There is no absolute
sharp line to be drawn between objects of this sort, which are
dangerous, and those which are not, since the dying out of
disease germs outside the body is a gradual one. We know,
however, that the danger varies inversely with the time
which elapses, and that the legends of disease caused by
toys, locks of hair, etc., put away for months and years, are
almost certainly apocryphal.
There are three principal vehicles which commonly serve
to effect a rather direct transfer of infectious material from
one person to another, and which between them account for
99 per cent, of all cases of communicable disease. These are
articles of food and drink, flies and other insects, and more
or less direct personal contact— food, flies, and fingers.
DISPOSAL OF WASTES
The germs of disease leave the infected person or the
n f carrier, in most instances, in the body dis-
_» , _. charges. The care of sputum and the fine
Body Dis- fe , , l \ . . .
. spray thrown out in coughing or sneezing is
essential in the control of such nose and
throat diseases as tuberculosis, diphtheria, measles, whoop-
ing cough, scarlet fever, septic sore throat, and the like;
while in the control of the bowel diseases, typhoid fever,
cholera, hookworm disease, and dysentery, the care of intes-
tinal and bladder discharges is of primary importance.
In army camps and in all unsewered districts, particularly
_ . . , . in warm climates, the proper care of excre-
yp . ment, so that the germs it contains may not
be carried by flies or in other ways to food,
is a first essential of sanitation.
Typhoid fever earned the name, "the scourge of armies,"
on account of the epidemics which occurred up to the pres-
ent century whenever large bodies of men were brought
together without adequate precautions in regard to the dis-
posal of bodily wastes. In our war with Spain, we had
20,738 cases of typhoid with 1,580 deaths among 108,000
men in a period of less than four months, nine-tenths of all
deaths among the troops encamped in the United States
being due to this cause.
In the disposal of excrement it is essential to avoid
pollution of water supplies, and above all r
the exposure of the wastes in such a manner ^ /? .
that infection may be carried by flies or in
other ways to food. In fixed garrisons satisfactoiy methods
of disposal will usually be provided. For use in camp good
portable incinerators have been devised; but when these
are not available, sink or latrine trenches may be dug to
receive the excreta, in such a position as not to menace any
source of water supply. In fly season the trenches should
be provided with seats with the lids and the open space be-
neath the seats boxed in or covered to the ground with mus-
lin or sacking. When it is impossible to prepare pit covers,
crude oil, kerosene or chloride of lime well distributed over
the sides and bottom will help to keep flies away.
Indiscriminate soil pollution is a military offense which
may be of serious magnitude, since an individual in perfectly
normal health may be a typhoid carrier and through care-
lessness may infect scores of his fellows. For the same
reason the habit of washing the hands after resort to the
toilet is of the greatest importance.
In civil life, where sewers are not available, the provision
of tightly built fly-proof outside toilets is _. . -
of vital sanitary importance. The screen- tt h m
ing of such closets in Jacksonville, Fla., w
and elsewhere has been followed by phenom-
enal decreases in the typhoid death rate. For thickly
settled communities the installation of a sewerage system
of course offers the ideal solution of the difficulty from the
standpoint of the individual householder. The sewage
collected by such a system may be so treated as to be purified
to any desired degree by screening, sedimentation, filtration
or disinfection before it is discharged into adjacent water-
INSECTS AND DISEASE
Insects were in the past a far more important factor in
p. . the spread of disease than is the case today.
~. , ~. Bubonic plague, which destroyed a quarter
Olden Times , ,, , .- r t^ • , L -L- , i,
of the population of Europe in the Middle
Ages, is primarily a disease of the rat, spread from rat to rat,
and from rat to man by the bite of the flea. The dreaded
typhus fever, which once decimated jails and camps, is
spread by the bite of the body louse. With improvements
in habits of personal cleanliness these pestilences have dis-
appeared from civilized countries. Plague broke out in
1894, ravaged India, and found its way to ports all over
the known world, but nowhere outside of Asia could it gain
a foothold. Typhus was almost forgotten until the con-
fusion and ruin of the European War permitted its appear-
ance on the Eastern battle front. It is controlled by de-
stroying lice through rigid measures of disinfection of the
bodies and clothing of those who have been exposed to
The most important insect carriers of disease today, out-
T , side of certain regions in Africa, are the fly
V'Mh V] an( * ^ e mosc l u ^o. The common house fly
or filth fly is only an accidental carrier of
such disease germs as it may happen to pick up on its feet
or body; but in warm climates, where excreta are improperly
disposed of, it is an important factor in the spread of typhoid
fever, and studies in New York City and Richmond, Va.,
have shown that it may play a considerable role in distribut-
ing the germs of infant diarrhea. The first essential in con-
trolling the fly is to do away with its breeding places b}^
proper care of stable manure, in which it lays its eggs by
preference, and by the elimination of other decaying rub-
bish. Manure should be stored in a closed dark bin with
an impervious floor and removed once a week. The tight
floor and complete removal are essential, since the fly mag-
got burrows down into the ground or out into the outer drier
portions of the manure to go into its resting or pupa stage,
before it hatches out as an adult fly. Fly maggots in
manure may be destroyed by the use of borax or hellebore.
