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HOW TO 
 KEEP WELL 
 
DR. EVANS' 
 * HOW TO * 
 KEEP WELL 
 
 A HEALTH BOOK 
 FOR THE HOME 
 
 BY 
 
 W. A. EVANS, M.S., M.D., LL.D., D.P.H. 
 
 President of The American Public Health Association, 1916-1917, Former Commissioner of 
 Health of the City of Chicago, Editor Health Department of the Chicago 
 Tribune and Other Newspapers, Professor of Sanitary Science in the 
 Northwestern University Medical School, Ex-President of the 
 Chicago Medical Society, Ex-President of the Illinois 
 Society for the Prevention of Tuberculosis, Mem- 
 ber of: the American Medical Association, 
 The National Society for the Study and 
 Prevention of Tuberculosis, The 
 National Safety Council, 
 Chicago Infant Wel- 
 fare Society, 
 Etc. 
 
 WITH COLORED PLATES AND OVER FIVE HUNDRED 
 ILLUSTRATIONS IN THE TEXT 
 
 PUBLISHED FOR 
 
 SEARS, ROEBUCK AND CO. 
 D. APPLETON AND COMPANY 
 
 NEW YORK 
 
 1917 
 

 COPYRIGHT, 191 7, BY 
 
 D. APPLETON AND COMPANY 
 
 m 
 
 JAN -4 1917 
 
 Printed in the United States of America 
 
 ©CI.A455010 
 
TO MY WIFE 
 
 WHO MAKES IT HER DUTY 
 TO KEEP ME WELL 
 
"Why shouldest thou die before thy time?" 
 
 — Eccl. 7:17. 
 
PREFACE 
 
 While Health Commissioner of Chicago, I was invited by the Chicago 
 Tribune to take charge of a Health Column ("How to Keep Well") which 
 they proposed to establish. The proprietors of the Tribune said they believed 
 that by joining them not only could I continue the good that I was doing 
 for the people of Chicago as Health Commissioner, but that I could reach 
 more people and make my work of much wider influence through such a column 
 as they proposed to establish. 
 
 There is a great reservoir of information on medicine which is sufficient 
 to prevent most diseases and to cure most of the developed ailments. If there 
 was to be an elevation of the standards of health, resulting in greater efficiency 
 and lower sickness and death rates, it was necessary that this great reservoir 
 of information be tapped and a means found for getting this information to 
 the people. The Chicago Tribune believed that they possessed the means — a 
 great daily newspaper, with a large circle of readers. That they were right 
 and that my column "How to Keep Well" has been of real benefit to the people, 
 has, I believe, been proven by the fact that there are now over four hundred 
 newspapers following substantially the Tribune plan; and during the past six 
 years, several million readers have had the opportunity to read "How to Keep 
 Well" each day in the year. 
 
 It is apparent to anyone who analyzes the known existing condition of 
 public health that something is needed. People drift into incurable — in some 
 instances fatal, in others disabling — conditions because of lack of knowledge 
 about the human body, health and disease; because of lack of elementary knowl- 
 edge of both curative and preventive medicine. A hundred or more health 
 surveys have been made in various parts of the country; some in cities, some 
 in small towns and some in rural communities. Some have been made in 
 industrial plants, some in farming communities and some in business estab- 
 lishments. The conclusions reached by all the investigators are practically 
 the same. They are all in substance that : when it comes to knowledge of dis- 
 eases, their causes, their manifestations and their cure, the average man or 
 woman is uninformed. When it comes to perfect health and the means of 
 achieving it, the average man or woman either does not know or else does not 
 apply what he knows. A large percentage of people in need of medical 
 service are not availing themselves of such service. The methods of preventing 
 disease are being neglected by the people themselves. On top of all this, demon- 
 strating both the proof of the conclusion and the need of some effort, the investi- 
 gations show that more than half the people are in some measure incapacitated 
 by disease most of which is preventable and nearly all of which is curable. 
 This condition is all the more inexcusable when it is borne in mind that the 
 majority of these people only needed counsel as to wrong habits of eating, 
 sleeping, exercising, worrying and using alcohol or tobacco. 
 
 This line of reasoning led me to the opinion that there was a need for 
 such a column and that it could be made influential with the several million 
 prospective readers. Then the question arose: Could I accomplish this end 
 or any considerable part of it? 
 
 I was reared in the country and in a small town. I had practiced medicine 
 
 vii 
 
viii PEEFACE 
 
 in this country place among my own people. I had moved to a large city 
 and practiced medicine there. I had conducted a clinical laboratory. For 
 sixteen years I had taught pathology in one large medical college. For nearly 
 half as long I had taught hygiene and sanitation in another. I had been active 
 in tuberculosis work, infant welfare work and other campaigns waged in behalf 
 of preventive medicine. I had served as health commissioner of the second city 
 in the Union. I might not be able, of course, to do all that "How to Keep Well" 
 would demand of me but, I reasoned, whose experience had been broader, more 
 varied or more preparing than mine ? It was up to me. 
 
 The next question which arose was — how could I keep in touch with what 
 the people wanted as well as with what they should have? Of course I could 
 depend on "sensing" the demand. But a person is so apt to "sense" what he 
 wants to "sense." There is no method for "sensing." I talk health to popular 
 audiences a great many times during the year, I belong to all sorts of health and 
 medical organizations and I attend them; but I could see where these, as 
 methods of discovering what was wanted, were insufficient. The plan hit upon 
 was questions and answers. By encouraging questions I would be informed 
 daily as to the popular mind. 
 
 And so I have found it. To change any of the habits or customs of a 
 people it is necessary to know them just as they are and to appeal to them in 
 terms of their daily experiences. The "Questions and Answers" department 
 was founded with a view to keeping the column in touch with the people. Expe- 
 rience demonstrated that it was the most effective part of my efforts. The 
 questioner asked a direct question in which he stated specifically what he 
 wanted to know. The answer was direct, stating specifically my reply to the 
 question asked. The reader interprets the question and answer. He either 
 sees a specific answer or he sees that the answer is not specific. If not specifically 
 answered he can form an opinion as to why it is not. The largest element con- 
 tributing to the success of "How to Keep Well" is the "Questions and An- 
 swers." 
 
 And lastly, I saw that if, making use of these approaches, I was to tap 
 the great reservoir of medical information for the benefit of those who needed 
 it I must keep "How to Keep Well" just as human as possible. 
 
 Out of this work grew this book. The strong appeal of the "How to Keep 
 Well" articles, as they appeared from day to day, resulted in a very large num- 
 ber of requests that they be put in permanent form. During the past five 
 years I have written a great deal, the result of much work, study, investigation 
 and research; but I believe it has proved to be of real and permanent value. 
 It is these articles, revised in the light of the latest discoveries in the science 
 of medicine and surgery, together with much new matter, which has not 
 appeared in the newspaper, that make up this book. This new material, I 
 believe, will make this book especially helpful, as it covers a number of subjects 
 which could not be discussed in a newspaper column. The questions and 
 answers contain many hundreds of letters received by me and my answers to 
 them. Some of these letters and their answers are now published here for the 
 first time. Among the most helpful features in this book, that did not appear 
 in the newspaper, are the illustrations. There are over five hundred of them 
 and they have been collected from three sources: (1) new illustrations made 
 especially for this book; (2) the most helpful illustrations, charts, diagrams 
 and tables of the various state and municipal boards of health and national 
 bureaus; and (3) illustrations selected from other medical works of established 
 merit. 
 
 For assistance in preparing this book I am grateful for the help given 
 
PREFACE ix 
 
 by Doctor A. R. Reynolds and Mr. Wyatt Rushton as well as the publishers. 
 As will be noted, for illustrations I have drawn freely upon various national, 
 state and municipal boards of health and various other governmental agencies 
 and various publications. I wish to thank them for the privilege of using these 
 cuts and illustrations. 
 
CONTENTS 
 
 CHAPTER PAGE" 
 
 I.— INTRODUCTION 1 
 
 The advent of preventive medicine — just a start. What is health? 
 Health can be bought. Ending well. 
 
 II.— THE NOSE 9 
 
 Construction of the nose. A baby's nose. Adenoids and enlarged 
 tonsils. 
 
 Questions and Answers. — Chronic nose infection. Have your nose 
 examined. Mouth breathing dangerous. Chronic nose trouble. 
 Obstructed nostrils. Mouth breathing. Harm of mouth breathing. 
 Cause of mouth breathing. 
 
 III.— THE TONSILS 15 
 
 Construction of the tonsils. Keeping the tonsils clean. 
 
 Questions and Answers. — Has tonsil trouble. Keeping tonsils clean. 
 Tonsillar crypts. Keeping crypts clean. Does not weaken lungs. 
 Developing the lungs. Fresh air counts. 
 
 IV.— ADENOIDS 20 
 
 Construction of adenoids. Clean mouths and infection. 
 
 Questions and Answers. — Cause, prevention and treatment of ade- 
 noids. Dryness and adenoids. Removal of adenoids. See throat 
 specialist. 
 
 Snoring. 
 
 Questions and Answers. — Cause of snoring. 
 
 V.— COLDS— CATARRH— SORE THROAT 25 
 
 Colds a luxury, not a necessity. What is a cold ? Cause of cold. The 
 cost :>f colds. Drafts and colds. Suggestion for prevention of colds. 
 
 Questions and Answers. — To get rid of cold. Toilet of the nose. 
 Cold in the head. "Chronic cold in the head." Cause and cure 
 of colds. To avoid taking cold. Treatment for cold. Cold con- 
 tagious. Habits may be cause. Complains of colds. How to 
 prevent colds. Take care of a cold. 
 
 Catarrh. 
 
 Questions and Answers. — Chronic catarrh. Catarrh. Catarrh a 
 symptom. Vaccine for nasal catarrh. See a physician. Catarrh 
 of the head. Treatment for catarrh. Offensive breath and catarrh. 
 
 Sore Throat. 
 
 Questions and Answers. — Hoarseness. Wash the throat daily. Trou- 
 ble in throat. Sore throat. 
 
 xi 
 
xii CONTENTS 
 
 CHAPTER p AGE 
 
 VI.— COUGH— ASTHMA 40 
 
 Cough. Useless coughs. What to do for a cough. 
 
 Questions and Answers. — Mild climate needed. Chronic cough. 
 
 Asthma. 
 
 Questions and Answers. — Incipient asthma. Curability of asthma. 
 Find underlying cause. Bronchial asthma. May be asthma. Va- 
 rious causes for asthma. 
 
 VII.— BRONCHITIS— HAY FEVER 46 
 
 Bronchitis. 
 
 Questions and Answers. — Chronic bronchitis. 
 
 Hay fever. Fighting hay fever. 
 
 Questions and Answers. — Hay fever antitoxins good. Causes of hay 
 fever. Hay fever cures. 
 
 VIII.— PNEUMONIA— PLEURISY 55 
 
 To avoid grip and pneumonia. Pneumonia. Pneumonia and drink- 
 ers. Cold air and pneumonia. What to do after pneumonia. Pneu- 
 mococci elsewhere than in the lungs. A possible pneumonia cure. 
 
 Questions and Answers. — Pneumonia and air. 
 
 Pleurisy. 
 
 Questions and Answers. — Empyema of pleura. 
 
 IX.— CONSUMPTION 70 
 
 Facts about tuberculosis. The relation of inheritance to consump- 
 tion. The relation of heart disease to tuberculosis. The relation of 
 diabetes to tuberculosis. The relation of pregnancy to tuberculosis. 
 The relation of alcohol to tuberculosis. The relation of chest develop- 
 ment to consumption. The relation of age to consumption. The 
 influence of race on consumption. Occupation in relation to consump- 
 tion. War against consumption. Early diagnosis necessary. When 
 to suspect consumption. What can the consumptive do to be safe 
 to others ? What is the consumptive to do for himself ? Heading off 
 consumption. How to have consumption. How is a consumptive to 
 know? How can a consumptive judge of progress? What the con- 
 sumptive should do. Chasing the cure in the clouds. Cure of tuber- 
 culosis. Where shall the consumptive go ? Climate and consumption. 
 Care of consumptives. Night camps for consumptives. Tubercu- 
 losis day. Captain Raoul's example. The consumptive nurse. 
 
 Questions and Answers. — Tuberculosis. Tuberculosis of the spine. 
 Curvature of the spine. Curvature of spine causes. Curvature 
 of the spine. Ill not transmissible. Consumption in diabetes. 
 Tuberculosis in animals. Symptoms of consumption. Consump- 
 tion and cough. Not tuberculosis cough. Looks like tuberculosis. 
 Pains, sputum, and cure of tuberculosis. Preventing consump- 
 tion. Needs medical advice. Enlargement of glands. Tubercu- 
 losis of the knee. Tuberculous sores. Advice to a consumptive. 
 
CONTENTS xiii 
 
 CHAPTER PAGE 
 
 Menace to neighbors. Should protect girls. Night sweats. Con- 
 sumption cures. Tuberculin as a cure for consumption. Treat- 
 ment of tuberculosis. Tuberculin is of value. Sun better than 
 sulphur. Medicines no use. Why consumptives go west. Advice 
 on a cure for tuberculosis. Going away question. May be curable 
 consumption. Reason for varying advice. Sanitaria about Den- 
 ver. Breathing and consumption. Arizona better place. 
 
 X.— THE EYE Ill 
 
 Preventable blindness. The sight fails. Trachoma. Eye fatigue. 
 Danger to the eyes. Smith cataract treatment. Squint. Pink eye. 
 
 Questions and Answers. — Cannot dissolve cataract. Trachoma. 
 Pings before the eyes. Causes of infant blindness. Eye drops for 
 baby. To prevent blindness. May need glasses. Bloodshot eyes. 
 Tears symptom of closed ducts. Glasses for astigmatism. Oper- 
 ation for cataracts. Failing sight. Tears best eyewash. Cataract 
 "ad" untrue. Treatment of styes. Infection causes styes. 
 Strained eyes. 
 
 XI.— THE EARS 133 
 
 An early sign of deafness. Earache. Reeducation of hearing. What 
 the mother of a deaf child ought to know. Lip reading. 
 
 Questions and Answers. — Perforated ear drum. Cotton in ears 
 harmless. Your physician will determine. Remedy for earache. 
 Approach of deafness. See ear specialist. Partial deafness hered- 
 itary. Running of the ear. To prevent deafness. Meniere's 
 disease. Lip reading. Ringing in the ears. 
 
 XII.— RHEUMATISM . 141 
 
 Eorms of rheumatism. "Full of rheumatism." Growing pains. Ar- 
 thritis germ infection. People with stiff legs. Hygiene versus rheu- 
 matism. 
 
 Questions and Answers. — Causes of rheumatism. Rheumatoid ar- 
 thritis. Rheumatism and climate. Troubled with rheumatism. 
 Rheumatoid arthritis treatment. Meat and rheumatism. Flan- 
 nel no rheumatism cure. 
 
 XIII.— GOUT 154 
 
 The gouty diathesis. 
 
 Questions and Answers. — Gout. Lumpy fingers show gout. Diet in 
 gout. Rheumatism and gout. 
 
 XIV.— DIABETES 158 
 
 Causes of diabetes. Types of diabetes. Diabetics subject to infec- 
 tions. Diet in diabetes. 
 
 Questions and Answers. — Diabetes — cause and diet. Possibly dia- 
 betes. Diabetes sometimes curable. Diabetes and Bacillus bul- 
 garicus. Symptoms of diabetes. Examination of urine for dia- 
 
xiv CONTENTS 
 
 CHAPTER PAGE 
 
 betes. Stages of diabetes. Not diabetes symptom. Testing for 
 sugar. Buttermilk in diabetes. Diabetes not hereditary. Diet 
 and diabetes. Teeth in diabetes. 
 
 XV.— PELLAGRA 165 
 
 Causes of pellagra. Diet in pellagra. Diagnosis and treatment of 
 pellagra. 
 
 Questions and Answers. — Concerning pellagra. Symptoms of pel- 
 lagra. Cause of pellagra. Warnings of pellagra. Reply to an 
 old lady. Thousands of cases. 
 
 XVI.— BERIBERI 172 
 
 Spread of beriberi. Diet. Prevention. 
 
 XVII.— SCURVY— SCROFULA— RICKETS 179 
 
 Scurvy. Scurvy, how to know it and what to do about it. 
 
 Questions and Answers. — May be scurvy. 
 
 Scrofula. Causes of scrofula. Symptoms. Prevention. Pickets. 
 How to know rickets and what to do for it. 
 
 Questions and Answers. — Cause of rickets. Child has rickets. Not 
 much difference. Treatment of rickets. Might be rickets. Curva- 
 ture of the spine. 
 
 XVIIL— CONTAGION— DISINFECTION 192 
 
 Contagion and infection. On reporting contagious diseases. Control 
 of contagion in small towns and country. Onset and incubation. 
 Danger from pets. Easy to control contagion. 
 
 Questions and Answers. — Destroying mold germs. How to fight 
 epidemic. Danger from rooms where consumptives have lived. 
 Contagious diseases. School and contagious diseases. Pule of 
 quarantine. Danger of contagion. 
 
 Fumigation. When to fumigate. Disinfection. 
 
 Questions and Answers. — How to fumigate. The grip and fumiga- 
 tion. How to fumigate room. Fumigate the book. Fumigation 
 by gas. Fumigation method. Fumigation of cars. Fumigation 
 after consumption. 
 
 XIX.— CONTAGIOUS DISEASES 213 
 
 Smallpox. How to control smallpox. Lesson of an epidemic. How 
 punish the weak sister? The two Niagaras. Cost of protection. 
 Varioloid. 
 
 Questions and Answers. — Finsen method has failed. No smallpox 
 danger. Mild form of smallpox. Two distinct diseases. 
 
 Vaccination. Discovery of vaccination. Production of smallpox vac- 
 cine. When to vaccinate. Where to vaccinate. How to vaccinate, 
 Anti-vaccinationists. 
 
CONTENTS xv 
 
 CHAPTER PAGE 
 
 Questions and Answers. — How to vaccinate. Experts and theorizers. 
 Blood test for vaccination. Smallpox and vaccination. Scarlet 
 fever. How scarlet fever spreads. Development of scarlet fever. 
 Scarlet fever and hot houses. Mystery of scarlet fever. Scarlet 
 fever incubation. Definition of scarlatina. Keporting scarlet 
 fever. Obey health board. Scarlet fever in school. Hot baths in 
 scarlet fever. Scarlet fever danger. Scarlet fever contagion. Dis- 
 infection after scarlet fever. Contagiousness of scales and disin- 
 fection. Scarlet fever aftermath. 
 
 Diphtheria. Development of diphtheria. Use of antitoxin. Almanac 
 talk on diphtheria. 
 
 Questions and Answers. — Carriers of diphtheria. What croup is. 
 To get rid of bacilli. 
 
 Croup in children. Treatment of croup. Measles. Development 
 of measles. 
 
 Questions and Answers. — Measles not universal. In cases of measles. 
 Conveying measles. Susceptibility to measles. Time of contagion 
 in measles. Open window no danger. German measles. 
 
 Whooping cough. Discovery of the germ of whooping cough. Sus- 
 ceptibility to whooping cough. Epidemiologic points to be noted. 
 
 Questions and Answers. — Whooping cough contagious. Incubation 
 period. Whooping cough danger. Shouldn't go to school yet. 
 Whooping cough and quarantine. - Duration of whooping cough. 
 Whooping cough treatment. City will fumigate. 
 
 Mumps. Development of mumps. Treatment. Chicken pox. How 
 chicken pox is spread. Period of incubation. Treatment of chicken 
 pox. Infantile paralysis. The virus of infantile paralysis. The 
 spread of the disease. Suggestions for its prevention. Infantile 
 paralysis exercises. What the mother of a crippled child ought to 
 know. 
 
 Questions and Answers. — Infantile paralysis. Infantile paralysis 
 infectious. Clothing and infantile paralysis. Spread of infantile 
 paralysis. Care of infantile paralysis. 
 
 Cerebrospinal meningitis. How cerebral meningitis is spread. Epi- 
 demic meningitis. Cerebrospinal fever. Symptoms of cerebrospinal 
 fever. Causes and precautions. Erysipelas. What, the ancients 
 thought of erysipelas. What others have said of erysipelas. What is 
 known of the disease at the present time. Chances of infection. 
 Chances of recovery from erysipelas. Yellow fever. Last yellow 
 fever region. Diagnosis of yellow fever. 
 
 Questions and Answers. — Cause of yellow fever. 
 
 Malaria. Causes of malaria. Day-biting mosquitoes. To control 
 mosquitoes. How to kill the mosquito breed. Mosquitoes. How 
 malaria spreads. How to end malaria. How to control malaria. 
 Eradicating malaria. Cure your malaria. Half cured malaria. The 
 cost of malaria on a plantation. Use of quinin. Outline of mosquito 
 work. A mosquito campaign. Oiling to prevent malaria. 
 
xvi CONTENTS 
 
 CHAPTER PAGE 
 
 Questions and Answers. — Weeds and malaria. Malaria easy to cure. 
 Daily allowance of quinin. Effect of quinin. Mosquitoes. Mos- 
 quitoes from cisterns. Malaria in Lexington. 
 
 Anthrax. Anthrax of the lungs. Anthrax in the blood. Anthrax and 
 furs. Plague. The present pandemic of plague. Diseases of rats. 
 Plague and the canal. Spread of plague. The cost of rats. 
 
 Questions and Answers. — Symptoms of bubonic plague. 
 
 Leprosy. Danger of leprosy. 
 
 Questions and Answers. — Causes of leprosy. 
 
 Hydrophobia. Dog days. Hydrophobia prevention. 
 
 Questions and Answers. — Hydrophobia and milk. Dog bites. 
 
 Lockjaw. Symptoms of lockjaw. Treatment and cure of lockjaw. 
 Typhoid fever. Typhoid a preventable disease. The typhoid bacillus. 
 Course of typhoid fever. Tests. Walking typhoid. Foods that cause 
 typhoid. Contact or finger typhoid fever. Activity of typhoid fever. 
 How winter typhoid is spread. 
 
 Questions and Answers. — Preventing typhoid. Milk and typhoid. 
 Typhoid vaccination. Cesspools and typhoid. Developing typhoid 
 fever. Avoiding typhoid germs. Protection of typhoid vaccina- 
 tion. Filters. Winter cholera. Cause of typhoid. 
 
 Foot and mouth disease. Fighting foot and mouth disease. Foot and 
 mouth disease easily avoided by people. 
 
 Questions and Answers. — Human foot and mouth disease. Prev- 
 alence of human foot and mouth disease. 
 
 Rocky Mountain fever. Its importance from an epidemic standpoint. 
 Preventive measures. Typhus. The history of typhus. Typhus in 
 Mexico. 
 
 XX.— HABIT-FORMING DRUGS 327 
 
 Dope fiends of one city. Dope law weaknesses. What is the drug 
 fiend to do? Morphin cure. Sceleth drug treatment. 
 
 Questions and Answers. — Do not take morphin. Drug habit danger. 
 Morphin habit. Must give up morphin. Bars morphin users. 
 Sleep caused by drugs. See doctor first. Don't take soporific. 
 Don't take bracers. Heroin derived from opium. An opium fiend. 
 When to use codein. Starts drug habit. Drug habit effects. 
 
 Cocain fiends. 
 
 Questions and Answers. — Cocain habit. Do not use cocain. 
 
 The alcohol habit. Whisky and heat. Rules for getting drunk. 
 
 Questions and Answers. — Periodic drinkers. Whisky and alcohol. 
 Drink habit. Cures for liquor habit. 
 
 Smoking. 
 
 Questions and Answers. — Tobacco and capacity. Not justified in 
 smoking. Giving up tobacco. Woman and tobacco. Should stop 
 smoking. Quit smoking. Tobacco stunts growth. Cigarettes 
 
CONTEXTS xvii 
 
 CHAPTER PAGE 
 
 of no benefit. Inhaling smoke. Smoking harms sight. Will alone 
 suffices. Chewing tobacco. Tobacco and weak heart. Tobacco 
 heart. Tobacco and hearing. Craving that persists. Danger from 
 cigars. Cigarette habit cnre. Use of snuff. 
 
 Coffee. Ingredients of coffee. Coffee effects. Coffee making. The 
 coffee or tea habit. Tea and war. 
 
 Questions and Answers. — Coffee and sleep. Avoid tea and coffee. 
 Harm from coffee. Coffee and tobacco. Coffee and caffein. Cof- 
 fee story false. No food value in coffee. No "weed" ; no tea ; 
 no coffee. To make tea. Too much tea. The coca cola habit. 
 
 XXI.— THE MIND 3G2 
 
 "The Human Machine." Human betterment advice. 
 
 XXII.— SYMPATHETIC NERVOUS SYSTEM . . . . . .370 
 
 Disturbance areas. To prevent nervousness. Influence of the mind 
 on digestion. The influence of mind on nutrition. The mind and the 
 heart and circulation. Influence of the body on the mind. The mind 
 in mental disorders. Persisting neuralgias. Neuralgia. Sciatica. 
 
 Questions and Answers. — Neuritis — Neuralgia. Adjust your mind. 
 Thinking disease. Has poor memory. Nervous indigestion. May 
 imagine illness. Nervous and run down. Should go to sanitarium. 
 Have him examined. Boy needs control. Has sudden fears. 
 Needs mental treatment. Relaxing body and mind. But little 
 danger. Stop worrying. Don't worry about it. Quit worrying. 
 
 XXIII.— NEURASTHENIA— THE PHYSICIAN AND NEURASTHENICS . 393 
 Symptoms of Neurasthenia. Treatment of Neurasthenia. 
 
 Questions axd Answers. — Neurasthenia. Medicine in neurasthenia. 
 Marriage and neurasthenia. Neurasthenic. Mild neurasthenia. 
 Try reading these books. Better read Du Bois. Cures self of 
 neurasthenia. Should learn control. Case for psychotherapy. 
 Temper in the morning. Victim of neurasthenia. Neurotic and 
 nervous. 
 
 Neurasthenia and hysteria. 
 
 Questions and Answers. — Treatment of neurasthenia. 
 
 Insomnia. 
 
 Questions and Answers. — Insomnia. Cause of sleeplessness. Sleep 
 mental condition. Needs more sleep. Cause of dreams. Wants 
 more sleep. Insomnia not disease. Mental training for dreams. 
 Afflicted with nightmare. Causes of nightmare. 
 
 XXIV.— INSANITY— TO PREVENT INSANITY . . . . . .413 
 
 Erysipelas in the insane. 
 
 Questions and Answers. — Insanity. Melancholia. Mysophobia. 
 Sign of nervousness. Biting the fingernails. 
 
 Dementia precox. — Plea for the child. 
 Questions and Answers. — Dementia precox. 
 
xviii CONTENTS 
 
 CHAPTEE j, AGl2 
 
 XXV.— DISEASES OF THE NERVES— CONVULSIVE DISORDERS . . 418 
 
 St. Vitus' dance. Epilepsy. 
 
 Questions and Answers. — Treatment for epilepsy. Care may cure 
 epilepsy. Looks like epilepsy. Epilepsy rarely curable. Value 
 not proved. Mild epilepsy. No epileptic colony. One chance 
 in ten. No institution for epilepsy. 
 
 Paralysis Agitans. 
 
 Questions and Answers. — Causes remain mystery. Marry him. 
 
 Huntington's chorea. 
 
 XXVI.— STAMMERING AND STUTTERING — STUTTERING SCHOOL 
 
 CHILDREN 435 
 
 Stammering. 
 
 Questions and Answers. — Stammering. Stammering a nervous con- 
 dition. To prevent stuttering. Cure matter of training. How 
 to cure stuttering. May help yourself. Suggestion for stam- 
 merers. Child stammers. 
 
 Phrenology. Head noises. 
 
 XX VII.— HEADACHES 443 
 
 Four kinds of headaches. Headache prevention method. Headache 
 medicines. 
 
 Questions and Answers. — Sick headache. Cause of sick headache. 
 Headaches from stomach. Migraine. Suffers from migraine. 
 Treatment for migraine. Not a headache preventive. Has harm- 
 ful effect. Forbidden by law. Dizziness. Paraffin and headache. 
 Too much aspirin harmful. 
 
 XX V1IL— FOODS 450 
 
 Bread. Meat. Frozen chickens. Fish as food. Oysters. Eggs. 
 Cheese. Mushrooms. Fruit as food. Cottonseed food. Pasteurized 
 butter. Milk. Food economics. Digestibility of foods. Preserve 
 fruits for winter use. Toxins in foods. Quantity of food. Over- 
 eating at dinner. Food values. 
 
 Questions and Answers. — No brain foods. Not blood builders. Food 
 value of grapes. How to tell butterine. Evaporated milk. Mixed 
 diet most helpful. No reason for it. May eat too much. Bulk 
 of food. Bran and agar for human food. Buttermilk tablets. 
 Fresh buttermilk better. Buttermilk. Colored butter. Bran gems. 
 Baked beans good food. Dried fruits. Value of oysters. Candy 
 concentrated food. Cottonseed meal. Cottonseed oil nutritive. 
 Foodstuffs. Water at meals. Tomatoes not harmful. Fruit acids 
 weak. 
 
 Food preservation. Refrigeration. Cold storage. Control of cold 
 storage. Ice box odors. 
 
 Questions and Answers. — Eefrigeration. To cleanse refrigerator. 
 
C0XTEXT3 xix 
 
 CHAPTER PAGE 
 
 XXIX.— MILK— COWS MILK 513 
 
 Age of milk. An infant diet. Milk production. Milk transporta- 
 tion. City delivery of milk. Indorsed milk report. Milk store score 
 card. How bad milk does harm. Certified milk. Clean milk. A 
 flyless, odorless dairy. La Salle milk. Milk of Eichmond, Ya. Milk 
 at summer resorts. Keeping- milk cold. Warm and dirty milk. The 
 government's position on milk. Another milk epidemic. Milk sold 
 in small cities. 'Tlain talk to Chicago milk producers." Treating 
 tainted milk. Ice cream. 
 
 Questions and Answers. — What constitutes fresh milk. Flesh made 
 by milk. Use of milk diet. Effects of milk diet. Milk disagrees 
 with her. Milk as food. Be careful of milk. Care of milk. Grape 
 fruit with milk. Thermos-kept milk. Is centrifuged milk safe? 
 How to get safe milk. Do not drink raw milk. Questions on milk 
 answered. Good milk proposal. Milk safety. Certified milk safer. 
 Is boiled milk nutritious ? Eefers to boiled milk. Heating water 
 and milk. Very warm and cold milk. Condensed milk safe. Try 
 cheese and milk. Ice cream poisoning. Pasteurized milk. Pas- 
 teurization enough. Pasteurized milk constipating. Pasteurize 
 the milk. Sour milk. Sweet milk and buttermilk. Buttermilk 
 safer. Buttermilk. Buttermilk as beverage. Kind of buttermilk. 
 Gives buttermilk formula. Culture buttermilk better. Yalue of 
 buttermilk. When buttermilk disagrees. 
 
 XXX.— LYMPHATIC GLANDS 547 
 
 Hodgkin's disease. 
 
 Questions and Answers. — Lumps on neck. Hodgkin's disease symp- 
 toms. Consult family physician. May need draining. Are easily 
 cured. Swollen lymph gland. Enlarged lymph glands. 
 
 XXXI.— DUCTLESS GLANDS 555 
 
 Acromegaly. Thyroid maladies. 
 
 Questions and Answers. — Enlarged thyroid glands. Thyroid gland. 
 Treatment of goiter. See best surgeon. Thyroid intoxication 
 case. May not need treatment. Goiter and children. Begarding 
 goiter. Graves' disease. When to remove goiter. Operation often 
 necessary. Goiters grow smaller. Goiter. Goiter not contagious. 
 Cause and cure of goiter. Treatment for cretinism. Life of cre- 
 tin. Operation not dangerous. Goiter and medicine. Thymus 
 gland tablets. 
 
 The adrenal bodies. Adrenalin. Addison's disease. 
 
 Raynaud's disease. 
 
 Questions and Answers. — Raynaud's disease. Symptoms of ray- 
 naud's disease. Xails turning black. White finger ends. 
 
 XXXII.— THE SPLEEN 583 
 
 XXXIII.— HEART DISEASE 590 
 
 Throbbing and beating. The heart aud exercise. 
 
xx CONTENTS 
 
 CHAPTER PAGE 
 
 Questions and Answers. — Valvular trouble symptoms. Care with 
 heart murmur. See heart specialist. Nervous heart. Nervous 
 heart evidence. Nervous heart not serious. Heart trouble. Heart 
 and altitude. Find cause. Chronic myocarditis. Nothing out 
 of the way. Have your heart examined. Irregular beat of heart. 
 Has years to live. Heart trouble. Probably angina pectoris. 
 Don't try "remedy." Heart trouble in son. Quick heart. Doctor 
 should superintend. Have heart examined. Blood pressure in 
 hardening of arteries. Prevention of hardening of arteries. Tis- 
 sue change in hardening of arteries. Cause of hardening of ar- 
 teries. Water in hardening of arteries. Premature hardening of 
 the arteries. Simple life only avails. Treatment of hardening 
 of the arteries. Symptoms of hardening of arteries. 
 
 XXXIV.— BLOOD PRESSURE— BLOOD PRESSURE RECORDS . . 605 
 
 Protecting the blood. 
 
 Questions and Answers. — Blood pressure. High blood pressure. 
 Temperate living urged. No great danger. Attitude effect exag- 
 gerated. On high blood pressure. Treatment of high blood pres- 
 sure. Blood pressure at forty. High blood pressure symptoms. 
 Blood pressure at 23. Leave the bed. Hemophilia. Nosebleed. 
 
 XXXV.— APOPLEXY 612 
 
 Apoplexy is cerebral hemorrhage. Cause of apoplexy. Warnings and 
 prevention of apoplexy. Forms of pseudo apoplexy. 
 
 Questions and Answers. — Not apoplexy sign. Due to apoplexy. Meat 
 and apoplexy. 
 
 XXXVI.— BRIGHT'S DISEASE 617 
 
 Warning of bright's. Acute bright's disease. Infection of the kid- 
 neys. Chronic bright's disease. Chronic bright's disease with much 
 albumin. Very slow bright's disease. Kidney of pregnancy. Albu- 
 minuria in pregnancy. Bright's and diabetes. Kidney cures. Bright's 
 disease treatment. 
 
 Questions and Answers. — Water and bright's. Bright's disease diets. 
 Bright's disease ration. Interstitial nephritis. To avoid uremia. 
 Symptoms of bright's disease. Try dieting and exercise. Loss of 
 one kidney. Tubercular kidneys. Case is incurable. Danger in 
 overeating. Use of the kidneys. Stone in the kidney. Gravel 
 in the urine. Salt and bright's disease. Concerning floating kid- 
 ney. Osier on floating kidney. Dropsy. Kidney "dopes." 
 Bright's and diabetes. 
 
 XXXVII.— DIGESTION 637 
 
 Importance of chewing food. Process of digestion. Digestive trou- 
 bles. Exercise and the stomach. Dieting for fermentation. Sugar 
 eating. 
 
 Questions and Answers. — Indigestion the cause. Nerves of taste. 
 Eat bulkier food. Breath of dyspeptic. Cut down starches. Sugar. 
 Indigestion. Catarrh of stomach. Intestinal indigestion. Mean- 
 
CONTEXTS xxi 
 
 CHAPTER PAGE 
 
 ing of proteid. Salt meat diet. Exercise more; eat less. Don't 
 eat apples. Onions and health. Ptomain poisoning protection. 
 Appendicitis. How to cure heartburn. Take cheese and milk. 
 Pork must be cooked. Drink more water. Buckwheat cakes. Eat 
 three meals. California raisins. Cuts out a meal. Effects of 
 gum-chewing. Bicarbonate of soda's use. Sour stomach. The 
 disease of "bad habits." 
 
 Belching. 
 
 Questions and Answers. — Cause of belching. Excessive belching. 
 Must work out own cure. 
 
 Constipation. 
 
 Questions and Answers. — The internal bath. Seeks constipation cure. 
 Liver does not cause constipation. Remedy for constipation. Con- 
 stipation. Constipation and pregnancy. Water in constipation. 
 Castor oil and calomel in constipation. Oatmeal in constipation. 
 Wheat for constipation. Senna in constipation. Laxatives. 
 Bowel obstruction. What to do. Pumpernickel in constipation. 
 Try eating wheat bran. Try eating wheat bran and agar. Use of 
 bran bread. ISTo harm from bran. Suggestion for constipated. 
 Uncooked bran better. Laxative food. See physician for consti- 
 pation. Enema in constipation and indigestion. Home treatment 
 for constipation. Food in constipation. What is agar? Keep on 
 with the oil. Patent medicine in constipation. 
 
 Seasickness. 
 
 Questions and Answers. — Consult the ship's doctor. To avoid sea- 
 sickness. 
 
 XXXVIII.— HERNIA .665 
 
 Questions and Answers. — Hernia. Xo bar to marriage. Rupture. 
 Operation should cure. Xeed operation for rupture. Cure for 
 rupture. Band may help. Truss will not cure. Knife for cure. 
 Rupture in baby. Hernia and rupture. 
 
 XXXIX.— OBESITY AND THINNESS 672 
 
 Too fat or too thin. Reducing and fattening. Scale of weights. 
 Obesity. Fat as a sign of age. How to decrease girth. Obesity cures. 
 Getting thin. Strain of reducing. 
 
 Questions and Answers. — Oertel diet for obesity. Fifty pounds over- 
 weight. One way of getting thin. Reducing weight at 68. Cut 
 down quantity of food. Take less food. Reducing weight. Don't 
 take medicine. Short cut obesity "cures." Diet held successful. 
 Peril in reducing weight. How to check obesity. Reducing weight 
 intelligently. Reducing weight too fast. Beware of fat reducers. 
 Water and weight. To overcome obesity. Reduce your food. To 
 reduce abdomen. Buttermilk and weight. To reduce weight. To 
 reduce weight at 50. Reduction of weight. How he reduced 
 weight. Reduce quantity of food. Limit to haphazardness. 
 Amount varies for persons. Practice is harmful. Should weigh 
 160 pounds. Proper weight. Keeping the weight down. 
 
 How to get fat. 
 
xxii CONTENTS 
 
 CHAPTER 
 
 Questions and Answers. — Bread and fattening food. Weight gain- 
 ing foods. Would gain flesh. To increase weight. Weight is too 
 low. Will make one fat. How to increase weight. Milk to in- 
 crease weight. Eggs to increase weight. Below normal weight. 
 How to get fat. Eat more; sleep long. In need of more fat. 
 Should increase diet. How to gain. Worry and weight. Would 
 lay on fat. 
 
 XL.— THE SKIN 700 
 
 Skin tan. Spare your skin. The skin and bathing. Pimples. 
 Eczema. Eczema in babies. Diseases which show themselves in the 
 skin. Straw itch. Psoriasis. Boils. Prickly heat. Dermoids. Dis- 
 eases contagious through the skin. Hives. 
 
 Questions and Answers. — Eczema loose term. Eczema in babies. 
 Cause of dry skin. Holds no theory. Eczema not contagious. 
 Has no effect. Eczema. Scalp eczema. Must cleanse daily. Sen- 
 sitive skin. What sycosis is. Warts. Let your moles alone. 
 Mole on the nose. Have mole cut out. Removal of scar. Treat- 
 ment for eczema. Tetter. Scalp eczema. Has flour eczema. 
 Cause of fever blisters. Camphor for cold sores. Itch. Cause of 
 itching. Has winter itch. Winter itch cure. Palliative for itch- 
 ing. Barbers' itch treatment. Dry air rash cause. Cuban itch. 
 Bath itch relief. Wrong kind of itch. Nails have diseases. In- 
 growing nail treatment. Keep nails oiled. Split finger nails. 
 Run-around. Removing tattoo marks. Spots on the face. Bad 
 complexion cause. Will discolor the skin. Bleaching the skin. 
 Liver spot. White spots on body. Brown patches on face. Sweat- 
 ing arm pits. Chapped hands. Cure cracked hands. Psoriasis. 
 Treatment of psoriasis. Not a bar to marriage. Psoriasis not 
 hereditary. Peroxid and psoriasis. Pityriasis. Have it removed. 
 What ringworm is. May be ringworms. Cures for ringworm and 
 warts. Cure for ringworm. Scars and their removal. Warts and moles. 
 Wrinkles can be reduced. Wrinkles defy lotion. Shingles. Shingles 
 not dangerous. Cause of it not known. Boils. Don't poultice a 
 boil. Carbuncles. Cause of pimples. Blackheads. Cause of 
 whiteheads. Acne. Pimples and blackheads. To prevent pimples. 
 Acne vaccine. Alcohol for blackheads. Pimples not blood dis- 
 ease. Serum treatment for acne. Cause of hives. Cause and 
 treatment of hives. How to avoid the hives. Freed of hives. 
 Treatment for hives. How to prevent hives. 
 
 XLL— THE TEETH AND HAIR . 738 
 
 The teeth. The teeth and health. Importance of good teeth. Care of 
 teeth necessary. Cavities in teeth. Irregular jaws. Erosions. Pyor- 
 rhea. Anemia and dirty teeth. Tooth brushes. 
 
 Questions and Answers. — Pyorrhea curable disease. Pyorrhea not 
 contagious. Pyorrhea cures. Bleeding gums. Unclean dental 
 tools. Decaying teeth. Pulling wisdom teeth. Some good in 
 fletcherizing. Consult your dentist. Go to dentist. Hardening 
 the teeth. Keeping the mouth and nose clean. Consult your 
 
CONTENTS xxiii 
 
 CHAPTER PAGE 
 
 dentist. Loose teeth. Sore gums. May save teeth. Tumor of 
 gums. Lime water and gums. Fletcherizing as preventive. Treat- 
 ment for pyorrhea. 
 
 The hair. Baldness. 
 
 Questions and Answers. — Has scalp disease. See a skin specialist. 
 Care of the hair. Bald head. Care of the hair. To remove dan- 
 druif. Superfluous hair. Removal of superfluous hair. Bald in 
 spots. Bald spots. Thin hair. Gray hair. Why does hair turn 
 gray? Hair turning gray. Keep hair clean. Hair dyes injurious. 
 Dyes not to blame. Wash scalp daily. Little absorbed by scalp. 
 
 XLII.— THE FEET . . . . . . . . . .761 
 
 Care of the feet. Slew-footed or pigeon-toed. Flat feet. Low heels. 
 Foot habits. Covering of the feet. 
 
 Questions and Answers. — Aching feet. Broken arch remedy. Treat- 
 ment for chilblains. Danger in using acid. How to cure bunions. 
 Bothered by great toe. For tender feet. For perspiring feet. 
 Effect of high heels. Aid for flat feet. Reason for flat feet. 
 Wear easy shoes. Chilblains. Itching feet. Causes of cold feet. 
 Treatment of feet. Change style of shoe. Cold hands and feet. 
 Need of arch support. Treatment of cold feet. Cure for sore 
 feet. Support the instep. Has flat feet. Best to consult doctor. 
 Swollen feet. 
 
 XLIII.— OBSTETRICS 775 
 
 Precautions at childbirth. Twilight sleep. Care of newborn baby. 
 Supplies for childbirth. 
 
 Questions and Answers. — Books on pregnancy. No age limit. Infec- 
 tion in childbirth. Presumptive symptoms. Should forget worries. 
 "Marking" of child. The nipples. No harm to child. Amenor- 
 rhea. No bar to marriage. Is no proof. Abderhalden test tells. 
 Hazard is decreased. Danger not great. When stork is expected. 
 Prospective mother. Reply to M. W. Reply to R. S. Can't deter- 
 mine sex. Will do no harm. Follow doctor's plans. No legal or 
 moral right. No need to fear for child. Need not worry. Marry- 
 ing at 48. Medicine no help. Fibroid tumors not cancer. Treat- 
 ment for fibroid. Operate for fibroid tumor. Radium and fibroids. 
 Operation will relieve. Operations no barrier. Should go to 
 hospital. No danger to offspring. Artificial change of life. Try 
 eating more. Not too late. Affliction not dangerous. Pregnancy 
 test. Difference not great. Leukorrhea. Need not fear. Regu- 
 larity should rule. Consult your physician. Operation not neces- 
 sary. Doctor's guess better. Can regain ground. Will have no 
 effect. May last four months. Two books suggested. Read Sle- 
 mons' work. Be examined by physician. Morning sickness. Cause 
 of "Blue" baby. Should not overeat. No need to fear. Preg- 
 nancy. Milk leg. 
 
 XLIV.— THE BABY 795 
 
 Helping baby live. Saving new lives. Nursing the baby. New 
 Zealand baby rules. What would you do? Feeding and growth of 
 
xxiv CONTENTS 
 
 CHAPTER 
 
 babies. Fresh air for the baby. Danger sign with babies. Baby's cry. 
 The baby's nerves. Fat babies. Country baby death rate. Heat kills 
 babies. Babies in hot weather. Summer complaint. Diarrhea — its 
 treatment. Colic in babies. Dyspepsia. Eye of the child. Weaning 
 the baby. Weight disturbance in babies. Feeding babies. Feeding 
 sick babies. Selection of baby food. Merit of baby foods. 
 
 Questions and Answers. — Soft spot on head. Shape of baby's head. 
 Mouse story untrue. Measurements for baby. Broken tooth. 
 Nursing the baby. Let the baby sleep. Good place for babies. 
 Child is cross-eyed. Cause of worms. May do baby harm. Left- 
 handed baby. Let baby sleep out of doors. Not robbed of vitality. 
 Avoid use of drugs. Baby with the colic. Dandruff on baby's 
 head. Baby's second summer. Feeding the baby. Baby improp- 
 erly fed. When the milk fails. Do not boil it. More fruit for 
 baby. Mother's milk. Feed baby now. Feeds baby too much. 
 Weaning the baby. Nothing to do with the moon. January good 
 weaning time. Bowlegs in babies. From babies to baby carriages. 
 Cause of stye. No remedy known. Break lad of habit. 
 
 XLV.— CHILDREN 841 
 
 Why is your child "it" ? Evidence of normality. Training the child. 
 Five children dead. What the mother of a crippled child ought 
 to know. 
 
 Questions and Answers. — Sugar good for children. Candy good for 
 children. Bad for child. Kernels in the neck. Aid for weak 
 ankles. Bath not harmful. Have children exercise. Keep room 
 cooler. Do not use a brace. Boy fitful sleeper. Night terror. 
 Nervous while asleep. Little lad dreams. Treatment for children's 
 colds. Mouth breathing. Diseases of children. Condition not dan- 
 gerous. Children's diseases. Feeding the little ones. Change boy's 
 diet. Growing pains of children. Child in need of treatment. 
 Promiscuous feeding. Bananas good for child. Take child to 
 specialist. Have child examined. Food for young child. Cellu- 
 loid toys. Sleep for the child. Baby likes to eat mud. Starch 
 craving unnatural. Feeding year-old child. Feeding the baby 
 potatoes. Nodding spasm. Cleft palate. Stature. Harelip can 
 be cured. 
 