Adult flies may be trapped or poisoned. The traps most
commonly used consist of a wire cone in a • «« T *
box or cage largely of wire, with bait under _/ _ .
., . % 6 J . ' , ~ Fly Poisons
the large lower opening of the cone. On
leaving their food the flies go upward toward the light,
through the small opening, and into the cage, in which they
perish. For fly poisons the U. S. Public Health Service
recommends formaldehyde or sodium salicylate. For house-
hold use these solutions may be prepared by the addition of
three teaspoonfuls of either the 40 per cent, solution of
formaldehyde found on the market or the powdered sodium
salicylate to a pint of water. Nearly fill a glass tumbler
with the solution, place over this a piece of blotting paper
cut to a circular form and somewhat larger in diameter than
the tumbler, and over this invert a saucer. Invert the
whole device and insert a match or toothpick under the
edge of the tumbler, to allow access of air. The blotting
paper will remain in the proper moist condition until the
entire contents of the tumbler have been used and the
strength of the formaldehyde solution will be maintained.
A little sugar sprinkled upon the paper will increase the
attractiveness of the poison for the flies.
The conquest of mosquito-borne disease is one of the most
brilliant triumphs of sanitation. The fact Th r
that yellow fever, the curse of tropical f y
America, was transmitted by the bite of _,
the Mdes mosquito was demonstrated by
Major Walter Reed and three other surgeons of the U. S.
Army in 1901, by experiments on themselves and other
volunteers, Jesse W. Lazear, one of the intrepid investi-
gators, giving his life for the cause. As a result of this dis-
covery the pestilence which had caused 750 deaths a year in
the City of Havana alone was wiped out in a few months,
the building of the Panama Canal was made possible, and
tropical America was rendered habitable for the white race.
Malaria, our principal insect-borne disease, is held re-
ly- . sponsible for an annual money loss of
^Malaria $ 100 > 000 > 000 in the United States alone.
It is transmitted by the bite of the Anopheles
mosquito, which breeds in pools of stagnant water and woody
sluggish streams. The adult mosquito of this type can be
distinguished from the common or Culex mosquito by the
fact that its wings are spotted and by its posture when
lighted. Its body stands out in a straight line at an angle
to the surface on which it rests, while the body of the com-
mon mosquito stands in a humpbacked position, with the
posterior part of its body roughly parallel to the wall or
The control of malaria depends on the elimination of
breeding places by drainage of swamps, by cutting out and
clearing ditches, streams and pools, and by the elimination
of small receptacles of stagnant water. Mosquito larvae,
or "wigglers," may be destroyed by the use of oil or poison-
ous larvicides or by stocking ponds with fish, which feed upon
them. Adult mosquitoes should be kept out of houses, and
particularly excluded from malaria patients by screening,
and in seriously infected regions, quinine should be system-
atically employed as a prophylactic.
SPREAD OF DISEASE BY CONTACT
While the diseases carried by food and by insects have in
r , large measure been brought under control,
_. the diseases which are chiefly spread by
contact, particularly such diseases as diph-
theria, measles, scarlet fever and whooping cough, which are
disseminated by the discharges from the nose and throat,
have been much less successfully controlled. The methods
by which infection finds its way from one mouth to another
are almost without number. The common drinking cup
and the direct discharge of mouth spray in coughing or
sneezing furnish two obvious modes of infection. A hun-
dred times a day fingers and other things that are not bac-
teriologically clean go to the mouth or nose, and to one who
considers the possibilities the wonder is, not that we contract
diseases, but rather that we so often fail to do so.
The only reliable defense against contact disease is the
cultivation of habits of personal cleanliness that will keep
everything but food and the toothbrush away from the
mouth, and that will make the thorough washing of the hands
before handling food an absolute and inevitable routine.
In all communicable diseases, but particularly in those
which are spread by contact, it is important T . . f
to surround all known infected persons with _ . ,,
, „ Communicable
special precautions, so as to reduce as tar _.
as possible the danger of the spread of
disease germs from them. For this reason the reporting of
communicable diseases to the health authorities is required
by law, and boards of health maintain special laboratories
to assist in the early diagnosis of suspicious cases of disease.
When the infected person is found he must be isolated or
cared for under such conditions that family and friends will
not be endangered; and if this cannot be done at home, he
must be removed to an isolation hospital.
In isolation emphasis is laid particularly upon limiting
direct contact with the patient to the nurse or person in
immediate charge, upon the prompt disinfection of body
discharges and clothing, bedding, etc., soiled with discharges,
and upon the disinfection of objects which leave the sick
room, and particularly of the hands of the attendant. If
such precautions are not conscientiously observed during the
course of the disease, fumigation at its close will be of little
use, since susceptible persons in the house will already have
been infected. If isolation has been thorough, terminal fumi-
gation is unnecessary, since there will be no gross soiling of
the sick room with discharges, and occasional germs coughed
out onto the floor or wall will soon die out and disappear.
Each communicable disease has its own definite period of
TT T <;* Xc duration, and experience teaches that a cer-
P 1 <*h 1H * a * n num ^ er °f days or wee ks must pass be-
"R T 1 t H ^ ore ^ * s sa ^ e ^ or *^ e P a ^^ en ^ ^° m ingle with
other people. The periods of isolation for
the more common communicable diseases are shown in the
following table. In each case, of course, the patient should
be isolated until he has entirely recovered from the disease,
and running of the nose and ears has ceased. In diphtheria
the only safe rule is to wait until tests made by a bacteriolo-
gist show that the nose and throat are free from diphtheria
Isolation Periods of Common Communicable Diseases
_ . Isolation Period from Time
of Beginning of Attack
Chickenpox 12 days
German measles 8 days
Measles 10 days
Mumps 2 weeks
Scarlet fever 30 days
Whooping cough 8 weeks, or until one week
after last whoop
The fact that many diseases are particularly catching just
_ 4 when they are beginning makes it very im-
8 portant to watch for the onset of disease
: ** and to start isolation as soon as possible.
Measles, for instance, begins like an ordi-
nary cold in the head, with sneezing and running nose and
eyes. It has been shown by the investigations of Anderson
that there is far more danger of spreading the germs of
measles at this time than there is later, when a rash has
appeared and the patient has been put to bed.
Children should never be sent to school and should not
play with other children when they have any of the signs
which may mean an attack of communicable disease, par-
ticularly if there is reason to think they may have been
exposed to infection.
The principal signs of the beginning of an attack of com-
municable disease are the following:
Coughing, Watery eyes,
Running nose, Vomiting,
Sore throat, Diarrhea,
Feverishness, Swelling or pain^back
Rash or spots of any kind, of or under the ears.
Weak, tired feeling,
In each particular disease a certain time must elapse
tween the day when a person first gets the
rm into his body and the day when the
actual symptoms of disease appear. This is
between the day when a person first gets the T . ..
germ into his body and the day when the p . , .
called the period of incubation. During this ^.
time the germs are growing in the body until
there are enough of them to make the person feel sick. The
incubation period varies with different diseases, from a few
days to several weeks. The periods for the commoner dis-
eases are shown in the table below.
Disease Incubation Period
Chickenpox 11-22 days
German measles 11-22 days
Measles 8-15 days
Mumps 15-22 days
Scarlet fever 7 days
Whooping cough 14 days
Those who have been exposed to any of the communicable
diseases should be kept under observation, and if possible
isolated from others until the period of incubation has passed
without any signs of the disease appearing. In the case of
chickenpox, German measles, measles, mumps or whooping
cough, this is not necessary if the person has had the disease
before, and is, therefore, immune. In diphtheria the incu-
bation period is short (from one to five days), but carrier
cases are so common that all those who have been exposed to
diphtheria should have their throats examined and a sample
taken from the throat for bacteriological examination.