 XLVL— FIRST AID 859 
 
 Internal hemorrhage. Nosebleed. Disclocations. Dislocation of the 
 lower jaw. Dislocation of a finger. Rescue of persons at fires. Treat- 
 ment of a burn. Electric shock. Some minor ailments. Colic and 
 cramps. Transient diarrheas. Nausea and vomiting. Hiccough. 
 Neuralgia. Emergencies. Black eye. Foreign bodies in nose. Nose- 
 bleed. Choking. Emergencies. Bites of insects. Rusty nail wound. 
 Burns. Bruises. Cuts. Artificial respiration. First sunstroke treat- 
 ment. First aid requirements. First aid outfits. Poisons and anti- 
 dotes. 
 
 Questions and Answers. — Poison oak treatment. Alcohol and snake 
 bite. Treatment of wounds. Toxemia. 
 
CONTEXTS xxv 
 
 CHAPTEPw page 
 
 XLVII.— OCCUPATIONAL DISEASES 893 
 
 Acid burns. Phosphorus poisoning. Accidents and diseases of iron 
 workers. Eemedy for being "gassed." Lead poisoning. Preventing 
 lead poisoning. Eecognizing lead poisoning. Mercury poisoning. Ar- 
 senic and benzine poisoning prevention. Caisson disease. Dusty 
 trades. Dust in shoe factories. Men who work in wet air. Sanita- 
 tion in the cloak industry. What the workingman should do. 
 
 Questions and Answers. — Regarding matches. Brass chills. Danger 
 from dust. Writer's cramp. Protecting workers from heat. Teleg- 
 rapher's palsy. Case of a painter. Cause of lead poisoning. Too 
 long a workday. Quit working there. 
 
 XLVIIL— HOT WEATHER ADVICE 911 
 
 Work in hot weather. Disease in hot weather. The liver in hot 
 weather. Crowds in hot places. Sleeping in hot weather. 
 
 XL1X.— PARASITICAL PESTS 917 
 
 Bedbugs. Straw itch. Itch parasites. Lice. Bedbugs. Fleas. 
 Ticks. Stinging pests. Scorpions. Centipedes. Bees, hornets, wasps, 
 and yellow jackets. Black flies. Pantry pests. Insects injurious to 
 cereals. Methods of control. Brown-tailed moth. Brown tail rash. 
 Flies. Flies and typhoid fever. Food and flies. Fly catechism. 
 Fly family described. Open season for flies. Preventing fly breed- 
 ing. Defense against flies. Why Havana is "flyless." Stables and 
 flies. Fall fly danger. How to avert fly menace. Household fly 
 trap. A new fly trap. Door fans for flies. Stable flies. Do not 
 remove your screen. Who has a new fly slogan? 
 
 Questions and Answers. — Case against flies proved. Plague of small 
 flies. To get rid of flies. Bothered by flies. Smudge plan to kill 
 flies. Try burning sulphur. How to bar flies. Iron sulphate and 
 water. To get rid of ants. Bed bugs. To get rid of fleas. Fungus 
 on insect. To get rid of mosquitoes. Insects in flour. To get 
 rid of flour bugs. When to remove fly screens. Flyless Havana. 
 Keep screens up. Moth miller trouble. Flies like electric mixers. 
 Duty of the city. "Sewer bug." Lice in girl's hair. How to re- 
 move "nits." Butter and juggers. Butter fatal to chiggers. Seeks 
 a preventive. 
 
 L.— LONGEVITY 949 
 
 Efforts of Metchnikoff. Belief of Metchnikoff. Growing old gradu- 
 ally. Some plans for a long life. 
 
 LL— CANCER 957 
 
 Importance of cancer knowledge. Cancer knowledge necessary. Can- 
 cer of the breast. Cancer of the face. Cancer of the mouth. Cancer 
 of the stomach. Diagnosis of cancer of the stomach. Cancer of the 
 skin. Cancer of the uterus. Sarcomas. To ward off cancer. Can 
 anything be done to cure cancer? Radium, x-rays, and ultra-violet 
 rays. 
 
xxvi CONTENTS 
 
 CHAPTER J, AGfi 
 
 Questions and Answers. — Probably not cancer. Needless cutting 
 deplored. Cancer of stomach. See your physician. Senseless 
 worry. Cancer cause not known. Cancer. Stomach cancer symp- 
 toms. Cancer not inherited. No good for cancer. X-ray and can- 
 cer. Fish and cancer. Need of cancer knowledge. Cancer of the 
 bladder. Should not cause cancer. Wait three weeks. See a sur- 
 geon at once. Might be cancer. Pork doesn't cause cancer. 
 
 LII.— TUMORS 982 
 
 Questions and Answers. — See your physician. Lump in the breast. 
 Tumor. Each case different. Let doctor decide. Medicine no 
 cure. 
 
 LIII.— CHILE'S METHOD OF ANESTHESIA . . . . .987 
 
 LI V.— EUGENICS 989 
 
 For race betterment. Collecting eugenic data. The optimism of 
 eugenics. Problem of the feeble-minded. Eugenics conclusions. 
 Tendency of bloods. "The survival of the fittest." "Unto the third 
 and fourth generation." The baby science. Eugenics and asylums. 
 The immigrant's child. Small families. The only child. 
 
 Questions and Answers. — Pre-natal marking. No cause for worry. 
 Cretinism. Exceptions not convincing. Have effect on child. 
 Marriage of cousins. Law forbids marriage. Size of family. Eu- 
 genics. Birthmarks. Question of physical condition. No bar to 
 marriage. Marriage of cousins. Second cousins may marry. In- 
 termarriage. Blindness not inheritable. Such marriage forbidden. 
 Marriage of double relations. Should cousins wed ? Mendel theory 
 of eugenics. Eugenics literature. Risk four cents. Advice on 
 eugenics. Book on eugenics. Mentality of twins. Reason for 
 birthmarks. Fright and birthmarks. Deafmutism inheritable. 
 Eugenics no fad. Books on eugenics. 
 
 LV.— MASSAGE 1026 
 
 Massage a curative aid. 
 
 LVL— EXERCISE 1032 
 
 Learn how to walk. Athletic games. Playing golf. Playing billiards. 
 Archery. Swimming. Exercises for convalescents. Exercises for 
 children. The play cure. "The outside of a horse is good for the 
 inside of a man." 
 
 Questions and Answers. — Expanding the chest. Exercise rests tire. 
 Play in open air. Not injurious to health. Exercise for muscle. 
 Too much exercise. Needs outdoor exercise. Physical exercise. 
 Horseback riding. Riding astride. Skating fine exercise. Advice 
 on tennis. Gymnastic dancing. Enter a gymnasium. Needs more 
 exercise. Should take exercise. Exercise after operation. Ex- 
 ercise for women. Special exercise necessary. S. B.'s exercises. 
 Benefit from massage. Exercise to prevent cramps. Swimming 
 better exercise. Effect of swimming. Exercise before breakfast. 
 
CONTENTS xxvii 
 
 CHAPTER PAGE 
 
 Exercise out of doors. Do gymnasium work. Rowing good exer- 
 cise. Stop the exercise. Bathing bracing practice. Massage and 
 exercise. Walking good for people. Continue swimming. Roller 
 skating example. Exercise in the open. To strengthen the ankle. 
 Take more exercise. In need of exercise. More exercise needed. 
 
 LVII.— POSTURE— HEIGHT 1059 
 
 Posture. Man and his posture. Stooping shoulders. Narrow chests. 
 Vertical line test. 
 
 Questions and Answers. — Stoop-shouldered girl. Stoop shoulders. 
 
 Height. Increasing the height. Long-bodied people. 
 
 Questions and Answers. — Wants to increase height. Will not grow. 
 
 Rules for height. How to grow taller. To increase height. 
 
 LVIIL— THE MUSCLES 1073 
 
 Leg and arm muscles. Muscle sagging. 
 
 Questions and Answers. — Walking will help. Deep breathing ben- 
 efits. Arm muscles exercise. Cramps while swimming. 
 
 LIX.— HOUSING 1084 
 
 Where shall one live? Houses and housing. Housing problems in 
 America. Housing plans. Housing plans. Influence of housing. 
 Effect of good housing. Rehousing financial plan. Rehousing in 
 Liverpool. Bad housing punishment. Disease history of houses. 
 Congestion of population. Price of land. Prevent land sweating. 
 More about town planning. Flat and cottage. 
 
 Questions and Answers. — Bad housing conditions. 
 
 LX.— THE HOME 1121 
 
 Sites for buildings. Selecting a house. Sunlight in the house. San- 
 itary bathrooms. Keeping the house. Kitchens, ice boxes, pantries 
 and closets. Cold walls. Damp walls. Curtains and carpets. A 
 sensible camp. Porches. Arrangement of house. Spring cleaning. 
 
 Questions and Answers. — House doctor needed. Space in tenements. 
 Safe but wasteful. Sunlight in bedrooms. Poor lighting in hotels. 
 Cleaning the sink. No sunlight in bedrooms. 
 
 LXL— VENTILATION— HEATING— HUMIDITY 1144 
 
 Ventilation. Value of fresh air. Ventilation and efficiency. Errors 
 in ventilation. Why ventilation fails. Ventilating offices, schools 
 and stores. Remedies for poor ventilation. Temperature of incoming 
 air. Limitations of gravity ventilation. Effects of wind on ventila- 
 tion. Ventilation by windows. The philosophy of fanning. Ozone. 
 Living rooms. For fresh air duct. Ventilation of the bedroom. 
 
 Questions and Answers. — Put up windows. Deflectors for open win- 
 dows. Suggestion on ventilation. Sleeping room regulation. 
 Regulation is necessary. Ventilate room. Sleeping out of doors. 
 Window-ventilated office. How to make deflector. Sleeping in a 
 
xxviii CONTENTS 
 
 CHAPTER 
 
 draft. How to ventilate a room. Yentilation. Outdoor sleeping. 
 Open windows in winter. Drafts and colds. Kitchen air. For 
 well-ventilated cars. More ventilation. Ventilating a house. Air 
 the house well. To insure pure air. Method to be avoided. Bad 
 air in a basement. Coughing in theaters. Church ventilation. 
 
 Heating. Healthful heating of houses. Heating the house. Problems 
 of heating. Types of heating. Using heat. Get the thermometer 
 habit. Thermometers inaccurate. 
 
 Questions and Answers. — Thermometers inaccurate. Care of ther- 
 mometer. Stove is explanation. Treatment of furnace heat. 
 Keeping off frost. Furnace may lack capacity. Would save heat. 
 Keeping warm at night. Outside air necessary. Storm window 
 problem. Cold sleeping quarters. Have fresh air enter. Proper 
 heat for flats. Recirculating system bad. Keeping warm prob- 
 lem. Correcting furnace trouble. Not as healthy. Steam heat 
 itch. 
 
 Humidity. Frosted windows. Method of humidifying. Why flowers 
 die. Wet bulb thermometers. A practical suggestion. Dry air. Get 
 the thermometer habit. Raising the humidity. 
 
 Questions and Answers. — Arrangement for humidity. Ideal humid- 
 ity. Dry air explanation. Bad air effects. Between 50 and 70. 
 Peril to picture operators. Should have hygrometers. Have hu- 
 midifier attached. Dry air and moist. Good compromise humid- 
 ity. Radiators and humidity. Call in steamfitter. Plan to in- 
 crease humidity. Humidity by pans. Use the hygrometer. Room 
 needs moisture. Humidity should exceed. To make a hygrometer. 
 Humidity discussed. Air too dry. More humidity needed. Itch- 
 ing from air too dry. Dirt bands on ceiling. Winter itch treat- 
 ment. 
 
 LXIL— GARBAGE 1214 
 
 How to dispose of garbage. Dumps. Garbage reduction. Burning 
 garbage. Garbage on the soil. Feeding to hogs. St. Joseph's garbage 
 report. Stable manure. 
 
 Questions and Answers. — Disposal of garbage. Burning out garbage 
 cans. Burning leaves. Danger has passed. Garbage as compost. 
 
 LXI1L— INSURANCE 1223 
 
 Effect of health insurance. Social insurance. Industrial insurance. 
 
 LXIV.— HOSPITALS— SCHOOLS 1226 
 
 Value of the hospital. Who should go to a hospital. Contagion in 
 hospital. Schools. School efficiency effort. School hygiene. School- 
 room ventilation. Medical school inspection. Feeding growing gen- 
 eration. Neglected children. Larger use of the schools. School lab- 
 oratories. Village school hygiene. Safeguarding the health of the 
 country school teacher. 
 
 Questions and Answers. — Heating schoolrooms. Help for teacher's 
 nerves. Purpose of school inspection. Systematic play for both. 
 
CONTENTS xxix 
 
 CHAPTER PAGE 
 
 May be clue to dry air. Have windows opened. School session too 
 long. Let boy remain in school. Let him play with children. 
 School inspection barred. Has some infection. 
 
 LXV.— SEX ORGANS OF WOMAN 1274 
 
 The female sex organs. Menstruation. Normal menstruation. Hy- 
 giene of menstruation. Scanty menstruation. Amenorrhea or ab- 
 sence of menstruation. Menorrhagia and metrorrhagia. Dysmenor- 
 rhea. Diagnosing the cause of sterility. 
 
 Questions and Answers. — Baths during menstruation. Change of 
 life. Menorrhagia. Amenorrhea. Too young for change of life. 
 Normal menstruation. Leukorrhea. Very scanty menstruation. 
 Leukorrhea. Can ride horseback during menstruation. Scanty 
 menstruation not a sign of pregnancy. Amenorrhea. Complete 
 recovery after severe operation. Is pregnancy safe? When can 
 pregnancy be diagnosed ? Children desired. Phantom tumor. An 
 old husband and a younger wife. Shall corsets be worn during 
 pregnancy? What is safe for a pregnant woman? Shall a woman 
 42 marry? Child-bearing and diseased ovaries. Shall she marry? 
 Care during pregnancy. Consult a physician at six months' preg- 
 nancy. Ergot will not cause miscarriage. To overcome sterility. 
 
 LXVL— VENEREAL DISEASES 1286 
 
 Venereal diseases. Venereal disease can be banished. So-called 
 venereal diseases. "No worse than a cold." Venereal diseases and 
 blindness. Syphilis. The venereal peril. Advertising doctors — men's 
 diseases. Measures for control. How to know syphilis. How to know 
 gonorrhea. Method now in use in II. S. Army. Prostitution in rela- 
 tion to venereal disease. Gonococcal infections in children. Marriage 
 requirements. Hospitals and dispensaries. Insanity and venereal 
 disease. Inherited venereal disease. Venereal diseases in New York 
 City. Continence. Night losses and wet dreams. Self -abuse. Lost 
 manhood. Varicocele. When can a syphilitic man marry? When 
 can a syphilitic woman marry? Marriage after infection with gon- 
 ococcus. 
 
 Questions and Answers. — Inherited syphilis. Insufficiently treated 
 syphilis. Contagiousness of syphilis. Safety of salvarsan. Infec- 
 tion from an unclean toilet. Cure of syphilis. Eelapse in syphilis. 
 Curability of syphilis. Neglected gonorrhea. Gonorrhea with few 
 symptoms. Gleet. Gonorrhea not inheritable. Contagiousness of 
 gonorrhea. Varicocele. Undescended testicles. Spermatorrhea. 
 Circumcision. Night losses. Mucus from urethra. Erections in a 
 child of no consequence. Self-abuse. Masturbation in a child. 
 Stupidity and self-abuse. A worrier. Fear and worry. A sexual 
 neurasthenic. 
 
 GENERAL INDEX 1315 
 
 INDEX TO QUESTIONS AND ANSWERS . . . . . - . . 1349 
 
LIST OF ILLUSTRATIONS 
 
 FIG. PAGE 
 
 1. — Which path are you on? ......... 1 
 
 2.— Health 4 
 
 3.— Why? 6 
 
 4 Temple of health 7 
 
 5. — Adenoids ............ 10 
 
 6. — Nasal syringe ........... 11 
 
 7. — Atomizer for spraying oils ......... 13 
 
 8. — Throat inspection ........... 15 
 
 9. — Location of glands which frequently enlarge ...... 17 
 
 10. — Peritonsillar abscess . . . . . . , . . .18 
 
 11. — Headquarters for gossip and germs <£ ...... 21 
 
 12. — Muzzle the microbe .......... 24 
 
 13. — The double cross 26 
 
 14. — Adenoids ............ 27 
 
 15. — Looking down the windpipe. Showing vocal cords ...... 40 
 
 16. — Average range of the human voice ........ 41 
 
 17 — Location of lobes of lung and of diaphragmatic pleura . . . ..46 
 
 18. — Wormwood . . . . . . ... . . . .48 
 
 19.— Eagweed 50 
 
 20. — Pneumonia germ ........... 57 
 
 21. — Kussell Sage Foundation report ........ 60 
 
 22. — Pleurisy with effusion .......... 65 
 
 23. — Diagram showing a bronchus branching to end in air sacs ... 66 
 
 24. — Consumption can be cured ......... 70 
 
 25. — See a good doctor . . 71 
 
 26. — Cures in ease of consumption ......... 72 
 
 27. — Sunlight — Out- door air 73 
 
 28. — To cure consumption .......... 75 
 
 29. — To cure consumption . . . . . . . . . .75 
 
 30. — A careful consumptive .......... 76 
 
 31. — A careful consumptive .......... 77 
 
 32. — Look out for consumption ......... 78 
 
 33. — A careful consumptive .......... 79 
 
 34. — A careful consumptive .......... 80 
 
 35. — A careful consumptive .......... 80 
 
 36. — (A) Chest in rickets badly deformed; (B) Deep narrow chest prone to 
 
 consumption ........... 81 
 
 37. — To avoid consumption .......... 82 
 
 38. — To avoid consumption .......... 82 
 
 39. — To avoid consumption .......... 83 
 
 40. — To avoid consumption .......... 83 
 
 41. — To avoid consumption .......... 84 
 
 42. — Cut of window tent showing ventilation .86 
 
 43. — Building plan for sleeping porch 87 
 
 44. — Mean rainfall for different parts of United States 90 
 
 xxxi 
 
XXX11 
 
 LIST OF ILLUSTRATIONS 
 
 FIG. PAGE 
 
 45 Sputum eup 92 
 
 46. — To fold a paper drinking cup ... . . . . . . .95 
 
 47. — Pocket sputum cup . . . . . . . . .96 
 
 48. — Eespiration ............ 99 
 
 49. — Frame for attached sleeping porch ........ 101 
 
 50 — Hip joint disease ........... 102 
 
 51. — Window ventilation .......... 103 
 
 52. — Eustic house for sleeping out ......... 104 
 
 53. — Exercises which develop the muscles of shoulders, chest, back and abdomen 107 
 54. — Position of lens during accommodation . . . . . . .111 
 
 55. — Save your baby's sight .......... 112 
 
 56. — Astigmatism chart ........... 113 
 
 57. — Diagrammatic section of eyeball . . . . . . . .115 
 
 58. — Foreign body on surface of everted upper lid . . . . . .116 
 
 59. — Method of everting upper lid ........ . 116 
 
 60. — Eyedropper 118 
 
 61. — Normal blind area ........... 121 
 
 123 
 124 
 125 
 126 
 127 
 128 
 129 
 
 133 
 135 
 
 as to contagion 
 
 in his own 
 
 62. — Outside of eyeball ........... 
 
 63. — Far-sighted eye focusing parallel rays of light behind retina 
 
 64. — Focusing of light rays in a normal eye ....... 
 
 65. — Near-sighted eye focusing parallel rays from a distant object . 
 
 66. — Far-sighted eye showing focusing of rays from near and far objects . 
 
 67. — Simple hyperopic astigmatism corrected by a convex cylindrical glass 
 
 68. — Simple hyperopic astimatism ......... 
 
 69. — Connections between external and middle ear, mastoid cells and throat and 
 
 nose cavity ........... 
 
 70. — Section of left ear and portion of skull ....... 
 
 71. — Cross-section (A) of head of a normal child and (B) of one whose adenoids 
 
 and tonsils have enlarged so as to block the nasal air passage, thereby 
 
 making a mouth breather of him 
 72. — Food values of milk .... 
 
 73.— Buffalo gnat 
 
 74. — Present social conditions and their prevention 
 75. — Alert as to contagion in his cattle — indifferent 
 
 family ...... 
 
 76. — A good type of dry earth privy 
 
 77. — Framework for model privy house 
 
 78 — A good cheap privy .... 
 
 79. — Diagram of gland groups in the groin and regions which should be examined 
 
 for sources of infection when these glands are enlarged 
 80. — Location of lymph glands which frequently enlarge . 
 81. — Shape of skull in rickets 
 82. — Cranial contours (comparative) 
 
 83.— "Pigeon chest" 
 
 84. — Bound type of chest .... 
 
 85. — Flat type of chest ..... 
 
 86. — Bulging backward on account of scoliosis . 
 
 87. — Marked shrinkage of left lung, due to post-pneumonic emphysema 
 
 88. — (A) Nearly normal stomach; (B) Dilated stomach 
 
 89. — Shape of head in rickets .... 
 
 90. — Bow legs ...,,,. 
 
 91. — Knock knees . . . , 
 
 92. — Decrease of contagious disease in New York State 
 
 93, — Decline in diphtheria in New York State , 
 
 146 
 159 
 166 
 
 167 
 
 169 
 173 
 175 
 177 
 
 182 
 183 
 185 
 186 
 187 
 187 
 188 
 188 
 188 
 188 
 189 
 190 
 190 
 192 
 194 
 
LIST OF ILLUSTRATIONS 
 
 xxxm 
 
 94. — Harm from not reporting contagion 
 
 95. — How one school spread scarlet fever 
 
 96. — Disgusting .... 
 
 97. — Study of rodent plague focus . 
 
 98. — At which shop shall we buy? 
 
 99. — Fly-speck greatly magnified, showing dangerous germs 
 100. — Pot method of burning sulphur 
 101. — Eoom prepared for fumigation 
 102. — Formaldehyd sterilizer 
 103. — Vaccination prevents smallpox 
 104. — Before and after smallpox 
 
 105. — Localized epidemics of typhoid due to milk; 1910 and 191 
 106. — Measles here ........ 
 
 107. — Atrophy of spinal cord after infantile paralysis 
 
 108. — Diagrams showing areas in cord most affected by infantile paralysis 
 
 109. — Age distribution of cases of infantile paralysis 
 
 110. — Seasonal distribution of infantile paralysis 
 
 111. — Braces to prevent deformity after infantile paralysis 
 
 112. — Shoes to prevent deformity after infantile paralysis 
 
 113. — Massachusetts Hospital School for Crippled Children 
 
 114. — Adult female mosquito, showing parts 
 
 115. — Larva ....... 
 
 116.— Pupa 
 
 117. — The pitcher in the spare room . 
 
 118. — Anopheles ...... 
 
 119. — Deposit of eggs of the Anopheles 
 
 120. — Position of Anopheles larva in obtaining air 
 
 121. — Usual position of larva in obtaining air 
 
 122. — Culex pungens or common house mosquito; female 
 
 123. — Manner in which the eggs of the Culex pungens, or common house mosquito, 
 
 are deposited . 
 124. — Culex solicitans, salt water swamp or striped-legged mosquito 
 125. — Stegomyia, or yellow fever mosquito; female 
 126. — Anopheles, or malarial mosquito; female . 
 127. — Resting attitudes of the Culex and Anopheles 
 128. — Where mosquitoes breed . 
 129. — How to prevent mosquitoes 
 130. — Eat guard for a ship 's cables 
 131. — The human flea 
 132.— Dog flea ... 
 
 133 — Clinical thermometer 
 134. — Typhoid fever death-rates in German cities, showing decrease in last three 
 
 decades . 
 135. — The fly as carrier of typhoid 
 136.— Typhoid fever 
 137. — Deadly parallels 
 138. — Well water and typhoid fever 
 139.— Safe well 
 140.— Jack and Jill . 
 141. — To prevent typhoid 
 142. — Taking patent medicine by the clock 
 143. — Penny wise and pound foolish. Headache medicine 
 144. — You can't float a balloon without gas 
 145.— Sunlight 
 
 PAGE 
 
 196 
 198 
 200 
 202 
 204 
 205 
 207 
 209 
 210 
 215 
 223 
 227 
 241 
 249 
 250 
 251 
 252 
 256 
 256 
 260 
 265 
 266 
 267 
 270 
 271 
 273 
 274 
 275 
 277 
 
 278 
 279 
 280 
 282 
 283 
 286 
 287 
 294 
 296 
 297 
 303 
 
 306 
 307 
 309 
 312 
 314 
 316 
 318 
 320 
 327 
 331 
 332 
 335 
 
XXXIV 
 
 LIST OF ILLUSTRATIONS 
 
 seat 
 
 of pain in 
 
 of pain in 
 
 of the pain 
 the eye, orbit and 
 
 146. — Tropical ameba cause abscess of the liver, dysentery and possibly diarrhea 
 
 147. — The spine. Lateral aspect ..... 
 
 148. — Tracts in the spinal cord ..... 
 
 149. — F. site of frontal sinuses ..... 
 
 150. — Showing location of headaches, according to their causes 
 
 151. — The possible causes of pain in the foot and heel 
 
 152. — Pain or tenderness at various points along the spine . 
 
 153. — The general diagnostic indications to be derived from the seat 
 
 the head and face ...... 
 
 154. — The possible causes of pain in various parts of the body 
 155. — The possible causes of pain in various parts of the body 
 156. — The general diagnostic indications to be derived from th 
 
 the face and neck ...... 
 
 157. — The possible causes of pain in various parts of the body 
 158. — The causes of localized headache according to the exact site 
 159. — -Trifacial nerve ....... 
 
 160. — Nerve of sensation to the soft palate, the teeth, the nose, 
 
 the sinuses of the upper face 
 161. — Distribution of nerves of sensation of the head 
 162. — Family history showing Huntington's chorea 
 163. — Composition functions and uses of food 
 164. — Bread and other cereal foods . 
 165. — Cereal grains ...... 
 
 166. — Meat, fresh and cured .... 
 
 167. — Diagram of cuts of beef 
 
 168. — Diagram of cuts of pork 
 
 169. — Diagram of cuts of lamb and mutton 
 
 170. — Diagram of cuts of veal 
 
 171. — Fish, fish products and oysters 
 
 172. — Eggs and cheese ..... 
 
 173. — Fruit and fruit products .... 
 
 174. — Nuts and nut products .... 
 
 175. — Eoots and succulent vegetables 
 
 176. — Fresh and dried fruit .... 
 
 177. — Legumes and corn ..... 
 
 178. — Butter and other fat-yielding foods . 
 179. — Milk and milk products .... 
 
 180. — Illinois State Board of Health, cartoon No. 10 
 181. — Sugar and similar foods .... 
 
 182. — Dietary standards ..... 
 
 183. — For sterilizing by heat, as in canning tomatoes 
 
 184. — Rochester home-made ice-box 
 
 185. — Strauss home pasteurizer 
 
 186. — Mother's milk for mother's babe, cow's milk for calves 
 
 187. — Cheap home-made ice-box 
 
 188. — A very poor milk pail .... 
 
 189. — A good milk pail ..... 
 
 190.— Why? 
 
 PAGE 
 
 358 
 
 milk 
 
 after 
 
 pasteurization or 
 
 191. — Keep baby's milk clean and cool 
 
 192. — Arrangement of apparatus for rapidly cooling 
 
 sterilization ..... 
 193. — Pasteurization at home . 
 194, — Time and temperature at which some bacteria are killed and at which the 
 
 composition of milk is changed ....... 
 
 535 
 
LIST OF ILLUSTRATIONS xxxv 
 
 FIG. PAGE 
 
 195. — Lymph vessels and glands of arm and hand ...... 548 
 
 196. — Thyroid gland. Subclavian artery (to arm) and some of the branches. Com- 
 mon carotid artery (to head and neck) ...... 568 
 
 197. — Thyroid gland. External carotid artery (to head and neck) and some of 
 
 its branches ........... 570 
 
 198. — Adrenal glands (or suprarenals) . Kidneys, abdominal aorta and some of 
 
 its branches ........... 576 
 
 199. — Diagram showing division of stomach into two physiological parts . . 583 
 
 200. — American Public Health. Element of mortality ..... 584 
 
 201. — The general death rate of American cities, 1815-1914 .... 586 
 
 202. — Investigation of sickness in Albany County, New York, by the State Depart- 
 ment of Health 588 
 
 203. — Heart and the great vessels which lead into and out from the heart . . 590 
 204. — Diagrammatic section of heart showing cavities and vessels . . .591 
 205. — Sketch showing approximate location of gall bladder (gb), appendix (a), 
 
 naval (N), crest of ilium — hip bone — (H), and rib border (R) . . 593 
 206.— -Scheme showing circulation of the blood . . . . . . .596 
 
 207. — Femoral artery and its branches . . . . . . .597 
 
 208. — Brachial artery (arm) and its branches ....... 598 
 
 209. — Veins, showing (a) valves open when blood is flowing .... 601 
 
 210. — Diagram explanatory of arterial tension . . . . . . . 605 
 
 211. — Method of taking blood pressure ........ 606 
 
 212. — Method of taking blood pressure ........ 607 
 
 213. — Method of collecting a sample of urine from a male baby .... 617 
 
 214. — Test tube used in testing urine for sugar and albumin .... 618 
 
 215. — Half a kidney showing suprarenal (or adrenal) kidney structure, pelvis of 
 
 kidney and ureter .......... 618 
 
 216.— Bed-grapple 619 
 
 217. — A human kidney a little more than one-half natural size in an adult . . 620 
 
 218.— Head coil 621 
 
 219. — Cold water coil applied to abdomen ........ 622 
 
 220. — Arrangements for prolonged bath ........ 623 
 
 221. — Section of a tooth, showing enamel, dentine and pulp .... 637 
 
 222.— The three salivary glands 638 
 
 223.— The jaws and the teeth 639 
 
 224. — Baby teeth, except the six-year molars ....... 639 
 
 225. — Diagram illustrating digestive organs ....... 641 
 
 226. — The pancreas, partly cut away, so as to show the duct which collects the 
 
 pancreatic juice and empties it into the duodenum .... 642 
 
 227. — Digestive apparatus .......... 644 
 
 228. — Position of abdominal contents 646 
 
 229 Trichina in muscle 650 
 
 230. — V-shaped colon may cause so-called intestinal indigestion .... 655 
 
 231. — Method of applying adhesive strips for maintaining reduction in infantile 
 
 umbilical hernia .......... 655 
 
 232. — A hernia sack is a pouch of peritoneum ....... 666 
 
 233. — Sites of ruptures: 1 and 2, epigastric hernia; 3, umbilical hernia; 4, inguinal 
 
 hernia; 5, femoral hernia ......... 666 
 
 234. — Skein of worsted truss 667 
 
 235. — Abdominal support, plaster and webbing . . . . . . .670 
 
 236. — Section of hair showing the epithelial cells which produce it and sebaceous 
 
 glands ............ 701 
 
 237. — Section of skin showing hair, sebaceous gland, sweat gland, and blood 
 
 vessels 702 
 
XXXVI 
 
 LIST OF ILLUSTRATIONS 
 
 tides, which, fermenting, form acid 
 
 dental disease 
 
 FIG. 
 
 238.— Eed bugs 
 
 239. — Infections at root of, beneath and near end of nail 
 
 240. — Hookworms 
 
 241. — Hookworms, actual size . 
 
 242. — Itch mite. Female 
 
 243.— Itch mite. Male 
 
 244. — Crab louse 
 
 245. — Ringworm of the scalp 
 
 246. — Uncared for teeth, showing food par 
 
 247. — Uncared for teeth. Acid attacking the lime in the enamel rods . 
 
 248. — Uncared for teeth, showing decay attacking dentine 
 
 249. — Uncared for teeth. Further progress of decay — tooth begins to ache 
 
 250. — Uncared for teeth. Undermining and breaking down of the enamel walls 
 
 251. — Uncared for teeth. Death of dental pulp or nerve . 
 
 252. — Points usually neglected in brushing teeth and where decay begins 
 
 253. — Growth and multiplication of bacteria in such a tooth in 24 hours 
 
 254. — Temporary and permanent teeth 
 
 255. — First and second lines of defense against 
 
 256. — Bones of right foot 
 
 257. — Shoe to prevent or cure bow-legs in children 
 
 258.— " Toe-in " shoe 
 
 259. — Ankle and arch supporting shoes 
 
 260. — Print of foot with high instep and print of flat foot with pinched toes 
 
 261. — Weak feet — seen behind . 
 
 262. — Weak feet — seen in front 
 
 263. — A print of normal foot 
 
 264.— Modified Thomas heel 
 
 265. — Shoes should have a broad toe 
 
 266. — A harmful, narrow-shaped toe . 
 
 267. — Toes pressed out of position, weakening 
 
 the foot . . 
 
 268. — A narrow-toed shoe and the natural shape 
 
 body 
 269. — Cross section of a corn . 
 270. — The rocker 
 
 271 The flat sole . . 
 
 272. — Bed rest and table . 
 
 273. — Pregnant uterus containing young embryo ..... 
 
 274. — Section of ovary .......... 
 
 275. — Massage of the breasts to increase their size ..... 
 
 276. — Massage of the breasts to decrease their size ..... 
 
 277. — New York State Department of Health ...... 
 
 278. — Comparison of the health of city and country babies .... 
 
 279. — Shape of a baby's jaw ......... 
 
 280. — Shape of an adult's jaw ......... 
 
 281. — The relative length of trunk and legs in a baby, a youth and an adult 
 282. — Rate of growth of babies ........ 
 
 283. — Rate of growth of children ........ 
 
 284. — Correct method of holding a baby ....... 
 
 285. — Incorrect method of holding a baby . : . . • . 
 
 286. — Bones of a baby's skull, showing "soft spot" .... 
 
 287. — Hand-I-Hold mitts to prevent thumb sucking 
 
 288. — How to place baby in his bath ....... 
 
 389. — Screened bed for out of doors sleeping ,..,., 
 
 both the instep and the ball of 
 of the foot when supporting the 
 
LIST OF ILLUSTRATIONS 
 
 XXXVll 
 
 FIG. PAGE 
 
 290.— Chicago State Board of Health— Comfort vs. looks 812 
 
 291. — Feeding tube lor premature baby ........ 815 
 
 292 (A) Nipple with proper perforation; (B) Nipple with faulty perforation, 
 
 permitting milk to run too freely ....... 816 
 
 293. — Lactometer for testing milk . . . . . . . . .818 
 
 294. — Simple milk testing apparatus . . . . . . . . .819 
 
 295. — Chap in dipper for removing top milk . . . . . . .819 
 
 296. — Breast pump in use . . . . . . . . . .821 
 
 297. — Diagram showing construction of breast pump ...... 822 
 
 298. — Arnold sterilizer 823 
 
 299.— Out-of-door pen 823 
 
 300.— The right way 824 
 
 301. — Cuts showing deciduous teeth ......... 825 
 
 302. — The wrong way 826 
 
 303.— What kills the babies? 828 
 
 304.— Make baby's milk safe 830 
 
 305. — Why, oh why pasteurize if you don't swat the flies! . . . . .831 
 
 306. — Tape worm. (A) magnified head; (B) segments; (C) egg . . . 834 
 
 307. — Eound worm greatly magnified ........ 834 
 
 308.— Pinworms 835 
 
 309. — Method by which one man can carry a wounded man ..... 859 
 
 310. — Another method by which one man can carry a wounded man . . . 859 
 
 311. — A short stretcher made with two rifles ....... 860 
 
 312. — Method by which two men can carry a wounded man ..... 861 
 
 313. — Compress the carotid artery for severe hemorrhage about the head and neck 862 
 
 314. — Digital compression of subclavian artery ....... 862 
 
 315. — Diagram showing position of important arteries ..... 863 
 
 316. — Digital compression of the femoral artery ...... 864 
 
 317. — Tourniquet to control hemorrhage in the forearm or hand .... 864 
 
 318. — Compressing the femoral artery with tourniquet and pad for severe hemor- 
 rhage in leg ........... 865 
 
 319. — Compressing brachial artery for severe hemorrhage in the elbow, forearm 
 
 and hand ........... 866 
 
 320. — Artificial respiration, inspiration, pressure off . . . . . . 867 
 
 321. — Artificial respiration, expiration, pressure on . . . . . 867 
 
 322. — Blanket stretcher 868 
 
 323. — A pillow used as a temporary splint in fracture of the leg .... 868 
 
 324. — Gun used as a temporary splint in fracture of the femur .... 868 
 
 325. — Sling made from coat .......... 869 
 
 326.— First aid in fracture of leg 809 
 
 327. — First aid treatment of fracture of both bones of leg . . . . 870 
 
 328.— Fracture of nose . 870 
 
 329. — Fracture of finger. Wooden splint applied to palm surface . . . 870 
 
 330. — Break of bone in back of hand ........ 871 
 
 331.— Fracture of wrist 871 
 
 332. — Dislocation of both bones of the forearm backward, showing position of the 
 ends of the dislocated bones, deformity of elbow, and position of 
 
 forearm 872 
 
 333. — Artificial respiration, Silvester method. Expiration . - . . . . 873 
 
 334. — Artificial respiration, Silvester method. Inspiration .... 873 
 
 335. — One method of resuscitation after drowning ...... 874 
 
 336. — Artificial respiration. Hall method ........ 875 
 
 337. — Triangular bandage . . . . . . . . . .876 
 
 338.— Triangular bandage ,,,.,. , . , . 876 
 
XXXV111 
 
 LIST OF ILLUSTRATIONS 
 
 FIG. 
 
 339. 
 
 340. 
 
 the 
 
 Method of rolling a bandage 
 
 Triangle bandage for head 
 341. — Four-tailed bandage for fracture of lower jaw 
 342. — Four-tailed bandage for chin . 
 343. — Double-headed, knotted bandage 
 344. — Figure of eight of the hand 
 345. — Cravat bandage for hand 
 346. — Adhesive plaster for sprain of the thumb 
 
 347 Bandaging wrist and hand 
 
 348. — Spiral reverse bandage 
 
 349. — Bandaging elbow 
 
 350. — Triangular bandage applied to shoulder, hand and elbow 
 
 351. — Triangular bandage used for arm sling . 
 
 352. — Triangular bandages used for arm slings 
 
 353. — Triangular bandage for collar bone fracture 
 
 354. — Dressing for collar bone fracture 
 
 355. — Triangular bandage of breast . 
 
 356. — Figure-of-eight spica bandage of shoulder 
 
 357. — Temporary dressing for fracture of clavicle 
 
 358. — Strapping with adhesive plaster for broken rib 
 
 359. — Cravat bandage for knee 
 
 360. — Spiral reverse bandage of thigh showing introduction of 
 
 361. — Spiral reverse bandage of thigh completed 
 
 362. — Bandaging hip and abdomen . 
 
 363. — Triangle bandage of hip .... 
 
 364. — Good method of strapping a sprained ankle with adhesive plaster 
 
 365. — Bandaging leg. Spiral reverse . 
 
 366. — Figure-of-eight bandage of the ankle and foot 
 
 367. — Triangle bandage of foot 
 
 368.— Eeef knot 
 
 369. — Grannie knots ..... 
 
 370. — Wrist drop due to lead poisoning . 
 
 371. — Drager oxygen apparatus for use in mines 
 
 372. — Eespirator 
 
 373. — Showing the choking with soot of a breathing pore of a leaf of 
 
 tree in seeds ..... 
 374. — Cabinet for sand blasting 
 375. — A harvest mite ..... 
 376. — Lice and nit . 
 
 377.— Bedbug 
 
 378. — Trap for cockroaches .... 
 
 379.— Cockroach 
 
 380. — Larder beetle ..... 
 
 381. — Larva of larder beetle .... 
 382. — Croton bug carrying egg capsule, natural size 
 383. — Case making clothes moth 
 384. — Webbing clothes moth 
 385. — Black carpet beetle 
 
 386. — Larva of above 
 
 387.— Fish moth 
 
 388. — Where do you eat? 
 
 389. — The Hodge fly trap on a garbage can 
 
 390. — Parasite ticks on the body of a house fly 
 
 391.— Flies— milk 
 
 first 
 
 a silver fir 
 
LIST OF ILLUSTRATIONS 
 
 XXXIX 
 
 and fly-proof cover 
 
 FIG. 
 
 392. — Fly season 
 
 393. — Fly season 
 
 394.— Fly food 
 
 395. — Giant fly trap 
 
 396. — Swat them early 
 
 397. — Plan for the Swain manure bin 
 
 398. — Flies all over town . 
 
 399.— A day in the life of a fly 
 
 400. — Cancer a curable disease 
 
 401. — Diagram showing relative importance of cancer as a cause of deaths in 
 
 Michigan during the seven years 1901-1907 
 402. — Pedigree of a family in which the father 's parents are both nervous and have 
 
 four nervous children 
 403. — Pedigree of family with color-blindness 
 404. — Pedigree of family showing degeneration 
 405. — Pedigree of family with deaf mutes in a large proportion in the later 
 
 generations ..... 
 406. — Pedigree of a family containing albinism 
 407. — Pedigree of a feeble-minded family in which criminalistic and licentious 
 
 traits also appear ........ 
 
 408. — Family history showing feeble-mindedness .... 
 
 409. — Family history showing deaf mutism ...... 
 
 410. — History (condensed and incomplete) of three markedly able families 
 
 411. — Pedigree showing hereditary persistence of color-blindness 
 
 412. — Pedigree of a family containing color-blind members 
 
 413. — Pedigree showing hereditary transmission of hemophilia . 
 
 414. — Exercise bars to be attached to window ...... 
 
 415. — Door exercising bar ........ 
 
 416. — Exercise for all muscles, especially for leg and shoulder muscles 
 417. — Exercise for all muscles, especially for muscles of abdominal wall 
 418. — Mild exercise for trunk and leg muscles 
 
 419. — The skeleton 
 
 420. — Upper surface of left clavicle or collar bone 
 
 421. — Fibula, lower leg, tied in a knot, after maceration in a dilute acid 
 
 422. — Left scapula, or shoulder blade 
 
 423. — Eight femur, or thigh bone 
 
 424. — Bones of the left hand, palmar surface . 
 
 425. — Left humerus ...... 
 
 426. — Left radius and ulna, or bones of the forearm 
 427. — Thorax, anterior view .... 
 
 428. — Thorax, posterior view .... 
 
 429. — Exercises to develop the chest . 
 
 430. — Bad posture due to desk which is too high 
 
 431. — Bad posture due to desk which is too low 
 
 432. — Faulty posture favoring enteroptosis 
 
 433. — Faulty posture enteroptosis 
 
 434. — Normal broad chest .... 
 
 435. — Enteroptotic build ..... 
 
 436. — Enteroptosis, showing head forward, shoulder blades and lower part of belly 
 
 prominent .... 
 
 437. — Belt for enteroptosis 
 438. — Faulty posture favoring enteroptosis 
 439. — Normal chest and abdomen 
 440. — Flat chest and sagging abdomen 
 
 PAGE 
 
 929 
 930 
 931 
 931 
 932 
 935 
 937 
 939 
 959 
 
 961 
 
 989 
 990 
 990 
 
 990 
 991 
 
 992 
 994 
 995 
 996 
 1000 
 1000 
 1004 
 1026 
 1027 
 1027 
 1029 
 1030 
 1032 
 1033 
 1033 
 1034 
 1035 
 1037 
 1039 
 1039 
 1040 
 1040 
 1048 
 1059 
 1059 
 1060 
 1060 
 1061 
 1061 
 
 1062 
 1063 
 1064 
 1065 
 1065 
 
xl LIST OF ILLUSTRATIONS 
 
 mG - PAG2 
 
 441. — Showing difference between Fig. 439 and Fig. 440 ..... 1065 
 
 442. — Normal chest with ribs running normally ...... 1066 
 
 443. — Eibs running more nearly perpendicular in a poorly developed chest and 
 
 sagging abdomen .......... 1066 
 
 444. — Normal angle of ribs in front of chest. Normal well developed chest . .1067 
 
 445. — Narrow angle of ribs in front of chest. A very poor sign .... 1067 
 
 446. — Biceps muscle as it appears when arm is extended . . . . .1073 
 
 447. — The bones of the upper extremity with biceps muscle .... 1074 
 
 448. — Biceps muscle as it appears when arm is bent ...... 1074 
 
 449. — Great muscles of the back, neck and arm ....... 1075 
 
 450. — Various types of striped or voluntary muscles . . . . . .1076 
 
 451. — Muscles ............ 1078 
 
 452. — Diagram of a bad tenement in Illinois ....... 1085 
 
 453. — Diagram giving an analysis of conditions in 1,003 houses in Philadelphia . 1086 
 454. — A certain district in Philadelphia ........ 1089 
 
 455. — Chart showing comparative standing of localities as " cities of homes" . 1091 
 
 456. — Ball's motto 1092 
 
 457. — Floor plan of one of a series of basement apartments .... 1093 
 
 458. — Six rooms, one behind the other; outside windows only in front and rear . 1094 
 459. — Three out of five rooms dark ......... 1094 
 
 460. — Basement apartments. Rear rooms virtually unlighted cellar rooms . . 1096 
 
 461. — Section of floor plan in a new apartment house (1912) .... 1098 
 
 462. — Dark, unventilated rooms and toilets in buildings ..... 1100 
 
 463. — Dark, unventilated basement rooms and toilets found in some buildings . 1101 
 
 464. — Typical floor plan, showing dark basement rooms in one section of build- 
 ing shown in figures ......... 1102 
 
 465. — Water may become impure in badly located wells from surface drainage . 1106 
 466. — Wrong construction of a well ......... 1107 
 
 467. — Proper construction of a well ......... 1108 
 
 468.— Ground water 1108 
 
 469. — Wells curbed with brick, stone, crock or wood are improperly protected and 
 seldom safe if there is any source of dangerous contamination in 
 the vicinity ........... 1108 
 
 470. — Safe well cement curbing ......... 1109 
 
 471. — Diagram showing how a well (with water proof wall) may extend through 
 
 danger zones and risky zones to reach water in safe zone . . . 1110 
 
 472.— William Penn 's plan of the city of Philadelphia 1112 
 
 473. — The usual way — the water front shut off . . . . . . . 1113 
 
 474. — An admirable exception. A promenade along the shore .... 1113 
 
 475. — Showing difference between haphazard and scientific street planning of 
 
 irregular plot ........... 1115 
 
 476. — A house for each family ......... 1117 
 
 477. — Mechanics' homes, six rooms and bath ....... 1118 
 
 478. — Another type of mechanics' homes ........ 1119 
 
 479. — Two springs. One protected from surface contamination; the other not . 1121 
 
 480. — Popular idea of how wells become infected from surface pollution . . 1122 
 
 481. — Ventilating by means of window lowered at top, raised at bottom . . 1137 
 
 482.— Window ventilator 1139 
 
 483. — Diagrammatic sketch of various provisions for ventilation .... 1145 
 
 484. — The position of inlets and outlets, and their relation to the air currents in 
 
 a room ............ 1146 
 
 485. — Window ventilator with deflector ........ 1147 
 
 486. — Influence of closed windows on room air current on a cold day. Hot air heat 1172 
 487. — Hygrometer composed of wet and dry bulb thermometers .... 1193 
 
LIST OF ILLUSTEATIOISTS 
 
 FIG. 
 