Everyone takes typhoid and scarlet fever seriously, but
T f measles and whooping cough are often re-
iur i j garded as unimportant and negligible in-
-^ . fections. This is by no means the case.
r u Measles is an important cause of in-
validism in the army. " In the Union Army
during the Civil War, there were 76,000 cases with more than
5,000 deaths. Among the Confederates whole brigades were
temporarily disbanded on this account in the early part of
the war." Among the civil population measles is in most
cities the cause of more deaths than either typhoid or scarlet
fever, while whooping cough stands very close to it. Above
all it should be remembered it is to young babies that these
maladies are most deadly. Measles and whooping cough
are more than five times as fatal in infants under one year
of age as in children over five. Every possible effort should
therefore be made to protect infants from contact with those
who have any symptoms of what may prove an infectious
IMMUNITY AND ITS CONTROL
Every attack of communicable disease is a struggle be-
v . 1 tween the invading microbes and the body,
p . for as soon as foreign germs enter, the sol-
dier cells of the blood attack the invaders
while the tissues of the body begin to produce chemical sub-
stances which tend to destroy the germs or neutralize their
poisons. The degree of this natural vital resistance varies
widely. Disease germs, like other enemies, are more likely
to attack weak people than strong ones, though some dis-
eases, like measles and smallpox, affect all alike.
Besides this sort of general vital resistance, a person who
lias recovered from an attack of some spe- T .
cific communicable disease enjoys a special . . , ,~
A , .. i • Against Specific
immunity against the particular germ m _?:
question as a result of the struggle through
which it has passed. In a number of diseases it is now pos-
sible to produce at will a state of immunity by the introduc-
tion into the body of weakened or killed cultures of the germ
which have lost the power to produce active disease, but
are still able to stimulate the tissues of the body, so that they
can defend themselves against a later attack of living and
This principle w r as applied over a century ago in the case
of smallpox by Edward Jenner, an English „ ..
physician. It has been said that this dis- TT . x .
covery of vaccination by Jenner was the
greatest single practical benefit ever bestowed by one man
upon the human race. As soon as vaccination was generally
introduced, the dreaded epidemics of smallpox ceased, and
this disease now exists only as far as vaccination is neglected.
During the eight years before the American Army entered
Havana, there were 3,132 deaths from smallpox in the city;
during the next eight years, when vaccination was enforced,
there were seven.
Vaccination has conquered smallpox so successfully that
people have almost forgotten what a terrible disease it was,
and some of them have grown careless about vaccination.
Others object to being vaccinated for fear some infection
may get into the wound. All vaccine used in the United
States is now tested as to its purity by the National Gov-
ernment, and there is no danger from its use, provided that
the place where the vaccine is rubbed into the arm or leg
is kept clean and free from dirt germs. The protective
effect of vaccination wears off after a time. Every child
should, therefore, be vaccinated when about a year old, and
again at about the seventh year.
The most brilliant practical application of the principle
Anti-Tvnhoid °^ vaccme th era Pv> since the time of Jenner,
Vaccination ^ aS ^ een ^ e P re P arat i° n °f the vaccine
now used for the prevention of typhoid fever.
Its adoption in the United States Army has been attended
with brilliant results, as indicated by the table below.
v v • f Cases of Typhoid Typhoid Deaths
x ear v accinaoion -r» , i-» ■
Number Rate P er Numhpr Rate P er
lNumoer 1QQ0 lNumoer 1000
1907 None 237 3.79 19 .30
1908 None 239 3.20 24 .31
1909 Voluntary 282 3 .35 22 .26
1910 Voluntary 198 2 .43 14 .17
1911 Voluntary 70 .85 8 .10
1912 Compulsory 27 .31 4 .04
1913 Compulsory 3 .03 .00
Mixed vaccines which will protect against typhoid fever
v . . and the two distinct forms of a similar
. .... , disease, paratyphoid fever, have been used
. . with striking success in the European armies
during the present war. The number of
cases of typhoid fever among British troops in France up
to November 1, 1916, was 1,684, of paratyphoid cases, 2,534,
and of indefinite related fevers, 353, a total of 4,571. In the
South African War nearly 60,000 cases of typhoid fever alone
were admitted into hospital, and there were 8,227 deaths.
Armies in the past have been an important agent in spread-
ing typhoid and other infections through the regions where
they operated and in the homes to which they returned.
Today the success of typhoid vaccination in our military
establishments points the way to the elimination of this
disease in civil life. Every man and woman under 45
should make use of this simple and efficient safeguard.
Another method of controlling immunity is by the use of
antitoxins, or antitoxic sera, as they are _,, n -
often called, of which diphtheria antitoxin . ... .
. , . . Antitoxic Sera
is the best example.
Diphtheria antitoxin was introduced into the United States
by the New York City Department of Health in 1894, and
it has reduced the death rate from diphtheria in that city
from 155 deaths for every hundred thousand of the popula-
tion, to 24. The antitoxin is of comparatively little value
when the attack has gone on for a long while and the body
has become severely poisoned, but if it is used as soon as the
disease begins, it is a practically certain cure.
Antitoxic sera are also used in the treatment of tetanus,
meningitis and more recently in certain forms of pneumonia.
From a military standpoint some of the most important
applications of the principles of vaccine and r tr 1 f
serum therapy are those which have been w «
worked out in connection with the treat- t f ti
ment of wound infections. The surgeon in
his operating room relies on antiseptic and aseptic methods
to keep out the germs of suppuration. Wounds received in
battle are generally already infected and the destruction of
germ life is impossible without serious injury to the tissues
themselves. The military surgeon must therefore rely
largely on the stimulation of the defensive machinery of the
body (except in the case of tetanus, for which a specific and
powerful antitoxin is at his disposal). The newer solutions
used in the treatment of wounds, such as Dakin's chloramine,
are specially adapted to check bacterial growth without
harming the soldier cells of the blood; and the use of a strong
salt solution for the treatment of an infected wound pro-
duces an increased flow of lymph from the tissues into the
wound, thus relieving the inflamed tissues of congestion and
setting up a flow of fluid from within outwards, which tends
to wash away bacteria. Both the lymph and the strong
salt solution are unfavorable to the growth of bacteria. So
far as the white corpuscles are concerned, strong saline solu-
tions are unfavorable to their vitality; but when the wound
has become healthier, it is usual to decrease the strength of
the salt solution until its saturation has reached that of a
fluid of the same specific gravity as the blood. In a fluid
of this degree of concentration the body cells can live and
Tuberculosis, a disease which causes about one-third of
Thf» C t a ^ ^ e deaths which occur between the
—~ . p- ages of 18 and 45, and kills each year about
le ague 15Q0Q0 people in the United states, is
caused by a bacterium which may grow in a great many
different parts of the body, although it is most likely to be
found in the lungs, causing tuberculosis of the lungs, or
consumption. The germ does not grow all through the
lungs in this disease, but here and there at special points,
where there form hard little knots or tubercles, from which
the disease is named.
Tuberculosis of the bones is not uncommon among children,
and a great many of the lame people we see on the streets
are crippled from this cause.
The primary cause of tuberculosis is a germ discharged in
T - r f the spray and sputum coughed out by con-
T , 1 . sumptives, and infection comes in most
cases from getting these human discharges
into the mouth. Sometimes the germ is inhaled in dust,
but it is more frequently transferred from one person to
another by rather direct contact.
A great many cattle suffer from tuberculosis, and children
may become infected by drinking the milk of tuberculous
To prevent the spread of tuberculosis it is necessary first
of all to destroy the germs discharged TT ~
t *u tu c *• & ,HowtoPre-
from the mouths ot consumptives; and ...
, . ... F ,j vent the Spread
second, to pasteurize the milk ot all cows . _ . . .
. ; . i r ■<• n of Tuberculosis
not certamlv known to be tree trom the T - ..
.. ' Infection
The careless consumptive is a great danger to his family
and associates, but one who is always careful to destroy his
sputum and to avoid coughing out mouth spray into the air
need not be a menace to the health and life of others. The
consumptive should always cough into a cloth or handker-
chief, or a paper napkin, which can be burned, and all sputum
should be received in paper cups and burned at the end of the
day. If handkerchiefs are used, they should not be put into a
laundrj' bag or basket with other soiled linen, but should be
boiled for twenty minutes in a strong soapsuds solution.
Tuberculosis is a disease in which vital resistance plays a
specially important part. The germ is un- v . - p .
fortunately very common; in fact, almost
,. ., , , . . « ,., tance agamst
every individual, sooner or later, is slightly „, , , .
. . \ , ... .. ' toJ Tuberculosis
intected with it.