 488. — Bryce method of humidifying a house heated by hot water 
 
 489. — Kentucky type privy with septic tank .... 
 
 490. — Specifications for Kentucky type septic tank . 
 
 491. — Cheap sanitary dry earth bucket privy .... 
 
 492. — Leaching cesspool constructed of field stones 
 
 493. — Hollow brick cesspool with overflow into agricultural tile . 
 
 494. — Concrete septic tank and dosing chamber attached, for household 
 
 10 persons ........ 
 
 495. — Cheap wooden septic tank for household of not over 10 persons 
 496. — Design for a pit privy ..... 
 
 497. — The pit privy, simplest form .... 
 
 498.' — Sewage disposal plant for private home . 
 
 499. — Typical sewage disposal by subsurface irrigation 
 
 500. — McCabe drinking fountain attached to a pump . 
 
 501. — Home-made filter for domestic or school use . 
 
 502. — Antiseptic tank or chemical system for one-room schools 
 
 503. — Perspective of modern one-room school 
 
 504. — Showing stairway to basement 
 
 505. — A less expensive school house 
 
 506. — One-room school 
 
 507. — Foundation plan 
 
 508. — Foundation plan 
 
 509. — First floor plan 
 
 510. — Inexpensive cloakrooms, entry and fuel house 
 
 511. — Showing old style country school house and manner in which 
 
 may be modernized at small cost 
 
 512. — The same 
 
 513. — Jacketed stove for heating and ventilating one-room schools 
 
 514. — Double flue chimney ventilation 
 
 515. — Single flue ventilation .... 
 
 516. — Construction of a double flue chimney 
 
 517. — Heater with jacket not reaching the floor 
 
 518. — Female reproductive organs 
 
 519. — Section of female pelvis, showing location of organs 
 
 xli 
 
 PAGE 
 
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 of not over 
 
 . 1210 
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 a one 
 
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 such 
 
HOW TO KEEP WELL 
 
 CHAPTEE I 
 
 Introduction 
 
 THE ADVENT OP PREVENTIVE MEDICINE— JUST A START 
 
 Between birth and death is life. Life occupies itself with its own con- 
 tinuation. Human life seeks to promote not only its continuation but to make 
 it enjoyable. We were long in finding that out. 
 
 For a long time the starting and stopping points were considered most 
 important. Life itself, the journey from oirth to death, was not well under- 
 
 STARTING THE BATTLE OF 
 LIFE WITH PERFECT HEALTH 
 
 WHICH PATH ARE YOU ON? 
 
 North Carolina Health Bulletin. 
 
 Fig. 1. 
 
 1 
 
2 INTRODUCTION 
 
 stood. It was not studied, measured, much thought about or valued. A per- 
 son lived until he died — that was definite. 
 
 Whether he lived a healthy, enjoyable life and died at a good old age, or 
 dragged out a miserable existence, pestered by many ills, devoured by fierce 
 diseases, and died young, was no one's concern. Most men fell early victims to 
 this ignorance and general indifference. 
 
 There was a reason for this then, as there is no reason for the existence 
 of the same state of affairs now. Food was scarce, life was cheap, health a 
 negligible quantity, death a release for the victim, a relief to the survivors. 
 They went away unwept. 
 
 It is different now, at least in one respect. Wealth is piled up. The in- 
 dividual can produce more than he can use. He is a valuable economic asset 
 to the state. 
 
 In the other respect, in longer and healthier life, much is still as it used 
 to be. Infant mortality, contagious diseases, tuberculosis, social diseases, occu- 
 pational diseases, and the general waste of health and life attest this. 
 
 An initial improvement is, however, noticeable. Preventive medicine 
 is becoming an established science; the laws of health and disease are better 
 understood; conservation of health is becoming a national policy. The people 
 are waking up. A new era is at hand. 
 
 WHAT IS HEALTH? 
 
 When man emerged from the purely animal state and woke up homo 
 sapiens, he found life hard and death easy. Of health he at first knew only 
 through disease. When he was tortured by pain or any other physical ill, he 
 prayed for deliverance. When deliverance came he blessed it as health. 
 
 That health is a godsend of man's making did not occur to him. For 
 many centuries health was considered as something beyond the control of man. 
 It was a gift from the gods, given or taken at the caprice of unknown powers. 
 That our own conduct and mode of life brings health or disease was not recog- 
 nized until much later. 
 
 That health is the. greatest asset of life the following, from an ancient 
 author, testifies : 
 
 "0 blessed health ! Thou art above all gold and treasure, the poor man's 
 riches, the rich man's bliss — without thee there can be no happiness." 
 
 Modern medical science teaches that health is the harmonious and pain- 
 less co-operation of all the organs and parts of the body: of the unconscious 
 and adequate response of the whole body to the various changes in the en- 
 vironment. It depends on natural laws as much as the flowing of water down 
 hill. 
 
 We are not the playground for good and evil spirits who torture and 
 trifle with us while we helplessly look on. Eather are we living machines, 
 more finely built and more properly adjusted than any other machines in 
 existence. 
 
 Your machine is subject to all the great laws of nature, in charge of an 
 engineer who should be well fitted for his post by virtue of his intelligence. 
 
 // intelligence and a clear understanding of the laws of life were more 
 
HEALTH CAN BE BOUGHT 3 
 
 widely spread, and if these laws (which are simple in the mam) were more 
 carefully practiced, there would not be so much disease and suffering. As it 
 is, universal lifelong health is the far-off dream of a few workers in the field 
 of human health conservation. The many neither think of health nor have it. 
 We may all ask with the prophet Jeremiah: "Is there no balm in Gilead? 
 Is there no physician there? Why then is not the health of the daughter of 
 my people recovered?" 
 
 There is balm in Gilead and elsewhere, and that is scientific understand- 
 ing of the laws of life. There is a physician there, and that is the application 
 of nature's laws to life and the removal of all hindrances to health. There 
 is recovery possible, just as soon as we understand that we cannot hold our life 
 positions unless we make good as engineers of the human machine. 
 
 HEALTH CAN BE BOUGHT 
 
 There is a popular idea prevalent concerning health to which frequent 
 expression is given thus : "You can buy everything for money, but you can't 
 buy health." 
 
 This is erroneous. The truth is that we cannot buy health after it is 
 thrown away and broken. Second-handed, tinkered-up health is hard to buy, 
 nor is it worth much. But good, first-rate health can be bought, like any other 
 commodity. 
 
 Let it be clearly understood that health and money are convertible things. 
 That health is sold and thrown away for money is a well established fact. 
 With foresight and wisdom, the reverse can be made true. 
 
 We can get health for money. It can be had at less cost in the end if 
 bought in season. The proper time to buy health for yourself and your family 
 is before the present supply (I am afraid we have not much on hand; we have 
 been shortly supplied to begin with) is exhausted. 
 
 I am led to write about this subject for the reason that the people of 
 Chicago will soon be in the market to buy a supply of good, vigorous, first- 
 rate health to last them for a year. Individual bargaining is impossible. We 
 do not know enough about it; also it would cost too much to order in small 
 lots. 
 
 We must authorize our representatives, whosoever they may be, to repre- 
 sent us in this matter. They, with their expert assistant, the commissioner 
 of health, can buy it and deliver it to us at reasonable rates and guarantee 
 satisfaction. 
 
 New, how much money are we going to give them for health protection, 
 for insuring the health and lives of ourselves and of our children? Last 
 year (surely, I do not want to embarrass any citizens, but the truth must 
 be faced), last year, I say, we each handed our representatives the magnifi- 
 cent sum of twenty-five cents and told them to buy us health protection for 
 that amount. 
 
 Did we really expect to get efficient protection for that sum ? If we did, 
 we have much to learn. If we did not, we have been playing the fool with 
 ourselves. In either case we have much to regret. 
 
 The impossibility of buying health protection for the community at 
 
I 
 
 CO 
 
 ♦ * 
 
 I 
 
 
 z 
 Jo 
 
 0> o 
 - UJ 
 
 O 
 
 to 
 
 £ 
 
 1 
 
ENDING WELL 5 
 
 twenty-five cents a head for a year is proved by several thousand unnecessary 
 deaths during the year. 
 
 We thought we were striking a splendid bargain; but figure it up. Fig- 
 ure up the loss of time, your doctor's and undertaker's bills, and you will find 
 that you have lost out; that you have paid dearly for what you thought you 
 bought cheaply. We have lost both in money and in lives. 
 
 Let us be sensible this time. A twenty-five-cent health department cannot 
 efficiently protect us. Other cities are paying from fifty cents to one dollar 
 per head. Chicago has done wonders with the little it has had, but it fell short 
 pitifully in proportion to the amount of good that could be accomplished with 
 a more liberal appropriation for health purposes. 
 
 A dollar a head is not too much. We spend much more privately and col- 
 lectively for things that are of far less importance. 
 
 Chicago cannot afford to have its babies die and its most useful men and 
 women carried off in the prime of life. Municipal thrift at the expense of 
 the lives of its citizens is a criminal blunder. 
 
 Buy health when it is still possible to buy it — before the hand of disease 
 is laid on it. Buy it and pay for it and insist on getting your money's worth. 
 
 When we authorize our mayor and councilmen to buy health for the city 
 for next year it must be with the understanding that they can invest a dollar 
 for each citizen of our community for the protection of his life. 
 
 ENDING WELL 
 
 Metchnikoff writes of the possibility of eternal life. He speculates on the 
 possibility that some day the human body will be shielded from all accidents, 
 a proper adjustment between work and food will be maintained, and the body 
 will be subjected to no adverse influences except legitimate wear and tear. 
 
 Among accidents he not only includes such palpable incidents as being 
 run over by street cars, gored by bulls, and falling into thrashing machines, 
 but also all bacterial diseases and intoxications. He says that in a properly 
 regulated society there will be no scarlet fever, diphtheria, consumption, or 
 pneumonia. In the list of accidents he would include inflammatory rheuma- 
 tism, diarrheas, and appendicitis. 
 
 Of course that day is far off. 
 
 Chronic bacterial infection of the intestinal tract causes putrefactions and 
 absorption of bacterial products, which he holds to be largely responsible for 
 what we now call senility. Bright's disease and heart disease he considers 
 divisible into two parts — the large part the result of old infections ; the smaller 
 part the result of a bad adjustment between food and work. 
 
 A proper adjustment between food and work is remote. 
 
 These things having been adjusted, he suggests that the body cells may 
 be able perpetually to repair wear. While we are waiting it is comforting to 
 know that human life is longer each year. 
 
 Men engaged in handling live stock say that an animal should live five 
 times as many years as it takes it to get its growth. On this basis the proper 
 age of man at death is at least one hundred years. 
 
 In 1909 in Chicago eight men died who were over 100; 146 died between 
 
WHY? 
 
 / -f 
 
 Ma John Mary Ben Sam 
 
 A FLY VISITED AN 
 
 COLLECTED SOME 
 THEN GATHERED 
 GERMS FROTlSArfS 
 DROWNED IN THE 
 FAMILY ORANK 
 
 OPEN PRIVY AND 
 TYPHOID GERMS. 
 TUBERCULOSIS 
 SPIT. AND LATER 
 miK PAIL THE 
 THE MILK 
 
 f 
 
 ^AllfTlE LATER PA AND MA AND 
 
 LITTLE BEN BEGAN TO FEEL TIRED > 
 
 ALL THE TIME AND TO COUGH A GREAT ) 
 
 DEAL. JOHN AND MARY CAME DOWN 
 
 ^-v WITH TYPHOID FEVER SAM 
 
 V^ ^A I DIED-NOBODY CARED, AND 
 
 %??^ EVERYBODY AVOIDED THEM 
 
 >va *£ ES it 
 
 HOG CHOLERA GERMS OOr INTO T«f 
 PIGS FEED, AND THE HOGS BECAME 
 SKK BUT /MOT FOP LONG HOG 
 CHOLERA SERUM WAS RUSH- 
 EO TO THEM AND IXPtRT VET- 
 ERINARIANS w ERE HURRlCOlv 
 C AILED 
 
 THE RESULT 
 
 y\ 
 
 Fig. 3. 
 
 TflE RE$ULT 
 
 Chicago Health Department. 
 
ENDING WELL 
 
 90 and 100. This was just about an average year in this particular. In this 
 year 3,530 died at ages in excess of three score and ten. 
 
 Irving Fisher's Bulletin on National Vitality shows this lengthening 
 of human life present wherever civilization has reached its higher planes. He 
 says that in England in the last quarter of the nineteenth century the average 
 length of life was increasing at the rate of fourteen to sixteen years per cen- 
 
 ^/^ODERftTION^^ 
 
 THE TEMPLE 0T HEALTH 
 IS FOUNDED ON MODERATIONS. 
 ITS FOUR MAIN PILLARS ARE: 
 FRESH AIR ♦ , , GOOD FOOD, 
 EXERCISE AND REST. §§© 
 
 Fig. 4. 
 
 Louisiana Almancc, 1916. 
 
 tury. In Massachusetts the rate of increase in the last half of the century was 
 fourteen years per century. 
 
 Many false conclusions can be drawn from such figures; yet, after the 
 application of proper corrective factors, it stands out that the average of 
 human life is getting longer and an increasing number of people are living to 
 a ripe old age. 
 
 This is because it deserves to be so. Occasionally you find an old rake 
 
8 INTRODUCTION 
 
 who is tobacco-soaked or whisky-soaked or obese and who boasts that he has 
 consistently violated every law of health. A careful study of the heredity 
 and life history of even these shows that "there's a reason/' 
 
 The truth is that the right to a long life is being earned. 
 
 Then let us be merry. 
 
CHAPTEK II 
 
 The Nose 
 
 Most of the organs are built with plenty of leeway. Half of the kidneys 
 could be removed, and what would be left could do the work without crowding. 
 The heart pumps away, working under low pressure, and holding much more 
 than half its power in reserve. The engine builders long ago told us that that 
 was the best way to get wear out of an engine. 
 
 The nose does not measure up to that standard. It is unlike the other 
 organs. It works on a narrow margin. If there is too much room, the air is 
 not cleaned of dirt and germs and it reaches the large air tubes too dry and 
 too cold. If there is too little room, not enough air can pass through and the 
 mouth opens to allow the deficit to be made up. 
 
 The nose is the only part of the body that is infected a good part of the 
 time. Besides the two main openings, one to the outside air and the other 
 to the back of the mouth, there are seven openings into each side of the nose, 
 or fourteen openings in all. Each of these openings drains some cavity, or 
 was put there for the purpose of draining it. Some of the drains are habitu- 
 ally clogged. 
 
 One duct runs from the eyes into the nose. This duct is exceedingly 
 necessary. The tears are needed to keep the eyes clean, and there must be a 
 drain through which the wash can run off. 
 
 It is a large duct running from an open cavity, the front of the eye, 
 to an open area, the nose. Down it there habitually flows a stream of fluid. 
 This fluid is a good washing compound, one of the best. No widely advertised 
 eye wash is to be compared with the tears as a wash. 
 
 Under these circumstances the tear ducts are seldom infected. Even 
 when an infection travels to the eyes from the nose, or the other way, a few 
 days of discomfort is the only harm. 
 
 The large duct keeps itself clean; also it keeps the upper cavity drained. 
 We except the tear duct, or nasal duct, from our bill of complaint against the 
 nose. 
 
 In the back of the nose, where it joins with the mouth to make the 
 upper part of the throat, called by the anatomists the nasopharynx, there is 
 an opening on each side. This is the opening of a duct which drains the 
 middle ear. It is called the eustachian tube. It is a branch sewer, draining 
 into the great sewer, the nose. 
 
 The middle ear is a small cavity on the rear side of the ear drum. There 
 had to be a cavity there ; it had to have air in it ; it had to drain, and probably 
 no better place was at hand than the nose. 
 
 Now, this little tube makes a lot of trouble. There is not much to drain 
 down this tube, but it must be kept open to equalize the air pressure. This 
 makes an arrangement that is subject to infection with air germs. 
 
 9 
 
10 
 
 THE NOSE 
 
 Bacteria of scarlet fever, of diphtheria, of ordinary sore throat, of ordi- 
 nary colds, travel up this tube to the middle ear cavity. 
 
 When a cavity is right out in front, as is the eye, keeping it drained and 
 
 Location of Adenoids in 
 posterior nasal passage, d 
 fypicaJ expression of victim. 
 
 Adenoids cause mouth 
 breathing, frequent colds, 
 catarrh, dea/rcess and 
 de/ormitg of the jaw 3 
 chest 
 
 They induce stupidity e? 
 skint mental 8 phusicaJ 
 c|rowtl\. 
 
 Do/s'T Let Your Ould 
 
 5& 50 /iANDICAPPED. 
 
 TKe removed o/adenoids 
 is a<. simple e\nd brie/ 1 — 
 operation,. 
 
 GivE YourOiilda 
 C/iance fo Breath Er 
 
 Cross section of head 
 showing Adenoids (A) 
 
 Chicago Health Depbri 'ment -Educ&iionaJ Poster 5er/es AtSJJO 
 
 Fig. 5. 
 
 cleaned is easy. When a cavity is stuck away up in the attic behind a curtain, 
 as is the middle ear, keeping it clean, drained and free from infection is diffi- 
 cult. But at that, our bill of complaint against the nose must allow that the 
 cavity had to be there and that it had to drain somewhere. 
 
 In addition, there are five other openings. Some are near-openings into 
 
THE NOSE 11 
 
 each side of the nose — ten in all. One of these drains is a cavity in the bones 
 of the forehead just above the eyes. 
 
 Why there should be a cavity there nobody knows. It gives the overhang- 
 ing forehead the beetling brow, but that does no good of which anybody knows. 
 
 A prominence in this locality is frequently held to indicate mental power. 
 What it does mean is a hole in the head, and an easily infected one at that. 
 So long as the hole was there it had to be drained, and about the most con- 
 venient sewer to empty the drain into was the upper front part of the nose. 
 
 Directly above the teeth lies another cavity in the bone called the antrum. 
 The roots of the jaw teeth sometimes run up into this cavity. This cavity is 
 below and just outside the nose. Being there, though nobody knows why, it 
 had to be drained. So a delicate drain empties its contents into the nose. 
 
 Back behind the nose and somewhat above it lies another cavity, the 
 sphenoidal sinus. Why it is there nobody knows. That space might have been 
 filled in with solid bone without materially increasing the weight of the body. 
 
 The face might have been flattened in a little, doing away with the last 
 two cavities — the antrum and sphenoidal — and in time we should have learned 
 to admire the new type 
 of beauty as much as 
 we do the present type. 
 Be that as it may, the 
 cavity is there, and it 
 had to drain. The 
 duct empties into the Fig. 6.— Nasal Syringe. 
 
 nose. 
 
 Lodged away up in the attic are three cavities called the ethnoid cells. 
 They are irregular in shape and size and they do not always have three open- 
 ings that remain open. But those were the plans and specifications. The bill 
 of specifications in our complaint against the nose contains several entries. 
 As we should expect, these cavities, hard to drain, are frequently infected. 
 There is no reason why infection cannot travel from the nose up these ducts. 
 
 The ducts do well enough as drains, as long as the amount to be drained 
 is normal. But when inflamed or when the cavity wall is secreting pus, the 
 drains do not work well. The sewer system clogs and the cellars overflow. 
 
 Wherever it may be, no suppuration tends to end unless the suppurating 
 area can drain well. It is for that reason that white swelling keeps on run- 
 ning for so long; that hip joint suppuration is so chronic; that pus in the 
 pleural cavity is so hard to heal. 
 
 When an ordinary cold starts the discharge is watery. In a few days it 
 is pus. If the pus germs travel up these ducts and infect the cavity with a 
 chronic suppurating process we have what is called catarrh. A great many 
 people have catarrh. 
 
 As we expected when we found all of these nooks, corners and cavities 
 leading off from the nose, we find troubles frequent. This faulty construction 
 puts the nose on the sick list most of the time. 
 
 When the air enters at the front of the nose it is cold, dry and dirty. 
 If the nose were a tube with a plain-, slick, smooth wall, the air would whistle 
 through it without much friction, but it would reach the larynx cold, dry and 
 dirty. 
 
12 THE NOSE 
 
 In order to condition the air, three baffles are hung on the outer wall of 
 each nose. They are long, bony curtains that hang down in the nose from 
 above. These are called turbinated bones. 
 
 They had to be there to make things right, but their being there creates 
 new fissures and nooks that do not clean themselves as well as a free surface 
 should. 
 
 These turbinated bones and the membrane covering them can swell and 
 shrink. If the air is dry and cold they fill up with blood, and, in consequence, 
 swell. If the air is warm they contain less blood and are smaller. 
 
 The space in the nose is pretty closely adapted to the amount of air pass- 
 ing through. If these bones swell much or a polyp grows somewhere, or if the 
 person becomes obese and fat is crowded into every loose place, breathing 
 becomes obstructed. 
 
 The mucous membrane of the nose is lined by ciliated cells, just the type 
 of cells best suited for a surface that must keep itself clean. In other words, 
 the nose is a self-sweeper. 
 
 Now the air, as it enters the nose, is extremely foul. It contains much 
 soot, dust, dirt, and germ life. The wet, warm, sticky surfaces remove most of 
 this dirt, and the sweepers sweep it away. Some of it, however, fails to be 
 removed. No sweeper is perfect in its action. 
 
 The dirt particles that get by the surface epithelium are picked up by the 
 lymphatics. They are carried in the lymph stream to the nearest lymph node. 
 Here they are stopped. 
 
 The first line of lymph nodes in the nose and upper throat is so highly 
 important that each has been given a name of its own. The best known of 
 these is the tonsil. The next best known is that gland of which the average 
 person has heard, calling it the adenoid. 
 
 A BABY'S NOSE 
 
 A baby's nose consists of two holes in the face — a lick and a promise 
 proposition. The nose of an adult is the most prominent and the most in- 
 dividual part of the face. No other organ changes so many hundred per cent 
 from babyhood to maturity as does the nose. 
 
 A baby's brain is nearly as large as that of an adult, but a baby's nose 
 does little more than mark the area to be given over to nose purposes. But the 
 looks phase is the least important phase of the question. 
 
 The nose is the instrument of breathing. Its work is to convert the air 
 as it is into air fit to be breathed. 
 
 The air must be warmed, moistened, and cleaned. This must be accom- 
 plished in a few inches of travel. The amount to be passed through is larges, 
 and the time is short. 
 
 The nose must be just right — not too large, not too small, with plenty of 
 cleaning surface, and not too much. A distinguished writer holds that the 
 reason negroes cannot stand cold weather is because of the fact that their 
 noses flare out and the air is not properly conditioned before it gets into the 
 lungs. 
 
 The usual difficulty is that the nose is too small, and there is not enough 
 
A BABY'S NOSE 
 
 13 
 
 air room. For this there are several reasons. Sometimes one is present and 
 sometimes another. 
 
 Adenoids and enlarged tonsils in children narrow the nose space. The 
 child breathes through its mouth, and the nose, unused, does not develop nor- 
 mally. The upper jaw does not spread from side to side as it should; the roof 
 of the mouth arches up and shuts off some of the nose space. 
 
 The midbone of the nose, called the septum, is set on the upper side of 
 the roof of the mouth, and, as the roof arches up, the septum crumples up 
 somewhat like an S. When the side bones grow out to moisten, warm, and 
 clean the air, not much space is left for the air to pass through. 
 
 What's to be done about it? Several 
 things. Clean out the adenoids and ton- 
 sils, when these are enlarged and obstruct- 
 ing. Stop children from sucking their 
 thumbs, or pacifiers, or nipples — habits 
 which narrow the upper jaw, raise the 
 roof of the palate, and narrow the nose 
 space. 
 
 For your children do everything pos- 
 sible to stimulate the growth of a large, 
 tony frame and a strong mass of muscles. 
 See that there is plenty of play with its 
 consequent deep, full breathing, and cor- 
 rect mouth breathing. 
 
 Until the youth has reached about twenty-five it is easily possible to 
 spread the upper jaw, drop the arch of the roof, and thus increase the nose 
 space. This is done by jackscrews pressing the sides of the upper jaw apart. 
 
 After twenty-five not much can be done. Cutting off spurs, straightening 
 the septum, and removing turbinates help a little. The real remedy is to see 
 that the upper jaw is broad enough and the mouth roof low enough in child- 
 hood and youth. 
 
 Fig. 7. — Atomizer for Spraying Oils. 
 
 Chronic Nose Infection. — L. K. A. writes: "I have heen troubled for 
 years with a hawking and spitting of thick mucus, sometimes very dark. 
 I am well and strong and breathe through nose and sleep with window 
 open. I catch cold easily, but never have sore throat/' 
 
 Eeply. — The color results from dust and smoke in the air breathed. 
 That feature is of no consequence. You have a mild chronic infection in 
 your nose or throat. It probably will never do you much harm. You 
 may get along just as well if you keep your nose and throat clean and 
 let it go at that. 
 
 Have Your Nose Examined. — C. A. M. writes: "I seem to have trouble 
 with my nose, especially one side. A dull feeling is felt on that side, 
 which feels as though something was pressing against the bone. I am 
 always clearing my throat, which is very disagreeable. I've been spraying 
 my nose with a salt solution, which helps, but only for the time being. 
 Do you think I ought to see a physician, or could I help myself in any 
 
 way. 
 
 Keply. — Have your nose examined and proper treatment given. 
 
14 THE NOSE 
 
 Mouth Breathing Dangerous. — S. B. J. writes: "I have lately fallen 
 into the habit of sleeping with my mouth open. I sleep on the right side — 
 never on the bach. Is there any way in which this habit can be corrected?" 
 
 Reply. — Mouth breathing is the stepping-stone from minor diseases 
 and obstructions in the nose to more serious diseases in the chest. It may 
 sometimes persist after the obstruction in the nose has been removed. It is 
 rarely due to habit only. If you are unable to breathe through the nose, 
 an obstruction is present which should be removed. Have this looked 
 into. 
 
 Chronic Nose Trouble. — A. G. J. writes: "I am troubled with pain in 
 my shoulders and chest, and I spit blood occasionally. I have been treated 
 by a specialist for catarrh. Do you think the bloody sputum comes from 
 that? I have been examined by four different doctors and t\ey all said my 
 lungs are in good shape." 
 
 Reply. — Yes. I assume by "sputum" you mean bloody nose and throat 
 secretions. Such bloody secretion does not mean consumption. On the 
 other hand, it could come from a chronic nose trouble. 
 
 Obstructed Nostrils. — 0. M. 0. writes: "During the rainy seasons of 
 the spring and fall I am afflicted with a sore chest and stoppage of the 
 nose. What course should be followed out that will serve to remedy this?" 
 
 Reply. — If your nose stops up it is because the air passage is too nar- 
 row. You may have polyps. You may have enlarged turbinated bones 
 growing into and filling up the air space. Neither of these conditions is 
 remedied by medicines. Go to a specialist and if obstructions are found 
 have them removed. 
 
 Mouth Breathing. — I. V. W. writes: "What is the most effective way 
 to overcome the habit of breathing through the mouth at night? During 
 the day I have no trouble breathing through my nostrils, but at night, on 
 retiring, it seems I cannot get enough air through them." 
 
 Reply. — You should have a nose specialist remove the obstruction from 
 your nose. In some cases, harness to keep the mouth shut suffices, but the 
 cases are few. It is usually a question of breathing room. 
 
 Harm of Mouth Beathing. — B. W. I. writes: "Does a mouth breather 
 contract a cold more readily than a nose breather? Does mouth breathing 
 do any other harm? How can it be overcome?" 
 
 Reply. — 1. Yes. 
 
 2. Increases infections of the lungs, bronchi, and throat other than 
 colds. Increases infections of the glands of the neck. Changes the facial 
 expression in children. Causes snoring. Disturbs sleep somewhat. 
 
 3. Remove the obstruction. 
 
 Cause of Mouth Breathing. — T. H. B.' writes: "Is it injurious to 
 breathe through the mouth while asleep? Is there a preventive?" 
 
 Reply. — It is. The nose has been devised as the best possible breathing 
 channel. Breath taken in through the mouth is not warmed and cleaned 
 as well as it should be. Among other things, mouth breathing leads to 
 adenoids, enlarged tonsils, and enlarged glands. To sleep on the side helps ; 
 to sleep in a cold room helps; to remove bony obstructions in the nose 
 helps. There are devices for keeping the mouth closed at night. 
 
CHAPTER III 
 
 The Tonsils 
 
 The tonsils are in the back portion of the mouth ; the adenoids are higher 
 tip, being behind the soft palate. The lymph nodes are there to stop foreign 
 bodies and prevent them from getting into the blood stream. As the first 
 breastworks they are excellently placed. 
 
 The air route (the nose, pharynx, larynx, bronchial tubes) crosses the 
 food route (mouth, pharynx, esophagus) at the back of the mouth (the 
 fauces). 
 
 This part of the tube serves a double purpose. It is a single-track stretch 
 in a double-track system. It is as though an electric line crossed a steam line, 
 and for a few miles the two services ran on a single track. 
 
 Since this piece of track (the 
 pharynx) is to serve also as a 
 food track, it cannot be lined with 
 the delicate, wavy, ciliated cells 
 found elsewhere in the air track. 
 It must be lined by flat epithelium 
 cells adapted to pressure. 
 
 As it carries air containing 
 dirt and bacteria and as flat cells 
 are not as efficient air cleaners 
 as the ciliated kind, infection 
 would be exceedingly liable to get 
 through at this point, and to pro- 
 vide against it a breastwork of 
 lymph tissue, called the tonsils, 
 has been thrown up. 
 
 Unfortunately, the tonsils contain one structure in addition to the lymph 
 nodes. On the surface are ten to twelve deep pockets, called crypts. The 
 crypts are about one-third to two-thirds of an inch deep. 
 
 There are many theories as to these crypts. Some think that bacteria 
 grow in them; that they act as test tubes and that the toxins being absorbed 
 constantly in time make one immune; in other words, that they do good. 
 
 Being deep, narrow, blind pouches, they do not easily clean themselves. 
 In fact, they are extremely apt to fill up with decomposing epithelium bacteria 
 and remnants. Such are the little, round, offensive balls which some people 
 find at times in their mouths. 
 
 In recent years physicians have found pneumococci, or one of the pus 
 cocci, in these crypts in many cases of rheumatism and rheumatic arthritis. 
 
 There are those who think the tonsillar crypts serve as a purpose and 
 others who think they do harm. I think the best arguments are with the 
 
 15 
 
 Fig. 8. — Throat Inspection. 
 
16 THE TONSILS 
 
 latter group. In filing specifications to a bill of complaint, I think we should 
 include the tonsillar crypts. 
 
 There is much controversy over the lymph gland portion of the tonsil. 
 Some think it helps to make blood; others that it protects the body against 
 disease ; others that it helps in other ways. 
 
 On the other hand there is a large group which thinks the tonsil serves no 
 good purpose at all, whether well or sick. 
 
 In a discussion before the staff of Mount Sinai Hospital, Dr. Freedman 
 summarized his views with this sentence : 
 
 "Removal of the tonsil does not remove from. the body any organ or tissue 
 absolutely necessary to the system, but, if not diseased, Us removal has left the 
 individual with one defense less/' 
 
 If a foreign body gets by the lymph tissues in the tonsil, it still has to 
 pass through some glands in the upper part of the neck below the angle of the 
 jaw. If it gets by these it has to run by a third barrier, deeper and lower 
 down in the neck. 
 
 It happens that infections frequently get into the system through the 
 tonsils. Some, referring to this, have called it a portal of entry. Some have 
 said that the tonsil is put there to absorb. 
 
 The view held by the better physicians is that the mouth and nose are 
 great portals of entry and that the tonsils stand there, as Goodale says, as 
 "sentinels of the body" In their effort to protect the body they frequently 
 become inflamed. 
 
 Freedman says : "When an infection enters through the tonsils, there is 
 great likelihood that the tonsil attempts to overcome the invader, and, failing 
 in this, the next lymph glands in order of defense take up the battle. How- 
 ever, if the tonsil is so diseased that its ability to cope with an infection is so 
 far reduced that on very slight provocation it becomes inflamed and too fre- 
 quently in the battl-e between it and the invading bacteria it becomes the loser, 
 so that constitutional symptoms intervene, it is then fair to presume that no 
 longer is it a sentinel, but rather an obstacle of defense and may then actually 
 serve as a portal of entry for disease." 
 
 This, put in another way, means that if the teeth, nose and tonsils can 
 be put in good condition; if the tonsils do not often become inflamed, and if 
 they do not interfere greatly with breathing, they should not be removed. 
 Under these circumstances they help to protect against infection. 
 
 If attacks of tonsillitis are frequent, if the tonsils are enlarged chroni- 
 cally, if they cannot be kept clean, then they should be removed. 
 
 In a certain sense tonsils can be outgrown. Tonsils enlarged enough to 
 interfere with breathing in children in time may get much smaller. Good 
 judgment is required to decide which cases can be left to outgrow their 
 trouble. 
 
 KEEP TONSILS CLEAN 
 
 When inspection shows the tonsils and adenoids enlarged, when the his- 
 tory records frequent sore throats and colds, and occasional earaches, the 
 doctor is called upon to decide whether the enlarged structures should or 
 should not be removed. After a gland has been swollen for some time, has 
 
PLATE I 
 
 > 
 
 
 TalllilHUI 1 - -■- ,;'--ft^--- 
 
 The Shape and Relations of the Thoracic and 
 
 Abdominal Viscera, 
 
 Anterior Aspect (Semi-diagrammatic) 
 
jam*.* 
 
 AVAJ AM3V \ 
 
 / 
 
 - 
 
 ■ 
 
 laO. R3WQJ 
 
 BQJJ 
 
 r... 
 
 ■,e. 
 
 
 ; 3Q0Aja-JJAD 
 
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 SUPERIOR 
 VENA CAVA 
 
 LOWER LOBE 
 PLEURA— I- 
 
 GALL BLADDER 
 
 
PI A 
 
 The Shape: and 
 
 
' 
 
 3 an 
 
 A 
 
 
 
 ■ 
 
 
 
 
 
 
 
 
 
 ! 
 
PLATE II 
 
 -, 
 
 ™ T 
 
 zLtl = . : —J 
 
 The Shape and Relations of the Thoracic and 
 
 Abdominal Viscera, 
 
 Posterior Aspect (Semi-diagrammatic) 
 
KEEP TONSILS CLEAN 
 
 17 
 
 been soaked in poison for a long time, it is a different structure from the 
 normal gland with which the body was originally endowed. It has become 
 like a befouled filter, befouled from the liquids that filter through it. 
 
 We must not forget, however, that when we are considering the tonsils 
 and adenoids we are not yet at the source of the stream. The man who studies 
 the Mississippi at St. Louis is nearer the source than the one who studies it 
 at New Orleans, but he is still far from the source. If he were trying to find 
 out the source of high water he must get information about melting snows in 
 Montana or rains in Ohio. 
 
 The tonsils and adenoids stand at 
 one gate; behind them lie the ears, the 
 lungs, the joints, the blood stream. 
 When they are diseased it is because 
 they are doing their best to protect the 
 structures which lie behind them from 
 the pollution which lies in front of 
 them. 
 
 One of these fields of pollution is 
 the teeth. The dentists tell us that 
 we should clean the teeth every day 
 as well as we can, and that several 
 times a year we should go to a dentist 
 for a complete cleaning. That is good 
 sense. 
 
 Some of us follow it. Unfortu- 
 nately, the grown people follow it bet- 
 ter than the children, while, unfor- 
 tunately, the children need to follow 
 it more than do the grown people. 
 
 The mouth cleans itself well with 
 the exception of the teeth, the upper 
 surface of the tongue and the tonsils. 
 The tongue can be washed, and, when 
 necessary, scraped with the edge of a 
 spoon. 
 
 I think the tonsils should be 
 systematically cleaned. A cleansing 
 .gargle, used each morning, is of some 
 service. Various instruments for 
 cleaning the crypts have been devised. 
 Some empty by suction, others by 
 pressing. I understand that none of 
 
 these is wholly satisfactory at present, but when periodic visits to the throat 
 man are as customary as periodic visits to the dentist, the former will perfect 
 his appliances for cleaning the crypts of the tonsil. 
 
 Absorption from the nose is largely responsible for swelling of the ade- 
 noids. Snufflers are most subject to adenoids. The first inch of the nose is 
 easily cleaned. A piece of cotton and some boracic acid solution (68 grains to 
 one pint) will suffice to clean this portion of the nose. 
 
 Fig. 9. — Location of Glands Which 
 Frequently Enlarge. Causes of En- 
 largement: 1. Disease of the ear. 
 Eruptions about the face. 2. Eruption 
 of the scalp, mastoiditis. 3. Infections 
 of the chin, tongue and lower lip. 4. In- 
 fections of the mouth and teeth. 5. In- 
 fections of the tonsils. 6. Pharyngeal 
 infections. 7 and 8. Infections of the 
 scalp and pharynx. Tubercular infec- 
 tions are especially frequent in 7 and 8. 
 Diphtheria in 4, 5, 6, 7 and 8. Scarlet 
 Fever in 5, 6 and 7. 
 
18 
 
 THE TONSILS 
 
 To cleanse the deeper parts many use sprays and douches. As to this 
 custom I have my doubts. The secretion of the nose is a good wash, and 
 probably all that is required for a normal nose. 
 
 Has Tonsil Trouble. — A. M. writes: "I have tonsil trouble. I wish to 
 have the tonsils cut out, but friends advise me not to, for the reason that 
 the lungs will be exposed to dust and dirt. Will you please advise?" 
 
 Reply. — If the tonsils are in good condition they protect the remainder 
 of the body. If they are much diseased they do not. Therefore, if your 
 tonsils are much disordered have them out. 
 
 Keeping Tonsils Clean. — 67. H. writes: 
 
 Fig. 10. — Peritonsillar Abscess. 
 
 "I notice you suggest putting 
 the nose, teeth, and tonsils in 
 order and keeping them clean 
 as a preventive against rheu- 
 matism. How would you do 
 this?" 
 
 Reply. — Some people can 
 cleanse their tonsils by mas- 
 saging with the finger or with 
 some blunt instrument — for 
 instance, the end of a spoon 
 handle. This should not be 
 done oftener than once a week, 
 and usually it will not be nec- 
 essary to do so often. Others 
 must have it done for them. 
 
 Effect of Infected Tonsils. 
 
 — Reader writes: "Will you please tell me what evil effects are apt to come 
 from infected tonsils? Could they cause a bad breath?" 
 
 Reply. — Mouth breathing, enlarged neck glands, pallor, frequent sore 
 throat, deafness, sometimes tuberculosis. As to bad breath, yes. 
 
 Tonsillar Crypts. — G. E. R. writes: "Are the white, cheesy particles 
 which form in the crypts of tonsils infectious? And should tonsils having 
 these crypts be removed to prevent poisons going through the system?" 
 
 Reply. — These cheesy particles are composed of bacteria, decomposing 
 epithelial cells, and food remnants. They may contain pus germs and 
 tubercle bacilli. They are partly responsible for enlarged glands in the 
 neck and what used to be called scrofula. If they can be removed easily 
 by the patient or his physician and are so removed from time to time, 
 the tonsils need not be cut out. If these masses form and are not removed 
 the tonsils should be cut out. 
 
 Keeping Crypts Clean. — T. L. writes: "Please tell me how the tonsil 
 crypts may be kept clean." 
 
 Reply. — Washing with tooth washes will suffice for surface accumula- 
 tions. Accumulations in the crypts can be squeezed out by going over the 
 tonsils with a loop made of smooth wire. Some can do this for them- 
 selves ; others must have it done periodically by their doctor or dentist. 
 
KEEP TONSILS CLEAN 19 
 
 Does Not Weaken Lungs. — Miss F. writes: "As I am troubled with 
 tonsillitis, getting it every year, sometimes twice, I would have you advise 
 me whether this indicates that my tonsils are diseased. What are diseased 
 tonsils? Would having them removed make the lungs weak? Many people 
 advise me not to have them removed; others think it beneficial." 
 
 Reply. — That you have tonsillitis once or twice a year does not neces- 
 sarily mean that your tonsils are abnormal, or that they should be removed. 
 If they are large and boggy, have crypts that fill up with debris, or if you 
 have quinsy once or twice a year, they had better be removed. In other 
 words, decide the question on the basis of the condition of your tonsils. 
 Get the best advice available, and follow it. Removal of the tonsils does 
 not make the lungs weak. 
 
 Developing the Lungs. — D. W. writes: "Please give directions for a 
 mode of life which will tend to develop strong, healthy lungs in a child. 
 The child's father at one time had pulmonary tuberculosis/' 
 
 Reply. — The best way to develop the lungs is to develop the legs. Keep 
 the child in the open air as much as possible. See that the nursery is well 
 ventilated and that the temperature there is kept low. Be on the watch 
 for the perfection of a method immunizing against consumption. It should 
 come before long. 
 
 Fresh Air Counts. — H. W. H. writes: "I sleep upon a sleeping porch, 
 but am afraid that I do not get the benefits of the fresh air, because when 
 sleeping I breathe through the mouth. A chin truss is said to make nose 
 breathing necessary, cure colds, throat troubles, etc. Do you consider it a 
 good thing? If not, could you tell me any better method? Also, could you 
 advise me on this point? I wish to get 'fattened up' and have a chance 
 to get both filtered, artesian water, and fresh, pure, cow's milk — as much 
 as I want of either. Having heard both the 'milk diet' and 'plenty of fresh 
 water recommended highly, I am undecided which to adopt. Which is 
 more fattening? When I have adopted one, should I cut the other one out 
 
 Reply. — 1. It is the fresh air that you get into your lungs that counts. 
 The air you fail to get is of no value to you. Mouth breathing does not 
 allow the air to enter the lungs freely. Another disadvantage is that air 
 taken directly through the mouth is not properly warmed, moistened, and 
 filtered. Mouth breathing is caused by some obstruction in the nose or the 
 pharynx, an overgrown bone or a foreign growth in the nose, enlarged 
 tonsils, or adenoids in the throat. To stop mouth breathing, these should 
 be removed. Rarely, mouth breathing persists as a habit for a short time 
 which can be easily overcome by letting the nose go ahead with its work 
 and keeping the mouth shut. I have no faith in the chin truss cure-all 
 and do not recommend it. 
 
 2. Good water and pure milk are both good things. To "fatten up/' 
 something is needed besides. Plenty of good simple food, exercise in 
 the open air, and a cheerful disposition will help considerably. 
 
CHAPTEE IV 
 
 Adenoids 
 
 There are at least six tonsils. The two large ones on the side of the 
 throat back of the palate are known as the faucial tonsils. When the word 
 tonsil is used, it is these large masses, the faucial tonsils, that are referred to. 
 In addition there are four other tonsils, and the six together make a picket 
 line called Waldeyer's ring. They are also called adenoids. 
 
 In Waldeyer's ring is a defensive line of filters, dotted around the field 
 much after the fashion of the players on a football team when the opposing 
 team kicks oif. One of these, called the lingual tonsil, is located on the back 
 of the tongue. Two, called the eustachian tonsils, are located at the mouths of 
 the tubes that run to the ears. One is at the back part of the roof of the nose, 
 near the point where the air route turns down to cross the food route. This 
 tonsil is usually called the pharyngeal tonsil. When we say that a child has 
 adenoids, we generally mean that this tonsil is enlarged. 
 
 This is a most important tonsil. It is frequently found large. When 
 it is large, it shuts off the breathing space; the child becomes a mouth 
 breather. Mouth breathers catch cold easily; they catch scarlet fever and 
 diphtheria ; they are "catchers." 
 
 In mouth breathers the roof of the mouth arches up; the nose space is 
 lessened, and the teeth do not meet properly. 
 
 These conditions are so important that it is good judgment to remove 
 adenoids that swell and stay swollen. They are diseased, and, therefore, are 
 not up to standard as filters. We know that a foul water filter increases the 
 foulness of water that passes through it. The same filter, properly cleaned, 
 cleans the water that passes through it. 
 
 It is good judgment to remove adenoids that swell and stay swollen, be- 
 cause they stop up the nose, befoul the mouth, increase infection, all by bring- 
 ing about mouth breathing. 
 
 The adenoid swells because it is doing an extra amount of filtering, 
 which means that it is swelling because the nose is dirty. If the nose is kept 
 clean and the air breathed is kept moist, tempered and clean, the adenoids 
 will not enlarge. 
 
 A large proportion of those enlarged would shrink up if the nose were 
 cleaned and kept clean, and if the atmosphere of the schoolroom and home 
 were made right. 
 
 CLEAN MOUTHS AND INFECTION 
 
 Physicians find that a large portion of the school children need to have 
 their tonsils and adenoids removed. Nearly all the infections which children 
 have, and most of those which adults have, get in through the mouth and 
 nose. 
 
 20 
 
CLEAN MOUTHS AND INFECTION" 
 
 21 
 
 Tonsils and adenoids are put in the nose, month, and throat because they 
 are needed to keep infections from getting into the blood, brain, lungs, or 
 other tissues, where they can do more harm than in the tonsils. 
 
 Healthy tonsils and adenoids should not be removed. Those that are 
 enlarged and swollen should be. Not one-half of the tonsils are removed 
 which should be removed. 
 
 Diphtheria infection may locate 
 on the gums, the nose, or the tonsils, 
 or in any one of several places. Diph- 
 theria located on previously healthy 
 tonsils requires less antitoxin, is more 
 easily cured than diphtheria anywhere 
 else. The reason is that tonsils help 
 to protect the tissues which lie beyond. 
 
 North Carolina Health Bulletin, Feb., 1913. 
 
 Headquarters for Gossip and 
 Germs. 
 
 The point is that we should go back of 
 the tonsils and thus try to keep them 
 healthy. 
 
 If the mouth, nose, teeth, and fold 
 of the tonsils are kept clean the prob- 
 lem is solved. The tonsils will not 
 enlarge. 
 
 The teeth should be picked, 
 washed, and brushed several times each 
 day. Periodically a dentist should 
 give them a more thorough cleaning. FlG n 
 The mouth and tongue should be 
 washed as frequently and as thor- 
 oughly as the hands. Periodically a physician should clean the tonsil crypts. 
 There are those who systematically wash the nose. 
 
 The human mouth is fearfully dirty. The wonder is that any tonsils 
 escape enlarging. Is there any reason why we should have clean hands and 
 faces and dirty mouths? 
 
 Cause, Prevention and Treatment of Adenoids. — E. D. W. writes: 
 "1. What causes adenoids in a child of 6 years? 2. What precautionary 
 measures should he taken by parents to prevent the development of ade- 
 noids in a child? 3. Will adenoids disappear in time, if they are let alone? 
 J+. If an operation is deemed necessary in case of adenoids, is it such an 
 important matter that an expert surgeon should be employed, or will any 
 family physician be competent to remove them? 5. How are tubercular 
 glands of the neck to be cured?'* 
 
 Reply. — 1. Absorption of germs and their products, and of decomposing 
 matter from the tonsils, teeth, mouth, and nose. 
 
 2. Keep the mouth, teeth, tonsils, and nose clean from babyhood up. 
 Keep the child in the open air. Keep him free from colds. ' Some children 
 have an inherited tendency to lymph gland overgrowth. These must be 
 better watched than the general run of children. 
 
 3. Yes, many cases will. In most cases, however, the child is a con- 
 firmed mouth breather, and his constitution is irretrievably gone before the 
 adenoids go. 
 
22 ADENOIDS 
 
 4. A nose and throat specialist is generally best. Some family physi- 
 cians can operate successfully on such cases. 
 
 5. Tuberculin tonics, open air, feeding, attention to the absorption areas 
 — tonsils, teeth, mouth, nose. 
 
 Dryness and Adenoids. — Reader writes: "Will you kindly inform me if 
 it is unhealthy to live in a cement house that has waterproof coating on 
 the outside? The house seems to be too dry, especially in winter. Can such 
 a house be kept moist in any way? Can too dry a house cause adenoids in 
 children f" 
 
 Reply. — 1. The house you have in mind is not unhealthy because of the 
 cement walls, but because, in heating it, you have fed heat and not water 
 to the air. Whenever one feeds heat to air he must also feed moisture; 
 otherwise there is trouble. If a cement wall house is unhealthy it is 
 because the walls are snug and heat cannot readily pass out. 
 
 2. Yes; evaporate enough water in connection with the heating system. 
 
 3. Yes ; it is the most frequent cause. 
 
 Removal of Adenoids. — G. S. E. writes that she has been told I do not 
 advise the removal of adenoids and tonsils. Is this true? 
 
 Reply. — My contention is that, if the mouth, teeth, and nose are kept 
 properly clean from infancy up, tonsils and adenoids will seldom require 
 removal. When the tonsils swell, sometimes the contents can be squeezed 
 out of the small cavities, and removal is not necessary. When these stages 
 have passed, there is nothing left but removal. Removal is not done in 
 fully half the cases in which it should be. 
 
 See Throat Specialist. — E. G. C. writes: "Kindly give me your advice 
 in regard to the removal of adenoids. A little girl of four has adenoids. 
 They do not trouble her, but she sleeps with her mouth open." 
 
 Reply. — I am inclined to think a throat specialist will advise their 
 removal. Sleeping with the mouth open is easily recognized. There are 
 other results from mouth breathing not so easily recognized. 
 
 SNORING 
 
 When the currents of the air cause the soft palate to flutter, a snoring 
 sound is made. This may happen when the mouth is closed. It is much 
 more likely to happen when some of the breath is coming through the nose 
 and some through the mouth. It may occur when the mouth is closed and 
 nothing is the matter with the nasal passageway. 
 
 The tendency to snoring, however, is increased by obstruction of the nasal 
 airway. During sleep the muscles of the body are relaxed. For this reason, 
 when one lies on the back while sleeping, the tendency is for the mouth to 
 open. Therefore, grown-ups who sleep on their backs usually snore more or 
 less. 
 
 When one snores it is usually because the nasal airway is not large 
 enough. There may be a crooked septum in the nose. There may be spurs of 
 bony substances partially closing the nasal cavities. There may be enlarged 
 
SNORIXG . 23 
 
 turbinates, diseased sinuses, polypi, or adenoids, which prevent free passage 
 of air through the nasal openings. 
 
 There may also be an undue smallness of the nares, or a tendency of the 
 soft parts of the nostrils to collapse during inspiration. Too much fat along 
 the air route, in the abdomen, or in the chest wall, may be the cause of the 
 embarrassed breathing. 
 
 The habit of snoring is difficult to cure. Abnormalities and diseased con- 
 ditions of the nose and throat act as a contributing cause. They should be 
 corrected. 
 
 In many cases it is necessary to straighten a crooked septum, remove 
 growths — adenoids, polypi, and spurs. It may be necessary to remove dis- 
 eased tonsils. 
 
 Inflammation involving accessory sinuses and tonsils must be cleared up 
 before the habit of snoring can be easily overcome. 
 
 Snorers should sleep on their sides. In this position the mouth is less 
 likely to drop open. Various mechanical devices have been suggested for 
 holding the lower jaw closed. A harness arrangement, extending about the 
 head and under the jaw, has been advised. 
 
 It has been suggested that holding pieces of muslin or cheesecloth be- 
 tween the teeth and lips would assist in controlling the habit. The presence 
 of foreign substances between the teeth would no doubt sufficiently impress 
 the subconscious operation of one's mind to such an extent that he would keep 
 his mouth closed. The presence of the foreign substance in the mouth keeps 
 the mind on the substance even when asleep. The sleep in this case is as 
 restful as when snoring. 
 
 Cause of Snoring. — J. P. E. writes: "You will perhaps recall when 
 Theodore Roosevelt was in a local hospital recuperating from the Milwau- 
 kee shooting he snored so loudly that it was heard in the entire ward. Now 
 T. B. is a 'physical marvel' and I wish to inquire if this snoring is pre- 
 ventable or not. I know an open mouth has nothing to do with it. I have 
 put a sealing plaster across my lips on retiring and found it intact in the 
 morning, yet my wife said I snored just as badly." 
 
 Reply. — Snoring does no harm. That is, it does you no harm; it may 
 prevent the "missus" from sleeping. It is due to flapping of the palate. 
 When two currents of air, one through the nose and one through the mouth, 
 meet at the edge of the palate, this pliable curtain flaps back and forth. 
 Occasionally a person will snore with his mouth closed. In that event little 
 or no harm results. The harm of snoring results from the mouth breathing 
 — the taking into the tubes of air not properly warmed and moistened. 
 Mouth breathing in grown people makes them more liable to colds, and 
 that is about all. It is more harmful in children. Snoring in grown 
 people is of some consequence because it indicates that the breathing space 
 is pretty near the limits of comfort and safety — the nose is not roomy 
 enough or the individual is getting too fat. 
 
UZZLE 
 
 the 
 
 CROBE 
 
 ANTICIPATE 
 
 ysur SNEEZES, 
 
 and help 
 
 PREVENT DISEASES 
 
 Ch/'c^o Department ct ' Health dttM.322 • Perfgaed fy Arthur M.Corww,AJl>MJb 
 
 Fig. 12. 
 
 24 
 
CHAPTER V 
 
 Colds— Catarrh— Sore Throat 
 
 COLDS 
 COLDS A LUXURY, NOT A NECESSITY 
 
 President Emeritus Eliot, in his address before the American Philo- 
 sophical Association on "Benjamin Franklin as Printer and Philosopher," 
 quotes that American scientist as saying : 
 
 "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. 
 
 "I have long been satisfied from observation, people often catch cold from 
 one another when shut up together in close rooms and coaches and when 
 sitting near and conversing so as to breathe in each other's transpiration, 
 the disorder being in a certain state." 
 
 Says the naturalist, John Muir : "As long as I camp out in the moun- 
 tains without tents or blankets, I get along very well, but the very minute I 
 get into a house and have a warm bed and begin to live on fine food, I get 
 into a draft and the first thing I know I am coughing and sneezing and threat- 
 ened with pneumonia, and am altogether miserable." 
 
 Says Irving Fisher: "Personally, I have known of scores of cases in 
 which the tendency to catch cold has been almost completely overcome." 
 After reciting some cases, he says that if outdoor life had been adopted simply 
 as a preventive of colds, it would have prevented, originally, as it cured sub- 
 sequently, their more serious disorders. 
 
 Gulick is inclined to believe that something like nine-tenths of all the 
 minor ailments that we have and which constitute the chief source of de- 
 creasing our daily efficiency could be removed by careful attention. "With 
 the removal of nine-tenths of our disabilities and the conservation and further 
 development of our natural powers, the average person can increase his effi- 
 ciency one hundred per cent, that is, he can be twice as effective." 
 
 The things which need to be done are : 
 
 1. Sleeping and living in cool, well ventilated rooms. 
 
 2. Eating moderately. 
 
 3. Keeping the secretory organs working properly. 
 
 4. Building up resistance by cold baths, air and water, and exposures 
 within reason. 
 
 5. Keeping the mouth and nose clean. 
 
 6. Keeping away from infectious people, sick and well. 
 
 To do these six things perfectly means absolute freedom from colds. To 
 
 25 
 
TttE DOUBLE CROSS 
 
 If 
 
 THAT THE WP0RE-A1R AND THE 1MPURE-F00& D15EA5E5 
 GIVE CH1CAGOAN6. 
 
 Monthly Death Bate5 Fpor^ Two 6couP5 of b»5EA5E$ 
 That Are Indirectly Affected by Weather Conditions. 
 1/^POPE.AlR Dl5F^E6- Pneumonia and Bronchitis- MlGH m Winter 
 when people hou6e therr>6elvG6 ap and breathe the /but air of 
 unVentWated room6 . LOW in Summer when people keep their doors 
 and windows open; when people live more in the open air. 
 
 IMPURE POOD bl6EA6E£- Diarrbea\ biseaSes-HlGrt in hot weather 
 Chie/l^ because heal Spoili; or/lie6, dust, etc., contaminate the /ood wc 
 eat — £6PEC!AUiy B^BYS POOD. 
 
 
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 26 
 
COLDS 
 
 27 
 
 do some of them and not do others, reduces the number of colds, though the 
 reduction can scarcety be put on an arithmetical basis. 
 
 If it is possible to escape colds, then they are not a necessity. On the 
 other hand, they are expensive enough to be termed a luxury. 
 
 WHAT IS A COLD? 
 
 A cold begins with a localized raw dryness at some point in the nose. 
 There is some aching and a little fever. A few hours later a clear liquid 
 begins to flow from the nose and the aching and general ill feeling persists. 
 The uncomfortable area spreads until all of the upper breathing passages 
 feel "raw." Frequently it spreads to the nerves, causing neuralgia of the 
 
 AOJ 
 
 Location of 
 Adenoids 
 shown x 
 
 Adenoids 
 
 cause mouth- 
 breathing, 
 freauenfcolds, 
 catarrh, deafness, 
 and deformity oi 
 jaw and chest. 
 They induce siupidiiy 
 stunt mental and physical growth. 
 
 DON'T LET TOUItCffllB 
 BE 3>0 HANDICAPPE1D. 
 
 Removal of Adenoids 
 is a simple and brief operation. 
 
 GIVE, YOUR. CHILD 
 A CHANCE. TO BREATHE 
 
 FlG. 14. 
 
 Chicago Health Department. 
 
28 COLDS— CATARRH— SORE THROAT 
 
 face and teeth. By this time the secretion from the nose begins to be thicker 
 and whiter. 
 
 The infection is now spreading down the larynx into the bronchial tubes 
 and the cough is becoming prominent. The nose secretion changes from a 
 clear water to whitish mucus, and finally to gray pus and mucus. And now 
 the symptoms begin to subside. In a few days the soreness of the throat and 
 nose passes away, but the nose secretion and the cough hold on for a few 
 weeks. 
 
 I have given these details because it is this type of cold that I have had 
 in mind when advising people with colds to go to bed and send for a phy- 
 sician. The bacteria are spreading along the surface from the nose to the 
 bronchi, and what is of much more consequence, they are spreading from the 
 surface to the underlying blood vessels, and, through them, are being scat- 
 tered widely — proof that they are capable of infecting the host and those with 
 whom he comes in contact. 
 
 From the standpoint of the sick man this is the kind of a cold which 
 demands care, since it results in pneumonia, heart and kidney disease, and 
 rheumatism. 
 
 I am also interested in that kind of a cold which is called "the cough 
 which hangs on," since it is so frequently an early stage of consumption. 
 
 The mild, temporary sore throats, the slight cold in the head, the little 
 bronchial coughs, the minor colds without aches and without fever are of 
 more consequence from the standpoint of the community than from that of 
 the individual. 
 
 Most germs that cause diseases, called pathogenic, cannot live outside the 
 bodies of animals. Some of these would have perished had it not been that 
 they were kept alive as mild, apparently harmless nose infections. In winter 
 flies find warm places in which they keep barely alive, but from these places 
 they go out to do a great deal of harm when the season is more favorable. 
 For bacteria some noses serve the same purpose as warm places do for flies. 
 
 CAUSE OF COLD 
 
 Colds may be due to any one of several different bacteria. They are con- 
 tagious, and should be treated accordingly. While not dangerous in them- 
 selves, they become dangerous, because they spread or develop into other and 
 more serious diseases — pneumonia, diphtheria, consumption, and Bright's dis- 
 ease. 
 
 Colds due to the presence of the pneumococcus, the germ of pneumonia, 
 and those due to the presence of the germ that causes diphtheria are of the 
 most importance. The reason for this is that these germs may produce a 
 sore throat or inflammation of the mucous membrane of the nose, from which 
 other people may catch diphtheria or pneumonia. While colds due to the 
 other bacteria may not prove serious, they should never be treated lightly. 
 
 A man may catch a cold from himself. He may catch a cold from an- 
 other man. When one has a cold he should avoid crowds ; remain as far away 
 from his fellow men as possible; avoid sneezing when in the presence of 
 others, or sneeze or cough into a handkerchief held before the nose. 
 
 Besides the germ which is the exciting cause of the cold there are con- 
 
COLDS 29 
 
 tributing causes, such as sudden exposure to cold, exposrre to hot, stuffy air, 
 overfeeding, underfeeding, failure of the organs of elimination (bowels and 
 kidneys) to carry away all waste products, errors in clothing, and overindul- 
 gence in alcoholic stimulants. 
 
 Colds usually begin in the nose. This is especially true where there is a 
 crooked septum, spur or bony growths, enlarged turbinates, or adenoids to 
 interfere with the free passage of air. A blockaded nose does not drain well, 
 and drainage is essential. 
 
 In case of mouth breathers, or where there are diseased tonsils, the cold 
 may begin in the throat. Such persons should exercise special care to keep 
 the mouth clear by the free use of antiseptic washes morning and evening. 
 The teeth should also be kept clean by brushing thoroughly after each meal. 
 
 To avoid catching colds, deformities in the nose should be put and kept 
 in order. The tonsils, if diseased, should be removed or cared for according 
 to the advice of a physician who knows how they should be treated. 
 
 Since lowered vitality has much to do with catching colds, body resistance 
 should be kept up to efficiency by proper regard for body hygiene. 
 
 "Cold catchers" should not overeat or undereat; they should avoid hot, 
 stuffy, poorly ventilated halls and poorly ventilated rooms where people as- 
 semble. They should live and sleep in the open air as much as possible, keep 
 the organs of elimination normal, and cultivate a cheerful disposition. 
 
 THE COST OF COLDS 
 
 Last year (1915) a report issued from Boston said that an economic study 
 of colds had been made there and that the estimated loss from this disorder 
 should be capitalized at something over $20 a year per person. Sadler, in 
 "The Cause and Cure of Colds," starting on the assumption that men lose on 
 an average two days a year from "bad colds," "colds in the head," and "slight 
 touches of the grip," calculates an annual direct money loss to wage earners 
 of this country of $60,000,000. To this he adds $20,000,000 for money spent 
 on patent medicines, "cold cures," and physicians' fees. He adds : 
 
 "The estimate of loss in wages does not include the loss to the employer 
 from the days of decreasing efficiency preceding the actual absence from work 
 of the wage earner, nor does it take into account the days or even weeks of 
 decreased efficiency which frequently follow cold infections. 7 ' 
 
 Irving Fisher in Bulletin No. 30 quotes Dr. Charles H. Castle as esti- 
 mating the average annual loss from minor ailments at three days per capita. 
 The estimate of Dr. J. F. Morse is five days. Minor ailments include colds, 
 headaches, toothaches, and some others. 
 
 It cannot be doubted that the direct cost of colds runs into the millions 
 in the United States. But at that, the direst cost is a small item as compared 
 with the indirect. 
 
 "Colds" is the term used to group many different kinds of infection. 
 Among them are such important bacteria as those of consumption, pneumonia, 
 diphtheria, meningitis, and the pus producers. 
 
 Among those who are said to have colds are many who are keeping, har- 
 boring, and "passing on" more violent diseases. Of importance are the nose 
 and throat infections, which, of themselves, are of no consequence, but from 
 
30 COLDS— CATARRH— SORE THROAT 
 
 which infection travels to joints, to be called acute rheumatism; to the heart, 
 to be called, a year or so later, heart disease; to the kidneys, to he called 
 Bright's disease. The portal of entry is somewhat harmed, but the main 
 trouble shows itself elsewhere. It is as if a garbage wagon, driving into a 
 private park, had scraped a gate post but then had gone on and dumped its 
 load on a flower bed. Fisher says : 
 
 "If what seem to be 'mere colds' were less commonly neglected, tubercu- 
 losis would more often be caught in its incipiency and pneumonia and diph- 
 theria would often be prevented." 
 
 DRAFTS AND COLDS 
 
 There are many who need to be set right on the relationship between 
 colds and drafts. When a man sneezes he exclaims, "I am catching cold," and 
 proceeds to find a draft on which to lay the blame. As a matter of fact many 
 colds do first show themselves by sneezing, but sneezing is more frequently 
 the result of other causes. Violent and continued sneezing is liable to come 
 when one sits quietly in a warm room after having overeaten, or from breath- 
 ing dust, or from other causes. 
 
 In the second place colds are infections with bacteria, in which the germ 
 is the most important element, and the condition of the man comes second 
 but closely following. Lowering of the man's temperature, the too rapid ex- 
 traction of heat, are items which influence him to catch cold in only a 
 minor way. 
 
 And thirdly, what is ordinarily called a draft is not a draft at all. What 
 one means when he says he feels a draft on his feet is that his feet are being 
 chilled. Heat is being abstracted faster than it is being furnished. 
 
 As the skin temperature is over 90 and the air temperature is 70 or lower, 
 much heat is given off by the body. The air next the skin is the warmest in 
 the room and when currents move this aerial envelope away and replace it 
 with cooler air, the skin may be cooled. Currents of cold air are more cooling 
 than still air, but low temperature air may chill whether still or moving. 
 What we call the "feel of drafts" is the feel of low temperature. 
 
 Unquestionably, to be chilled beyond the reacting power helps to bring 
 on infections. As the Bulletin of \he Pennsylvania Tuberculosis Society says: 
 "To sleep cold brings on pains and assorted ills." But warm, flowing air is a 
 draft just as much as cold, blowing air, and Leonard Hill, Fluegge, and all of 
 the best authorities are of the opinion that health and comfort are impossible 
 except where the air is kept in motion — drafts, if you please. 
 
 If we must have drafts, and drafts at times do harm, what must we do? 
 Why, regulate the drafts. Get good drafts rather than bad ones. 
 
 The skin has a temperature of 96. The temperature of the room should 
 be 68. Incoming air should not strike the body, and especially the extremities 
 below the knees, at a temperature below 64. Incoming air should not strike 
 the occupants at a velocity of more than 100 feet a minute, if the air is lower 
 than 64. When the temperature of the room is 68 the leg zones should not 
 be below 66. Young vigorous persons do not need such narrow limitations of 
 temperature environment, but the average coddled clesk worker does require 
 them. '■ ".:• "' ' i: \-..?.v :....:>• -.:;• .■.■■:::: : .::. : .:. .-: 
 
COLDS 31 
 
 The fear of drafts is morbid and should end. The breezes of summer 
 are drafts. When temperatures are regulated drafts are necessary for com- 
 fort and health. When unregulated as to temperatures they are something of a 
 factor in colds, but not much. 
 
 SUGGESTION FOR PREVENTION OF COLDS 
 
 "I sat in a draft and caught a cold" is an expression familiar as a 
 household remark. It is partly correct, mostly incorrect. What did happen, 
 perhaps, is this: You remained for too long a time in a stuffy, overheated, 
 ill-ventilated room, overate, and otherwise disregarded bodily hygiene; then 
 put yourself in a current of moving air. You caught cold, not because you 
 were exposed to the breeze, but because of your indiscretions. They lowered 
 your body vitality and body resistance. 
 
 In other words, the sudden stress and strain to which you had exposed 
 your body — the necessity for adjusting it to complex conditions — was greater 
 than its machinery was equal to. This made it possible for the cold germs to 
 enter the blood stream and cause such symptoms as the particular germ is ex- 
 pected to produce. 
 
 To keep from catching colds it is necessary to keep the body up to effi- 
 ciency, and not subject it to too great a strain by overindulgence and lack of 
 care. This can only be done by good habits of sleeping, eating, good body 
 hygiene, and by taking plenty of exercise. These precautions are absolutely 
 essential to health and freedom from colds. 
 
 Another thing to take into consideration is the organs of elimination. 
 That they carry away all the waste products is highly important, as, otherwise, 
 the blood stream becomes vitiated, thereby lowering vital resistance. The most 
 important of these organs is the bowels. By all means do not allow yourself to 
 become constipated. 
 
 If there is poor drainage in the air passages of the nose the cause is to 
 be found and removed. Many times there are bony growths attached to the 
 septum. There may be deflections of the septum. There may be enlarged 
 turbinals. 
 
 These abnormalities reduce the size of the air passageway and interfere 
 with breathing as well as drainage. If for no other reason they should be re- 
 moved. 
 
 Where there are adenoids and polypi these should be removed, since they 
 too interfere with free drainage and breathing. 
 
 Lack of drainage in the above named structures favors congestion, thus 
 making an ideal place for harboring and developing the germs of various 
 diseases. It is the presence of these germs which frequently brings us down 
 with some serious sickness, when, for some reason or other, body resistance 
 and vitality have been suddenly and sufficiently lowered to enable the cold 
 germs to produce only symptoms of a cold. 
 
 Where the throat is unhealthy as a result of enlarged and diseased tonsils 
 they should be removed. The germs of diphtheria and pneumonia have an 
 especial liking for the fauces. They find a hiding place in and about the 
 crypts of the tonsils. 
 
 Here they lie in waiting for the presence of such physical condition as 
 
32 COLDS— CATARRH— SORE THROAT 
 
 will enable them to cause the manifestation of such a train of symptoms as 
 they are expected to produce. 
 
 The necessity of early recognition of such a condition of the throat and a 
 correction thereof becomes at once apparent. 
 
 To Get Rid of Cold. — 8. J. writes : "I am 6^ years old and in excellent 
 health. For the last two years I have not taken medicine of any kind. But 
 once or twice a year I catch cold. It always takes me about a week to get 
 rid of it, so I suppose I am not treating my cold right. I sleep with 
 windows open all the year. Should I close the windows till I get well 
 when I have a cold? What else can I do to get rid of a cold quickly? As 
 a rule my cold seems to be in my head mostly/' 
 
 Reply. — Do not close the window, but place a screen so that the air 
 does not blow directly on you. Take one or two doses of aspirin and a 
 purgative and let that suffice. To get rid of a cold in a week is doing well. 
 
 Toilet of the Nose. — W. B. A. writes: "What in general is the cause of 
 ozena? Is it usually cured by a series of treatments?" 
 
 Reply. — Ozena is an after effect of neglected colds and chronic nose 
 conditions. The dry nose secretions are infected and decomposing. Ex- 
 perimenters are working hard on a cure now but they have not, as yet, 
 much to offer. About the best that can be done is to maintain a proper 
 toilet of the nose. 
 
 Cold in the Head. — H. H. writes: "As soon as cold weather comes I 
 am troubled with cold in the head, which is almost continuous during fall 
 and winter. The inside of my nose is sore. My health otherwise is good. 
 What is advisable for me to do?" 
 
 Reply. — I judge you have a chronic infection somewhere about your 
 nose. Keep in the open air, keep away from crowds, keep out of cold places. 
 These procedures will help you, but you should go to a nose specialist and 
 have him find the infected area and put it in better order. 
 
 "Chronic Cold in the Head." — W. H. M. writes: "I am troubled con- 
 stantly with what is called 'a cold in the head/ accompanied by constant, 
 heavy discharge, smarting of the nasal cavity and forepart of forehead. 
 If not attended to promptly and relieved in some way, it travels from there 
 to the upper part of lungs and starts a cough. I am employed nights, in 
 an office with about 100 others, and the windows are lowered from the top 
 for ventilation. I seem to feel the effects of the draft therefrom the 
 moment I sit down. I wear plenty of clothes, a sweater, a hat, and when 
 draft is overly strong, a coat, but seem to keep taking fresh colds every 
 night or two. This often incapacitates me for duty. Can you give me any 
 information or suggestions to overcome this trouble?" 
 
 Reply. — The probability is that you have a chronic infection of one of 
 the sinuses leading from your nose. Every so often it travels to your nose 
 and thence to your bronchial tubes. To "harden one's self" by cold baths, 
 sleeping in a cold room, eating lightly, and keeping the bowels open makes 
 one more resistant to these excursions of the cold germs from their lair. 
 Ofttimes it is necessary in addition to have a throat and nose specialist 
 find the lair and clean it out. 
 
COLDS 33 
 
 Cause and Cure of Colds. — M. 0. writes: "1. Are aching bones and 
 
 muscles, great weakness, and a dull headache symptoms of the grip? 
 
 "2. What causes grip? 
 
 "A young man, otherwise in good health, gets such an 'attach' three or 
 four times a year. 
 
 "3. How can he avoid it? 
 
 '%. What course of home treatment will cure him of an 'attach'?" 
 
 Reply. — 1. They are symptoms of a cold, frequently called grip. 
 
 2. Colds are caused by germs. 
 
 3. Eating lightly, hardening himself, keeping his nose clean, avoiding 
 people with colds, keeping out of warm rooms and badly ventilated rooms. 
 
 4. Purgatives. Going to bed. 
 
 To Avoid Taking Cold. — 0. F. P. writes: "For years I have found 
 myself a slave to a continual cold. As soon as the weather begins to get 
 cool my cold sets in and will hold me in some way or other throughout the 
 entire winter. I wish you would advise me as to what I should do to pro- 
 tect myself during the winter, as I am engaged in outdoor worh the year 
 around." 
 
 Reply. — 1. Don't get overheated while indoors. The house temperature 
 should be between 68 and 70 degrees (Fahrenheit), and the windows kept 
 open to allow the constant changing of air. 
 
 2. Sponge your chest with cold water every morning. 
 
 3. Wear woolen socks. 
 
 4. Throw away chest protectors. 
 
 Treatment for Cold. — A. M. D. writes: "Will you please outline what 
 treatment could be given at home for the dangerous sort of colds such as 
 you described in the paper? There are many who would take the time and 
 trouble to do the right thing if they hnew what it was, but who cannot 
 afford a physicians attendance every time a cold is contracted. Can you 
 tell me what causes the painful sensation in my nose when I exhale a deep 
 breath or sneeze in cold weather? What sort of treatment could be given 
 at home for catarrh of the nose?" 
 
 Reply. — Go to bed, take a purge, drink an abundance of water. You 
 must have a chronically infected area in your nose. Catarrh may be any 
 one of several conditions. I think yours must be due to the inflamed sore 
 spot. You should have your nose examined and treated. 
 
 Cold Contagious. — C. L. R. writes: "When do you consider a cold con- 
 tagious? For three days I have had a bad sore throat, and now my cold 
 is in my head. Is it now contagious?" 
 
 Reply. — Yes ; you are right at the time of maximum danger. 
 
 Habits May Be Are Cause. — W. L. M. writes :"1. Please explain why 
 cathartics do not relieve a chronic cold which lasts throughout every win- 
 ter? 2. Does the fact that I travel through Illinois and Iowa constantly 
 make this cold chronic? 3. Are Rochelle salts safe for a purge? k- Will a 
 good purge, used frequently, stop the lodging of the refuse from the bowels 
 at the rectum?" 
 
 Reply. — 1. The use of cathartics will not benefit a chronic cold. 
 
 2. No. Blame yourself and let Illinois and Iowa alone. See if some 
 
34 COLDS— CATARRH— SORE THROAT 
 
 physician cannot tell you what is wrong with you or which of your habits 
 needs to be changed. 
 
 3. Yes. 
 
 4. It is good judgment to take a purge to remedy some temporary symp- 
 tom, for example a fresh cold, a headache, an attack of vertigo. To take 
 purges regularly or frequently is the summit of folly. 
 
 Complains of Colds. — Sufferer from Cold writes: "My wife insists that 
 to get fresh air the windows and doors should he open. We seem hardly 
 over one cold or cough before we get another, and I am sure it is caused by 
 the drafts in our sleeping rooms, the windows and doors being open all the 
 time. Every time I speak of this I am informed that you advise fresh 
 air. If you will let us have a line or two on this subject, I am sure that 
 many will thank you; I know I shall/' 
 
 Reply. — Your sleeping room should have the window wide open. The 
 temperature should be 40 to 50. A screen should keep strong wind from 
 blowing across your bed. You should have enough cover to keep warm. 
 
 If you "sleep cold" you will have neuralgia, cold, or something else. If 
 you "sleep warm" in a cold room, you must look elsewhere for the cause of 
 your colds. 
 
 Is your office too hot or dry? Do you ride in crowded cars? Do you 
 avoid breathing the breath and mists from other people ? Are your throat, 
 nose, tonsils, and teeth in good clean condition? 
 
 How to Prevent Colds. — Mrs. A. B. C. writes. "1. I have a cold in my 
 head and I'm aching and sore below the breasts and around the ribs. My 
 back is sore and aches. I have a slight cough. Does this mean my lungs 
 are affected or is it pleurisy? 
 
 "2. How can one who is subject to colds prevent them? Does chronic 
 constipation have anything to do with it? This soreness in the ribs I have 
 most of the time, even when I have no cold. My doctor says it's sore 
 
 Refly. — 1. Your physician probably is right, since you have the pain 
 in your chest most of the time. A cold accompanied by general aching 
 pain around the ribs, and a little cough, all coming on as an acute attack, 
 usually means pleurisy. 
 
 2. By keeping the tonsils and teeth clean and the bowels open ; by eating 
 moderately; by sleeping in a well-ventilated room and keeping out of hot, 
 ill-ventilated, and especially crowded places; by taking cold air or cold 
 water baths. 
 
 Take Care of a Cold. — J. G. A. writes: "I notice in your article of 
 'How to Live to a Happy Old Age' you speak of avoiding pneumonia by 
 taking care of a mild cold, etc. Please tell us how to take care of a mild 
 cold. 'Take care of a cold' or 'do not neglect a cold' means but one thing 
 to the masses who read it, and that is to dose one's self with some of the 
 various brands of cough syrup, a meaning which you and other physicians 
 do not intend to convey." 
 
 Reply. — To take care of a cold means: (1) to take a purge; (2) to eat 
 lightly; (3) to go to bed and stay there until the fever and aching has 
 ended. 
 
CATARRH 35 
 
 CATARRH 
 
 Colds are due to bacteria. These germs locate somewhere on the lining 
 of the nose. They travel along the surface and find their way into the cavities 
 that open off the nose. We might compare this process to an overflowing 
 stream. 
 
 When the acute infection subsides in the nose proper, a suppurating area 
 is left behind, usually in some one of these cavities. When the overflow sub- 
 sides everything drains off and dries out except certain low places that stay 
 like malaria-breeding, snake-infested ponds. 
 
 These sinuses, or cavities, discharging pus that drains into the nose 
 periodically is what is called catarrh. From such pools are absorbed the 
 poisons which cause the suffering of so-called catarrh. From them are ab- 
 sorbed some of the germs which cause rheumatism and rheumatoid arthritis. 
 They are responsible for various forms of neuralgia, some of which are not 
 easily diagnosed. 
 
 Inflammation of the nose caused by colds and grip may extend upward 
 through the eustachian tube to the middle ear. When this occurs the lining 
 of the tube often closes the passage through it so that fluids forming in the 
 middle ear cannot escape into the throat. These conditions are sometimes 
 present in such quantities that they break through the drumhead, and the 
 fluids are discharged externally. 
 
 Such conditions may cause severe pain (earache), which nearly always 
 subsides with rupture of the drumhead and discharge of fluids and pus. 
 When the matter reaches this stage it should be regarded as serious. 
 
 If people would hear well when they are old, they should take good care 
 of their ears in their younger days. To do this the nose and throat should be 
 kept healthy, and earache or running ear properly treated early. 
 
 Nose diseases are responsible not only for ear and other diseases; they 
 are responsible for many eye disturbances. Hence, before having glasses fitted 
 to your eyes, it is well to discover if there is some nose disease present. If so, 
 this should be corrected, and then the eyes cared for. In many cases after the 
 nose disease is cleared up eyeglasses are no longer needed. 
 
 Chronic Catarrh. — Reader writes: "I am troubled with chronic catarrh. 
 Is there a cure, climatic or medical?" 
 
 Reply. — Chronic catarrh means nothing. There are about as many 
 different conditions called chronic catarrh as there are kinds of men called 
 Smith in a city directory. Find out from a throat and nose physician what 
 your trouble is, and have done for it whatever is advised. "Shotgun" 
 douching slops are useless. 
 
 Catarrh. — H. M. I. writes: "If one has catarrh is it oeneficial to spray 
 the nose and throat? If so, will you please tell me what preparation to use, 
 and how often?" 
 
 Reply. — It will help to keep the nose clean and, in this way, will be 
 of some service. Use Seiler's or Dobell's Solution. Your druggist will 
 furnish either. The proper policy for you is to go to a nose specialist, find 
 
36 COLDS— CATAEEH— SOKE THEOAT 
 
 out what is the matter with you, and have the condition corrected. Catarrh 
 is only a symptom. There is no such disease. 
 
 Catarrh a Symptom. — L. E. writes : "You recently declared "catarrh is 
 a symptom." As I am troubled with what is commonly called nasal catarrh, 
 I would be interested in knowing what it is a symptom of." 
 
 Eeply. — Catarrh is a symptom of any one of several conditions, such as 
 enlarged turbinated bones, spurs on the septum, polyps, chronic infection of 
 the nose, chronic infection of some cavity leading from the nose. Still oth- 
 ers might be mentioned. Is it wise, when a disease is known by a catch-all 
 name, to try to treat it as if it were one and the same condition in everybody 
 who has it? 
 
 Vaccine for Nasal Catarrh. — H. H. writes: "Will you please tell me 
 if there is a cure for nasal catarrh? Is there a cure for a man who has 
 been wearing glasses for the last six years, such that he will not have to 
 wear them? Will nasal catarrh give a person weak eyes?" 
 
 Eeply. — 1. Suppose you try a vaccine. Your physician will direct you. 
 
 2. I don't think so. Nearsightedness starting in childhood is sometimes 
 so corrected by the changes due to age as to make it possible to leave off 
 glasses. I don't think you belong in that group. 
 
 3. No. 
 
 See a Physician. — C. D. F. writes: "What causes catarrh, and is there 
 no cure for it? Do you think the advertised patent medicines for catarrh 
 safe?" 
 
 Eeply. — The advertised remedies are useless at best. Many are harm- 
 ful. Have a physician find out just what is the disease in a case of so- 
 called catarrh. Most nasal diseases are curable. Some are the effects of 
 neglected conditions. These generally cannot be remedied. 
 
 Catarrh of the Head. — Reader writes: "What do you consider the best 
 cure for a catarrh of the head, especially ringing or buzzing of the ears? 
 Are Glaubers salts helpful for constipation?" 
 
 Eeply. — Catarrh of the head is a term used loosely to cover several dif- 
 ferent conditions. Find out which you have and have that one treated by 
 a competent physician. As to Glauber's salts, no. 
 
 Treatment for Catarrh. — F. E. Z. writes: "Will you kindly inform me 
 whether or not there is a cure for catarrh (chronic) ? A physician advised 
 me that the only cure was a change of climate, and that not always a cure." 
 
 Eeply. — Find out what is the condition in your nose. Many different 
 conditions are called catarrh. Some are cured by operation, some by 
 change of climate, and some in other ways. Many cases are of no con- 
 sequence. Catarrh does not lead to consumption or any of the so-called 
 catarrhal states played up in the advertisements. 
 
 Offensive Breath and Catarrh. — M. E. C. writes: "Is there a cure for 
 catarrh of the head, causing bad breath? I have taken patent medicine, 
 but the catarrh returns/* 
 
 Eeply. — The form of catarrh causing bad breath is known as atrophic 
 rhinitis. In this form the mucous membrane has shriveled and its glands 
 
 
SORE THEOAT 37 
 
 secrete but little moisture. Hard, dry scabs form and these decay, causing 
 the odor. The National Association of Nose Specialists has a committee 
 to find out what it can about this condition, what causes it, and what cures 
 it. Some physicians recommend injecting paraffin under the membrane of 
 the septum. Frequent and thorough washing keeps down the odors. Patent 
 medicines and catarrh remedies will do you no good. 
 
 SORE THROAT 
 
 Grown persons as well as children suffer from sore throat. Dust, damp- 
 ness, diphtheria, and other germs are the chief causes. Sudden chilling of 
 bare feet, coddling, mouth breathing, overcrowded and overheated dwellings 
 sometimes serve as the beginnings. 
 
 The distinct germ infections, particularly diphtheritic sore throat, are the 
 most serious. Children are attacked more frequently. Their close association 
 at home, at school, and at play helps the disease to spread amongst them. 
 
 Sore throat in young or old should not be neglected. The first principle 
 of treatment is not to get it. Avoid overcrowded and overheated places, mouth 
 breathing, and coddling. Avoid contact with people who have sore throat. 
 
 Simple sore throat in healthy adults is not often serious unless it recurs 
 frequently. Sore throat in children is always a serious proposition for the 
 following reasons : 
 
 1. They "catch" it easier. 
 
 2. They cannot be depended upon to guard against it. 
 
 3. It is more often diphtheritic. 
 
 4. Some are too young and others don't know enough to complain of it. 
 
 5. They are very apt to develop the form of sore throat known as 
 "croup." 
 
 6. Their resistance to disease is not so great. 
 
 7. If they get diphtheria it often leads to very serious after results, hin- 
 dering growth or permanently maiming. 
 
 Sore throat in a child should be given immediate attention. Complaint of 
 the child or the following symptoms should put you on guard : 
 
 1. Fever ishness. 
 
 2. Paleness. 
 
 3. Difficulty in swallowing. 
 
 4. Croupy cough. 
 
 5. Hard breathing. 
 
 6. Running of the nose. 
 
 7. Swelling of the neck below the ears. 
 
 If you notice any of these symptoms, call your doctor at once. Many 
 mothers do not call a physician until they see white patches in the throat. 
 Don't wait for that. That is giving the disease a good start and the child 
 a possible bad finish. The membrane may be in the windpipe and not vis- 
 ible. 
 
 Castor oil, cloths about the neck, ham slices and turpentine, which 
 mothers frequently use, do not cure sore throats. In diphtheria they are 
 positively injurious on account of the loss of time occasioned by them in get- 
 ting the proper treatment. 
 
38 COLDS— CATARRH— SORE THROAT 
 
 If your child has a sore throat do not trifle with it, do not neglect it, do 
 not attempt to "cure it up" or to cover it up. The best and only thing to do 
 for the child with sore throat is to call in a physician. 
 
 Hoarseness. — Mrs. G. R. H. writes: "I am a woman of 50. When 
 younger I had a good voice, but now I grow hoarse after singing a few 
 lines. Talking is difficult sometimes. 1. What causes it? 2. Can anything 
 be done? 3. What causes a neuralgic condition of the bowels? The pain 
 is mostly of a heavy, dull nature instead of sharp and cutting. If. Can 
 anything be done to prevent it? I have been troubled with it at times for 
 five years. 5. Is there any remedy?" 
 
 Reply. — 1. You probably have nodes, cord nodes, or a chronic laryngitis. 
 
 2. See a throat specialist, particularly one who has had experience in 
 treating singers and speakers. Perhaps the condition can be remedied. 
 Probably, however, it cannot be. In those cases where help is possible it 
 means a good deal of trouble and expense. 
 
 3. Pain in the abdomen may be due to different things, such as gall- 
 stones, intestinal ulcers, appendicitis. Have a physician find out what is 
 the cause of your pain. The answer to your other questions is dependent 
 on the answer to the third. 
 
 "Wash the Throat Daily. — A. L. F. asks: "1. Would the daily use of a 
 throat wash be advisable? 2. If oxygen in air is good for us why not 
 breathe oxygen out of a tank?" 
 
 Reply. — 1. Yes. It is wise to wash the teeth, gums, tongue, and throat 
 every day. 
 
 2. Good pure air is 1 part oxygen, 4 parts nitrogen, a trace of carbonic 
 acid, and a little moisture. Pure oxygen is not so good for a well man as 
 pure air. There is such a condition as "too much of a good thing." Pure 
 air contains about the best proportion of gases for human use. The harm 
 that is done by bad air is due to the impurities in it rather than to a lack 
 of oxygen. 
 
 Trouble in Throat. — C. C. C. writes: "I have been troubled of late 
 with a swollen throat; at times it is so bad I can hardly swallow. I am 
 continually troubled with a cold, and have a large lump in my throat, and 
 expectorate small lumps of a yellow, heavy substance. What are adenoids? 
 Do you think my tonsils are affected? I have had medical examination 
 several times, but have been advised that I had nothing but a cold, and 
 was prescribed for accordingly. Do you think the bad atmosphere and poor 
 ventilation of the office in which I work can have anything to do with the 
 case? I am otherwise in perfect health, and am a hearty eater." 
 
 Reply. — Adenoids are enlarged lymph glands in the back part of the 
 throat, "behind the soft palate. As you tell me nothing about your tonsils, 
 I cannot judge whether they are affected. It seems to me quite certain that 
 you have some mild infection somewhere in your upper breathing appara- 
 tus, and a poorly ventilated office is the most likely cause. 
 
 Sore Throat. — M. C. G. writes: "I suffer with sore throat constantly, 
 summer and winter. The crypts in my tonsils fill with white matter and 
 I am told my throat is sore on account of being always infected. Is it a 
 
SOEE THROAT 39 
 
 coincidence that I have a sore throat every time I get damp or chilled? Or 
 has this something to do with the process of infection?" 
 
 Reply. — Chilling or getting damp causes some of the bacteria in the 
 crypts to infect you. You can be infected by bacteria in the crypts of 
 your tonsils as readily as by those in the throats of other people. Have a 
 physician empty the crypts at intervals or else have him remove your 
 tonsils. 
 
CHAPTER VI 
 
 Cough — Asthma 
 
 COUGH 
 
 Whenever there's a cough there's a reason. A cough means that some- 
 thing is irritating the coughing center in the brain. The brain has a cough 
 center just as it has a speech center. A brain center is like a telephone switch- 
 board. It is a collecting place with incoming and outgoing wires. There may 
 be trouble in central, whereupon the ability to cough is lost and the bronchial 
 tubes fill up with secretion. The man may drown in his own secretions. 
 
 The irritations capable of 
 causing cough come over eight in- 
 coming lines: 
 
 1. From the brain covering — 
 of no consequence. 
 
 2. From the ear canal. No- 
 tice the tendency to cough when 
 you remove wax from the ears. 
 
 3. From the upper back part, 
 of the mouth and nose — a trunk 
 line frequently used. 
 
 4. From the back part of the 
 tongue down the windpipe to the 
 vocal cords. This trunk line keeps 
 the windpipe clean. 
 
 5. From the lower windpipe 
 and lungs. This trunk line keeps 
 the smaller air tubes clean and 
 gives air a right of way. 
 
 6. From the heart — a little 
 used wire. 
 
 7. From the esophagus — 
 usually a dead wire. 
 
 8. From the stomach — gener- 
 ally a useless trouble maker. 
 
 Any irritation along any of these lines may result in a cough. If the 
 irritation comes in over Trunk Line 4 or 5 it means that somewhere in an air 
 passage something has got in the tube and an effort is being made to clear it 
 out. When the message comes in over Line 5 it means that the lungs are 
 trying to help themselves. The lungs have but this one way to cry. They 
 have but few ordinary nerves — nerves to register heat, or cold, or pain. 
 When there is pain in the chest it is in the chest wall or pleura. 
 
 40 
 
 Fig. 15. — Looking Down the Windpipe from 
 Above, Showing Vocal Cords. Glottis 
 closed — half open — wide open. 
 
COUGH 
 
 41 
 
 If the small bronchials send in a complaint that there is pus and mucus 
 in the way and that air is being kept out the coughing center sends down a 
 muscle impulse. A cough results and the offending pus is moved out of the 
 way. 
 
 A cough that brings something up is helpful. We divide coughs, there- 
 fore, into those that are helpful and those that are useless. Helpful coughs 
 are to be encouraged; useless coughs are to be discouraged. 
 
 Eight there is the keynote to the treatment of coughs. The old style 
 plan was "to take something for a cough/' to take the same thing for every 
 cough. That something usually was an opium mixture. Often this practice 
 worked out this way : The lungs sent up a message, "Send me a cough to clear 
 the airways." The answer was a dose of opium, which cut the telephone wires 
 and left the lungs floundering. 
 
 USELESS COUGHS 
 
 A cough that does not clear out something is a useless cough. Useless 
 coughs should be suppressed. The way to suppress the cough is by remedying 
 the cause — if it can be done. 
 
 Sometimes the cause is wax in the ear — remedy is easy. 
 
 Sometimes it is eczema in the ear canal — remedy is more difficult. 
 
 Soprano. 1024 
 
 256 
 
 m 
 
 Cgatrafto> 
 
 684 
 
 EFGAB cdefigab c'd'e / .fg'a'b / 
 
 t 1 , f 
 
 r 
 
 80 
 
 c" d" e" £ " g" & \T € 
 
 342 
 
 m 
 
 Tenor. 
 
 512 
 
 Fig. 16. — The Average Range of the Human Voice, c' to f is common to all voices. The 
 'figures indicate the number of vibrations per second in the corresponding tones. (Landois 
 and Stirling.) 
 
 Sometimes it comes from smoking or dust — easy to suggest the remedy, 
 but hard to get it carried out. 
 