This does not mean that every man has tuberculosis, in
the sense of suffering from actual disease. The human body
has a wonderful power of defending itself against this in-
vader, and a few germs entering a healthy body are quickly
overcome. It is when a great many germs are taken in, and
particularly when the strength is reduced by attacks of other
diseases, or when resistance is lowered by intemperate habits,
by living and working in overheated rooms, by eating insuf-
ficient food, or by breathing sharp dust particles, that the
invisible enemy overcomes the defenses of the body. France
has today some 500,000 cases of tuberculosis to care for
because of the deadly effects of the strain of trench life
upon soldiers who, in a time of crisis, had to be sent to
the front whether they were in full physical health or
People who have recovered from tuberculosis, and those in
-. , whose family there has been a case, should
„, , . . be specially on guard against allowing their
Tuberculosis , T . / ~ , . . ?
vital resistance to become weakened. Among
the most important causes of tuberculosis are the unsanitary
conditions of factory life. An overheated, un ventilated
workshop is certain to lower vital resistance and make the
worker an easy prey to the tuberculosis germ, particularly if
he is weakened by long hours of labor. An especially dan-
gerous thing about some industries is the fact that the air of
the workshops is full of fine particles of mineral or metallic
dust. These dust particles are inhaled and injure the deli-
cate tissues of the lung, so that tuberculosis germs find it
easy to grow there. The workers in some of these industries
— granite workers and grinders, for instance — are two or
three times as likely to contract tuberculosis as are people
who work at less dangerous trades.
In all such places there should be special pipes with exhaust
fans to draw off the dust from the air. Where this cannot be
done, the worker should wear a respirator over his mouth, to
keep out the dust particles.
Just as the tuberculosis germ fails to gain a real foothold
T r . in the body of a thoroughly healthy person,
_ , , . so by proper hygienic treatment it can be
Tuberculosis , , A .,, , ., ,
conquered even alter it has begun its work.
There are no medicines, in the ordinary sense, that will
cure tuberculosis. All so-called " Consumption Cures" are
frauds which take the money of their victims and do them
immeasurable harm by wasting precious time. The cure for
tuberculosis is hygienic living under the advice of a compe-
tent physician, properly directed rest and exercise, plenty of
fresh air, and a sufficient amount of wholesome food. If
such treatment is taken early in the disease, tuberculosis can
generally be cured.
The main thing is to begin the treatment of tuberculosis as
soon as possible. The time to put out a fire, or to control
a disease, is before it gets well under way. When tuberculosis
has Kone far, it cannot usually be checked, T r
.. , .. . , , , ., , Importance of
but if the disease is attacked at its beginning, _, r .
there is everv reason to be hopeful. Among _ y
* . , , - Ireatment
the common danger signals are loss 01
weight, loss of appetite, prolonged "cold" with cough and
spitting — the expectorations sometimes blood-tinged — fre-
quent hoarseness, afternoon fever, chills, nightsweats, easy
tiring, and pains in the chest. One of the earliest symptoms
of pulmonary tuberculosis is a sense of weakness and loss of
energy, both of body and mind, not infrequently out of all
proportion to the extent of the disease. If any of these
symptoms are present, the patient should go to a physician
and have his lungs examined.
Success in the struggle for existence involves
Perpetuation of the Race
Both personal health and success in leaving progeny are
threatened by the grave communicable T , M
maladies which are known as the venereal f v .
diseases. Lack of self-control endangers ~.
one's life ; it threatens the life of the wife;
it endangers the life of the mother; it imperils the life and
the sanity of the child. From the medical standpoint it
is vitally important that these diseases should be more
fully controlled by public health authorities, that facilities
for laboratory diagnosis should be furnished, and that pro-
vision should be made for dispensary and hospital treat-
ment. Concealment, delay in securing treatment, and resort
to advertising quacks and charlatans are in large measure
responsible for the extent of the damage wrought by these
Around all the camps of England and France the great-
T , „ f est enemy of the soldier is the diseased
xi. o u- prostitute. Some of the finest British and
the Soldier , . , . , , ,
, _ M colonial regiments have been seriously
and Sailor «. , , ™, ^ ... t .
affected, ine British government is
now taking stern measures to protect its soldiers by
the establishment of health zones, and the keeping of
the men within certain bounds. In view of the special
temptations which will surround our new army in this
country and on the continent, the most earnest efforts
should be made to control the surroundings of encamp-
ments in this regard.
Lieutenant-Colonel Frank R. Keefer, in his text-book on
n . . - "Military Hygiene and Sanitation," says:
M .J. " Venereal infections are responsible for an
. ,. J. enormous amount of sickness in the army —
Authorities .. ,, ,, ,
vastly more than any other cause — and
constitute the most important health problem with which
we have to deal." In the "Manual of Military Hygiene," by
Colonel Valery Havard, the author points out that on
account of the importance of this question, " soldiers should
be taught all knowledge deemed necessary and useful on
the subject. For instance, that sexual intercourse is not
necessary for the attainment of the best physical and mental
health, and that a strong, manly character is developed only
by self-control and continence. They should have a proper
appreciation of the prevalence and gravity of venereal
"Many men expose themselves thoughtlessly, with the
impression that, at the worst, a few days in hospital will
suffice to get rid of the consequences. This is foolish
and dangerous ignorance which officers, especially medical
officers, should endeavor to dispel by a few plain talks,
demonstrating to them the many complications and sequels
of gonorrhea as well as the ravages of syphilis, which affect
not only the incontinent, but, through matrimony, many
innocent women and children. Let them know that, in
the opinion of gynecologists, a majority of the hazardous
surgical operations performed upon married women are
made necessary in consequence of gonorrheal infection
by the husband; and another terrifying fact, that
syphilis, so far as absolutely known, is not only directly
transmitted from father to children, but the sole disease
thus transmitted, as it were, a special curse upon the
More recent studies have shown that the proportion of
prostitutes afflicted with venereal disease is far higher than
has been assumed by earlier writers. Dr. Walker in an in-
vestigation in Baltimore found over 90 per cent, of a group
of prostitutes suffering from syphilis alone.
The good soldier owes to his country today his full meas-
ure of strength and vigor. He owes to his country of the
future a full measure of strength and vitality to be handed
on to coming generations. Both may be fatally jeopardized
by a moment of weak self-indulgence.
ACCIDENTS AND FIRST AID
Slight cuts and scratches should be washed free from dirt,
then carefully dried and painted with a r + H
little tincture of iodine. More serious w -
wounds should be dressed temporarily, until
the doctor can attend to them, by covering them with sur-
geons' gauze fastened on with a bandage. A deep wound,
particularly if produced by a rusty nail or other dirty object,
should always receive prompt medical attention; so should
even the slightest scratch, if, after a few days, it is red, hot
or painful. Any wound will heal without much pain or
redness if there are no germs in it. Remember that germs
get into a wound, not from the air, but from dirty things
that touch it. A scratch or cut should never be touched
with anything but sterilized surgeons' gauze. In connec-
tion with automobile accidents, it is well to remember that
gasoline is a good disinfectant.
If the blood comes from a wound in jets or spurts, an
artery is bleeding, and the result may be serious if the flow is
not checked. Fortunately, at most parts of the body the
arteries are deeply buried in the flesh. A severed artery
calls for prompt action. Put firm pressure close to the bleed-
ing part, between the wound and the heart. In case the
wound is in the arm or the leg, the pressure is best applied
by tying a knot in the center of a folded handkerchief, and
laying this knot over the artery. Tie it loosely around the
limb, but with a good knot. Place a stick under the bandage
and twist it round and round until the bandage is tight
enough to stop the bleeding.
The pain and swelling of an ordinary bruise will be much
_» . . less if something cold is placed on the bruise
Bruises and . , , , . & ., , . ^ , T .
_ . at once to drive the blood away. Ice in a
cloth may be used for this purpose, or simply
a cloth wrung out in cold water.
If a joint has been sprained (which means that the liga-
ments that hold the bones together have been strained or
torn), the same treatment with cold cloths is very useful,
and should be kept up at intervals for twelve hours. In
old and enfeebled patients, hot wet cloths are better. The
injured part should be placed as high as possible, so as to
keep the blood out of it.
If a bone is broken, medical care is, of course, necessary.
. While waiting for the doctor, the only thing
to do is to keep the broken limb in as com-
fortable a position as possible. Above all,
do not let the limb bend at the place where the bone is
broken, because that gets the splinters of bone out of place,
and may drive them through the skin and lead to an infected
wound. If you find it necessary to lift a broken limb, put
one hand on each side of the break and lift it with both
hands at the same time.
A person who has become faint and dizzy from the direct
ect of strong sunlight shining on the
ad should be placed in a seated position
in the shade. His clothing should be loos-
effect of strong sunlight shining on the . -
i-juuui j • a j u- Sunstroke and
head should be placed in a seated position
ened, and cold water poured on his head, or
his body rubbed with bits of ice. Cool drinks should be
given, if possible.