 Sometimes it is the result of other irritation in the upper air tubes. Il- 
 lustrations of this group are elongated uvula, enlarged tonsils, large turbinate 
 bones, polyps in the nose. The remedy is removal of the irritating tissue. 
 
 Sometimes the irritation is due to causes operating indirectly on the nose 
 and throat; for example, coughing spells when the skin is chilled or is over- 
 heated. Of this group are the coughing spells that develop in the theater, 
 those that come on in other warm, closed rooms, also those that develop as the 
 temperature of the bedroom changes during the night. The remedy for this 
 group is better temperature regulation. 
 
 Sometimes a coughing spell starts when one lies down. Think of an 
 elongated uvula as a probable cause. 
 
42 COUGH— ASTHMA 
 
 If the coughing spell comes on as the result of exertion the cause may be 
 heart disease or pressure on an air passage, from an aneurism or a tubercular 
 gland attached to an artery wall in the chest. 
 
 Finally there are the stomach coughs. Even when the cough is for the 
 purpose of clearing mucus and pus (called sputum) out of the air tubes a 
 good many of the coughing spells will bring nothing up. Those particular 
 coughing spells have been useless. The irritated apparatus is temporarily 
 set on hair trigger and it "goes off half cocked" about as often as otherwise. 
 
 The offending mucus is gradually being worked from the air cells toward 
 the larger tubes by tiny hairs called ciliae. After it has worked far enough up 
 the lines the cough can catch up and carry it away. 
 
 The movement by ciliae is slow, by cough fast. When one's coughing ap- 
 paratus is on edge it keeps grabbing at the mucus before it gets in reach or 
 before it can get a hold on it. 
 
 Such coughing spells are useless. They are worse than that. They hurt 
 the air tubes and air sacs ; they tire the muscles ; they use up energy. 
 
 Where there is consumption, pneumonia, bronchitis, or colds, anything 
 which results in mucus and pus in the tubes, such coughing as produces 
 phlegm should be encouraged. Such as is unproductive should be discouraged. 
 
 WHAT TO DO FOR A COUGH 
 
 The first question to be answered is, Shall anything be done for a cough ? 
 The old policy of taking medicine for a cough beyond question was harmful. 
 It made dope fiends. In most cases nature went ahead and cured the cough 
 in spite of the dosing with morphin-filled expectorants. The expectorants 
 got the credit because nobody thought to try nature without expectorants, and 
 therefore nobody was able to say which cured the quicker. 
 
 The proper answer to the question depends on the cough and the cougher. 
 Coughs are divided into useful and useless. Useless coughs should be discour- 
 aged. How? If the cause can be removed, the way to discourage the cough 
 is to remove the cause. If the cough is due to warm, bad air the proper pro- 
 cedure is to get into fresh air — not to take cough drops. If you doubt this, 
 go to any fresh air consumption hospital and listen for coughs. Fresh, cool 
 air is a better cough allayer than paregoric. 
 
 But not all of the freedom from coughs at a sanitarium is due to fresh 
 air. The patients are trained not to cough uselessly. They learn to cough 
 when they need to in order that the tubes may be cleared out. They also 
 learn not to cough when there is no need for it. 
 
 How do they tell ? Nobody can tell. But there is a little different "feel" 
 when the something is in reach. Any one can speedily learn this "feel" — and 
 then comes the effort to resist the impulse to cough when the "feel" is not 
 present. Ofttimes the force of will is sufficient. When it is not there comes 
 the question of cough medicine. There are times when the hair trigger state 
 can be calmed down better by a dose of cough medicine than in any other way. 
 
 There is a field for cough medicines. The mistake comes in promiscuous 
 doping for coughs. There is even a field for cough medicines containing 
 opium. But they do more harm than good if they are used longer than a few 
 days, or habitually, or indiscriminately. The so-called consumption cure cough 
 
ASTHMA 43 
 
 medicines are safer now than they were before the food and drugs act of 1906. 
 The amount of opium, codein or heroin contained is printed on the label. 
 Previous to the act some of them had more opium inside, but whether more or 
 less none of them told on the label how much opium was contained or that 
 any was present. 
 
 The answer to what to do for a cough should include an answer to what 
 to do with the sputum. The answer is to burn it or cook it regardless of the 
 cause of the cough. 
 
 Mild Climate Needed. — J. A. W. writes: "A lady, aged 70, has been 
 troubled for three or more years with coughing spells at night and some- 
 times during the day, raising a slimy mucus, which, when examined, indi- 
 cated no consumption, the doctor stated. He calls it bronchitis. Will 
 such affect the lungs? Can bronchitis be cured? If so, where? The 
 same lady also has an inward goiter of small size. Would it produce 
 coughing spells, as above? Can it be cured? If so, where? The coughing, 
 when started, lasts quite a while and completely tires her out. It is more 
 noticeable in winter than in summer. Please express your candid opinion." 
 
 Reply. — Chronic bronchitis in an old woman may not be due to con- 
 sumption. Such a bronchitis may bring on a bronchial asthma, make the 
 person short-winded, or some other inconveniencing condition. If you 
 can find a cause for the bronchitis and remove it, you will get well. If it 
 is due to a change in heart or kidney, or blood vessels, due to age, you 
 probably will not get well. A milder climate — the South or California — 
 will help you if you can be comfortable and happy away. Goiter occasion- 
 ally causes coughing through pressure. In a person of TO it is rarely 
 advisable to be operated on for goiter. 
 
 Chronic Cough. — J. H. writes: "I am continually suffering from a 
 cough, and I am always coughing up gray pus. What is the cause of this?" 
 
 Reply. — It is bronchitis. It may be a tubercular bronchitis, otherwise 
 consumption. Get your sputum, the gray pus, examined right away. The 
 examination will show whether it is a consumption bronchitis or some 
 other sort. 
 
 ASTHMA 
 
 The object of breathing is to get oxygen into the blood and waste gases 
 out of it. Whenever the breathing center in the brain feels the need of more 
 oxygen and less carbonic acid and at the same time the passage of gas be- 
 tween the lungs and the blood is interfered with, the condition is called asthma. 
 
 In asthma the patient feels the need of air. So far as he can see there 
 is no reason why his blood cannot take it up, but somehow or other it does not. 
 And that is asthma — a yearning for air which somehow cannot be satisfied. 
 It is just a symptom, not a disease at all. Therefore Stedman's dictionary 
 gives eighteen kinds of asthma. 
 
 Sometimes the trouble is with the kidneys, sometimes with the heart, 
 sometimes with the thymus, nose, the sex organs, the tonsils, the nervous 
 system, the bronchial tubes — anything that prevents a free play of gases be- 
 tween the lungs and the blood and leaves the breathing centers on edge to 
 help out. 
 
44 COUGH— ASTHMA 
 
 Asthma comes in paroxysms. It may disappear entirely and for a long 
 time or it may continue without inter mittence, getting better and worse. 
 Spells generally come on at night. Bad weather may bring on an attack. So 
 may any emotional disturbance or a bad cold. ' 
 
 In a bad attack the patient has to stop everything else and work at the 
 job of breathing. He sits up because that is the easiest breathing position. 
 He may seek an open window. His face registers distress. His abdominal 
 breathing is exaggerated; his chest breathing, strange to say, is below normal. 
 He coughs. The mucus rattles in his bronchial tubes. 
 
 The theory is that the reason asthma gets worse and better by spells is 
 because the muscles surrounding the small bronchial tubes contract spas- 
 modically and then relax. When they contract a paroxysm of asthma results. 
 When they relax breathing becomes easy again. 
 
 These small muscles are not at the end of the bronchial tubes. The end 
 of the tube is an air sac, and that has no muscle in its wall. But when the 
 muscles in the tube walls spasmodically close down the shape of the air sac is 
 changed. It cannot do its work and the blood vessels cannot get oxygen from 
 it or feed it carbonic acid, as is normal. 
 
 All asthmatics have bronchitis a good part of the time and some of them 
 have it all the time. Nevertheless, bronchitis is an attachment of asthma and 
 not an essential. 
 
 Being no one disease, asthma has no one treatment. What helps one 
 asthmatic is of no service to the next. One man finds relief by having his 
 nose treated. Another gets well by changing to a dry climate, where his 
 bronchitis dries up. A third finds relief from changing to a vegetarian diet, 
 eschewing meat, milk, eggs, and all other foods rich in the amino-acid, 
 histidin. 
 
 Because one man has been cured by a given procedure it does not follow 
 that the next will be benefited by it. The proper plan is a careful study of the 
 given case, and that, too, before the disease has run too long. Men get the 
 asthma habit just as men get the fit habit in epilepsy, and after the habit has 
 been well established the symptom may persist after the cause has been re- 
 moved. 
 
 Incipient Asthma. — A. B. L. writes: "Is asthma a form of tubercu- 
 losis? What treatment can be given in incipient asthma to avoid its 
 becoming chronic? If a patient sleeps with much air in the room will it 
 bring on an attach? Could asthma symptoms be mistaken for symptoms 
 of goiter?" 
 
 Reply. — 1. Asthma is not a form of tuberculosis. 
 
 2. To prevent incipient asthma from becoming chronic, avoid all irrita- 
 tion that brings on an acute attack. 
 
 3. Much air in the room will not bring on an attack if the current of 
 air is directed so as not to strike the body directly. A slanted board put 
 into the open portion of the window, so as to direct the current of air up- 
 ward, or a cloth hung across the open space will do that. 
 
 4. Asthma is not usually mistaken for goiter. The two conditions may 
 be associated. 
 
 5. Asthma is frequently a symptom of heart or kidney disease. Is it 
 with you? 
 
ASTHMA 45 
 
 Curability of Asthma. — W. T. H. writes: "Kindly let me know if 
 there is any positive cure for asthma that you hnow of. I know it can be 
 helped through medicine; also that a change of climate sometimes effects 
 a cure." 
 
 Eeply. — Some cases of asthma are due to heart disease, some to kidney- 
 disease, some to bronchitis, some to polyps, etc. The question as to the 
 curability must be answered for each case. 
 
 Find Underlying Cause. — M. R. writes: "Is chronic bronchitis curable? 
 If so, how? Life in New Mexico for more than a year has made the cough 
 worse. Do you believe the more even temperature of southern California 
 would be better, even if more moist?" 
 
 Reply. — 1. The curability of chronic bronchitis is determined by what 
 is back of it. Most cases are due to tuberculosis. Many are asthmatic; 
 many are due to heart disease. What is to be done is to be determined by 
 what underlies it. If tuberculosis, no climate will be so helpful as the one 
 you are in. If asthma, try a vaccine. If heart disease, at whatever altitude 
 your heart works best you will find the most ease. 
 
 Bronchial Asthma. — R. N. D. W. writes: "Kindly give advice regard- 
 ing bronchial asthma. If a man in the forties has had asthma only two 
 years, it following a case of the grip, should he not get over it?" 
 
 Reply. — Can't you get back of that diagnosis ? Many cases of bronchial 
 asthma are in reality consumption. Some cases are due to heart disease, 
 some to Bright's disease, some to growths in the nose. In a case of asthma 
 the first thing to do is to find if there is a curable cause, and then to cure 
 it. The case of asthma which cannot be cured is about as hard to do any- 
 thing with as any disease I know. Climate helps more cases than any- 
 thing else. 
 
 May Be Asthma. — Mrs. E. R. writes: "My daughter is troubled with 
 shortness of breath. Sometimes it is hard for her to breathe. What is 
 this caused by? Is there any danger?" 
 
 Reply. — I can do nothing more than guess. My guess is that she lias 
 asthma. Her asthma may be due to heart disease or kidney disease, or it 
 may be ordinary asthma, called bronchial asthma, or it may be due to other 
 causes. Nobody is justified in allowing shortness of breath to run on. 
 Always find out what lies behind it. It may mean a most dangerous 
 condition or it may mean a disturbing but not a dangerous condition. 
 
 Various Causes for Asthma. — J. R. L. asks what is the best cure for 
 asthma and how to keep from getting asthma t 
 
 Reply. — There is no "cure" for asthma. There 'is neart asthma, which 
 can be partly relieved by treating the heart; kidney asthma to be treated 
 by treating the kidney ; asthma due to reflexes from nose conditions, to be 
 treated by treating the nose, and asthma associated with clironic bron- 
 chitis, the cause of which is not yet worked out. Because one case of 
 asthma has been relieved by a given remedy does not mean that the same 
 treatment will help the next man. The so-called asthma cures seldom do 
 good, and, taken indiscriminately, may do harm. Some of them lead to 
 drug habits. 
 
CHAPTER VII 
 
 Bronchitis — Hay Fever 
 
 BRONCHITIS 
 
 The bronchi are the tubes which carry the air to and from the air sacs. 
 The first part of the air tube is the nose, the second part is the pharynx, the 
 third is the larynx, and the fourth the trachea. 
 
 After the tube has reached the root of the lungs it branches, sending one 
 tube to each lung. From the point of branching on the air tubes are called 
 the bronchi. 
 
 It will be noted that the bronchi lie deep in the chest. Immediately 
 after the division each bronchus enters the root of a lung and immediately 
 divides. The constantly dividing tubes get smaller and smaller until the name 
 
 bronchioles is applied to them. The air 
 sacs open off the bronchioles. 
 
 Bronchitis is inflammation of the 
 bronchial tubes. Theoretically the in- 
 flammations of the larynx are called 
 laryngitis and those of the trachea are 
 called tracheitis. In everyday life we are 
 apt to call any inflammation of the air 
 passages which results in cough bron- 
 chitis. 
 
 As the air 
 chial tubes has 
 
 which enters the bron- 
 not been filtered of its 
 bacteria, infections of the bronchi are fre- 
 quent. In fact, bronchitis is a bacterial 
 disease. Practically there is no cause of 
 bronchitis except germs. Every case of 
 acute bronchitis is a case of infection. 
 The same may be said of chronic bron- 
 chitis, for even in those cases when the 
 first cause was not an infection infection 
 soon occurs and remains thereafter the most prominent element in the case. 
 The prominent symptom of bronchitis is cough. The cough is the result 
 of irritation of the nerves of the bronchial tubes. Impulse to cough is fur- 
 nished by these nerves. The force of cough is furnished by the muscles of 
 the abdomen, the diaphragm, and the chest wall. 
 
 The "soreness in the lungs" in bronchitis is not soreness in the lungs. 
 The lungs do not have that kind of sensation. The soreness is in the muscles 
 
 46 
 
 LOWER BORDER? 
 PLEURAL 
 
 Fig. 17. — Location of the Lobes of 
 the Lung and of the Diaphbag- 
 matic pleuea. 
 
HAY FEVER 47 
 
 overworked by the effort of coughing. If there is sputum in the bronchial 
 tubes and a current of air can be got behind it it will be coughed up. The 
 muscles of the chest or of the bronchial tubes do not directly expel the 
 sputum; the force is the blasts of air which we call coughing. 
 
 The above statement of facts is meant to be informing. Now let me add 
 a practical point. Nine times out of ten a cough will do better without cough 
 remedies than with. Cough remedies contain two types of medicine. One is 
 a group called expectorants, such as carbonate of ammonia, muriate of am- 
 monia, squills, tolu, etc. Careful experiments have shown that these medi- 
 cines do not loosen the phlegm or cut it or affect the cough in any way. They 
 do nothing but ruin the stomach. Therefore mark this, never take any cough 
 medicine that contains any one of them or any other expectorant. 
 
 The other group comprises the sedatives. The most frequently used of 
 these are heroin, codein, and morphin. If a cough is dry, hacking, and per- 
 sistent a dose of cough medicine containing a sedative will do good. 
 
 The object of cough is to clean the tubes. If it does not do that it is 
 doing some harm. Therefore one is justified in taking a sedative for a useless 
 cough. 
 
 However, forget not the harm which comes from overindulgence in 
 heroin, codein, and morphin. Unless they are used judiciously the remedy is 
 worse than the disease. 
 
 Chronic Bronchitis. — M. R. P. writes: "What can I do for a child who 
 has coughed most of the time since she was 9 months old? She is now 6V2 
 years old. She coughs at night, at times two hours steadily, then again 
 from 5 o'clock in the morning until she gets up in the morning. She has 
 slept on the porch since last May. Would you advise sleeping indoors 
 while coughing so hard? Have tried camphorated oil and almost every- 
 thing without success." 
 
 Reply. — I judge the child has a chronic bronchitis. This condition 
 does not threaten life, but it is hard to do anything with. It is likely to 
 keep hanging on. Is it possible to keep her in the dry region of the south- 
 west for a while — say western Texas, Arizona, or New Mexico ? Wherever 
 she is, she must lead the most hygienic out-of-door life possible. As to 
 sleeping out, I would say make proper arrangements for her comfort and 
 have her stay out. Keep her out much of the time during the day also. 
 Feed her up well. These are the lines toward which to look for help rather 
 than applications of oil and other things to the chest. 
 
 HAY FEVER 
 
 For a long time people scoffed at hay fever; said the sufferers were hys- 
 terics, neurasthenics, and faddists; that everybody had summer colds; that 
 the poor man called his sickness a cold and stayed at home; while the rich 
 man called his hay fever and took a long vacation. There are still people who 
 scoff, but they are not so aggressive as they were. 
 
 Medical science has gone far enough to clear the hay fever sufferers of the 
 charge of bad faith, without, however, having gone far enough to cure or pre- 
 vent the disease with any degree of certainty. The science has worked out 
 the basic, pathologic principle of the disease, has found a way to help some 
 
48 
 
 BRONCHITIS— HAY FEVEK 
 
 cases, but for the great majority it cannot do much more than tell them when 
 to run and where to run to. 
 
 Fig. 18. — Wormwood (artemesia absinthium). (Dr. William Scheppegrell.) 
 
 For a long time it has been known that certain persons were capable of 
 being violently poisoned by substances which were not in the least poisonous 
 to the general run of people. For instance, while hay fever appears at any time 
 of the year, two usual varieties are recognized — the spring and the fall. The 
 hind that comes in the spring is attributed to the pollen of different hinds of 
 grasses, hays, and sedges. 
 
HAY FEVER 49 
 
 In addition a man having an idiosyncrasy toward horses would sneeze 
 violently whenever he came near one. Another would eat a salad containing 
 some lobster, and within a few hours would be badly broken out. 
 
 A certain physician took anti-plague serum when he was working at the 
 suppression of plague in California. For ten years thereafter, and perhaps 
 even yet, he broke out in great wheals whenever he got into cold water. 
 
 A term used to designate this peculiarity was idiosyncrasy. Some of 
 these idiosyncrasies were scientifically studied with the result that a good deal 
 was learned about a subgroup that was called anaphylaxis, or the condition 
 opposite to prophylaxis. 
 
 The idea of the scientist naming the condition was that, prophylaxis 
 having to do with protection against a poison, anaphylaxis would be a proper 
 term to use when, on the other hand, the body became exquisitely sensitive to 
 a poison. 
 
 The proof that hay fever is an anaphylaxis is not convincing. Neverthe- 
 less it seems plausible that, in hay fever, the susceptibles are poisoned by vege- 
 table irritants — pollens that are bland enough not to affect the general run of 
 people. 
 
 A person suffering from hay fever has the usual symptoms of a bad cold, 
 plus some spasmodic symptoms. His illness has a greater tendency to hang 
 on. An ordinary cold passes in two or three days through the dry stage, then 
 the watery-eye, watery-nose stage, and later, into the stage of mucopurulent 
 discharge. 
 
 The hay fever subject weeps for weeks. An ordinary cold is prone to de- 
 velop into pneumonia or rheumatism or something else serious. Hay fever 
 seems to satisfy its ghoulish glee in just being hay fever. The disease differs 
 in so many particulars from an ordinary cold that almost anybody can make 
 the diagnosis. 
 
 Elsewhere we have drawn the distinction between diseases whose harm is 
 measured by the numbers killed and others by nonfatal illness caused. A good 
 illustration of the latter group is malaria, with us a disease not important as 
 a killer of men, but important as a destroyer of human efficiency. 
 
 It is by the same yardstick that hay fever is to be measured. It does not 
 kill, but for many men it shortens the working year from twelve months to ten. 
 
 In addition, indulgence in hay fever draws on the storehouse of vitality. 
 Every experience that wears and tears draws from the bank some of the capital 
 stock with which life began, or from life's savings account, or both. 
 
 Whenever a physician comes in contact with a hay fever patient he must 
 start his consideration of the case by thinking of the patient himself; then 
 he considers the patient's nose, and, last of all, he takes dust, pollen, and plant 
 life into consideration. 
 
 Generally speaking, hay fever subjects are neurotics and neurasthenics. 
 This means that they are generally susceptible to irritants, they may be upset 
 by various things which glide from the calmer man like water from a duck's 
 back. 
 
 When it comes to treating hay fever the physician must pay a little more 
 attention to the way the patient looks at things — the psychology of the situa- 
 tion — than with the usual run of men. 
 
 Passing briefly to the second head, nasal spurs, enlarged turbinated bones. 
 
50 
 
 BBONCHITIS— HAY FEVEK 
 
 Fig. 19. — Ragweed (Ambrosiatrifida) . (Dr. William Scheppegrell.) 
 
 deviated septums, infected accessory sinuses, abnormal conditions are of im- 
 portance in many cases. 
 
 Therefore, a physician consulted by a hay fever subject should study, 
 first, the temperamental makeup of the patient, and, next, the condition of 
 the nose and the cavities leading from it. Sometimes he should prescribe 
 rest cure, psychotherapy, tonics, iron, arsenic; and proper cases will be bene- 
 
HAY FEVER 51 
 
 fited thereby. Operations in the nose, from burning with a cautery anywhere, 
 sometimes in the cavity (and one place to burn is as good as another) to 
 the removal of polypus, will help greatly. 
 
 Now let us briefly touch on washes, snuffs, and cures. Not any wash 
 is better than no wash, and some are much worse. The nasal secretion is wash 
 enough. But if the patient must have something, let him use some placebo, 
 something with no effect at all except that from suggestion. 
 
 Above everything, let him refuse to use cocain, morphin, and adrenalin, 
 and every snuff, or wash, or cure that he does not know to be free from them. 
 
 In the United States Hay Fever Association's leaflet for 1912 three pages 
 are given over to "Sneezes and Snuffles, Joy and Gloom in 1911, Experiences 
 of Members." Thirty-seven experiences are told. Some narrators were cured 
 by this thing, some by that, and some by nothing. 
 
 Hay fever illustrates well the folly of drawing conclusions from a single 
 experience, especially a personal experience, the most misleading of all experi- 
 ences. When there is a -multitude of cures, there is no cure. As Osier's 
 "Modern Medicine" says: 
 
 "Every patient who has tried the whole series of remedies is always con- 
 vinced that there is no cure for hay fever." 
 
 Having considered the temperamental basis of the disease, and then the 
 relation of the nose, we come to the aggravating cause. This disease differs 
 from an ordinary cold in that the exciting cause, instead of being a microscopic 
 vegetable called a bacillus, or a germ, is a microscopic part of a vegetable, the 
 part called the pollen. A cold may be caused by any one of several bacteria. 
 Hay fever may be caused by any one of several pollens. 
 
 In the present status of hay fever therapy interest centers in those things 
 that relate to pollens. While hay fever may develop at any time of the year, 
 most of the cases fall into the spring or the autumn group. 
 
 In this country there is little spring hay fever. The disease of the spring- 
 time is caused by all kinds of grass and hay pollens, by the pollens of different 
 sorts of sedge, by that of lilies of the valley, of cabbage, thistles, and spinach. 
 
 That of the fall comes from ragweed, golden rod, daisies, and a few 
 other plants. It is pretty well accepted that eighty per cent of the August 
 cases are due to ragweed, and practically all of the balance to golden rod. 
 
 Accepting these statements as true, there are two things to do in the way 
 of prophylaxis. The one is a community matter — to cut the weeds before 
 pollen time. The other is an individual matter — to run away from the pollen 
 which harms the individual case. 
 
 In "Sneezelets," the bulletin of the Hay Fever Association, is the fol- 
 lowing : 
 
 "Anti-weed ordinances are on the books of most municipalities, but that 
 is about all that can be said of them. Let every hay feverite write to the city 
 board of health, calling attention to specific places where the sharp edge of 
 a scythe will prevent the spread of pollen before the blooming period arrives. 
 Enforcement of the ordinances will relieve the distress of many sufferers." 
 
 In this connection we must remember that ragweed is a plant which 
 depends on the wind for fertilization of its seed by pollen. Such plants must 
 "paint with a comet's tail." There must be a wild extravagance of pollen, and 
 no anti-weed campaign will accomplish anything unless it is fairly citywide. 
 
52 BRONCHITIS— HAY FEVER 
 
 When is the time to run? Research indicates that the pollen poisoning 
 begins with the first dose inhaled, increases a little day by day, until, after a 
 few days, the flood gates break loose. 
 
 Each hay feverite knows just about the date when his attack is due. 
 He gains nothing by running from any pollen except that which poisons him. 
 The season may be a little backward or a little early, and so he may modify 
 his departure by the state of vegetation. 
 
 Having determined to go away, the question is — where ? The answer is 
 to go to a place where the harming weed does not exist or has already 
 flowered. 
 
 Many escape by remaining at sea until the season has passed. Some 
 escape by going to sections where the ground is barren. Many go to Europe, 
 where the flora is different. Some go south, where the disease is not prevalent, 
 and others go north. 
 
 The proper plan, in a general way, is to travel north or south, and to 
 travel far, rather than to go east or west. Some writers claim that the disease 
 does not exist at all in the South ; it is certain that it is not abundant there. 
 In addition, the stage of vegetation there in the middle of August differs 
 much from that of the North. 
 
 For these reasons it seems to me that a visit to the gulf coast or some 
 of the islands near by should be as good a preventive measure as one could find. 
 
 FIGHTING HAY FEVER 
 
 Many attempts have been made to vaccinate against hay fever. The 
 German remedy, pollantin, is a preventive rather than a cure. So are the 
 remedies made from bacteria. 
 
 Last year we published the suggestion of Dr. Scheppegrell of New Orleans 
 that hay fever subjects accustom their noses gradually and in advance, accord- 
 ing to a method he proposed. 
 
 The last number of the Journal of the American Medical Association 
 contains a letter from Dr. Brown of Minneapolis, suggesting another way to 
 vaccinate against hay fever. Dr. Brown's son is a hay fever subject. 
 
 Dr. Brown collected some ragweed pollen. He ground up one dram of 
 this in one ounce of glycerin. This was filtered and brought up to two ounces 
 with water. To the mixture were added five drops of strong carbolic acid. 
 He washed his son's arm with ether, placed a drop of the pollen solution on 
 the skin, and made a vaccination scratch through it. This scratch healed 
 promptly. Three days later the process was repeated. In a short while the 
 skin around the wound looked like the hives. 
 
 Dr. Brown suggests that people start with this solution diluted one 
 to one million; that the vaccinations be done once or twice a week, and 
 that the strength of the solution be increased as rapidly as possible without 
 producing hive-like swelling. All of this is to be done before the attack is 
 due. 
 
 At the New York cancer hospital, Dr. Clowes has been working on the 
 nature of hay fever. He found that hay fever subjects were exceedingly 
 sensitive to pollen. Those who had fall attacks were sensitive to autumn 
 blooming plants; those who had spring attacks were affected by the pollen 
 
HAY FEVER 53 
 
 of spring blooming plants; while those who were subject to both spring and 
 fall attacks were sensitive to both spring and fall pollens. 
 
 Dr. Clowes vaccinated through the skin and also injected hypodermically. 
 He got both local and constitutional symptoms somewhat as they are in hay 
 fever. 
 
 It seems positively proved that hay fever is not an imaginary disease 
 and the sufferers have not always been justly treated. 
 
 It seems also to be proved that the nose is not all important. Most people 
 are affected through their noses. People with polyps, enlarged bones, infected 
 cavities (the so-called catarrh) are more liable to infection than other people. 
 To treat the nose will prevent some attacks and cure others. 
 
 All of this is true, yet the nose is not all important. 
 
 Hay fever can be caused by vaccination of the skin and by injection under 
 the skin. If this information stops the use of cocain and morphin snuffs 
 and washes for hay fever, it will have done enough good. 
 
 Dr. Clowes is working on a vaccine to prevent the disease and a remedy 
 to cure it. A few favorable results have been obtained, but no opinion on a 
 remedy is of any value unless it is based upon a few hundred observations. 
 
 Hay Fever Antitoxins Good. — H. W. Z. writes: "Consideration and 
 reply to the following questions will be highly appreciated: 
 
 "1. Is hay fever antitoxin efficacious, and to what degree? 
 
 "2. From what is it derived? 
 
 "3. How long before the 'regular season should it be administered? 
 
 "k> Has it any noticeable effect on the nervous system when adminis- 
 tered, and is there any element of danger therefrom? 
 
 "5. Where can it be procured?" 
 
 Reply. — 1. There are two or three hay fever vaccines. Some of them 
 may be antitoxins, and that, I judge, you mean. The one made from 
 pollen has been in use longest. Dunbar's statistics show a good degree 
 of efficiency. Those made from bacteria are newer. Their advocates pub- 
 lish favorable results. 
 
 2. As indicated above, some are from plant pollens and others from 
 bacteria. 
 
 3. It is best to begin several months before and increase the dose 
 gradually. However, they are used after the attack has begun. 
 
 4. There is no harmful effect on the nervous system. Those of the 
 remedies that consist of the serum of injected horses are dangerous when 
 used in full strength on people who get asthma when around horses. There 
 may be some danger in the use of bacterial vaccines. 
 
 5. Your druggist. 
 
 Causes of Hay Fever. — 0. R. S. writes: "What causes hay fever? Is 
 it a sign of physical weakness? I go away every year for four or five 
 weeks. I plan while gone where to go the next year. I weigh 200 pounds 
 and am always able to eat and sleep well, but the thought of hay fever is 
 constantly on my mind. Am I in any physical danger?" 
 
 Reply. — Hay fever does not mean physical weakness. It occurs in 
 nervous people. It is quite liable to occur in neurasthenics. The imme- 
 diate cause is the pollen of some plant. You are in no more physical 
 danger than if you did not have hay fever. 
 
54 BRONCHITIS— HAY FEVER 
 
 Hay Fever Cures. — N. A. S. writes: "What causes hay fever, and is 
 there any cure for it? Have been told that it sometimes develops into 
 asthma. Is there any truth in that statement?" 
 
 Reply. — 1. Hay fever results from infection with germs or with pollen. 
 Certain types of nervous people are more susceptible than others. People 
 with certain nose conditions are more susceptible than others. As to 
 cures, yes, several — (a) the climate cure; (b) the serum cure, so called. 
 
 2. Yes. 
 
CHAPTER VIII 
 
 Pneumonia — Pleurisy 
 
 TO AVOID GRIP AND PNEUMONIA 
 
 The newspapers tell us that we are in the midst of an epidemic of grip 
 and that everybody is sick. Bad colds, pneumonia, and grip prevail, according 
 to the reports. The vital statistics report shows a considerable increase in 
 deaths from all causes in Chicago. This is a fairly good sign of an epidemic 
 of grip. When grip, pneumonia, or colds are bad the death rates from all 
 sorts of seemingly unrelated diseases go up. 
 
 Neither grip nor colds are reportable. Reporting pneumonia is not the 
 custom, so the only signs by which to judge are the reports of general death 
 rate and the newspaper stories. 
 
 In 1891 there was a fearful epidemic of grip. At that time the grip 
 bacillus was found in the sputum of most of the cases of colds, bronchitis, 
 and pneumonia. Between 1907 and 1911 the Chicago Health Department 
 rarely found the grip bacillus. I do not know whether the grip bacillus is now 
 being found, but I am willing to venture the guess that it is not. It would 
 be just as well to drop the term grip and to speak of this epidemic as one 
 of colds and pneumonia. 
 
 Assuming that the reports are correct, and we are in for a nation-wide 
 epidemic, is there anything a person can do to protect himself? The answer 
 is yes. 
 
 The most important thing is to keep out of crowds. Whenever a man 
 goes into a crowd there is a reasonably good chance that he will get close to 
 somebody capable of infecting him. The person capable of infecting him may 
 not be sick. As there is no way of knowing who is an infector, the safe 
 policy is to avoid crowds. As a further factor a crowded place is very liable 
 to be an ill-ventilated place. The air probably will be too hot, too dry, and too 
 dusty. 
 
 The second most important admonition is to keep away from people 
 known to have colds. 
 
 Next in importance is that colds be nursed. It is good judgment to go 
 slowly when one has a cold. During the fever stage it is well to remain in bed. 
 After the fever stage has passed, the better one guards against fatigue and 
 exposure the less the danger of pneumonia and other complications. 
 
 Ordinarily diseases do not run into each other, but there is reason for 
 believing that neglected colds do run into pneumonia. Bacteriologists have 
 shown how pneumonia cocci, at first incapable of getting into the blood, after 
 a few days in the throat become changed so that they can enter the blood stream 
 and be carried to different parts of the body. 
 
 55 
 
56 PNEUMONIA— PLEURISY 
 
 Next in importance is the injunction against drinking. Whisky and 
 every other form of alcoholic drink is a pneumonia begetter. Alcohol lowers 
 the fighting defenses of the human body against all forms of disease, but 
 especially against pneumonia. This has been proven by careful scientific 
 tests. It is a universally recognized clinical fact. This is one of the points on 
 which the laboratory men and the practicing physicians are in full accord. If 
 an ordinary man gets pneumonia the chances are three to one that he will get 
 well. Whisky drinkers who gel: pneumonia do not have a three to one chance 
 for life. 
 
 The next admonition is against gorging with food. We hear every little 
 while of some person who has eaten a very heavy meal and gone down with 
 pneumonia less than a day afterward. 
 
 Next in order is the oft-repeated advice to keep the air in the living rooms 
 fresh, clean, and cold. At this point a friend came in and asked to add a 
 word of advice. For many years he has taken a cold shower every morning, 
 regardless of the temperature. He has not had a cold for forty years. His 
 advice is that all who are strong enough to get up a good reaction should take 
 a morning cold bath. 
 
 PNEUMONIA 
 
 While pneumonia outranks all diseases in the number of deaths which it 
 causes, in point of importance it holds second position. Most people have it 
 at least once during their lives. Many people have it more than once, and 
 some more than twice. 
 
 Men are far more susceptible to pneumonia than women, but the attacks 
 are usually less severe and less fatal. Foreigners are more liable to the disease 
 than natives, and negroes than whites. Negroes and foreigners are more 
 liable, perhaps, by reason of their disregard for hygiene and on account of 
 overcrowding and density of population. 
 
 It is also noticeable that people living in country districts are less liable 
 than city folk. Inasmuch as they spend most of their lives in outdoor work, 
 it would seem but fair to conclude that poor sanitary conditions, overcrowding, 
 and bad ventilation are more important factors to be reckoned with than 
 climate. 
 
 Pneumonia is the most widely spread disease in the world. It is less 
 prevalent at the poles and the equator than in the intervening territory. In 
 Chicago, for instance, it is an endemic at all seasons of the year. 
 
 More than 50 per cent of the people in Chicago have pneumonia once 
 "between the nursery and the grave; almost one-eighth of the people have 
 tuberculosis. 
 
 Pneumonia is, therefore, about four times as prevalent in Chicago as 
 consumption. From an epidemiological and medical standpoint pneumonia 
 would appear to be most important, while from a sociological standpoint con- 
 sumption is most important. 
 
 Pneumonia is no respecter of age. It attacks alike the babe in the arms 
 of the mother and the octogenarian. In fact, it is during these extremes — 
 childhood and old age — that the mortality from this disease is highest. 
 
 Pneumonia seems to have an especial liking for the rich. This is due, 
 
PNEUMONIA 
 
 57 
 
 perhaps, to the fact that among the rich are to be found the idle, the obese, 
 and the plethoric men and women. 
 
 However, excesses in eating, drinking, and inactivity are somewhat offset 
 by the splendid hygiene of their homes, when compared with the prevalence 
 of the disease in the insanitary and unhygienic homes of the poor and less 
 fortunate. 
 
 Pneumonia is a preventable disease. It is also a contagious disease. 
 
 It will be wise during the winter and early spring months to avoid 
 
 Chicago Health Department. 
 
 "SWiPR *SfLfcER.< 
 
 Fig. 20. 
 
 catching cold as much as possible, since colds are usually the first steps toward 
 contracting the disease. 
 
 One should avoid people who have colds and who do not have extraordi- 
 nary regard for others when coughing, especially in large crowds and in 
 crowded street cars and other inclosures that are ill-ventilated. 
 
 If brought in contact with a person who is constantly coughing and 
 sneezing it is just as well, when possible, to move to other quarters. These 
 people many times throw off the germs that cause the cold. They may also 
 throw off the germs of pneumonia. 
 
 If one happens to be within the field of activity of these germs he becomes 
 infected. He may catch only a cold. He may contract pneumonia. 
 
 In either case a trouble has been negotiated that may be difficult of solu- 
 
58 PNEUMONIA— PLEURISY 
 
 tion. This is a danger then that should be studiously avoided. If physical 
 efficiency is high, one may escape both. 
 
 A man may catch pneumonia from himself. In other words, we carry 
 around with us constantly the germs which cause the disease. They are nearly 
 always to be found lurking about in the mouth, nose, around the teeth, and 
 in the throat. Hence the importance of avoiding colds. 
 
 Keeping the mouth and throat clean by having proper regard for 
 hygienic and sanitary conditions, then, becomes a means for lessening the 
 chances of contracting pneumonia. By this means we maintain, as nearly 
 as possible, a healthy condition of the mucous membrane which makes it 
 more difficult for the germs to propagate their kind. 
 
 Where there is an enfeebled condition of the system resulting from cold 
 and many other diseases, such as indigestion, Bright's disease, diabetes, bron- 
 chitis, or intestinal diseases, pneumonia is most likely to be a serious complica- 
 tion. When brought down with any of these diseases, it not infrequently 
 happens that pneumonia is the disease that comes along and puts in the final 
 stroke toward placing our names upon the final roll call. 
 
 It is particularly important to keep the bodily resistance up to a high 
 point of physical efficiency if we would avoid contracting pneumonia. 
 
 To accomplish this it will be necessary not to overeat, not to allow our- 
 selves to become obstinately constipated, and to avoid as much as possible 
 irritation of our nervous system by useless worry and loss of sleep. 
 
 The use of stimulants to any great extent, of course, is positively inter- 
 dicted. 
 
 These warnings are especially true in cases of obesity, as the heart already 
 has its full measure of work to do in pneumonia. It is the one organ that 
 is excessively overworked by this disease. It is the one organ in the treatment 
 of this disease that must be nursed to avoid a fatal termination. 
 
 Most people have a rather clear and correct impression of the disease. 
 As far back as the fifteenth century Fohne tells us that "the people of 
 Switzerland referred to pneumonia as the stitch, Alpenstitch, malignant stitch., 
 and putrid stitch ; that cases occurred almost every year at the melting of the 
 snows, and particularly when the damp winds were blowing strong ; that these 
 cases were sometimes sporadic and at other times small epidemics." 
 
 The stabbing pain in the chest, the quick, rapid breathing, the cough, 
 the rusty and blood-stained sputum are unmistakable evidences of this dis- 
 ease of the lungs. Its curious onset with chill, pain in the side, followed by 
 rapid rise in temperature and difficult breathing, mark it off sharply from all 
 other diseases of the chest and lungs. 
 
 Epidemics of pneumonia have occurred in all countries, according to the 
 history of the disease, as chronicled by many writers. Italy, Germany, and 
 England were visited by epidemics in 1564, according to Hirsch and others. 
 
 Practically all countries of the habitable globe have suffered from epi- 
 demics of this disease at different times and in different sections of the 
 country. 
 
 Illinois, for instance, has been visited by epidemic pneumonia, and be- 
 cause of its viciousness business became paralyzed. Large numbers of people 
 became sick, and the disease swept down upon family after family. 
 
 While the germ is the exciting and active cause of pneumonia there are 
 
PNEUMONIA 59 
 
 many contributing and predisposing causes. Statistics show that there are 
 marked exacerbations during certain years, and that in countries where the 
 twelve months of the year can be spent out of doors, there is an absence of the 
 pneumonia. 
 
 Fatigue, anxiety, poverty, and debility predispose to attacks during an 
 epidemic. Insanitary and unhygienic conditions, especially where there is 
 overcrowding, want of ventilation and accumulations of filth, act as predis- 
 posing causes. 
 
 In many extensive outbreaks it has been found that those sections suffered 
 most where sanitary and hygienic conditions were worst. This is especially 
 so in prisons, barracks, and on sailing vessels. 
 
 The poorer classes usually suffer far more than the wealthy. Bad hygiene 
 in the workhouse and factory, exposure to the inhalation of irritating dust, 
 long and unavoidable fatigue, are contributing causes. 
 
 Much has been written about the influence which climate, weather, and 
 soil have in spreading pneumonia. One thing would seem sure — that the 
 state of the weather would many times have much to do with physical 
 efficiency, and physical efficiency surely has much to do with whether or not 
 the pneumococcus is going to be able to find a lodging place in a particular 
 person's lungs or circulation. 
 
 Concerning the meteorological influences as a causative factor in pneu- 
 monia, Anders has the following to say: 
 
 "First, that the seasons exert a marked effect upon the prevalence of 
 lobar pneumonia, the maximum mortality being observed during the winter 
 and spring months. 
 
 "Second, that insular climates probably manifest the greatest rise in 
 pneumonia mortality in winter, while that of the continental climates coin- 
 cides mainly with spring. 
 
 "Third, that the mortality of the epidemic form of the disease is, to a 
 less extent, influenced by the seasons, and that it may occur in the fourth 
 and even third quarter of the year. 
 
 "Fourth, that an apparently close relationship exists between periods of 
 low temperature and the death rate from pneumonia. 
 
 "Fifth, that the mortality rises and falls with the barometric pressure, 
 the maximum being reached during periods of highest pressure and vice 
 versa ; that the barometric pressure, however, is governed by the temperature, 
 being inversely to the latter, is to be recollected. 
 
 "Sixth, that the average velocity of the winds and the death rate from 
 this disease would appear to stand to one another in relation of cause and 
 effect (a provisional explanation of this fact being found in the controlling 
 influence exerted by the winds upon temperature and barometric pressure). 
 
 "Seventh, that the coincidence of existing low temperatures, high baro- 
 metric pressure, the direction and velocity of the winds, and the maximum 
 mortality from pneumonia is so uniformly constant as to merit serious con- 
 sideration, and suggests a close and direct relation between their combined 
 influence and the progress of mortality from pneumonia. 
 
 "Eighth, that the mean relative humidity of the atmosphere shows equally 
 decided variability during the periods of abeyance in the prevalence and 
 fatality of the disease with that of the cold or annual pneumonia season. 
 
60 
 
 PNEUMONIA— PLEURISY 
 
 "Ninth, that the major influence exerted by the seasons, however, is 
 probably not direct (e. g., by a lowering of the bodily resistance due to low 
 temperatures, high barometric pressure, direction and velocity of the winds, 
 etc.) but indirect, namely, by bringing about that effective element in the 
 causation, concentration, and increased virulence of the specific poison in con- 
 sequence of closed doors and windows and lack of free ventilation." 
 
 PNEUMONIA AND DRINKERS 
 
 Fat people and heavy drinkers are afraid of colds and pneumonia. On 
 the one hand, they are more subject to infection, and, on the other, infection 
 is more dangerous to them than to lean people or to those who are habitually 
 temperate. Their fears are justified. There is more than one reason for the 
 hypersusceptibility of these groups. 
 
 Leading Causes of Death, Topeka, 1912. 
 (Rates per 100,000 Population.) 
 
 Tuberculosis 
 
 Bright's disease 
 
 Organic heart disease. 
 
 Old age 
 
 Pneumonia 
 
 m 
 
 •H 
 
 't^^^^^^^^^^^^^ 
 
 >immmsBm L 
 
 - V)))WW)), 
 
 Bronchopneumonia SS9S8T —. 
 
 Paralysis wmmmmmm 
 
 u. 
 Respiratory diseases not specified . 
 
 •EB! 
 
 Nervous diseases not specified .... wmmmmtmmmmmmmmmm 
 
 Diarrhea and enteritis under 2. . . . ppppppjp pppp— ■«; 
 
 Diseases of early infancy ... ...g^ggggg^, 
 
 General diseases not specified. . . .wmmammmmtm 
 
 Typhoid fever mjmmmmammmt ? 
 
 Homicide wmmmmmmmmm^ } 
 
 Accidents mmjmmmmmuJ. + 
 
 Cerebral hemorrhage — ^^m . i 
 
 _,. . A ... V)})}}}}}/t77TrM )7 
 
 Circulatory diseases not specified. — — — 
 
 . . V/ ////////// '//Ait J 
 
 Appendicitis 
 
 Malformations 
 
 Cancer 
 
 Diphtheria 
 
 Rheumatism 
 
 Acute nephritis wmmtoi 
 
 zzm 
 
 Genito-urinary — not specified. . . .mmmt«i 
 
 Peritonitis mmmt»t 
 
 Diseases of the skin 
 
 Diabetes 
 
 Diseases — ill-defined 
 
 ' ^^^ T77///////////J9f f 
 xamm 
 
 
 ■MBS ' 
 
 X'tJO 
 
 Uojy* 
 
 mmmm Neervoj 
 
 Fig. 21. — Russell Sage Foundation Report (By Schneider). 
 
 The human animal at best has not a capacious nose. Its passages are 
 large enough in healthy children, but, by the time adult life is reached, certain 
 bones are larger and the airway is smaller. In fat people, this normally 
 small space is further encroached on by fat. Not being able to get enough 
 air through the nose they take in a good deal through the mouth. They are 
 notorious snorers. Mouth breathers and partial mouth breathers are more 
 subject to colds than nose breathers. 
 
PNEUMONIA 61 
 
 Fat people and alcoholics are badly out of nutritional balance, hence they 
 are unduly subject to colds and pneumonia. What frightens them more, 
 these conditions go hard with them. When a person is fat his system is clut- 
 tered with an excess of food which is stowed away under the skin, around 
 the heart, anywhere to get rid of it. When food and alcohol are taken to- 
 gether, the alcohol is burned and the food clogs the tissues just as the oil 
 burns out of a lamp wick and leaves the wick nearly as it was. 
 
 When the obese or drinking man, or the two in one, -finds himself with 
 pneumonia, he is poisoned by the toxins of pneumonia plus an embarrassing 
 amount of food and drink but partly changed into compounds ready to make 
 tissue. Pneumonia at best is a hard fight. The fighting forces of the sick man 
 hardly have a fair chance when they are further burdened by these incum- 
 brances. 
 
 If the muscle fibers of the heart are obstructed by fat they cannot work 
 as advantageously as when they are clean. And finally, the man who has 
 learned to lean on alcohol has not much in reserve for this trial of strength. 
 