Heat prostration due to excessive heat acting on the whole
body, and not to the direct sun's rays, should be treated
somewhat differently. The patient should be laid flat on
his back in a cool place, his clothing loosened, and his hands
and feet rubbed, to restore the circulation. The face and
body should be bathed in warm water and warm drinks
should be given.
If the clothing catches fire, there is only one thing to do,
and it must be done quickly: smother the R
flame. Fire needs plenty of oxygen, and ~. A1 _.
- u wif- • i Clothmg and
if a person whose clothing is on fire is _, -
. , ; , i , , ■ Treatment of
quickly and closely wrapped in a coat, _.
shawl, blanket, or rug, the fire will go out.
It is important to remember to wrap the cloth from above
down. If the wrapping is done from below, the flames
may be driven up and inhaled into the lungs with very
serious results. If your clothing catches fire when you
are alone, do not run for help, but lie down flat and roll
over and over on the floor or on the ground, to smother the
In the case of a slight burn which only reddens the skin
without forming a blister, the pain will be lessened if the air
is kept from the burned place. A paste of ordinary baking
soda and water applied to the burn will do this, or carbolized
vaseline, or any grease, like lard, may be used instead. The
burn should then be covered by tying a piece of cloth or
bandage around it. If there is extensive blistering, the
application of soda or vaseline may do harm; and severe
burns should be treated like open wounds.
If ears, nose, or fingers are frost-bitten, the affected part
„ - . should be rubbed with snow or very cold
water until the blood has come back and
the flesh begins to sting and burn. On no account should
the person go into a warm room until this has been done, and
until the frozen part has become gradually warm by rubbing.
Even after the circulation has come back, the patient should
become warm only gradually.
When a person has been under the water or in some suffo-
n . - eating gas for a long time, the breathing
~ ~ . stops, and the patient becomes unconscious.
If breathing can somehow be started again,
recovery may follow. The starting of the breathing move-
ments in a person who has ceased to make them for himself
is called artificial respiration.
Artificial respiration should be begun by laying the patient
face downward upon the ground. The feet should be raised
to drain out any excess water. Stretch the arms of the
patient straight above his head and let them rest on the
ground in that position. Turn his head a little to one side,
so that the air will not be impeded in entering the nose and
mouth. Next stand astride of the patient, with your body
directly over his hips and facing his head. Put your hands
on each side of his back, below the shoulder blades. Your
hands now rest upon the patient's lower ribs. The fingers
are spread out, pointed toward the head and away from the
Swing your body forward, keeping your arms straight and
allowing your weight to rest on the patient's back; then
swing back, taking all your weight off the patient. Do this
fourteen or sixteen times per minute. This imitates the
motions of breathing. When you put your weight on the
patient, you press his chest together and force the air from
the lungs; when you release the pressure, the chest springs
back into place, and the lungs expand and draw air into
Recovery may be very slow; keep up your work for at least
While this process is going on, some one should remove the
patient's clothing. If necessary, he should be dried with a
towel and then covered with a blanket. This work must
not interfere with the operator who is causing artificial
respiration. Compel bystanders to stand back. The patient
needs every bit of air he can get.
When the patient begins to breathe, — but not before, — he
should have his legs and arms rubbed toward the body.
This should be done without removing the blanket. The
patient will not breathe well all at once, and it will be neces-
sary to help him at first by continuing the artificial respira-
tion every little while. Of course, if he stops breathing at
any time, the artificial respiration must be renewed.
After he is breathing well, put him to bed. Surround him
with hot water-bottles and cover him up well. As soon as
he can swallow, give him some hot coffee. Open the win-
dows wide, and allow him to sleep quietly.
Cases of electric shock (from contact with live wires, for
example) and cases of gas poisoning require the same treat-
ment — artificial respiration.
If some poisonous drug has been taken, the first thing to
do is usually to get it out of the body again _. .
• i i ui u • •*• Poisons
as quickly as possible by causing vomiting.
This may be done by running the finger down the throat, by
drinking a large quantity of warm water, or by taking some
substance which will cause vomiting, called an emetic. A
teaspoonful of mustard or salt in a glass of lukewarm water
will serve as an emetic. Promptness is more important than
an exact dose. After the emetic has been taken, large
quantities of warm water should be drunk, to dilute the poison