 Obese people and alcoholics do not have the same chance to recover from 
 pneumonia as others. This does not mean that they stand no chance. It 
 means that the proportion of recoveries to deaths, instead of being six to one, 
 is only two to one. 
 
 COLD AIR AND PNEUMONIA 
 
 The pneumonic should be taken care of either in the open air or else 
 in a cold room, according to the season of the year and the climate. He some- 
 times objects mightily when his physician tells him to throw away poultices, 
 flannel jackets, and steaming teakettles, to throw open the windows, and let the 
 cold air blow right across the bed, when the room temperature is so cold that the 
 nurses have to wear wraps; and yet in a room where the temperature is 45° 
 to 50° and the air is fresh, the pneumonic finds the best chance in his fight. 
 
 This plan has been in use long enough to have demonstrated its efficacy. 
 The modified open-air treatment of pneumonia is as logical as the open-air 
 treatment of consumption. The fresh-air treatment is not a complete treat- 
 ment. Rather it is the basis on which treatment must be founded. Pneu- 
 monia is a fight disease. There is an intense poisoning by bacteria and a 
 violent fighting back by the human body. The fever, the cough, and the 
 other symptoms are the smoke of battle. Fresh, cool air gives the human 
 fighter vantage ground. The work of the physician is so to guide the patient 
 that he is freed from any load which cumbers him in the fight. 
 
 WHAT TO DO AFTER PNEUMONIA 
 
 When a person has just recovered from pneumonia he wants to know what 
 he shall do. During pneumonia the blood clots more readily than normal, 
 hence the pneumonic patient must be moved with care that a blood clot may 
 not break away and float off to an area where it would do great harm. He 
 must exercise a similar precaution to prevent his very flabby, weak heart 
 from stopping suddenly. 
 
 The fever having gone down, the patient rapidly recovers unless there 
 be an infection somewhere besides that in the lung. Clearly, the rapid improve- 
 
62 PNEUMONIA— PLEUKISY 
 
 ment in the patient who is due to get well is because his system is making 
 an anti-toxin which destroys the toxin of the coccus, or else it is making 
 something which destroys the coccus itself. Nevertheless, sometimes a group 
 of cocci in the heart or pleura or in a joint may go on doing harm after 
 the crisis of pneumonia. 
 
 The kidneys bear the brunt of pneumonia about as much as the heart 
 does, and a fair part of the people having Bright's disease should date their 
 trouble back to an attack of pneumonia. 
 
 Generally speaking, convalescent pneumonia patients recover promptly. 
 Their lungs are not weakened or changed in any way or any more susceptible 
 to infection with consumption than if they had had no pneumonia. The late 
 effects of pneumonia are to be looked for in the heart and kidneys. 
 
 During the attack of pneumonia the sputum must be disinfected by 
 burning. But it is much more important to know that, after recovery, pneu- 
 mococci remain in the mouth secretions indefinitely. The convalescent should 
 have his teeth cleaned; his tonsils put in sanitary condition, and in addition 
 he should be careful about spitting, for probably in spite of everything he can 
 do he will remain a pneumococcus carrier. Not infrequently he reinfects his 
 own lungs months or years later. It is due to this rather than to crippled 
 lungs that pneumonia frequently recurs. A man has been known to have it 
 more than a dozen times. So far as we now know the way to stop such 
 recurring attacks is to make the most thorough effort possible to clean up the 
 mouth, teeth, and throat. 
 
 PNEUMOCOCCI ELSEWHERE THAN IN THE LUNGS 
 
 The idea is more or less general that, when pneumonia follows a cold, the 
 disease has spread along the surface of the air passages from the nose to 
 the throat, the larynx, and the lungs. As a matter of fact, when things get 
 just right, the pneumococcus gets into the tissues and then into the blood, and 
 from the blood it is carried to the lungs. It is easier to make the cultures 
 of this germ from the blood than from the sputum. 
 
 When the main effect of the pneumococcus is found in the lungs, the 
 disease is called pneumonia. But the pneumonia germ can be carried to 
 other parts of the body, and, locating there, cause disease. In some instances 
 the coccus sets up changes in other organs at the same time as it does in the 
 lungs. Sometimes infection of other organs follows infection of the lungs, 
 and sometimes the germ locates in other organs and does not affect the lungs. 
 
 The pneumococcus is one of the more frequent causes of heart disease. 
 It causes 56 per cent of the pleurisies where there is pus; 17 per cent of 
 those where the fluid which is drained away from the chest is a clear water. 
 It causes a large part of the meningitis. A pneumococcus meningitis looks 
 much like the epidemic form. 
 
 A rather famous case of meningitis which came on in a girl who had 
 been vaccinated was caused by a pneumococcus infection of her brain through 
 her nose. Many of the inflammations of the joints called rheumatism are 
 pneumococcus infections and it is these which are most liable to result in 
 stiff joints. 
 
 The diseases due to pneumococcus vary greatly in their severity. For 
 
PNEUMONIA 63 
 
 instance, pneumococcus infection of the lungs is, next to tuberculosis, the 
 most virulent of the usual infections of the lungs. Pneumococcus infections 
 of the pleura are about the most curable kinds of pleurisy. 
 
 We get a better idea of the pneumonia question by knowing of the other 
 diseases which may be due to the germ of pneumonia and how the coccus varies 
 in virulence in different parts of the same body — just as we have long known 
 how it varies in different people. 
 
 A POSSIBLE PNEUMONIA CURE 
 
 For years physicians have been trying to find a cure for pneumonia. It 
 was plain that digitalis, nux vomica, carbonate of ammonia, guiacol, whisky, 
 and the old lot of cures were ready for the same scrap heap as bleeding. 
 In fact, time has demonstrated that a certain group of pneumonia cases were 
 helped by bleeding, and in consequence there has been some revival of bleed- 
 ing. Eelief in some stages of some cases of pneumonia will result from the 
 use of ammonium carbonate, guiacol, digitalis, or the other, but they are 
 not cures in any proper sense. 
 
 These latter-day studies have been on the pneumonia coccus. When this 
 coccus was discovered it soon developed that it did not grow well on the 
 foods for germs commonly used in the laboratories. After a few days of 
 feeble growth it always died. In consequence study of the pneumococcus 
 lagged. Laboratory men knew the consumption germ and the diphtheria germ 
 like books, but the pneumonia germ was undiscovered country. 
 
 In time a better food for this germ was found and the study of it began. 
 Some facts were discovered that seemed to point a way to a remedy. It 
 was found that when a mass of pneumococci were washed in weak salt water 
 most of the poison was washed out of them. The washed germs had a slight 
 power to produce fever and to harm the subject, but on the other hand they 
 seemed to have great power to stir up the defensive forces of the body. 
 Finally it was possible to get the cocci washed so clean that two teaspoonfuls 
 of a suspension of them would not kill a guinea-pig when injected into its veins. 
 
 For three pneumonia seasons Dr. Rosenow has been using this method of 
 treating pneumonia. Of thirty patients treated this way by physicians in 
 private practice three died — 10 per cent. In a hospital group of thirty-five 
 cases in 1910, nine died — 25.7 per cent. In the next group were 294 cases 
 treated in Cook county hospital. One hundred and forty-six received the 
 injections — 148 did not. All other treatment and care was exactly the same. 
 The cases were not selected. The death rate in the noninjected group was 
 37.8 per cent (fifty-six deaths) ; the injected group, 23.3 per cent (thirty- 
 four deaths). 
 
 An injection of about 15,000,000,000 cocci was made the first day in 
 the hospital. It was repeated each day. After the first injection there was a 
 rise of fever of a degree or two, but after that the fever declined and it 
 disappeared a few days earlier than is usual in pneumonia. 
 
 It is most important that the treatment be begun early in the disease. 
 The results are best when the injection is given the first day. Each day of 
 delay lessens the chances of cure. 
 
 In order to form a correct opinion of the value of any treatment it is 
 
64 PNEUMONIA— PLEURISY 
 
 necessary to have a number of cases. Among young, healthy, clean people at 
 least three out of every four ought to get well with any treatment. The only 
 way to judge of whether a remedy is in the 40 per cent class or in the 20 
 per cent class is to study enough cases. 
 
 Dr. Rosenow does not yet know the value of this proposed remedy. In 
 one of his articles he tells how to make it, what it contains, and how to 
 use it. He thinks it will be especially valuable when given to nonalcoholics 
 immediately after the pneumonia chill. 
 
 He offers it free and has written about it prematurely in the Journal of 
 the American Medical Association, because he wants family physicians to give 
 it a trial and send in the records of the cases, that a better opinion of its 
 value or lack of value may be had. 
 
 Pneumonia and Air. — Inquirer writes: "It is said that hack drivers 
 suffer more from pneumonia than any other class. If this be true why is 
 pneumonia considered essentially a bad air disease? It is steadily increas- 
 ing from year to year in the rural districts, as it is said to be in the cities" 
 
 Reply. — 1. That pneumonia is an impure air disease is amply proved by 
 its greatest occurrence during the months when houses are generally over- 
 heated and a good many overcrowded. 
 
 2. Pneumonia occurs with greater frequency in cities. 
 
 I know of no proof that cab drivers suffer more from pneumonia than 
 any other class. I do not think that they do. 
 
 PLEURISY 
 
 The pleura is slipped in between the lung substance and the chest wall. 
 It is put there to prevent friction. It is the ball-bearing of the lung. It 
 is a delicate structure, so delicate that it is not easy to see. When the lungs 
 are removed and superficially noted the surface is smooth and glistening. 
 There must be a membranous covering present. It is so delicate that the 
 anatomists, before the days of the microscope, could not make it out well. 
 
 When the inside of the chest wall is examined another smooth surface is 
 noted. This pleura must have two layers, one covering the lung and the 
 other lining the ribbed chest wall. 
 
 The anatomist cannot outline it well without his microscope. It is not 
 necessary to take the word of the anatomist for this. If you will try to strip 
 off the shiny lining of a chicken's chest, or of a piece of rib pork, or of ribs of 
 beef, you will find that this delicate layer is so thin that it will not strip. 
 
 This pleura covers the lungs everywhere. Likewise it lines the chest 
 everywhere. It lines the bony part of the chest wall and also the muscular 
 wall, called the diaphragm, which divides the great body cavity into two — the 
 abdomen and the chest. 
 
 In this little more than microscopic membrane, the pleura, are located 
 nerves, blood and lymph vessels. It is, in fact, provided with its own supply 
 of these, separate and apart from the supplies on the one hand to the 
 lungs and on the other to the chest wall. 
 
 The reason is that this pleura is a buffer as well as a ball-bearing. Can- 
 cer, consumption, and other enemies cannot shoot straight across from the 
 
PLEURISY 
 
 65 
 
 skin to the lungs, or vice versa. They do get across sometimes, in time, but 
 they must stop at the pleural barriers and give the countersign. They must 
 cool their heels in the antechambers. Most of them give up in disgust. 
 
 We may say then that the pleura has two jobs — the ball-bearing job and 
 the buffer job. 
 
 I understand that cable, telegraph and telephone companies have instru- 
 ments with which they can accurately locate trouble on the lines. A cable 
 operator can hitch an instrument on a cable line and tell that the trouble is 
 2,037 miles out. A telephone operator can hitch in a locater and find out just 
 where the trouble is located. 
 
 The nerves are exact duplicates of cable, telegraph, and telephone lines. 
 The ordinary nerves correspond to insulated cables; 
 the sympathetic nerves to ordinary exposed unin- 
 sulated wires. Some of the nerves are well trained 
 to local impulses; some of them are poorly trained. 
 
 The best trained are in the palms of the hands 
 and especially those of the tips of the fingers. If the 
 tip of the finger is touched by two pin points the 
 finger registers two points, even when the pin points 
 are close together. 
 
 On the back of the hand the two pin pricks are 
 registered as one, even though the points pricked are 
 half an inch apart. On parts of the body the nerves 
 are so poorly trained that they cannot distinguish 
 two pricks even when the two points are held inches 
 apart. 
 
 You can learn something by trying the training 
 of your nerves in different locations on your skin. 
 The nerves of the skin at that are much the best trained nerves of the body. 
 
 The nerves to the pleura are so poorly trained that the hurt never 
 shows just where the trouble is. This is especially true when the affected part 
 of the pleura is some place on the diaphragm. Some men with diaphragmatic 
 pleurisy will feel their pain in the appendix ; others in the gall-bladder ; others 
 in the kidney, and others in the stomach. 
 
 Ordinarily it is pain in the ribs that makes a man think he has pleurisy. 
 This catch in his side may be due to muscular rheumatism in the muscles 
 of the chest wall, to neuralgia of the nerves that run between the ribs, or to 
 inflammation of the pleura. 
 
 The ordinary treatment is to put on a porous plaster and to let it go at 
 that. That is the way the ordinary man has worked it out, and that is about 
 the best way. 
 
 With some kinds of pleurisy, where there is no cough, no fever, and no 
 effusion, this treatment is as good as any, provided there is free purgation. 
 This is also true of the neuralgic pains and the muscular-rheumatism pleurisy 
 pain. 
 
 The porous plaster makers generally put some drug in the plaster. 
 They do that so they can call it capsicum plaster or belladonna plaster; or 
 maybe they will even put in some hot stuff and call it an electric plaster. 
 
 The object of this is the same as the object in putting pepsin in chewing 
 
 Fig. 22. — Pleurisy with 
 Effusion. A consider- 
 able quantity of fluid is 
 pressing the lung up- 
 ward and forward. 
 
66 
 
 PNEUMONIA— PLEURISY 
 
 gum. It does no harm; it does no good, but it makes a fine talking point in 
 the advertisement. 
 
 The plaster straps the side; holds the movement down, and in this way 
 helps to cure. Meanwhile the mind is at ease ; something is being done. That 
 also helps the cure. 
 
 These mild cases of pleurisy that the doctor is accustomed to dismissing 
 lightly, calling them intercostal neuralgias, or muscular rheumatisms, tend 
 
 to heal quickly, and leave no 
 after effect. They are not worth 
 much trouble. 
 
 There are forms of pleurisy 
 that are of great importance and 
 that are frequently overlooked. 
 I think doctors are agreed that 
 there are more mistakes in diag- 
 noses in pleurisy than in any 
 other disease. 
 
 Are there any signs by pay- 
 ing heed to which we can escape 
 these mistakes? 
 
 When the pleura inflames, 
 fluid is poured out of the blood 
 into the tissues. As there is so 
 little space in that delicate mem- 
 brane the serum exudes from the 
 pleura as water oozes out of wet 
 ground. 
 
 As the serum accumulates in 
 
 the pleural cavity the lung is 
 
 pushed away from the chest; 
 
 pleural friction is lessened; the 
 
 chest wall moves less, and the 
 
 lung is partially collapsed. 
 
 In consequence the pain with which the attack may have started stops 
 
 or nearly stops. As a matter of fact, in the pleural cavity there may be a 
 
 gallon of clear, straw-colored serum. 
 
 Is there anything to make a patient suspect? It is not my part to 
 describe how the doctor would examine with the stethoscope and hammer. 
 My part is to tell the man walking around the street with a gallon of serum 
 in his chest what should make him suspect, and acting upon that have a 
 diagnosis made. 
 
 He will notice that since the pleurisy pain he has been short-winded. He 
 was not sick enough to be short-winded. He knows of no cause for being 
 short-winded. 
 
 He strips the clothes from his chest. By careful observation he notes that 
 the two sides of his chest do not move evenly. One side moves much less 
 than the other. If it were not hooked up in the same ribbed wall it would not 
 move at all. The space between the ribs does not fall in the same way on the 
 two sides. In fact, on the affected side the spaces may even bulge. 
 
 Fig. 23. — Diagram Showing a Bronchus Branch- 
 ing to End in Air Sacs. At the upper left are 
 two large cavities. Sputum at the points in the 
 bronchus at the left causes coarse dark rales. 
 
PLEUEISY 67 
 
 Of course, if a man is exceedingly fat this point cannot be noted. If he 
 is thin he may note that the heart beat does not show just below the left 
 nipple, but does show to the right or left of where it belongs. 
 
 Finally he has a sense that something is wrong in his chest. Something 
 feels tight inside one chest or the other. 
 
 This form of pleurisy is called pleurisy with effusion. The French call 
 is pleuresie a frads, or pleurisy with a chill. 
 
 It is a sneaking disease. So far as the pleurisy part of it is concerned 
 it is of no great consequence. The significant feature is that consumption 
 so frequently starts that way. 
 
 Of the pleurisies with a clear, straw-colored effusion, these sneaking 
 pleurisies, more than half are due to tuberculosis. Straus says 56 per cent 
 of them; Landouzy says 75 per cent of them; Kelsch and Yaillard say 82 
 per cent of them. 
 
 The Bowditches of Boston have been prominent physicians there for a 
 long time. The fathers hand down the families in their practice to the sons. 
 
 One of the Bowditches looked over the histories of their patients, espe- 
 cially of those families whom they had continuously cared for since 1849, and 
 he reported that most of those who had had pleurisy with effusion subsequently 
 showed consumption. 
 
 Osier says : "I confess that the more carefully I have studied the ques- 
 tion the larger does the proportion appear to be of primary pleurisies of 
 tuberculous origin." 
 
 Sometimes the pleura fills up with fluid during the course of consump- 
 tion. Sometimes consumption starts with the pleural effusion. But the 
 rule is to have the person who has had this kind of pleurisy get well and ap- 
 pear to be well for a year or two, and then begin to show signs of consump- 
 tion. 
 
 The extremely important reason for finding out that one's pleura, is full 
 of fluid is that consumption is then present. In all probability it will not be 
 exceedingly active for a year or more, and the disease is easily curable. 
 
 The method of cure is to change one's method of living. Two years later 
 the disease may be so far advanced as to put the cost of cure so high that the 
 sick man cannot reach it. By cost I mean cost in time, in rest, in money, and 
 in those things that money can buy. 
 
 A group of cases often overlooked, though more easily diagnosed, is that 
 in which there is fever, general aching, pains in the chest and a dry cough. 
 
 The above description reads much like an ordinary hard cold. There 
 is but one way to tell these cases from a hard cold, and that is when the 
 physician listening to the chest sounds with his stethoscope on the skin hears 
 a friction sound if pleurisy is present. 
 
 If he listens to a chest covered by clothes the friction sound given will be 
 due to the shirt rubbing on the undershirt. A physician who listens to chest 
 sounds through the clothes obtains money under false pretenses. Some day 
 the state's attorney will charge the grand jury to that effect. 
 
 The chance of getting well with or without medical care is fine. Much 
 depends upon the germ which causes the pleurisy. Many of these are due to 
 the tubercle bacilli. Those cases will get well if the patients will get busy; 
 not otherwise. 
 
68 PNEUMONIA— PLEUKISY 
 
 The cases due to infection with pneumonia germs will stand a little 
 better chance to get well than the cases of pneumonia, in which latter con- 
 dition the germs have been deposited by the blood in the lungs. 
 
 The pleurisies due to the staphylococcus will probably get well. The 
 chance is not so good for those due to the other pus cocci. 
 
 A better way to tell what the outcome will be is to put in a needle and 
 draw off fifteen or twenty drops of fluid. If this fluid is of a clear straw color 
 the germ is generally the tubercle bacillus. If it is a little cloudy, or is pus, 
 the germ is probably a pneumococcus, or an ordinary pus coccus. 
 
 If the pleurisy has followed pneumonia, or has been left by pneumonia, 
 the germ is pneumococcus. The people who convalesce slowly after pneu- 
 monia, who "don't get their strength back," who have a nagging afternoon 
 fever, who sweat, or have night sweats, will, if carefully examined, usually be 
 found with a pleura full of pus. 
 
 In a child this is not an extremely serious condition. Children with sup- 
 purative pleurisies, following pneumonia, generally get well. The pus may 
 open into a bronchial tube and be coughed up, or it may be drawn off with a 
 needle, or it may absorb. The condition is much less grave than with a 
 grown person. 
 
 When the pleura of a grown person is found full of pus the condition is 
 one of gravity. If the pus is white and creamy it will be found that the 
 pneumococcus is the most frequent cause. The chance of cure of that group 
 is better than that of the next. If the pus is ordinary the chance is that 
 streptococcus is the cause. 
 
 Curing up a suppurative pleurisy is a most difficult process. It is easy to 
 understand the reason. 
 
 When a boil is lanced the pus flows out and the walls fall in. This col- 
 lapsing of the walls is what makes the cure easy. 
 
 When the boil is in a bone the walls cannot collapse. The suppuration 
 goes on and on. Witness how white swelling holds on. 
 
 The chest wall is composed of bony ribs. It cannot fall in or collapse. 
 When the pus is emptied out a cavity is left. Cavities cannot remain. This 
 one fills up with pus again. 
 
 These cases must be cared for by the surgeon. What the surgeon does is to 
 open up the chest and cut away the ribs. The stiff bones being out of the 
 way the muscles cave and the pleurisy heals up, as would any other boil. 
 
 When ribs have been cut away they have a great tendency to grow back. 
 In fact, when but little has been cut away the rib may grow back so fast as 
 to prevent the proper healing of the cavity. If a rib was taken from Adam to 
 be used as a basis for Eve the chance is that before the season was over Adam 
 was around with a full supply of ribs. 
 
 Fowler's and Godlee's book contains an illustration showing how a drain- 
 age tube, left in the pleura for a few months, was found encircled by newly 
 grown ribs like the tombstone-eating trees in the old cemetery at James- 
 town, Ya. 
 
 Empyema of Pleura. — J. V. C. writes: "Please advise me regarding a 
 disease called empyema. What is its nature? How is it contracted? How 
 avoided? Is it difficult to cure? Is it contagious or infectious?" 
 
PLEURISY 69 
 
 Reply. — Empyema means pus m a cavity. Generally the name specifies 
 the location of the pus — e. g. : empyema of the gall-bladder. If you mean 
 empyema of the pleura (or chest) the following are the answers to your 
 questions : 
 
 1. It is a suppurative inflammation of the covering of the lung. It 
 may be due to ordinary pus cocci, to pneumococci, to tubercle bacilli, or 
 some other bacteria. 
 
 2. The bacteria may spread to the pleura from the lung. They may 
 be carried by the blood. It is frequently secondary to pneumonia, con- 
 sumption, or lung abscess. 
 
 3. By living a hygienic life. 
 
 4. It depends. Generally speaking, it is difficult to cure. Pneumococcus 
 pyemia in children is cured rather easily. Pneumococcus pyemia in adults 
 is harder to cure. Pus cocci pyemias are more difficult to cure than those 
 due to pneumococci. 
 
 5. Practically, no. 
 
CHAPTER IX 
 
 Consumption 
 
 PACTS ABOUT TUBERCULOSIS 
 
 The consumption situation is improving. Careful students are of the 
 opinion that the disease is milder now than it was a century ago. When we 
 come to the last twenty years the figures are accurate enough to permit of 
 dependable judgment. The cities that began fighting consumption first have 
 only half as much as when they began. Chicago began fighting it about ten 
 years ago, and has only three-quarters as much. 
 
 CONSUMPTION CAN BE CURED 
 
 l«l. I> .) ■linn. ii in in hi "~ "" linn m i ii — — "■■ i I i op».vaMawv>— »» 
 
 if treated in time. Most consumptives do not know 
 they have it until too late. You may have it. Have 
 your doctor find out NOW with a tuberculin test or 
 otherwise before too late. The thousands of hopeless 
 cases are due to neglect. 
 
 Fresh air prevents consumption and pneumonia* 
 Ventilate all the time—winter and summer—day and 
 night "Too much fresh air is just enough." 
 
 DEPARTMENT OF HEALTH 
 
 Chicago Health Department, Jan. 8., 1910. 
 Fig. 24. 
 
 The national census office tells us there is a general improvement down 
 the line, the older cities showing great improvement, the younger cities show- 
 ing some improvement, the country districts showing a little loss, but not 
 enough to neutralize the gain. 
 
 The death rate from consumption in Chicago is less than was the typhoid 
 rate twenty years ago. The typhoid rate is not one-twentieth of the rate 
 twenty years ago. Within the next twenty years the consumption rate will 
 be chopped to pieces. People generally see that, and therefore they want to 
 know everything they can about consumption. 
 
 The Relation of Inheritance to Consumption. — A few children have 
 been born tuberculous. The child when born contained tubercle bacilli in its 
 tissues. The tubercle bacilli were passed from an infected mother into the 
 body of the unborn child. Such are cases of inherited tuberculosis. These 
 cases are rare, so rare as to be medical curiosities. That is all there is to 
 inherited tuberculosis. 
 
 70 
 
FACTS ABOUT TUBERCULOSIS 
 
 71 
 
 As we go through life, we are attacked by tubercle bacilli from time to 
 time. Therefore the ability to throw off tubercle bacilli is a highly important 
 question. People have this ability in varying degrees. Some are extremely 
 resistant ; others are but little so. 
 
 Resistance is modified in different ways. We strengthen resistance by 
 breathing fresh air, eating good food, and exercising. 
 
 The life insurance tables show that fat people have a lower tuberculosis 
 rate than thin ones. This means that people who for one reason or another 
 are more liable to tuberculosis than the average will lessen their chances of 
 having the disease by keeping somewhat overweight. 
 
 Some inherit a lowered resistance 
 to tuberculosis. If more than one- 
 twelfth of the members of a family die 
 of consumption the family is a con- 
 sumptive family. Of course, in order 
 to draw any conclusion at all, it is 
 necessary to get the cause of death of 
 at least 100. 
 
 Statisticians, after carefully study- 
 ing family histories, have concluded 
 that consumption does run in families. 
 This does not mean that consumption 
 never develops outside of these con- 
 sumption families. What it means is 
 that if a member of a consumptive 
 family gets infected with consump- 
 tion he does not have the average 
 chance of throwing off the infection 
 before getting sick or of getting well after the disease has developed. 
 
 Williams studied 1,000 cases of consumption and found that 488 of 
 them belonged to consumptive families. Walsham found that the proportion 
 was 320 out of 1,000. After we make allowance for the danger that members 
 of a family catch the disease from one another, we see that much more than 
 half the consumptives do not belong to consumptive families. 
 
 Walsham tells us what every physician knows : "A man starting life with 
 a constitution favorable to the growth of the tubercle bacillus can,, by his 
 habits and environment, over which he generally holds some control, to a 
 large extent alter his tissue resistance to his advantage." 
 
 In other words, a man, by carrying out the laws of personal hygiene, can 
 be reasonably safe from consumption. If he is of a consumptive family he 
 should be doubly careful in living. He must live right to be safe, and living 
 right, he will be safe. 
 
 The Relation of Heart Disease to Tuberculosis. — As a general proposi- 
 tion those people who tend to heart disease, apoplexy, and Bright's disease 
 do not tend to consumption. As rheumatism lies at the base of a good deal 
 of the apoplexy and heart disease, we may also say that the rheumatics have 
 a slightly better chance not to become tubercular than have the average. 
 
 However, if a man concludes that because he is in less danger than the 
 average man he is in no danger, he will be in error. 
 
 £E£ • A • GOOD • DOCTOR- • 
 
 North Carolina Health Bulletin. 
 Fig. 25. 
 
72 
 
 CONSUMPTION 
 
 Again, the heart is really four pumps set side by side, and disease of one 
 part may have just the opposite effect from disease of another. 
 
 A learned Austrian of the latter part of the last century, Eokitansky, 
 wrote : 
 
 "Persons laboring under enlargement of the heart do not contract tuber- 
 culosis." 
 
 Eokitansky's opinion carried so much weight that for a long time it was 
 accepted blindly. Further analysis has shown that certain kinds of heart 
 disease protect against tuberculosis and other kinds help to produce it. 
 
 About the most important of the valves of the heart is one known as the 
 mitral. Sometimes this valve is diseased in such a way that the blood cannot 
 pass easily from a cavity called the left auricle to another called the left 
 ventricle. The condition is called mitral stenosis. Mitral stenosis offers 
 protection against consumption. 
 
 IN CASE OF CONSUMPTION, LOOK TO THESE FOR CURE 
 
 THE DOCTOR. 
 
 SUNLIGHT. OUT-DOOR AIR. GOOD FOOD. 
 
 NEW YORH STATE DEPARTMENT OF HEALTH. 
 
 REST. 
 
 Fig. 26. 
 
 There is a valve located where the important artery, the pulmonary, starts 
 from the right ventricle to run to the lungs. When this valve is stenosed, 
 infection of the lungs with tubercle bacilli is apt to occur. 
 
 The Relation of Diabetes to Tuberculosis. — Diabetes is a symptom. 
 Any one of several conditions may be responsible for this symptom. Speak- 
 ing generally there is little danger of diabetes directly causing death. 
 
 However, diabetics are more liable to become infected than is the average 
 run of men, and infections in diabetics are especially liable to be severe. 
 
 Ordinarily, boils and carbuncles are not dangerous. In diabetics car- 
 buncles and boils are quite dangerous. A pneumonia in a diabetic is much 
 more dangerous than in a nondiabetic. 
 
 Diabetics are prone to consumption. A young person with diabetes stands 
 about an even chance of getting consumption. 
 
 Consumption in a diabetic runs a rapidly fatal course. In a diabetic 
 tissue is burned much more rapidly than in a normal person. In a consump- 
 tive the same is true, though in a lesser measure. 
 
 When diabetes and consumption are combined in one patient the fires 
 burn out the body rapidly, as a furnace in which wood and paper are burned 
 melts out the grate bars and blisters the boilers. 
 
 The Relation of Pregnancy to Tuberculosis. — The idea is general 
 among medical men that pregnancy occurring in a tubercular woman would 
 cause the disease to become highly active. Walsham gives it as his opinion that 
 "pregnancy does not predispose a woman to tuberculosis, and even when preg- 
 
FACTS ABOUT TUBERCULOSIS 
 
 73 
 
 nancy does occur in a tubercular woman the complication is not a serious one, 
 although, of course, it is a complication we would rather be without." 
 
 I have observed a number of pregnancies in tubercular women. If the 
 women have had good care they have gone through the period without a flare- 
 up in the disease; good healthy babies have been born, and the disease has 
 not progressed rapidly immediately after the confinement. 
 
 I have known of cases where the baby, born in the spring or early sum- 
 mer, has been left at the breast until the cool weather of autumn without 
 harm. The baby born to a tubercular mother probably will be free from 
 tuberculosis and otherwise healthy and strong. 
 
 //n\ x 
 
 SUNLIGHT. OUT-DOOR AIR. 
 
 Fig. 27. — To Cure Consumption. 
 
 Michigan Public Health. 
 
 A careful mother can prevent her baby at the breast from becoming 
 infected. The weaning of the baby is for the purpose of saving the mother's 
 strength. 
 
 The Relation of Alcohol to Tuberculosis. — Walsham tells us that "a 
 large section of the public believe that alcohol protects the body from the at- 
 tack of the tubercle bacillus. This belief is due to the teaching of the older 
 physicians, as the medical opinions of the public of today are generally those 
 of the last generation of physicians. There can be no question that physicians 
 in the middle of the last century did not consider that alcohol predisposed the 
 organism to tubercle. They even considered it beneficial and gave it to 
 phthisical patients in large quantities." 
 
 At the present time up-to-date physicians do not give alcoholic beverages 
 to consumptives. Furthermore, statistics convince them that users of alco- 
 holic drinks have more than the average amount of consumption. Addiction 
 to drink predisposes to tuberculosis. 
 
 In addition, as Kelynack says: "There can be no doubt that the non- 
 hygienic surroundings of many chronic alcoholics afford important conditions 
 suitable to tuberculosis invasion." 
 
 Some years ago at Dunning, 111., we noted that consumptive women who, 
 
74 CONSUMPTION 
 
 prior to contracting consumption, had been drinkers or who had been notori- 
 ously immoral succumbed rapidly to the disease. 
 
 The Relation of Chest Development to Consumption.— Many observ- 
 ers have noticed that stoop-shouldered, narrow, deep-chested people were prone 
 to develop consumption. People whose chests are shoulder bound do not 
 expand the upper part of their chests well. Sometimes those upper ribs get 
 so ossified that they can move but little, and in breathing the upper part of 
 the chest moves only slightly. Freund thinks this lessened movability of the 
 upper chest is largely responsible for consumption. 
 
 The Relation of Age to Consumption. —Infants in arms are fairly sub- 
 ject to the tubercular infection. When the tubercle bacillus enters their bodies 
 it is apt to locate in the lungs. Such children have ordinary lung consump- 
 tion as grown people do. With them the disease runs a rapid course. 
 
 Children past the age of infancy are prone to have scrofula, glandular 
 tuberculosis, and bone tuberculosis. In them tuberculosis is quite mild and 
 tends to get well. 
 
 Young men and women, say from 15 to kO, are apt to have lung infec- 
 tions. In them the disease tends to progress rapidly. 
 
 In older people the disease is slower; the lungs are apt to harden up 
 and the overgrowing fibrous tissue either cures the disease or makes it take 
 on a chronic form. 
 
 The Influence of Race on Consumption.— The negro race is exceedingly 
 liable to become infected with consumption. Consumption in a negro is liable 
 to progress rapidly. The lungs are usually moist and much sputum is raised. 
 
 Occupation in Relation to Consumption.— There is the widest varia- 
 tion in the amount of consumption among the different groups of workers. 
 The dusty trades are the worst sufferers. At the head of the list are those 
 who work in metal and stone dust. In some lists stone cutters stand at the 
 head; in others, metal polishers. There is not a great amount of difference. 
 
 The printer and compositor are near the top. There is not so much dust 
 in their working place, but what is there is kicked up from a dusty floor, and 
 there are always likely to be consumption germs in floor dust. The printer 
 works in an ill-ventilated room, which makes a little dust as harmful as a 
 larger amount would otherwise be. 
 
 The cigarmakers are usually fourth on the lists as printed. Janitors 
 stand near the top. 
 
 In Pittsburgh they claim that coal smoke makes for pneumonia but that 
 it makes against infection by consumption. They say the solid particles of 
 unburned coal fill up the lymph spaces in the lungs so that consumption germs 
 cannot get in. 
 
 WAR AGAINST CONSUMPTION 
 
 In the United States the consumption death rate is falling in a dozen 
 or more cities, but in the country at large it is not falling. New York and 
 Boston have cut their consumption rates in half. Many other cities have done 
 well, but not so well as the cities named ; and the rate in the rural districts is 
 increasing slowly. 
 
 In Germany, prior to the insurance period, the consumptive rate was 
 
WAR AGAINST CONSUMPTION 
 
 75 
 
 stationary. Soon after insurance was begun the rate began to fall. The rate 
 for all Germany has fallen from 3.25 per 1,000 to 1.65. The rate for German 
 cities fell from 3.1 to 2.2 in 1897, when the anti-consumption crusade of the 
 pension boards began. Since then the fall has continued until now the cities' 
 rate is lower than the rural rate. 
 
 Dawson quotes Professor Kayserling of Berlin and Professor Frankel, 
 who rank among the highest German authorities upon the subject, as attrib- 
 uting the progress made "more to the industrial insurance laws than to any 
 other cause, owing to the fact that these laws have placed within the reach 
 of the working classes sources of healing which were never dreamt of before. 
 . . . There is little room for doubt that, before many years have passed, this 
 scourge of the race will be robbed of its terrors and take its place as one of 
 the minor afflictions of mankind." 
 
 GOOD FOOD. REST 
 
 Michigan Public Health. 
 Fig. 28. — To Cure Consumption. 
 
 Michigan Public Health. 
 Fig. 29. — To Cure Consumption. 
 
 Professor Kayserling also says: "We will conquer this disease by [a] 
 recognition of the fact that we have to deal with a specific infectious disease 
 caused by the tubercle bacillus, and by [b] the largest possible development 
 of treating tuberculosis by means of the machinery of industrial insur- 
 ance." 
 
 Nor is the effect of these measures limited to tuberculosis. "It seems 
 impossible to deny to insurance legislation some credit for the fact that, 
 during the last twenty-five years, the rate of mortality for the whole empire 
 has fallen from 25.4 per 1,000 to 19 for the last ten-year period and 16.2 
 for 1910. 
 
 "In Germany the contention is general that the effect of the insurance 
 legislation and of the various activities to which it has given rise has been 
 marked improvement in the physical, mental, and moral condition not only 
 of the insured but of the poorer section of the population, and this improve- 
 ment is reflected in a higher standard of civilization and of economic effi- 
 ciency/' 
 
 The authorities seem agreed that an improvement in the efficiency of 
 men has been one of the noticeable consequences of the better housing and 
 better public health resulting from these laws. 
 
76 
 
 CONSUMPTION 
 
 EARLY DIAGNOSIS NECESSARY 
 
 Early diagnosis is the heart of the consumption question. Consumption, 
 diagnosed in the early stages, is curable in nearly every case, and, what is 
 just as important, cure can be brought about with the expenditure of so little 
 time and money that it is within the reach of nearly every one. 
 
 On the other hand, late consumption is not often cured. Part of this is 
 because the disease in that stage is hard to cure, and part of it is because 
 the time and money required put the cure beyond the reach of most people. 
 
 The cure of consumption by fresh air, rest, and feeding, while the best 
 cure we have, is far from being perfect. When scientists have discovered a 
 better cure there will no longer be so great a premium on early diagnosis. 
 After that, men can go along foolishly saying, "There is nothing the matter/' 
 saying, "Thinking consumption makes consumption," trying in every way to 
 deceive themselves, and still be cured. 
 
 WHEN TO SUSPECT CONSUMPTION 
 
 The earliest sign of consumption is unwarranted tire. This is always 
 very suggestive of consumption, but it is also suggestive of many other condi- 
 
 COUGHS, SPITS AND 
 SNEEZES INTO 
 PAPER OR CLOTH,- 
 
 Michigan Public Health. 
 
 Fig. 30. — A Careful Consumptive. 
 
 BURNS OR BOIU 
 BEFORE IT DRIES, — 
 
 tions. This symptom would have qualified Napoleon Jackson, "who was 
 marked for rest." It would qualify those who suffer from hookworm, to say 
 nothing of a good many other ills, some of which are of no particular im- 
 portance, while others are. 
 
 If the person who suspects he has the disease will take his temperature 
 four times a day for a week or more, he will find a morning drop to a little 
 below 98 J and an afternoon rise to a little over 99. The range of temperature 
 is not conclusive proof of the disease. It is suggestive only, but it is a more 
 reliable sign than the rundown feeling. 
 
 Both of these symptoms come before the cough appears, and, of course, 
 
WHAT CAN CONSUMPTIVE DO TO BE SAFE TO OTHERS? 77 
 
 weeks before bacilli can be found in the sputum. They bespeak an easily 
 curable stage of the disease. 
 
 Cough follows a little after the onset of the infection in the nose and 
 throat. The consumption cough is much more liable to sneak in without 
 aches and pains. This symptom, too, is suggestive only. There are other 
 causes for a slowly developing, persisting, mild cough. By the time the 
 cough comes the disease has progressed far enough for a fairly good diagnos- 
 tician to find evidence of it in the chest by a physical examination. 
 
 There is another suggestive circumstance that is of great importance. 
 That is a history of having been thrown in close contact with consumptives. 
 
 If a member of one's family has recently had an open tuberculosis, spit- 
 ting tubercle bacilli or having a wound or sore throat discharging them ; if one 
 has worked recently by the side of a spitting consumptive; if one has been 
 drinking milk from cows proved to have had consumption — such a personal 
 history is just as suggestive as the feeling of tire, or a little range of tempera- 
 ture, or a little cough. Any one of the four suggestions brings two bits of 
 advice: the first that, whatever in the method of living is insanitary or un- 
 hygienic be changed; the second, that effort be made to get a diagnosis. 
 
 CONTENTS 
 
 0p <A*»OUCACH 
 T °EACHQ<JAf r 
 
 £ 
 
 f 
 
 WHAT CAN THE CONSUMPTIVE DO TO BE SAFE TO OTHERS? 
 
 The consumptive starts out with an infection located in one part of one 
 lung. If he is not to harm himself he must not infect other parts of his 
 
 own body. He starts out as the only case in 
 his home and his office. If he is not to harm 
 his fellow man he must not infect his sur- 
 roundings. How can he earn security for 
 himself? How can he earn security for his 
 fellows ? 
 
 In order to prevent infection of other 
 parts of the infected lung and of the other 
 lung it is necessary that sputum should be 
 cleared out of the lungs just as soon as it 
 comes in coughing reach. But coughing 
 which does not produce sputum jerks the 
 lungs and thus harms them and forces bacilli 
 into new areas in them. Therefore, there 
 should be enough coughing to empty the lungs, 
 but no more than is needed for this purpose. 
 The throat must not become infected. 
 The cough must keep the vocal cords clean, 
 but it must not be hard enough to hurt them. 
 The mouth must be kept scrupulously clean. So must the teeth, the tongue, 
 the tonsils. Sputum must not be swallowed, because tubercular ulcers in the 
 intestines very nearly end all possibility of cure. 
 
 Pneumonia and common colds must be avoided by keeping in the open 
 air and avoiding people who have colds. 
 
 The man must not infect his family or his work fellows. First of all, 
 he must not cough or sneeze without holding a napkin or handkerchief in 
 
 ¥ 
 
 or puts it into 
 a disinfectant:- 
 
 Michigan Public Health. 
 Fig. 31. — A Careful Consumptive. 
 (See Fig. 30). 
 
78 
 
 CONSUMPTION 
 
 front of his face, so that no mist may be thrown into the air. He must not 
 spit either the sputum or ordinary spit on the floor, the wall, the bed, or any- 
 where except into a napkin or some receptacle, which in turn must have 
 
 proper care. He must 
 not kiss those suscepti- 
 ble to the disease. He 
 must have his own eat- 
 ing and drinking uten- 
 sils. He must not han- 
 dle the food of others. 
 He must be careful that 
 he does not stay long in 
 badly ventilated places, 
 nor in places where sun- 
 light does not reach. 
 
 It is difficult to in- 
 fect a well-ventilated, 
 sunlit room. He must 
 not luork at a dusty 
 trade. 
 
 Following these few 
 simple rules, he is a 
 good neighbor and a 
 good fellow workman. 
 As an associate he is 
 safe and he should be 
 allowed an opportunity 
 to work and to enjoy 
 himself. On the other 
 hand, a reckless con- 
 sumptive should have 
 fewer rights than any 
 other man. He is an 
 enemy to his fellow 
 man. Perhaps more of 
 charity and humanity 
 would decrease the 
 number of community 
 enemies. How often a 
 consumptive gets careless and reckless, bitter and vindictive, because he 
 believes that consumption is a sin of society and that he is being made to 
 suffer unjustly. He grows resentful and strikes right and left, or maybe, 
 tired and worn, he ceases to care for men because he thinks that no man 
 cares for him. 
 
 Fig. 32. — Look Out for Consumption. 
 
 WHAT IS THE CONSUMPTIVE TO DO FOR HIMSELF? 
 
 There is no cure for consumption in the sense that diphtheria antitoxin 
 is a cure for diphtheria, or even in the sense that quinin is a cure for malaria. 
 
HEADING OFF CONSUMPTION 
 
 79 
 
 When antitoxin is injected it searches out the diptheria toxin, neutralizes it, 
 and leaves the tissues of the body untouched. When quinin is taken for malaria 
 every tissue in the body is poisoned, but the malaria organisms are poisoned so 
 much more than any other cell that the result, in a certain sense, is specific. 
 
 For tuberculosis we have tuberculin. This carefully used over a long 
 time builds up the resistance of the body to the toxin of the tubercle bacillus, 
 but not to the bacillus itself. Certainly there is none of the magic effect seen 
 after diphtheria antitoxin is used. 
 
 The present consumption cure consists in building up the resisting forces. 
 They then fight back in a general sort of way and as the tubercular process is the 
 most evident force at which to strike, 
 the quickened resistance strikes at it. 
 
 It is as if a sleeping giant had 
 been half awakened to a sense of dan- 
 ger, and, simultaneously, to a desire 
 to fight back. The monster lunges 
 out against whatever is at hand. It 
 may fight against the enemy. It may 
 waste its force in a futile struggle. 
 The elements of cure are rest, food, 
 and fresh air. 
 
 One of the best books on curing 
 consumption is "My Personal Experi- 
 ence with Consumption/' by Eoss. In 
 an article in the October number of 
 the Journal of Outdoor Life, Eoss says : 
 
 "The day's work should consist of rest; rest should be the only business 
 on hand. . . . The error that many fall into is in confusing rest with some 
 of the many forms of recreation. Hence, it is necessary that we 'standardize' 
 our meaning of rest to fit the case of the person suffering with tuberculosis. 
 The matter is an important one, equally as vital as the proper regulation of 
 the other requisites of the cure, for it has been very clearly demonstrated that 
 the cure depends not on any single one of the major necessities, i fresh air, 
 wholesome food, and rest/ but on all of them, sensibly applied and regulated." 
 
 As a matter of fact, the need is that the patient be told just how much 
 to rest, just how to rest, and just what is rest. In his book Eoss says : 
 
 "Besting is a severe test upon one's patience. It will be taxed to the ut- 
 most again and again. The real battle is taking place at this point. Getting 
 well requires the exercise of many of one's powers, and foremost of these is 
 patience and restraint. The development of these two faculties will save much 
 energy, every ounce of which is needed. A large percentage of those who have 
 not been cured might have been had they learned to rest in the proper manner 
 during the curative period." 
 
 WASHES HER HANDS 
 BEFORE AND AFTER EATING* 
 
 Michigan Public Health. 
 
 Fig. 33. — A Careful Consumptive. 
 
 HEADING OFF CONSUMPTION 
 
 Whenever close association with a consumptive, or lassitude, or fever, or 
 cough has made one suspect that he has consumption, the proper course for 
 
80 
 
 CONSUMPTION 
 
 him to follow is to find out if he has the disease and if so to adjust his life 
 so as to fight it successfully, and, if he has not, to dismiss the subject from his 
 mind. 
 
 Nothing could be more asinine than a policy of dread of the disease so 
 great that one is afraid to investigate and inquire, afraid to know the truth. 
 Such a policy means a foolish drifting into breakers from which there is no 
 escape. 
 
 The most searching and thorough test for tuberculosis is the tuberculin 
 test. The principle of the tuberculin test is that when tuberculin — a secretion 
 of the tubercle bacilli — is put in the body it will search out the tubercle 
 
 AlWflfS USES THE SAME 
 DISHES AND BOILS THEM 
 IN WATER BEFORE WASHING 
 WITH OTHER DISHES,— 
 
 Michigan Public Health. 
 Fig. 34. — A Careful Consumptive. 
 
 AND SLEEPS ALONE 
 
 Fig. 35. — A Careful Consumptive. 
 
 bacillus and, if any are found, the two of them working together will cause a 
 reaction. The lock fits the key, the key fits the lock, and put together they 
 bring results. Tuberculin applied when there are no tubercle bacilli in the 
 body is without any effect. 
 
 Tuberculin is sometimes dropped in the eye, sometimes injected into the 
 skin, sometimes vaccinated into the skin, and sometimes injected under the 
 skin. The latter is the method generally employed, and in my opinion the best 
 method. Its disadvantage is that it gives the person with tuberculosis an un- 
 comfortable day. 
 
 There are those who believe it sometimes causes the disease to flare up and 
 spread more rapidly. In a disease whose natural course is alternately to flare 
 up and settle down, it is difficult for anyone to decide the cause of any flareup. 
 Allowing that these men are right in their supposition that the use of tuber- 
 culin has sometimes caused the disease to flare up, the fact remains that the 
 enormous good from the early, exact, certain information given is of over- 
 shadowing advantage. 
 
 The trouble with the tuberculin test is that it is too searching to fit in 
 with other tests. It finds tubercular lesions that are not of much consequence 
 as well as those that are. The proper plan in one of these conditions that 
 suggest tuberculosis is to have a tuberculin test. If there is no reaction, all 
 thought of the disease can be dismissed from one's mind. If there is a reac- 
 
HOW TO HAVE CONSUMPTION" 
 
 81 
 
 tion, searching physical examination should be made to determine whether the 
 infection is of any clinical importance. 
 
 Bacilli in the sputum is an infallible sign, but the trouble about it is that 
 it is a late sign. A man with consumption ought to know of his disease and 
 change his method of living before that sign develops. 
 
 HOW TO HAVE CONSUMPTION 
 
 Much is to be said in favor of optimism. It buoys one over the rough 
 places. As an antidote to worry and the habit of anticipating ills it is about 
 the best medicine ever taken. It is much better than medicine poured out of 
 a bottle. 
 
 On the other hand, optimism has taken the lives of many thousand con- 
 sumptives. Men cheerily, smilingly saying that all is well, and, acting on this 
 
 Fig. 36. — A. Chest in Rickets 
 Badly Deformed. 
 
 B. Deep Narrow Chest Prone to 
 Consumption. 
 
 assumption, have drifted from good health into early consumption or from 
 early consumption into the incurable stages. Proper effort based on common 
 sense would have kept them on good ground or pulled them out of tight 
 places. 
 
 As between a pessimistic consumptive, self-centered and selfish, and one 
 who is optimistic, who bathes himself in sunshine and radiates hope, every man 
 would choose the optimist. But those who have had experience with con- 
 sumptives know that there is a frame of mind preferable to optimism. It is 
 the facing of the situation with frankness and intellectual honesty backed by a 
 quiet courage and persisting determination. 
 
 There is no hope for the pessimistic consumptive. There is little for the 
 optimistic. The reward of recovered health does not always come to those 
 of the third group. ISTevertheless, they can reasonably expect it. The others 
 cannot. 
 
 The first element in the right way to have consumption is the right frame 
 of mind. 
 
 Rest is necessary for a cure. A man is a machine daily engaged in eating 
 food and converting it into energy — assets. He does work. Let us call this — - 
 
82 
 
 CONSUMPTION 
 
 liabilities. Normally he maintains a balance between these. When tubercu- 
 losis is added to his liabilities the load becomes too heavy. It is necessary to 
 readjust by increasing food and decreasing labor. Eest is necessary for a 
 cure. 
 
 Worry is a form of mental labor. It uses up energy needed to fight the 
 disease and it brings no proper return of any kind. The consumptive must 
 not worry. 
 
 And another detail well worth while is that he must not use up energy 
 
 •EXEQCISE-IN-OPETi-AIR.- 
 
 North Carolina Public Health. 
 
 Fig. 37. — To Avoid Consumption. 
 
 •RE-ST-WflEN-TIB&D' 
 
 North Carolina Public Health. 
 
 Fig. 38. — To Avoid Consumption. 
 
 by needless coughing. A certain amount of coughing is necessary to keep the 
 bronchial tubes clean. Any coughing in excess of this wastes energy and in- 
 jures the lungs. Needless coughing must be controlled by will power. Medi- 
 cines should not be used. 
 
 A man can fight his consumption in a reasonable or in an unreasonable 
 way. Proceeding with reason and common sense he gives his fighting forces 
 the most favorable ground from which to win. 
 
 HOW IS A CONSUMPTIVE TO KNOW? 
 
 It is easy to tell late consumption, but then no good comes to the sick 
 person from knowing what his disease is, because cure is beyond his reach. 
 Even the few who are cured have lungs so badly crippled that they have no en- 
 durance. 
 
 It is difficult to discover early consumption, but so much is gained by 
 early diagnosis that it is all important. Very early consumption will get well 
 after tivo to three months of rest, air, and feeding. Early consumption will 
 get well in six months. A diagnosis that is not made in one of those two 
 stages is not worth much to the patient of average means. The average man 
 can find a way to rest for six months, but any need in excess of that is beyond 
 him. Who should suspect that he is tubercular ? 
 
HOW IS A CONSUMPTIVE TO KNOW? 
 
 83 
 
 1. Any person who has been in contact, within a year, with a consumptive 
 or a cougher should consider himself under suspicion. 
 
 2. Any person who catches one cold on top of another should suspect himself. 
 
 3. Any person who has a cough which holds on without cause. 
 
 4. Any person who does not feel vigorous, especially those who feel de- 
 pressed before 8 in the morning and after 3 in the afternoon should take the 
 morning and afternoon temperature. If the morning temperature is under 98 
 and the afternoon is over 99 he should consider himself under suspicion. 
 
 5. Any person losing weight without apparent cause. 
 
 Any person belonging to any of these groups should have his condition 
 carefully looked into. This means a careful examination of the chest, a de- 
 
 •5LE.EP • WITH* WINDOWS-OPCM* 
 
 North Carolina Health Bulletin. 
 
 Fig. 39. — To Avoid Consumption. 
 
 -DVST*COHT&\nS * GERflS' 
 
 North Carolina Health Bulletin. 
 
 Fig. 40. — To Avoid Consumption. 
 
 tailed inquiry into the history, and such other procedures as may be necessary. 
 A good physician will probably want to watch the patient a while before he 
 makes a diagnosis. 
 
 The procedures which are valuable in these early cases are : 
 
 1. Careful, painstaking examination of the chest. 
 
 2. Careful consideration of the history. 
 
 3. The use of tuberculin in the average case, and in the hands of the aver- 
 age physician is the most valuable of all. It is most reliable in the early cases 
 which offer so much hope. 
 
 4. Examination of the sputum by the microscope, a procedure of great 
 service in the late cases but which does not help much in the early ones. It is 
 desirable to have the diagnosis established before tubercle bacilli appear in the 
 sputum. The cases which have fever, sweats, coughing, and spitting are late 
 cases and easily diagnosed. 
 
 To know, and to know early, is an absolute necessity if the consumptive is 
 to get well. For knowing early there are two requisites : , First, to become 
 suspicious just as soon as there is reasonable ground for it ; a sense of mental 
 security not based on physical facts is a delusion which inevitably leads into 
 situations from which there are no escapes. Second, a careful, comprehensive 
 examination. 
 
84 
 
 CONSUMPTION 
 
 HOW CAN A CONSUMPTIVE JUDGE OF PROGRESS? 
 
 The signposts are temperature, pulse, weight, cough, and expectoration. 
 The morning temperature is generally below 98, the afternoon temperature is 
 above 99. When the temperature stays below 99 things are usually going 
 nicely. When it goes over 100 the poisoning is getting beyond the system's 
 carrying capacity and the patient's work must be lessened, his food and air 
 increased. 
 
 After a certain fashion the pulse indicates the progress of tuberculosis. 
 The number of beats will mount up rather faster than does temperature. A 
 patient who has fever and a rapid pulse can bring his temperature to normal 
 much more easily than he can cause his pulse to slow up. A fast pulse will 
 persist for weeks after temperature has become normal. 
 
 When a person who is eating well 
 and not worrying loses weight con- 
 sumption is to be thought of, particu- 
 larly if there is a cough which hangs 
 •on. In the early stages of consump- 
 tion if work is lessened and food in- 
 creased properly the patient always 
 gains in weight. If he is of the lean 
 kind he will gain more slowly; if he 
 is a good feeder he will gain more 
 rapidly. The uniformity with which 
 early stage consumptives gain flesh 
 when properly fed is proof that any 
 healthy person can get fat if he wants 
 to. Of course thinking he wants to 
 does not get him anywhere. 
 
 When a consumptive gets to the 
 point where he will not fatten even 
 though he rests and feeds he is not doing well. In some cases the patient fat- 
 tens even though his disease is progressing. In other cases the patients gain 
 fat faster than their lungs improve. Nevertheless fattening and wasting are 
 signs which indicate how the battle is going. 
 
 Cough and expectoration are signs of value. Consumptives soon learn to 
 cough little. A visitor to a consumptive hospital does not hear one-tenth the 
 coughing that he does in a theater. The amount of expectoration is a more 
 valuable sign than the cough. In measuring the sputum an average must be 
 struck. A temporary nose cold or a temporary ordinary bronchitis will tempo- 
 rarily increase the amount of sputum. 
 
 Sweats, pallor, emaciation, diarrhea, indigestion mean that the fight is 
 running strongly against the patient. 
 
 Signs which the patient can notice in his chest are not of much service 
 in determining how his disease is progressing. He should tell his physician 
 of such sounds, pains, and unnatural feelings as he has observed, in order that 
 the physician may interpret them. The results of physical examination of 
 
 •5D0NT- GET -"RUM 'DOWr* • 
 
 North Carolina Health Bulletin. 
 
 Fig. 41. — To Avoid Consumption. 
 
WHAT THE CONSUMPTIVE SHOULD DO 85 
 
 the lungs by the physician are not of the value in indicating progress of the 
 disease that people generally believe. 
 
 And, finally, conclusions must not be drawn from observations of but a 
 few days. Consumption is a disease which goes by "fits and starts." Each 
 case calls for careful, close study. Each case needs to lean on a master mind. 
 
 WHAT THE CONSUMPTIVE SHOULD DO 
 
 It is most important that he should eat enough food. It should be of the 
 proper kinds. A standard day's ration should consist of : 
 
 Meat 6 ounces 
 
 Milk 4 pints 
 
 Eggs 2 
 
 Cereal 1 plateful 
 
 Bread 8 ounces 
 
 Butter 2 ounces 
 
 Potatoes 4 ounces 
 
 Pudding 1 helping 
 
 Apples or oranges 2 
 
 Lemon, or juice of 1 
 
 Spinach, cauliflower, lentils, peas, and beans may take the place of po- 
 tatoes. Nuts may take the place of some of the butter. Honey and sugar may 
 be taken freely, providing these articles do not disturb the digestion. 
 
 Some people can profitably increase the above quantities about 50 per 
 cent. A few people can double them. Some will do better if they decrease 
 them 20 per cent. 
 
 The winter diet should have more fats than that of summer. There 
 should be four meals a day. The food should be eaten slowly and be well 
 chewed. The mouth and teeth should be cleaned before and after eating. 
 
 He should sleep at least nine hours of the twenty-four. He should sleep 
 on a sleeping porch properly protected against rain and snow. If he sleeps in 
 a room the temperature must not go higher than 45°. The window must be 
 wide open, for it is more difficult to get air into a cold room than into a 
 warm one. 
 
 In order to keep warm he must have a paper blanket between the mat- 
 tresses and another between the quilts which cover him. He must have a 
 woolen nightcap, woolen mitts, a long woolen bathrobe, and slippers made of 
 soft sheepskin tanned with the wool on them. 
 
 Under no circumstances must he work over six hours a day. A fair 
 number of cases can work four hours a day, many can work two hours, many 
 must sit out in the sunshine and air all day without working. No whisky 
 or other stimulants should be used. No cough medicine nor any other medi- 
 cine should be taken except as a physician directs. 
 
 No case should be without medical direction. The proper way, in con- 
 sumption, is to have a physician call at stated intervals, study the history, 
 and direct the method of living. A detailed history of the case and the house- 
 hold happenings should be kept by a trained nurse or by a member of the 
 
86 
 
 CONSUMPTION 
 
 family. When a case is being cared for by the family, a nurse should call in 
 
 at intervals. 
 
 In Chicago it is estimated that there are 15,000 people with tuberculosis. 
 
 In 10,000 of them the disease has progressed far enough so that they know 
 
 they are tubercular. Less than 1,000 are in hospitals and sanitariums. 
 
 There are 9,000 people in this 
 community who have a close per- 
 sonal interest in knowing what to 
 do at home. From these 9,000 about 
 5,000 persons contract the disease 
 each year. They, too, are interested. 
 This makes a total of 14,000 per- 
 sons who have a direct personal in- 
 terest in knowing what a consump- 
 tive should do in the way of eating, 
 sleeping, and resting. These are 
 about one one-hundred-and-sixtieth 
 of the total population. 
 
 Sanitariums and hospitals do 
 magnificent work, but the great ma- 
 jority of consumptives are cared for 
 in homes, are nursed in the main by 
 members of their families, and cared 
 for by family physicians. 
 
 There is a general agreement 
 that the treatment of a consumptive 
 must not stop with the arrest of the 
 disease. The patient must be got 
 back into social and industrial life. 
 Cabot tells us that men live by work 
 in more senses than one; that a 
 
 sanitarium that does not lead back into life is a blind pocket; its statistics 
 
 of cures do not stand when the cases are looked up ten years after they have 
 
 left the institution. The report of the social service department of Indiana 
 
 university says: 
 
 "Once interest a patient in his own condition and problem and give him 
 
 hope, and he will go further than anyone else, according to his ability, toward 
 
 solving that problem." 
 
 Fig. 
 
 42. — Cut of Window Tent Showing 
 Ventilation. 
 
 CHASING THE CURE IN THE CLOUDS 
 
 In the cure of consumption, climate counts for 15 per cent. If we take 
 two men with the same degree of infection, having about the same capacity 
 for resisting the disease, having about the same amount of money to provide 
 rest and open air treatment, submitting themselves to the same degree of con- 
 trol, the man who is in Colorado will stand a 15 per cent better chance than 
 the man in Illinois. 
 
 If the one goes to Colorado without money and takes his chances in the 
 
CHASING THE CURE IN THE CLOUDS 
 
 87 
 
 catch as catch can of what is called ranching it, he will lose more than 15 per 
 cent of his chance, and therefore Colorado will net a loss for him. 
 
 As so many of the people who chase the cure in the West plunge foolishly 
 into the venture it is probable that the real value of climate is under 15 per 
 cent rather than over 15 per cent. 
 
 How does climate work the cure? Probably some part of it is due to 
 sunny days, low air humidity, dry soil, and slow winds. Each of these agencies 
 
 —.Of •" — 
 
 -i*f Sps-i/cc *>#". 
 
 rX^mrrnrpr^ 
 
 
 
 '•'-» 
 
 
 1; 
 
 i! 
 
 i!' 
 
 
 i! 
 
 1! 
 
 1 1 
 
 ll 
 
 — t ■*' ij 
 
 ;i 
 
 \ 
 
 
 
 
 !i! 
 
 -Ji- 
 
 
 i 
 
 _ ..! i , 
 
 -41 — 
 
 
 
 L 
 
 
 M 
 
 -.»•-♦-= — 
 
 -j&. — 
 
 
 
 • *-°>" — ■# 
 
 Fig. 43. — Building Plan for Sleeping Porch 
 
 of good have been written about until everybody knows of them. Recently 
 scientists have been trying to discover whether altitude of itself is of advan- 
 tage, and if so, how. 
 
 In 1911 some scientists from Oxford, England, and one from Yale con- 
 ducted some studies on mountain sickness on Pike's Peak. Incidentally they 
 discovered that at high altitudes the blood is richer than at sea level, and that 
 a certain blood cell called the lymphocyte is increased in numbers. 
 
 Before Metchnikoff began to study men he was known as a great zoologist. 
 He was especially learned in the ways of animalculae, the microscopic animals 
 which the boil-the-water film at the moving-picture shows as crossing the cur- 
 tain and eating up everything within reach. 
 
 When Metchnikoff took up the study of men he found in his blood small 
 cells called leukocytes. Most of these leukocytes are called polynuclears, be- 
 
88 CONSUMPTION 
 
 cause they have several nuclei. These polynuclear leukocytes move around like 
 the animalculae at the picture show and eat up all the germs in reach. 
 
 Among these active, rustling, hungry polynuclears are certain quiet leuko- 
 cytes with but a single nucleus. These were called lymphocytes. 
 
 The tubercle bacillus is an armored knight, as truly armored as the 
 knights of the middle ages. Its armor is wax. But wax to a polynuclear leuko- 
 cyte is as impenetrable as iron. 
 
 Therefore, although in pneumonia, appendicitis, and many other kinds of 
 infection the white cells jump from the normal 5,000 to 20,000 or more, and 
 the polynuclears jump from the normal, 60 per cent about, to 80 per cent 
 about, in consumption there is no considerable increase in the number of leuko- 
 cytes, and the polynuclears actually decrease in percentage. 
 
 However, it has been found that the quieter mononuclear leukocytes called 
 lymphocytes can eat the wax out of the consumptive germ, and then proceed 
 to kill it. The investigators above referred to found that at high altitudes 
 the percentage of lymphocytes was increased. 
 
 Bunting at Madison, Wisconsin, found that the sturdy students of Wis- 
 consin university had 42 per cent of lymphocytes among their leukocytes. 
 Harvard students had 37, and Colorado college 52. Webb at Colorado Springs 
 found that children had 60 per cent and adults 14. 
 
 The visiting scientists found that each cubic centimeter of blood normally 
 had 2,200 lymphocytes, and that on Pike's peak this rose rapidly to 4,100, and 
 then settled back to 3,300, where it remained. 
 
 In plainer words, altitude increases the number of those blood cells which 
 are the best fighters of the consumption germ We have — an additional factor in 
 that 15 per cent. 
 
 CURE OP TUBERCULOSIS 
 
 Our present cure of tuberculosis is a four-legged stool. One leg is rest, the 
 second control, the third food, and the fourth fresh air. 
 
 The object of rest is that all of the energies of the body may be available 
 for combat with the disease. a 
 
 The need of control rests on many factors. The fight is to be trying. 
 Backbone will be required. Nobody gets well except the fighting men. Op- 
 timism is needed — optimism savored with sanity. Quiet courage is needed. 
 Persistent, dogged determination is a requisite. Earely does any man alone 
 and of himself measure up to these demands. The control must help to make 
 backbone. And then the waters are beset with rocks and skilled piloting is 
 required. 
 
 The need of an excess of food is that resistance may be heightened. In 
 addition, tuberculosis bears a peculiar relation to nutrition. The neglected 
 consumptive falls off out of all proportion to the disturbance of his digestion. 
 
 Fat people have always had a partial immunity towards it. Since the 
 start of things man has somehow sensed the idea that oils and fats were helpful 
 in curing the disease. In addition to the general increase of resistance from 
 full eating consumption seems peculiarly responsive to a good food intake. 
 
 The need of air comes from the gain of breathing pure air as compared 
 with the breathing of foul air. We would expect neither a sick nor a well 
 
WHERE SHALL THE CONSUMPTIVE GO? 89 
 
 man to thrive on sewage as a drink. Neither can we expect men to thrive on 
 sewer air, even though they have been trying to get accustomed to it for a long 
 time. A further gain comes from the power of fresh cold air to absorb heat 
 from the body. 
 
 When all this volume of food is being burned into energy and resistance 
 an excess of heat is made. It must waste. If there is plenty of cold air in 
 contact with the body it can be wasted to the air. If the air of the room is 
 warm the chance to waste surplus heat disappears, the excess of food cannot be 
 taken and resistance cannot be built up. 
 
 Such are our only elements of cure. The whole makes up the only cure. 
 The advertised cures — the patent medicines — are the rankest fakes and frauds. 
 The wrappers and testimonials in the old days were tissues of falsehoods. The 
 Shirley Law, passed on August 20, 1912, may force them to quit lying. Many 
 of them depend upon opium and alcohol for the only effects which the patient 
 could feel. They were, therefore, not only dopes but they were habit-breeding 
 dopes. They were robbers, for they took the money of poor unfortunates on 
 pretext of doing for them what they could not possibly do. 
 
 One of the arguments in favor of the national insurance plan in operation 
 in some parts of Europe is that it pulls the teeth of these fakes. The source of 
 much of the abuse of Wiley and of the American Medical Association is that, 
 in protecting the people by exposing these frauds, they have put a crimp in the 
 gains of certain people. 
 
 WHERE SHALL THE CONSUMPTIVE GO? 
 
 So far as the average consumptive is concerned, he will have to stay at 
 home. There is no other place for him. Ten years ago, someone, Osier, I 
 think, said that 98 per cent of the consumptives must stay at home. Change 
 of climate was available for only 2 per cent. The situation has improved in 
 the last few years. 
 
 Nearly every fraternal order now has a well regulated, well run sana- 
 torium. One old line life insurance company, the Metropolitan, is building a 
 consumption sanatorium, and before long the old line companies will follow 
 the lead of the fraternals. Many of the trades are now doing relief work for 
 their tuberculous members, and some part of the relief consists in organized 
 machinery for caring for their consumptives who are chasing the cure. The 
 printers have their own home and, I dare say, other trades also have equipped 
 homes. The Y. M. C. A. has its tuberculosis camp at Denver and the Jews 
 have their hospitals. 
 
 An organization of medical men in the West has expressed violent objec- 
 tion to having that section made a dumping ground for consumptives without 
 strength to work and without resources to sustain them without work. The 
 Rocky Mountain Public Health Association recently estimated that 11,000 of 
 the 12,775 consumptives in Colorado were citizens of other states. Therefore, 
 133-134ths of the financial burden on Colorado for consumption is properly 
 chargeable to other states. From the standpoint of the individual, it is the 
 height of folly for a consumptive to go away from home unless he has resources 
 enough to curry him without work in his new home, 
 
90 
 
 CONSUMPTION 
 
 In changing climate the individual must be studied from every stand- 
 point. People from northern Europe and the northern United States, accord- 
 ing to Knopf, do best in Colorado. The people who come from the sunny 
 parts of America and Europe do best in New Mexico, Arizona, California, and 
 North Carolina. Observers have noticed that Europeans generally do best 
 when they go back home — e. g., the Irish to Ireland. Bone tuberculosis, gland 
 tuberculosis, and tuberculosis in children generally do best at or near the sea 
 shore. Lung tuberculosis does best in the mountains. Moist tuberculosis — ■ 
 
 
 MEAN RAINFALL (in inckes & by seasons) FOR 
 DIFFERENT PARTS OF THE UNITED STATES. 
 
 • • place: • 
 
 •WINTER 
 
 ■ SPRING 
 
 •SUMMER- 
 
 •FALL.- 
 
 SARANAC LAKE, NY 
 
 J4" 
 
 7.8" 
 
 11 b' 
 
 3.8" 
 
 PHILADELPHIA, PA. 
 
 _q.?_ 
 
 1.5" 
 
 11. V 
 
 «LS" 
 
 ASHEVILLE, N.C. 
 
 JjJ__ 
 
 ,U * 
 
 ia.c" 
 
 S_2.'^_ 
 
 
 AIKEN, S.C. 
 
 JLV 
 
 ■H^^a 
 
 155 
 
 JOS" 
 
 COLORADO SPRINCS.COL 
 
 0.8" 
 
 4.5" 
 
 7.0" 
 
 2.0' 
 
 ALBUQUERQUE, N.M. 
 
 1 0" 
 
 ■ 
 
 13" 
 
 ■ 
 
 3.4" 
 
 IS' 
 
 m 
 
 SANTEFE, N.M. 
 
 2.0" 
 
 k. 
 
 fe I' 
 
 3.3" 
 
 PRESCOTT, N.M. 
 
 4.5* 
 Em 
 
 2 8" 
 
 in 
 
 5.3" 
 
 3.0* 
 
 PHOENIX, ARIZ. 
 
 2.2" 
 
 F~ 
 
 JP" 
 
 i 7 " 
 
 YUMA, ARIZ. 
 
 I 
 
 ,0 4- 
 
 0.4* 
 
 O.fc* 
 
 ■ 
 
 LOS ANGELES , CAL. 
 
 _8_q" 
 
 4.5" 
 
 o.r 
 
 Z.J" 
 
 SAN DIEGO, CAL. 
 
 5.4" 
 
 2 4' 
 
 3" 
 
 L3" 
 
 I 
 
 
 
 Fig. 44. 
 
 tuberculosis with sputum — does best in a dry climate, one, however, where 
 there is not too much wind and dust. 
 
 If a patient is sanguine, cheerful, and bright he will stand a change of 
 climate well. If he is morose and Irypochondriacal or given to homesickness, 
 he will not stand going away well. Generally, patients with heart trouble or 
 great nervous tension or tendency to hemorrhage do not stand elevations well. 
 Less than 7,000 feet does not seem to make any difference. 
 
 CLIMATE AND CONSUMPTION 
 
 The climate of Colorado, western Texas, New Mexico, and Arizona is 
 without equal for tuberculosis. The weather reports for the last twenty years 
 show that San Antonio has a yearly average of 99 cloudy days; El Paso, 36, 
 
CLIMATE AND CONSUMPTION 91 
 
 and New Mexican points about the same number. The daily mean humidity 
 at San Antonio is 67.5 ; that at El Paso, 40, and that at some points in New 
 Mexico and Arizona lower still. The average rainfall at San Antonio is 
 twenty-six inches ; at El Paso, nine inches, and at Albuquerque, eight inches. 
 
 However, the trouble about the matter is that the average man does not 
 know what climate can and what it cannot do for a consumptive. More than 
 half the consumptives who travel to these resort regions would have been 
 better off, more comfortable, more contented, and would have had a better 
 chance to live had they stayed at home. 
 
 Dr. Sweet of the Public Health Service estimates that there are 30,000 
 consumptives in western Texas alone and that there are 27,000 in New Mexico. 
 Many of these are entirely well. Many are on the road to recovery. But, un- 
 fortunately, a large number are there without funds or income wandering 
 around from place to place. 
 
 Ten years ago more than 50 per cent of the consumptives dying in El 
 Paso, Texas, had been in the region less than six months, and 20 per cent had 
 been there less than a month. In 1913 the figures were 22 per cent and 8 
 per cent respectively. In Albuquerque, New Mexico, in 1913 the figures were 
 still 42 per cent and 13 per cent respectively. 
 
 In El Paso the length of residence there of the 2,791 consumptives who 
 had died there during ten years was divided as follows: Under thirty days, 
 11.5 per cent; thirty days to six months, 19 per cent; six to twelve months, 
 8.3 per cent; one to two years, 7.9 per cent; two to five years, 12 per cent; five 
 to ten years, 5.6 per cent. The percentages for Albuquerque were similar. 
 
 Of 1,775 bodies of consumptives shipped out of western Texas, 225 went 
 to Illinois; 217, to Missouri; 131, to Ohio, 32 per cent of the whole. Add to 
 these the numbers from Kentucky, New York, Tennessee, and Mississippi and 
 we get more than 900 — over 50 per cent of the whole. 
 
 The normal consumption death rate of a well regulated community is 
 around 140 per 100,000. The mean death rate of Albuquerque from consump- 
 tion for ten years past has been 1,404.6 — about ten times the normal; that of 
 El Paso, 788.7; Asheville, North Carolina, 672.9; Colorado Springs, 607.6; 
 San Antonio, 449 ; Denver, 372 ; San Diego, 324, and Los Angeles, 299.8. 
 
 The reason for these high rates is because each year Albuquerque receives 
 something over 2,000 consumptives from outside its state; El Paso, nearly 
 3,000, and San Antonio, 3,500. But 7.8 per cent of the consumptives dying in 
 Albuquerque were born in New Mexico. But 12.1 per cent of the consumptives 
 dying in El Paso were born in Texas. 
 
 Furthermore, a very large proportion of those traveling about in trains in 
 the health resort region are in the last stages of the disease, and a fair pro- 
 portion of those on the through trains entering the resort region are very far 
 advanced cases. 
 
 The lessons are two. First, very advanced cases should stay at home. 
 The chance of cure is very slight. The chance of accidents on the road is not 
 to be overlooked. The sick must see that going away is bad judgment. 
 
 The second lesson is that the climate cannot cure unless it has a fair 
 chance. Wandering around from place to place does not help. Restlessness is 
 a serious handicap. The best chance lies in settling down in one place, getting 
 into the hands of well-equipped physicians and nurses and obeying orders. 
 
92 
 
 CONSUMPTION 
 
 CARE OF CONSUMPTIVES 
 
 Fig. 45. — Sputum Cup. 
 
 Custodial care of consumptives is better than no care at all ; curative care 
 is, of course, better ; and best of all is prevention. So much for the standpoint 
 of the sick person. From the standpoint of the community, custodial care is 
 best. 
 
 Consumption is generally contracted through continuous, close, personal 
 contact. Air infection and milk infection are of consequence, but continuous 
 contact infection leads all the rest. It is in the home that the conditions of 
 
 close, continuous, personal contact are most fre- 
 quently found. Therefore the most important 
 consideration is to get consumptives from their 
 families into the hospitals, where they will have 
 custodial care. 
 
 A French physician has recently investi- 
 gated 500 consumptives, with a view of discover- 
 ing whether susceptibility to the disease is in- 
 herited. The conclusion at which he arrived is 
 that a case in the family increases the tendency 
 to the disease to at least the second generation. 
 Communities should have hospitals for late 
 cases. Many of them have seen this need; 
 many of them have not acted on this need be- 
 cause, somehow or other, such hospitals are usually filled up with tramps, 
 hobos, homeless men, casual workers, aliens, and such people. The family 
 man or woman, the home man, the steady worker, the people who made up 
 the steady, day in and day out citizenship, would not go to such hospitals. 
 The home, the family, and the factory took care of the citizen until pretty 
 near the end. In the meanwhile he was endangering his children and his 
 *benchmates. In the light of what the Frenchman quoted above tells us, it 
 is, above all, necessary to protect the parents. The homeless men and women 
 are rarely parents. 
 
 The remedy? To provide care in the hospital for late cases so humane 
 and comfortable that the man with a home will voluntarily go there and stay 
 there. To equip consumption hospitals as well as general hospitals are 
 equipped with nurses, physicians, instruments, and laboratories. To provide 
 open air treatment for suitable cases. To furnish good food and enough of 
 heat for comfort. To locate them in the city and reachable within one hour 
 and by a 5-cent fare from the homes that they draw from. In a word, to draw 
 patients from their homes because they are more comfortable, happier, and 
 more hopeful in the hospital than elsewhere. By persuasion rather than by 
 compulsion will the family be protected against its dangerous members. 
 
 NIGHT CAMPS FOR CONSUMPTIVES 
 
 An interesting report on the work of the New York Night Camp has 
 been made to the New York State Medical Society. 
 
TUBEKOULOSIS DAY 93 
 
 A night camp is a place where a consumptive, still able to work, can get 
 his dinner, his lodging, and his breakfast. The food furnished is even better 
 and more abundant than that of a consumptive sanitarium. He sleeps out of 
 doors on a sleeping porch or in a room where out-of-doors conditions prevail. 
 In a word, a right-at-home sanitarium. 
 
 The people who need night camps are early stage consumptives who must 
 keep at work, who cannot go away, and who cannot get proper food, sleeping 
 arrangements, ventilation, or nursing in their homes. As they are working 
 during the day, they cannot make use of a night camp unless it is conveni- 
 ently located. 
 
 The night camp idea has been tried before. It must have been eight 
 years ago that Miss Addams tried to interest someone to give about $2,000 to 
 inaugurate such a camp to be maintained particularly for working women 
 living in the neighborhood of Hull House. She did not succeed. Perhaps the 
 time was not ripe. Our minds were then running on sanitariums located off 
 somewhere. At any rate, Chicago lost its chance to be early in the field. 
 
 TUBERCULOSIS DAY 
 
 The custom of setting aside certain days as saints' days is older than our 
 country and much broader. On such days everybody who can, stops work 
 and gives over the day to the customary observance. The money cost of these 
 days is enormous, and yet willingly we pay the cost. 
 
 Tuberculosis day is a new sort of a day. On the other days we do honor 
 to the memory of some dead and gone servant of the common good. Tubercu- 
 losis day is the season when we pledge ourselves anew to a growing movement 
 — the movement to end consumption. 
 
 Consumption is decreasing — that much is certain. The figures show the 
 disease to be on the decrease. It is plain, though there is no way to show, 
 that the decrease is in those parts of the country where the interest in the fight 
 is most general. Furthermore, the decrease is in proportion to the interest. 
 In those places where the people think they have no consumption problem and 
 where they are not joining in the crusade, the disease is on the increase. 
 
 Consumption slipped up on us while we were not watching. While we 
 were busy with the work of everyday life it was quietly eating away like a 
 moth in a chest. The remedy is to get busy. It is not the custom for 
 90,000,000 people to get busy in a hurry. We must first talk about it. 
 
 The first year you talk about it a few see the point and get busy. The 
 crusade is begun. The next Tuberculosis Day starts a few more. After a 
 while the employers of labor see where they are putting the moth in the chest, 
 and they get busy. 
 
 The next year the woman who keeps the windows nailed down and the 
 children sewed up from fall until spring sees where she has put the moth in 
 the chest and gets busy. Maybe the next year it's the taxpayer who sees that 
 caring for consumptives is the cheapest way, and he gets busy. Maybe next 
 year it's the spitter, and he gets busy by being careful. 
 
 The consumption fight is being won. The number of deaths from the 
 disease in the active centers of the fight is less than the number ten years ago. 
 
94 CONSUMPTION 
 
 It takes three years for results to show. Our only way of judging is by vital 
 statistics. The disease lasts nearly three years. Therefore, judge your 1914 
 and 1915 activities by your 1916 consumption death rate. 
 
 The fight is being won. Tuberculosis Day is helping to win it. A day 
 that is contributed to giving battle is worth while. No feast day, national 
 birthday, or great battle anniversary celebration is better worth while. 
 
 CAPTAIN RAOUL'S EXAMPLE 
 
 . For many years Captain W. G. Eaoul was president of a railroad in 
 Mexico. When the railroads of the republic were taken over by a new com- 
 bination Captain Eaoul returned to his old home in Georgia. 
 
 The captain found himself in a position in which many most capable 
 men have found themselves, and many others will find themselves. He was too 
 old for the aggressive work of managing a great corporation. The competitive 
 basis of that work did not fit this man, well on toward the evening of life. 
 
 He might have returned to the home of his early years and led a life of 
 ease, but he preferred to take another course. He had a few more fights in 
 him. 
 
 The fight against consumption was to his liking. He was no longer a 
 two minute horse, but the tuberculosis fight is in the three minute class, and 
 he felt able to hold his own in that class. He became an officer in the tubercu- 
 losis organization and fought for a sanitarium. The sanitarium secured, he 
 became one of its officers. Instead of rustfng out he worked to overcome con- 
 sumption until he died. 
 
 I do not know why he became interested. He may have had some per- 
 sonal interest in consumption, or his interest may have been on the grounds of 
 general welfare. Whatever was the cause the example was of the best. 
 
 Why will not that group of men who are too much worn out for the hard 
 strife of the severest competition give to great philanthropic and economic 
 enterprises out of the abundance of their trained judgment and executive 
 ability ? 
 
 When Captain EaouFs will was read it was found that he had left $50,000 
 for anti-tuberculosis work in Georgia. The first expenditure of the income 
 from this bequest has been used for a state tuberculosis survey. 
 
 It is usually difficult for legislatures to decide what to do because of lack 
 of information. The idea prevails rather generally that consumption is a dis- 
 ease of cities only. Many people think because not everybody has consumption 
 that nobody has it. 
 
 When we say that the consumption death rate is 170 for each 100,000 
 people it does not mean anything to a man who lives in a sparsely settled 
 country and never saw two hundred people assembled. 
 
 Tuberculosis surveys are just as necessary for community life as taking 
 stock is for a merchant. The Illinois Federation of Women's Clubs has com- 
 pleted a tuberculosis survey of Illinois. Wisconsin has been making surveys 
 through its State Tuberculosis Society for several years. Most states are in 
 the dark as to tuberculosis conditions among their people. Perhaps here, too, 
 Captain EaouFs excellent example will be followed. 
 
THE CONSUMPTIVE NURSE 
 
 95 
 
 THE CONSUMPTIVE NURSE 
 
 Is it safe to have a tuberculous nurse care for your baby? Is it safe to 
 liave your baby cared for by a nurse that you do not know to be free from 
 contagion ? 
 
 One year a New York infant asylum employed a nurse in May. She had 
 
 Chicago State Board of Health. 
 
 Fig. 46. — To Fold a Paper Drinking Cup. 
 
 been in a tuberculosis sanitarium during the previous winter, but the asylum 
 authorities did not know it. 
 
 In June they noticed that the nurse was sick with a cold. About July first 
 they found that she had tuberculosis, whereupon they removed her. 
 
 She had cared for ten children for six weeks. During this time many of 
 these children had had some digestive trouble, and, in consequence, the nurse 
 had given extra attention to the bottles and nipples. 
 
 In this asylum all the children are fed on pasteurized milk. These chil- 
 
CONSUMPTION 
 
 dren came in contact with no outside people. It was possible to eliminate 
 every source of infection except the nurse. 
 
 Now, what were the results of these exposures ? 
 
 In April all of the children were tested for tuberculosis by the skin 
 tuberculin test. Three reacted. In July they were all tested again. The 
 same three reacted ; the others did not. 
 
 In October they were tested again and all reacted. In January of this 
 year all of them reacted. The nurse had infected the seven previously unin- 
 fected children. 
 
 In the meanwhile the other children in the asylum did not develop 
 tuberculosis. Those that showed reaction when 
 they first came continued to show it, but no new 
 cases reacted. None developed the disease ex- 
 cept the babies cared for by this nurse. None of 
 the children was extremely sick. Apparently 
 each of them will completely encapsulate his 
 tubercular focus, and these foci may break out 
 in later life, or they may be permanently walled 
 off. 
 
 Had this nurse cared for these babies for 
 six months instead of six weeks, the story might 
 have been different. The dose of tubercle bacilli 
 might have been so large as to have caused an 
 acute, progressive infection instead of the walled 
 off patches, such as they clearly have. 
 
 This thing of resisting the disease does not 
 seem to mean that we can prevent it from get- 
 ting a foothold. Every one of the exposed babies 
 was infected. What it means is that the re- 
 sistant person will be able to wall it off with a 
 fair chance that it will stay walled off. 
 
 Of course, it is unfortunate that this experience occurred, but if it will 
 make mothers more careful of the health of the nurses to whom they intrust 
 their babies it will do more than enough good to compensate. 
 
 Fig. 
 
 47. — Pocket 
 Cup. 
 
 Sputum 
 
 Tuberculosis. — T. H. G. writes: "1. Why is it that tuberculosis so 
 often follows typhoid fever? 2. Isn't it a fact that more people are attached 
 with tuberculosis between the ages of 25 and 30 than at any other period? 
 3. Why is it that the tubercle bacilli hover so conveniently and success- 
 fully near people of that age? -4- Why is it that in proportion to the popu- 
 lation there is as much tuberculosis in the country as in the city?" 
 
 Reply. — 1. It does not. Nearly always, when consumption is supposed 
 to follow typhoid, the case was consumption from the start. There are a 
 few exceptions. Consumption after typhoid is rare. 
 
 2. Yes. 
 
 3. The health between 20 and 30 averages the very best. There is 
 almost no death rate from any disease except consumption in those years. 
 Susceptibility to disease in general in those years is at its lowest. 
 
 4. The city consumption rate is higher than that in the country because 
 of more consumption contagion, poorer houses, and poorer hygiene. The 
 
THE CONSUMPTIVE NURSE 97 
 
 city rate is falling and the country rate is not. Before many years, the 
 statement on which you base your fourth question may be true. 
 
 Tuberculosis of the Spine. — G. D. F. writes: "Please tell me the symp- 
 toms of tuberculosis of the spine and how it affects the patient. Also the 
 cause and how it should be treated/" 
 
 Reply. — The most prominent symptom is pain. The pain being due to 
 the pressure on the nerves, it may be felt some distance away, down the 
 leg, where it may be called sciatica, or in the abdomen, for instance. The 
 muscles near the affected bones are held rigid. As jarring increases the 
 pain, the muscles try to protect the sore bone. Later the spine twists. It 
 may show a knuckle over the affected vertebra. There may be fever. 
 X-ray shows the diseased bone, the deformity, and the abscess, when there 
 is one. A keen diagnostician catches the disease before there is much 
 deformity. A careless one treats the disease as rheumatism or sciatica for 
 a long time. The cause is infection with the tubercle bacillus — frequently 
 through milk. The treatment is rest in bed for a while; then proper 
 braces, tonics, forced feeding, out-of-door life, tuberculin. 
 
 Curvature of the Spine. — I. M. writes: "I have a daughter 15V2 years 
 old, whose spine has become crooked in the last two years, the right side 
 bulging out under the arm, and the reverse on the left side. I have been 
 sending her to a gymnasium, but without result, and it is becoming worse. 
 A year ago she weighed lOlf- pounds and now but ninety-five pounds, and I 
 fear she is becoming tubercular. Where in Chicago could I get a free, 
 reliable diagnosis of her case, as our financial circumstances prohibit a 
 specialist? 
 
 "Do you consider the wearing of appliances beneficial for crooked 
 spines, or will it cramp other organs so as to do more harm than good?" 
 
 Reply. — Your child has been tuberculous for more than two years. The 
 disease was breaking down some part of a bone in her spinal column before 
 her back began to bend. She probably got it from tuberculous milk which 
 she drank about three years ago. She probably will have to go to bed for 
 a while and then she can put on proper appliances. These appliances will 
 straighten out some of the curve and in that way lessen the "cramping of 
 the other organs." A crooked back cramps organs. Go to any orthopedic 
 clinic. Find out what days the clinic is running and then bring her in. 
 They will find a place in a hospital for her. 
 
 Curvature of Spine Causes. — G. A. writes: "I am a man 25 years of 
 age. Kindly advise me of the cause of curvature of the spine. I have never 
 been able to find out the cause of the deformity." 
 
 Reply. — There are several causes. 
 
 1. A frequent cause is tuberculosis of one or more bones of the spine. 
 The bacilli are taken in with the food — usually milk. 
 
 2. Old infections outside the bones of the spine, but producing heavy 
 scar tissue which pulls the spine out of line ; for instance, an old pleurisy. 
 
 3. Habits, position of body while at work or at the school desk. 
 
 4. Infection of the joints between the bones of the spine; for example, 
 rheumatoid arthritis. 
 
 Curvature of the Spine. — A. J. writes: "I am a woman about 28 years 
 old. I have curvature of the spine, caused by a fall when I was 6 years old, 
 but have never been sick a day from it. 1. Wont it be wrong for me to 
 
98 CONSUMPTION 
 
 marry f 2. Would my children necessarily have curvature? 3. Is there 
 danger of me getting tuberculosis?" 
 
 Reply. — 1. That is a matter for you and your affianced to decide. A 
 physician can tell you whether your curvature would prevent you from 
 bearing living children. 
 
 2. No. Practically, they would be as liable to tuberculosis of the spine 
 (the cause of curvature) as other children and no more so. 
 
 3. You are about in the same average danger as women of 28. Intrin- 
 sically your danger is a little above the average but, being apprehensive, 
 you lead an above-the-average hygienic life. 
 
 Ill Not Transmissible. — Constant Reader writes: "I am a young man 
 not 27 years old. I think a great deal of a young woman of 20, but she has 
 a curvature of the spine, so that one shoulder is quite prominent and her 
 chest also somewhat out of position. Will it be safe for me to marry her? 
 Would our children be normal?" 
 
 Reply. — If the deformity is considerable it is probably due to tubercu- 
 losis, caused by drinking milk from tuberculous cows. If so, it is not 
 transmissible; her children will not inherit it. 
 
 If the deformity is slight it may be due to sitting habitually in a 
 cramped position. If so, it is not transmissible; her children will not 
 inherit it. 
 
 If the curvature is limited to the region of the chest it will not inter- 
 fere with child bearing. Frequently, however, a curve high up is accom- 
 panied by a countercurve lower down. Would the young woman be willing 
 to have her physician pass on these points ? 
 
 Consumption in Diabetes. — 0. 0. A. writes: "I have read quite a num- 
 ber of your articles on the subject of tuberculosis. The only thing ever 
 mentioned as incurable is the third stage. Nothing is ever said as regards 
 tuberculosis following diabetes and the hopelessness of such a case, or the 
 following of tuberculosis after any other serious illness and what might 
 be done. It is true people who have only tuberculosis, if action be taken 
 early, can be helped a great deal and perhaps cured. But what of the 
 patient who has diabetes or one who has had pneumonia, and tuberculosis 
 begins to set in? What care should he have? Why not have this informa- 
 tion published as well as the other? What is to be said of the patient who 
 has fistulas?" 
 
 Reply. — I am sorry that you have not found what you want in the 
 articles. As I understand it, you seek answers to three questions : 
 
 1. What is the outlook when a diabetic contracts consumption ? A. — It 
 is exceedingly bad. 
 
 2. What is the outlook of the man who has pneumonia and later de- 
 velops consumption, and what should be done for him ? A. — If his supposed 
 case of pneumonia be pneumonia, he has the same chance as a man who 
 develops consumption in the ordinary way. Many cases of pneumonia that 
 "run into consumption" are really cases of acute or galloping consumption 
 from the start. The outlook for these cases is poor. They must go to 
 bed, preferably in an institution, and take even stricter rest, open air, and 
 feeding than the other consumptives. 
 
 3. The consumptive who has fistula is practically in about the same 
 position as other consumptives. His fistula should be cared for. It adds 
 a little to the gravity of his case. 
 
THE CONSUMPTIVE NURSE 
 
 99 
 
 Tuberculosis in Animals. — J. K. H. writes: "You said recently that 
 tuberculosis in the lower animals — cows, pigs, etc. — resembles that disease 
 in man. The treatment prescribed for tuberculosis is in the main fresh 
 air. Now, why do animals have this disease, when they live out of doors 
 all the time?" 
 
 Reply. — Cows that are on the range do not have tuberculosis to any 
 appreciable extent. They have it in proportion as they are housed. Pigs 
 have tuberculosis contracted through food. Most of their tuberculosis 
 conies from drinking tubercular milk or eating tubercular germs from cows. 
 
 Will you please tell me 
 
 Symptoms of Consumption. — A. F. writes: " 
 what are the symptoms of consumption?" 
 
 Reply. 
 
 A. Very early: 
 
 1. Low temperature in the morning. 
 
 2. Slight fever in the afternoon. 
 
 3. Loss of weight. 
 
 4. Slight cough, persisting. 
 
 5. History of exposure to person with consump- 
 tion. 
 
 6. Reaction to tuberculin. 
 
 B. Early : 
 
 1. Low temperature in the morning. 
 
 2. Fever in the afternoon. 
 
 3. Loss of weight. 
 
 4. Persisting cough and sputum. 
 
 5. Sometimes tubercle bacilli in sputum. 
 
 6. Signs on physical examination. 
 
 7. Reaction to tuberculin. 
 
 C. Later : 
 
 1. Fever. 
 
 2. Cough. 
 
 3. Sputum containing bacilli. 
 
 4. Physical signs. 
 
 5. Loss in weight. 
 
 Diagnosis should always be made before bacilli appear in the sputum. 
 Late diagnosis makes cure impossible for any except the better-to-do. 
 
 Consumption and Cough. — J. P. S. writes: "Is it possible for one to 
 have consumption without a cough. What is the difference between 
 tuberculosis and consumption, or is there none?" 
 
 Reply. — When the tubercle bacillus locates in the body it sets up a 
 disease called tuberculosis. If it has located in the lungs the disease is 
 called lung tuberculosis or pulmonary tuberculosis, or by the shorter term, 
 consumption. 
 
 When the tubercle bacillus locates in the lung small tumors begin to 
 grow. When these nodules are small there is no cough. When they have 
 grown large enough to press on the bronchial tubes cough starts. At first 
 the cough is a slight hack. Nothing is coughed up. After a few days 
 coughing raises a little. Some weeks or perhaps some months later it raises 
 sputum containing bacilli. 
 
 You see it is possible to have consumption a short while before the 
 cough starts, but only for a short while. 
 
 Fig. 48. — Respirator. 
 
100 CONSUMPTION 
 
 Not Tuberculous Cough. — F. W. writes : "I have had a sort of chronic 
 cough for the last year. I went to a prominent doctor and he told me as 
 soon as the hot weather would arrive I should get rid of it by perspiring. 
 I am perfectly well, weigh 215 pounds, and am gaining all the time. I 
 sleep well, eat well — in fact, feel better now than I ever did before. Please 
 advise me." 
 
 Reply. — There are many causes for coughs. Tubercle infection is one. 
 If you are gaining in weight, are feeling well, and your physician cannot 
 find tuberculosis, put that cause out of your mind. 
 
 Looks Like Tuberculosis. — E. R. S. writes: "Last spring I had my 
 tonsils removed. I caught a heavy cold and doctored it myself. Now I 
 cough slightly. The lymph glands were much swollen, but are ordinary 
 now. But I have a swelling of the thyroid gland. My temperature rises 
 in the afternoon. I lose my voice also. My doctor says there is no con- 
 sumption. I have leukorrhea. Do you think that weakness causes other 
 faults?" 
 
 Reply. — An afternoon fever, a slight cough, and some disposition to 
 loss of voice suggests tuberculosis. Have at least one more examination 
 for tuberculosis. 
 
 The physician examining will advise you about your thyroid. Not 
 much can be done to prevent the thyroid from swelling. 
 
 Leukorrhea is not a source of weakness, nor does it result from weakness. 
 It is the result of a local infection with any one of several bacteria. This 
 infection usually is innocently acquired. It must be treated locally or by 
 vaccines. Keep this clear: This condition does not cause constitutional 
 weakness nor does it arise from constitutional weakness. 
 
 Pains, Sputum, and Cure of Tuberculosis. — H. A. L. writes: "1. Bo 
 tuberculosis pains of the lungs come in the back? 2. Is black sputum at 
 times a sign of tuberculosis? 3. Is there any certain cure for tubercu- 
 losis?" 
 
 Reply. — 1. Pain as a sign of consumption is not of any value. People 
 who think they have consumption because of pains in the chest are gen- 
 erally mistaken in their diagnosis. 
 
 2. The black color of some sputum is due to soot and dirt. People who 
 think they have consumption because of black sputum are generally 
 mistaken. 
 
 3. No. Nothing is certain but death and taxes. If 100 people in the 
 early stages of consumption change their methods of living and live right, 
 75 will get well. If 100 people in the late stages of consumption change 
 their methods of living and live right, eight or ten will get well. 
 
 Preventing Consumption. — J. L. B. writes: "I wish you would tell us 
 a few ways of prevention of consumption, such as exercise, foods, and 
 tonic." 
 
 Reply. — 1. Keep away from careless consumptives. 
 
 2. Keep away from dusty working places. 
 
 3. Keep out of ill-ventilated rooms. 
 
 4. Do not neglect colds. 
 
 5. Keep in the open air as much as possible. 
 
 Many other preventive measures could be suggested, but these are the 
 most important. 
 
THE CONSUMPTIVE NURSE 101 
 
 Needs Medical Advice. — Inquirer writes: "I wish to know if a slow 
 form of tuberculosis is curable. Should one have the lungs examined 
 every three or four months? I am short of breath and seem to get choked 
 up, so I have to take deep breaths to get air. I cough a kind of a short 
 bronchial cough quite often and my limbs have a tired ache almost all 
 the time. I am nervous and am troubled with insomnia sometimes. I have 
 been told it is useless to go to a physician for examination, as there is 
 
 Fig. 49. — Frame for Attached Sleeping Porch. (Carrington's " Fresh Air and 
 
 How to Use It.") 
 
 nothing to do but live in the air and sunshine and eat nourishing food. 
 Please advise me what to do." 
 
 Reply. — A fair percentage of cases of advanced tuberculosis get well. 
 The person who told you that you did not need medical supervision gave 
 you bad advice. You need advice as to how to live out of doors, what to 
 eat and what not to eat, how to get sleep, how much or how little to 
 exercise. 
 
 Where one has a disease like malaria, he may cure himself by a course 
 of quinin and may need no medical guidance. Where one has a disease such 
 as tuberculosis, for which no specific is known, he must have a pilot. 
 
 Enlargement of Glands. — Reader writes: "What treatment would you 
 advise for children threatened with tuberculosis of the glands of the back 
 of the neck? Is it contagious? We sleep with the windows open, but 
 the children are in school, thus preventing them from being out. Do you 
 think it necessary to give them any medicine aside from cream, milk, olive 
 oil, and the necessary foods?" 
 
102 
 
 CONSUMPTION 
 
 Reply. — Enlargement of the glands of the neck may be due to tubercle 
 bacilli or may be due to other bacteria. Unless they continue to absorb 
 bacilli the enlargement can be expected to disappear. The condition is 
 not contagious. The condition may be due to (1) dry, hot air in the school- 
 room, (2) tubercular milk, (3) enlarged tonsils, (4) adenoids, (5) bad 
 teeth, or several of these combined. 
 
 The remedy is to pasteurize the milk, see that the schoolroom air 
 is cooler or moister or else take the children out of school, put them 
 
 In Hip Joint Disease the knee is drawn up when the back is straight. 
 
 In Hip Joint Disease the back bows when the leg is straightened. 
 Fig. 50. — Hip Joint Disease. 
 
 in an open window school, see that the tonsils and teeth are put in 
 good condition, see that the children play out of doors, give them 
 meat, bread, vegetables, fruit, and milk in abundance. Olive oil has no 
 advantage over milk and butter and probably they do not care for it. 
 
 Tuberculosis of the Knee. — M. M. R. asks if any cases of tuberculosis 
 in the knee joint have been cured without causing permanent stiffness. 
 His trouble is of seven years' duration, and for three years he has been 
 wearing a cast which keeps the limb from bending. The result is that 
 there is little motion left. When it is no longer sore and weak he asks if 
 it can be "broken" to produce a good range of motion. 
 
 Reply. — If tuberculosis in the joint is discovered early there is a pos- 
 sibility that it can be cured without permanent stiffness. After the disease 
 has subsided, surgeons will be able to repair the injured joint and give a 
 good range of motion. 
 
 Tuberculous Sores. — Mrs. A. G. writes: "Kindly let me know if lupus 
 of the nose of seven years' standing can be cured? Can a tuberculous sore 
 of five years' standing on the face be cured?" 
 
 Reply. — Lupus and tuberculous sores on the skin can be cured rather 
 readily. Skin tuberculosis is about the mildest form of tuberculosis. If 
 you will persist in proper care of your case under the direction of a com- 
 petent physician, you will be cured. 
 
 Advice to a Consumptive. — R. C. L. writes: "In the first stages of 
 tuberculosis, where the patient has gained ten pounds weight and coughs 
 very little, would it be advisable to come to Chicago in April, after spend- 
 ing the winter in western Texas?" 
 
 Reply. — No. 
 
THE CONSUMPTIVE NUESE 
 
 103 
 
 Menace to Neighbors. — Subscriber writes: "We have in our neighbor- 
 hood a man who has had tuberculosis of the lungs for a year and a half. 
 He has had several hemorrhages, yet he goes about the yards and gardens, 
 his own and his neighbors', expectorating where he will, as well as all the 
 way from his home to the station. Is not this a menace to the neighbor- 
 hood? He also uses his handkerchief to expectorate into when in company 
 indoors. These are sent out to be laundered. Is this right? After his 
 eating at one's house 
 should his dishes, etc., I . 1 S 3 
 
 be boiled separately? 
 If he persists in these 
 things would it not be 
 wise to cease visits, or 
 is the risk not great?" 
 
 Eeply. — 1. Yes, he 
 is much of a menace 
 to his family and 
 something of a menace 
 to the community. 
 
 2. No; it unneces- 
 sarily endangers those 
 who work in the laun- 
 dry. 
 
 3. Yes. 
 
 4. It would. 
 
 Should Protect 
 Girls.— H. F. W. 
 
 writes: "In a home a 
 block from my house 
 lives a woman badly 
 afflicted with tubercu- 
 losis of the lungs. 
 
 X" 
 
 Fig. 51. — Window Ventilation: Lower Sash Raised, 
 Upper Sash Lowered. Shade roller is placed several 
 inches below top of window. Space between roller 
 and top of window is covered by wire screening. (Car- 
 rington's " Fresh Air and How to Use It.") 
 
 There are several girls in the home. My 13-year-old boy is frequently in 
 the home and often sits in the hammock with the girls. Is there any 
 danger?" 
 
 Eeply. — If the girls are well, no. If the girls are tuberculous, yes. 
 Someone should see that proper effort is made to protect these girls. The 
 chances are more than even that several of them will be found to be tuber- 
 cular within two years from now. 
 
 Night Sweats.— E. L. M. writes: "I have been having night sweats 
 for the last two weeks. I had them about seven years ago. I do not drink 
 liquor. I eat and sleep well. I have lost about ten pounds in the last two 
 weeks. What would you advise me to do?" 
 
 Eeply. — I should say, if you have lost ten pounds in two weeks, and 
 are having night sweats, you should have a physician discover the cause. 
 Night sweat by itself is of no special consequence, but taken in conjunction 
 with rapid loss of flesh is suspicious. 
 
 Consumption Cures. — G. E. 8. writes: "There are thousands of poor 
 souls in the southwest, just hanging on to life in the hope that someone 
 will find a cure for their terrible disease." He mentions a newspaper 
 
104 
 
 CONSUMPTION 
 
 article, which said that a man in England claimed a cure by inhaling the 
 odor of putrid meat. He asks about a cure which consists of an injection 
 into the veins. He says the same man has a cure for pneumonia, which 
 consists of injecting something hypodermically. 
 
 Reply. — We know nothing of this cure for consumption. If there is 
 anything in it that fact will be demonstrated. This seems slow to those 
 poor souls who are waiting for a cure, yet it is the way which experience 
 has shown to be the only way. 
 
 As a general proposition it can be stated that consumption cures are all 
 worthless. Rest, feeding, and fresh air will cure all the early cases, about 
 half of the moderately advanced cases, and a few of the late cases. The 
 dry climate of the West will cure about 15 per cent of the cases which 
 
 Fig. 52. — Rustic House for Sleeping Out. (Carrington's 
 
 How to Use It.") 
 
 Fresh Air and 
 
 cannot be cured in this climate (Chicago), provided the cases are properly 
 directed. Cases without money will do better at home than in the West. 
 
 Tuberculin, properly used, adds about 25 per cent to the chance of 
 getting the disease arrested and keeping it from recurring. Properly used 
 it requires about six months to a year. Improperly used, it does more 
 harm than good. 
 
 The hospitals, sanitaria, and laboratories are filled with men who are 
 working to find a cure for the late cases — those with cavities. In the 
 meantime advertised cures are worse than useless. They do harm. Many 
 of them contain opium. They prevent people from taking air, rest, and 
 feeding. 
 
 Tuberculin as a Cure for Consumption. — J. K. writes: "So much has 
 teen written about vaccination against smallpox and typhoid that I think 
 it about time to bring in the idea of the tuberculin vaccine or injection 
 as it is properly called. 
 
 "Now it is an understood fact that medicine taken into the stomach 
 never cured tuberculosis; then we know that what a doctor prescribes is 
 merely a tonic so as to build up the system and overcome the germs. 
 
 "Now then the modern treatment of injection is to immunize the ailing 
 hody to further attack and thus give the patient a chance to recover. Does 
 this injection wear off in time? What chance has a person to recover 
 from the disease? Is there a better treatment?" 
 
THE CONSUMPTIVE NURSE 105 
 
 Reply. — Open air treatment of tuberculosis is the proper treatment, and 
 you should not get the idea that tuberculin or any other serum will take its 
 place. However, it is quite generally believed that tuberculin is a valuable 
 aid to open air, and that by its use in connection with the open air treat- 
 ment the chances of cure are materially improved. Trudeau has found 
 that there is a further gain from using tuberculin in connection with the 
 open air treatment, in that the people who have had their disease arrested 
 are much more liable to remain well. The danger of a recurrence is greatly 
 lessened. The estimate of the value of tuberculin is that it improves the 
 chances of permanent cure about 18 to 25 per cent. It is not possible to 
 get much advantage from the open air treatment without having good 
 nursing and good medical supervision, and this is also true of the use of 
 tuberculin. 
 
 I am not able to answer your question as to how long the effect of 
 immunizing with tuberculin lasts. It was found in the case of vaccination 
 of calves that it was not permanent. 
 
 The chance of a person recovering from consumption would depend 
 upon several things. The most important thing is how early is his case. 
 Early cases nearly all get well. As time goes on the chance of getting 
 well decreases rapidly. 
 
 Treatment of Tuberculosis. — H. A. J. writes: "What is the proper 
 course of treatment, diet, etc., for pulmonary tuberculosis in an early 
 stage?" 
 
 Reply. — The three important factors in the treatment of tuberculosis 
 are food, rest, and fresh air. Meat, eggs, and milk in generous quantities 
 are the staple articles. Cream, butter, fish, bread, vegetables, and fruits are 
 added. Raw lean meat, soaked in water for two hours and finely chopped, 
 may be given. The process of overfeeding must be carefully watched and 
 indigestion prevented. Rest is very important. Fresh air and plenty of 
 sunshine are essential. Cases that require such treatment need careful 
 medical supervision. 
 
 Tuberculin Is of Value. — J. W. writes: "I am very much worried 
 about my neck, which has been operated on seven times for tubercular 
 glands. These operations occurred in the last six years. Now they are 
 growing again on both sides. 
 
 "I thought I would ask you if there is anything else which might 
 help me. 
 
 "Is tuberculin of any use in such a case, or would change of climate 
 help? Otherwise my health is very good." 
 
 Reply. — Tuberculin is of value. Change of climate is of value. But 
 my suggestion is that you have your physician see if he cannot find where 
 the bacilli get into your tissues — probably in your throat, possibly in your 
 nose or mouth there is a place through which bacilli are entering to be 
 stopped by the glands of your neck. You may say that the glands of your 
 neck are the second gate. Cannot the first gate be found and attended to ? 
 Do you drink nothing but boiled milk? 
 
 Sun Better Than Sulphur. — Anxious Contributor writes: "Is there any 
 danger of infection in sleeping on a spring and mattress that was used 
 by a tubercular patient, if disinfected with ordinary sulphur candles?" 
 
10G CONSUMPTION 
 
 Reply. — If the articles were properly disinfected there is no danger. 
 In addition to the disinfection, sun them for several days. Several days' 
 sunning will be as efficacious as steam disinfection and more so than 
 sulphur. 
 
 Medicines No Use. — A. F. T. writes: "What is the condition of a per- 
 sons lungs described as fibroid? Does it mean the person has consump- 
 tion? What ought he to do?" 
 
 Reply. — The frame-work — the scaffolding of the body — is called fibrous 
 tissue. Whenever the proper tissue of a part wears out this scaffold tissue 
 replaces it. The organ in which there is too much fibrous tissue is said 
 to be fibroid. 
 
 A fibroid lung may result from slow, chronic consumption, one that 
 has lasted five years or more. It may result from an old asthma or an old 
 bronchitis. It is found in coal miners and others who breathe a great deal 
 of dust. 
 
 When you are told that your lungs are fibroid ask whether it is tuber- 
 cular. If the condition is due to tuberculosis, it is advisable to move to a 
 drier climate. If it is due to coal dust, change occupation. Medicines 
 will not be of service. 
 
 Why Consumptives Go West. — W. J. M. writes: "Is it not a fact that 
 the Arabs of the Sahara Desert are among the most virile and longest- 
 lived people in the ivorld? Is it not also true that mountaineers in all 
 parts of the earth are exceptionally healthful? Now, we know that desert 
 air is extremely dry, and that the air at high altitudes is much less humid 
 on the average than it is at sea level. You recommend consumptives to 
 seek high altitudes, 'preferably from 5,000 to 8,000 feet,' on account, as I 
 suppose, of the low relative humidity. 
 
 "What puzzles me is how you square these facts with your oft-repeated 
 warning as to the injurious effects of dry air. Is it not possible that the 
 bad physical conditions sometimes observed in persons who live in hot 
 rooms in which the air is very dry may be caused solely by the heat and 
 the lack of ventilation rather than by the dryness of the air? 
 
 "I lived for many years in a house which was heated by hot air, the 
 temperature being maintained constantly, night and day, throughout the 
 winter, at 68 degrees. The air supply was direct from out of doors, no 
 water was evaporated, and the humidity was always far below normal. 
 Under these conditions my health and that of all the other members of my 
 family was excellent. The supposed injurious effects of living in a dry 
 atmosphere certainly failed to materialize in our case. How about it?" 
 
 Reply. — Arizona atmospheric air does not have as low a humidity by 
 odds as house air in Chicago in winter. When you live in Chicago in 
 winter, part of the day you are outside, where the humidity is, say, 90, and 
 part you are inside, where the humidity is 25. In Arizona the humidity is 
 rather evenly near 50. Consumptives go West for: 
 
 1. Humidity around 50. 
 
 2. Maximum sunshine. 
 
 3. Low precipitation. 
 
 4. Clean air. 
 
 5. Air low in bacteria, especially those which produce putrefaction. 
 
 6. Elevation. 
 
 7. Maximum possibility of being comfortable out of doors all of every 
 day and night. 
 
:• \ 
 
 Fig. 53. — Exercises Which Develop the Muscles or the Shoulders, Chest, Back and 
 
 Abdomen. 
 
 107 
 
108 CONSUMPTION 
 
 The climate of the West is good for consumption; it is bad for other 
 diseases and conditions. Low humidity is not the only benefit. In indoor 
 air low humidity is not the only harmful quality. Not all people who 
 breathe improper air die or get sick. If they did, Chicago would have been 
 handed back to the Indians a long time ago. 
 
 Advice on a Cure for Tuberculosis. — F. C. C. writes : "Kindly give me 
 your opinion of the efficacy of the newly discovered 'deoraden in the treat- 
 ment of tuberculosis." 
 
 Reply. — You had better let it be tried on the other fellow. Consump- 
 tion gets well so frequently under rest, food, and air, that many remedies 
 claim to cure that do not. No treatment can be judged of fairly until it 
 has been used on enough people to satisfy the law of averages. 
 
 Going Away Question. — J. K. writes: "Some months ago I had a 
 hemorrhage. I took twelve treatments of tuberculin, and am now contem- 
 plating going to northwestern Texas or farther south into New Mexico, 
 where the climate is milder and the altitude greater. I have had no hemor- 
 rhages since the first and have increased twelve pounds in weight. My 
 occupation is that of bookkeeper. An examination previous to taking the 
 treatment showed bacilli. Would a warmer climate of the same altitude 
 be better than one subject to 'northers,' as Amarillo, Texas? If sputum 
 shows bacilli at this time how soon should I take the second treatment of 
 tuberculin? If I remain in Texas or New Mexico until May next could I 
 with safety return to Chicago if I am of usual weight and apparently 
 cured? Does the fact that I have regained my usual weight indicate that 
 I have no tubercular germs?" 
 
 Reply. — 1. Amarillo, Texas, is a good place for a consumptive, but 
 Arizona, or New Mexico, or Colorado is somewhat better. Do not try for 
 a warm climate. Avoid places subject to "northers." 
 
 2. The presence or absence of tubercle bacilli does not determine the 
 question. The proper method of treatment is to give it in slowly increasing 
 doses about once a week, or at most twice, and to keep it up until about 
 five drops of straight tuberculin cause no reaction. 
 
 3. If you have had bacilli in your sputum for several months, there is 
 no probability that you can return to the city by spring. In fact, this third 
 question is the key to the situation. I feel quite certain you are making a 
 mistake in going away. He who goes away counting the months until he 
 can return is not liable to return alive. There is some advantage in going 
 to a better climate, but it is only for those who have money enough to 
 sustain themselves without work for a year or more, for those who will not 
 become homesick, for those who will go into a sanitarium or under the best 
 of control. 
 
 4. No. 
 
 May Be Curable Consumption. — V. L. writes : "Kindly tell me whether 
 a morning temperature of 97.1). to 98 degrees is unusual. The afternoon 
 temperature is about 98 degrees, but has times of running to 99.k or 
 99.6 degrees. The person has a good color and seems well. She is free 
 from heavy colds, but seems to have a slight cold constantly, and is subject 
 to headaches that sometimes last three weeks. She is rather chilly in the 
 morning and very suddenly becomes extremely tired toward the end of 
 the afternoon. She is 5 feet W2 inches tall and weighs 120 pounds." 
 
THE CONSUMPTIVE NURSE 109 
 
 Reply. — This reads like a history of early curable consumption. She 
 should have an expert examination without delay. 
 
 Reason for Varying Advice. — C. 8. asks why some patients suffering 
 from consumption are sent to one place and others to another. 
 
 Reply. — Whether a patient is to go to one place or another is depend- 
 ent on : 
 
 1. Personal considerations. 
 
 2. Social considerations. 
 
 3. Sanitarium considerations. 
 
 4. Climatic considerations. 
 
 Patients go to Denver because they have friends there or hope to get 
 some work, want city life, or sanitaria, as well as on account of the climate. 
 It is highly desirable that the patient should be satisfied and happy. 
 
 Many patients are sent to places where there is a good sanitarium in 
 which they will be controlled and closely studied. The physician sending 
 patients away is wise if he gives great weight to sanitarium facilities. 
 
 Climate is the prime consideration in the advice given many patients. 
 Here, too, the individuality of the patient must be taken into consideration. 
 Generally speaking the requisites are: 
 
 1. Low relative atmospheric humidity. 
 
 2. High percentage cloudless days. 
 
 3. Low rain and dew precipitation. 
 
 4. Freedom from winds of velocity of more than twenty miles an hour. 
 
 5. Freedom from dust. 
 
 6. Elevation 1,000 to 8,000 feet, preferably 5,000 to 8,000. 
 
 Many physicians advise their patients to keep away from states and 
 cities which have no laws regulating tuberculosis, or laws which are 
 worthless. 
 
 Sanitaria About Denver. — M. writes: "I wish you would let me know 
 of any camp or tent colony at Denver for tuberculous patients. There 
 is a hoy, 18 years old, a printer by trade, who has just started for Denver. 
 I imagine, from what he has told me, that the disease has advanced pretty 
 far, as he says he has had four or five hemorrhages. The boy has little 
 money, probably $100 in all, and, if there is a colony where he could live 
 for two or three months at a nominal sum each week, I ivish to write to 
 him of it as soon as possible." 
 
 Reply. — If the boy is a member of the International Typographical 
 Union and has been for five years, he is entitled to free care in the Union 
 Printers' Home at Colorado Springs. The tuberculosis directory gives the 
 following list of sanitaria in or near Denver: 
 
 Agnes Memorial, Association Health Farm, the Home, Mrs. Fare's Tent 
 Sanitarium, National Jewish Hospital, Jewish Consumptive Relief, Sun- 
 light, Swedish National, Evangelical Lutheran, Fern Hill. 
 
 It is most unfortunate that cases of this class go to Denver or elsewhere 
 searching for a climate cure. With the little money at his command he 
 stands but a slim chance of improving. He probably will shortly be penni- 
 less and helpless among strange people. His chances would have been 
 better at home. 
 
 Breathing and Consumption. — Dr. A. W. Foreman of White Hall, Illi- 
 nois, says that for thirty years he has sent his tubercular patients to the 
 
110 CONSUMPTION 
 
 Rocky Mountains with excellent results. The altitude he has found test is 
 5,000 feet. His explanation is that the air is poorer in oxygen, and the 
 breathing must be deep in order to have the blood get enough oxygen. This 
 brings into play all the air sacs. Lazy breathing is not possible. He has 
 seen patients increase their chest measurements in this way three to four 
 inches. 
 
 Reply. — The reasons consumptives do well in the Rocky Mountains are 
 several. Elevation is one of them, and not the most important. In certain 
 stages of the disease the lungs heal better when kept as quiet as possible; 
 in others they get on better when breathing is deeper. So, deep breathing 
 may do good or do harm. 
 
 Arizona Better Place. — B. E. 8. writes: "Do you consider the climate 
 of Florida, say Tampa, or near there, a healthful place for one who has 
 tuberculosis? If the rainfall there is between fifty and sixty inches, would 
 that not be too damp? Is malaria prevalent there? Would the climate of 
 Arizona be more beneficial?'" 
 
 Reply. — 1. No. 
 
 2. Yes. 
 
 3. Yes. In the summer and fall; not in the winter and early spring. 
 
 4. Yes. 
 
CHAPTEK X 
 
 The Eye 
 
 PREVENTABLE BLINDNESS 
 
 The last edition of the Encyclopedia Britannica says: "The data fur- 
 nished in various countries by the census in 1901 showed generally a decrease 
 in blindness, due to the progress in medical science, use of antiseptics, better 
 
 CORNEA 
 
 CONJUNCTIVA 
 ANTERIOR- 
 CHAMBER 
 
 CILIARY 
 MUSCLE 
 
 RETINA 
 
 OPTIC NERVE 
 
 Fig. 54. — During accommodation the lens becomes more convex through contraction of the 
 ciliary muscle, as shown in the left of the diagram, while to the right is shown the position 
 of the lens at rest. 
 
 sanitation, control of infectious diseases, and better protection in shops and 
 factories." 
 
 That blindness is on the decrease is much more apparent in recent years. 
 This fact is a reason for still greater endeavor. We are winning a fight. The 
 fact that we are winning calls on us for renewed, redoubled endeavor, that the 
 enemy may be wholly routed. 
 
 The control of preventable blindness is a battle. The enemies are enumer- 
 ated in the above opening quotation. We are making a winning fight. The 
 statistics from England and Wales show that in 1851 there was one blind 
 person for every 979 with sight, 1,021 blind for each 1,000,000 of the popula- 
 tion. This fell during each decade. In 1901 there was one blind person to 
 
 111 
 
112 
 
 THE EYE 
 
 every 1,285 able to see, 778 per 1,000,000 of the population. The decrease in 
 blindness in the other countries of the world is at about the same rate. 
 
 However, much remains to be done. According to the census of 1900, 
 there were 85,662 blind in the United States, 1,125 per 1,000,000. 
 
 The low blindness rate countries are Holland, 5,414 ; Denmark, 427 ; and 
 Belgium, 487. 
 
 The high blindness rate lands are Eussia, 2,000; Finland, 1,191; Italy, 
 1,175, and the United States, 1,125. 
 
 Dr. Alexander Graham Bell was appointed a special expert of the census 
 
 There are 60,000 blind per6on5 in the United States, 
 /\t le^st Z0,000 o^ these sad ca^es 
 
 were Preventable ! 
 
 IF CHICAGO 
 
 WILL ENFORCE 
 
 THE USE OF 
 
 -THIS- 
 
 Si 
 
 w 
 
 THE DROPS 
 
 THE 
 MEDICINE 
 DROPPER 
 
 IT WILL COST 
 
 -THIS- 
 
 FIVE CENTS 
 
 AND 
 PREVENT 
 
 -THIS- 
 
 To Lose ones 5IGHT -is LiKe Losiscj LIFE rrseLF. 
 
 SAVE YOUR BABYS SIGHT 
 
 gfelCArfb TWAffmenr «t r H^ALTK-> gducAtlon*L -Series <Ve-91 
 
 Wl.fi. 
 
 Fig. 55. 
 
 office to inquire into blindness in the United States. He investigated about 
 65,000 blind, making some interesting observations. Of this 65,000, 2,300 
 were under 10 years of age. 
 
 Some children under 10 years of age are blind by reason of accident, but 
 the very important cause of blindness in this group is what is known as oph- 
 thalmia neonatorum. This term means infection of the eyes occurring during 
 birth or within the first few days thereafter. 
 
 This form of blindness is preventable. The methods of prevention are 
 known. They have been tried. They work. 
 
PREVENTABLE BLINDNESS 
 
 113 
 
 Now the question is: Will the mothers see that the approved measures 
 are carried out ? 
 
 The method was devised by Crede, and goes by his name. It consists in 
 dropping a drop of 2 per cent nitrate of silver solution into each eye of the 
 newly born child immediately after the face has been carefully washed. 
 
 The cloths, grease, water, and soap used to cleanse the balance of the 
 baby's body should not be used on his head. A separate lot of cloths and 
 cleansing material should be used for the head. 
 
 To cleanse the eyelids, absorbent cotton should be used. The pledget 
 used for one eye should not be used for the other. To wash the corners of the 
 eyes and the margin of the lids, a little saturated 
 solution of boracic acid should be employed. 
 
 The pledget of cotton saturated with boracic 
 acid solution used on one eye should be thrown away 
 at once, and not returned to the solution, lest an 
 infection of one eye be carried to the other. 
 
 Next a drop of silver solution is put into each 
 eye, followed a moment after by a few drops of 2 per 
 cent salt solution. 
 
 If the eyes seem to be at all inflamed the doctor 
 must be told without delay. This form of eye in- 
 fection works very rapidly. If neglected for a few 
 days, no doctor, however skillful, can save the sight. 
 
 Before Crede began the use of his method at 
 the Leipsic Hospital, one in every eleven babies born 
 in that hospital speedily lost its sight from this one 
 type of infection. Within a short while the use of 
 this method had reduced the blindness to one in 
 every 1,000. 
 
 Harmon's book on preventable blindness tells us that, of 25,317 blind in- 
 vestigated in England and Wales in the census of 1901, 489 were children 
 under 5 years of age. According to Dr. Tivnen, of the blind treated in the 
 Illinois Charitable Eye and Ear Infirmary in 1909 and 1910, 13 per cent 
 were blind as the result of infection at birth. 
 
 Some other percentages also noted by Dr. Tivnen are as follows : Massa- 
 chusetts Eye and Ear Infirmary, 1.04 ; Manhattan Eye and Ear Infirmary, .03 ; 
 New York Eye and Ear Infirmary, .08. [Magnus' table for Germany, 10.8; 
 Troussean's for France, 4.6 ; Oppenheimer's for the United States, 3.1.] 
 
 Anyone who thoughtlessly reads the above figures is liable to get an 
 erroneous opinion. People go to infirmaries to be treated for conditions 
 which can be relieved. It is only a small percentage of the blind people 
 blind from birth who find their way to infirmaries. 
 
 Harmon says that an investigation of the causes of blindness among 
 London school children showed that 25 per cent were so as the result of con- 
 genital defects, 36 per cent because of infections of the eyes at birth, and the 
 remainder as the result of miscellaneous causes. 
 
 The percentage of ophthalmia neonatorum blindness to total blindness in 
 children of school age for Berlin, Breslau, and Paris is around forty. 
 
 In ten state schools for the blind classified by Tivnen, the percentage 
 
 Fig. 56. — Astigmatism 
 Chart. — Test one eye at 
 a time. If all the lines 
 appear of the same shade 
 astigmatism is not pres- 
 ent. If any lines look 
 darker or less clear than 
 others, astigmatism is 
 present. 
 
114 THE EYE 
 
 of birth caused blindness to total blindness ranged from 12.5 for the Con- 
 necticut school at Hartford in 1907 to 44 for the Pennsylvania school in 
 1909. 
 
 However, these figures are too high to be accepted as general averages. 
 
 Among the school children, and especially among the school for the blind 
 children, the number of afflicted as a result of birth accident is disproportion- 
 ately high. Much nearer a true figure are the following estimates: 
 
 The New York Association for the Blind goes on record as thinking that 
 10 per cent of the blindness is the result of this infection. 
 
 Then let us say that about one in each twenty of the blind people are 
 blind because of neglect of their eyes at the time of birth and for a few days 
 thereafter. 
 
 O F 
 
 Can you read these letters at the distance of forty feet? 
 
 P H E 
 
 Can you read these letters at the distance of thirty feet? 
 
 Z P L R D F 
 
 Can you read these letters at the distance of twenty feet? 
 
 A F E T B X V 
 
 Can you read these letters at the distance of fifteen feet? 
 
 V B S H O K HE D A 
 
 Can you read these letters at the distance of ten feet? 
 If so you are neither nearsighted nor farsighted. 
 
 The situation is serious enough to warrant effort. The percentage is 
 decreasing; the fight is a winning one, and that is the second reason which 
 warrants effort. 
 
 Dr. Parke Lewis thinks the state and city governments should pass laws 
 making this infection of the eyes reportable. Many states and some cities now 
 have such laws, but it has not been found easy to enforce them. Since nitrate 
 of silver solution is unstable, uneven, and rather undependable, he would have 
 the solution furnished, dated and ready for use, by the government. This is 
 the practice in many states. He especially advocates measures for the educa- 
 tion of the public. 
 
PREVENTABLE BLINDNESS 
 
 115 
 
 Dr. Tivnen advocates education of the public and particularly of indi- 
 viduals. He would labor to secure the cooperation of medical societies, 
 mothers' clubs, nurses, and individuals with the health departments to bring 
 about the education. 
 
 In the meanwhile why not let each mother individually do her part ? She 
 can see to it that her baby does not go blind. 
 
 First, every mother should enter labor as free from infection as possible. 
 But there is a way to guarantee the sight of the child even when the ideal 
 condition of the mother is unattainable. She can understand the method. 
 
 SUPERIOR RECTUS 
 
 CHOROID 
 
 ^ OPTIC NERVE 
 
 CHOROID 
 
 INFERIOR RECTUS 
 
 Fig. 57. — Diagrammatic Section of the Eyeball. 
 
 There is little to it, and she can see that it is carried out in the case of her 
 child. 
 
 Another cause of preventable blindness is trachoma. Trachoma is said 
 to have come from Egypt. 
 
 Napoleon went to Egypt with an army for the purpose of capturing a 
 pyramid or some other white elephant. He got trachoma. Nearly every 
 soldier of his 32,000 got trachoma. When he returned to Europe this modern 
 Cleopatra refused to be left at home. 
 
 From the armies it spread to the people. From the European peoples it 
 spread to the L T nited States. 
 
 Not only is it to be found everywhere in the congested quarters of our 
 great cities, but it has penetrated to the most inaccessible of our mountain 
 populations. One of the great fights being made by McCormack in Kentucky 
 is against trachoma among the pure-blooded Americans of the Blue Ridge 
 Mountains. 
 
116 
 
 THE EYE 
 
 Fig. 58. — Showing For- 
 eign Body on Surface 
 op everted upper lld. 
 
 The keynote of the trachoma situation is cleanliness. It is difficult to cure 
 the cases of trachoma, hut it is easy to prevent them. Prevention is more 
 than a bargain. It is cheap. The necessity is for clean wash basins, clean 
 water, clean soap, clean towels, clean hands, and clean faces. 
 
 It is highly desirable to have separate wash basins and separate towels 
 under all circumstances. When a case of trachoma develops in a family, a 
 school, or in a factory, what before was desirable be- 
 comes absolutely necessary. 
 
 Turning again to the tables prepared by Pro- 
 fessor Bell, we find that nearly twice as many go 
 blind between the ages of 10 and 19 as lose their sight 
 under 10. I have never seen a close analysis of the 
 causes of blindness in this group. Some of them are 
 the result of smallpox; some of cerebrospinal menin- 
 gitis, and more are due to other infections. 
 
 Looming large in this group are the accidents of play. The "sane 
 Fourth" movement has demonstrated that the play customs of children need 
 not endanger their sight. I am sure that the census of 1920 will show a 
 smaller number of cases of blindness that are the result of the accidents of 
 Play. 
 
 A large portion of this group, though, is due to accidents of work rather 
 than to accidents of play. The "safety first" movement has had a marvelous 
 growth in the last five years. Born out of the flood of workirgmen's com- 
 pensation laws which were passed after 1905, this movement has had the 
 moral and financial support of large corporations and men of brains, energy, 
 judgment, organizing ability, as well as means. 
 
 On no part of their program is there more concentration of energy than 
 that relating to protection of the eyes. It will be ten years before the result 
 of these activities can be seen in statistics. 
 
 I learn that the chief difficulty is with the men 
 themselves. Goggles are a nuisance. They are in the 
 way; they are hot. The glass gets covered with dust 
 or clouded with moisture. 
 
 I have often seen workingmen picking particles 
 from each other's eyes. I have seen them picking out 
 iron particles with a knife blade and other particles 
 with a handkerchief. They are adept at it. But every 
 now and then an eye becomes infected; the sight is 
 lost, and sympathetic ophthalmia costs the sight of the 
 second eye. 
 
 The remedy is the use of shields and goggles. 
 Because the men will not always do what is best for them the facilities 
 around factories for caring for injured eyes should be improved. 
 
 Professor Bell found that one in each twenty persons between 90 and 
 100 years of age was blind. For those over 100 the rate was one in fourteen. 
 Among the old are to be found the congenitally blind, the blind from trachoma 
 and from accident, and to these have been added those blind from the changes 
 of age, including cataract. 
 
 Cataract is to be found among the old of every land, but some peoples 
 
 Fig. 59. — Showing 
 Method of Everting 
 Upper Lid, Using a 
 Tooth Pick and Fin- 
 ger. Foreign body is 
 seen near end of finger. 
 
THE SIGHT FAILS 117 
 
 are more subject than others. It is much more common in hot countries than 
 in cold ones. It is said that in Egypt one person in every fifty is blind, and 
 cataract seems to be more prevalent in India than in any other portion of the 
 world. 
 
 Among workingmen, glass blowers are noted for having cataract. 
 
 There has been a great deal of discussion of the cause of cataract among 
 people in hot countries and among men working at hot occupations. 
 
 It has been charged to the glaring sunlight, the dust and the dryness of 
 the air. Some have thought it due to ultraviolet rays. 
 
 So far as glass blowers are concerned, the tendency of the times is to 
 charge it to the effects of the heat on the cornea and lens. 
 
 Whatever the condition is due to, some part of it can be prevented and 
 some remedied. 
 
 THE SIGHT FAILS 
 
 There are a number of conditions of the eye which tend inevitably, at 
 least in a fair proportion of the cases, to blindness. The result can be foreseen 
 a long time in advance. In some of these diseases death can be foretold. 
 For instance, when the blindness results from Bright's disease, death within 
 less than two years can be expected. 
 
 In a case in which inevitable blindness is in prospect and the outlook for 
 a long life is good, it is the duty of the physician to inform the unfortunate 
 person frankly yet sympathetically of what is in store for him. Given an 
 opportunity, he can then equip himself to increase his capacity for work and 
 pleasure. 
 
 Dr. Parke Lewis, in his pamphlet entitled "Preparations for the Oncom- 
 ing of Blindness," says : "Of first importance is it that he continue actively 
 in the world's work." 
 
 Warned, he may devote the months of fading sight to training his other 
 faculties to take the place of sight. In the first place he should learn to 
 typewrite, making use of the touch system. He should train his fingers to 
 read rapidly manuscript prepared for the blind. He should learn to carry 
 on his present occupation without the use of his eyes, or else he should learn 
 and become settled in a new occupation, one that can be carried on without 
 the use of sight. 
 
 During this period of failing sight he can learn orderly habits for his 
 wardrobe that will enable him to pick linen or to choose cravats without see- 
 ing. He can train his touch and muscle sense so that he can find his way 
 around and avoid dangers and accidents. He can learn to sense his sur- 
 roundings, to see with his fingers. 
 
 Given some months of warning, fully understanding the meaning of his 
 infirmity, and with a will to overcome difficulties, he may train himself for a 
 life of usefulness and happiness. It is not necessary that he should become 
 antisocial, embittered, soured, morose, morbid, careless, or even inefficient. 
 
 Some of the happiest people have been blind. Some of the most useful 
 people have been sightless. Not only have some of the greatest geniuses of 
 the world seemingly had their talents increased by blindness, but some people 
 with ordinary minds have not let blindness cut them off from useful lives. 
 
118 THE EYE 
 
 Some men who, while they had sight, labored with their hands, who seemingly 
 had no talent but pluck, after losing their sight have led efficient lives. 
 
 The period of failing sight offers an invaluable opportunity for training 
 for blindness — training of body, mind, and soul. 
 
 TRACHOMA 
 
 Trachoma is one of the diseases which the old-style health officer missed 
 completely. He might pore over death returns as long as he pleased and still 
 be in ignorance of trachoma. A health department which concerned itself 
 with diseases usually fatal would miss it entirely. It is not until health de- 
 partments become interested in increasing efficiency that they take notice of 
 trachoma, for trachoma Minds but does not kill. 
 
 It is not until health departments go gunning for defects, calling the 
 adventure sanitary surveying, or health survey- 
 ing, or some similar name, that trachoma is 
 thought worth while. The man with trachoma 
 must be sought out. Rarely does he come of 
 his own accord. The condition is so mild, so 
 symptomless, so free from pain, so slowly pro- 
 gressive that the subject sees the shadows slowly 
 close around him, the light slowly fade away, 
 and makes little effort to save himself, or makes 
 Fig. 60.— Eyedropper. some effort but is easily discouraged. 
 
 The government has inspectors who try to 
 turn back immigrants with trachoma because, at one time, it was a Euro- 
 pean disease and we thought our uncrowded people were free from it. 
 
 Some good authorities hold that trachoma is not a specific disease due 
 to one germ, but that it may develop from any case of neglected sore eyes. 
 These people hold that, where many people use the same wash basin and the 
 same towel, the "sore eyes" of the one presently become the trachoma of the 
 group. At any rate, trachoma is now as abundant in the United States as in 
 Europe. 
 
 Kentucky is making a trachoma survey. They have examined about 
 4,000 people in Knott, Perry, Leslie, Breathitt, Lee, Owsley, and Clark coun- 
 ties and have found that about one out of every eight has trachoma. Six of 
 these countries are in the mountains and one is in the blue grass country. 
 
 The physicians at the Hebrew Dispensary, Chicago, have no trouble in 
 finding cases by the hundred among the people who come to them. The 
 probability is that a nationwide survey would show trachoma in all parts of 
 the United States and among all classes of people. 
 
 We of the city are wont to think there is no sickness and disability 
 among the people who live in the pure air and sunlight of the mountains. 
 The people of the neglected mountain country see the great machinery for 
 human care in the cities and conclude there can be no eyes developing tra- 
 choma from neglect in such surroundings. 
 
 There is an Arkansas story of a log camp lad who marveled at the clothes 
 brushes, shoe brushes, hair brushes, tooth brushes, towels and soap of a city 
 
TRACHOMA 119 
 
 visitor and exclaimed: "Is yo ? always that much trouble to yo'sef?" The 
 heart of the trachoma situation is in being trouble to "yo'sef" — care of the 
 eyes by oneself, by the parent, by physicians, by the school authorities, by 
 boards of health. 
 
 Trachoma is a chrome inflammation similar to, and may be just what we 
 formerly called granular eyelids. In time the scar tissue contracts and pulls 
 the lids away so that the eyeball is not properly protected and is harmed. It 
 is contagious. It kills nobody, but reduces the efficiency of many people, 
 especially in the crowded districts in the city. It puts many otherwise able- 
 bodied people on charity or in county institutions. It burdens families and 
 is a heavy drag on taxpayers and philanthropists supporting homes and hos- 
 pitals. 
 
 A while ago somebody became suspicious that there was trachoma among 
 the school children of Tuscaloosa, Alabama. The attention of the public 
 health service was called to the situation and it sent Dr. Herring there to 
 investigate. He examined the entire school population of Tuscaloosa, 1,122 
 pupils, of every station in life, and in addition 497 students in rural schools 
 in the neighboring country. 
 
 He found that one child out of about every twenty positively had tra- 
 choma, and, in addition, the eyes were suspicious of trachoma in one out of 
 about every sixteen. If these be counted as cases it means that in Tuscaloosa 
 one school child out of every nine has trachoma. 
 
 Neglected trachoma is a serious disease. In the first place it is catching. 
 It is spread by towels, wash basins, handkerchiefs, fingers. Unlike pink eye, 
 it does not tend to get well. On the contrary, it tends to get slowly worse 
 and in time to impair the sight seriously. 
 
 It passes through a stage wherein there are granular lids and a little mat- 
 tering of the eyes. In this stage light hurts the eyes; the sight is slightly 
 impaired, and headaches are frequent. 
 
 It finally enters the cicatricial stage. In this stage the lids are drawn 
 in, or out, or down. They are persistently red along the edge. The vision 
 is very much impaired. The poor vision may result in persistent headaches 
 and other forms of nervous disturbance. In this late stage the disease is not 
 thought to be contagious. 
 
 However, before either of these stages is reached there is a stage on 
 which I want to center attention. Get it clear in your mind, even if you 
 must forget the other stages. The eyelids are opened not more than half so 
 far as if normal. The eye holes out through a narrow fissure. In most cases 
 the lids are stuck together in the morning and there is a little matter in the 
 inner corner. 
 
 A little mucus-like secretion is sometimes found in the corner of the eyes 
 during the day. Light is a little unpleasant. These signs may not mean 
 anything more than pink eye ; or, if they keep it up, may not mean anything 
 except eye strain, need for glasses. 
 
 The majority of the children in Tuscaloosa found to have trachoma did 
 not think their eyes were wrong in any way. In the case of some of them 
 the parents thought there was some trouble with the eyes and if it did not 
 get well shortly they would have glasses for their children. 
 
 These symptoms do not necessarily mean trachoma. They indicate that 
 
120 THE EYE 
 
 suspicion of trachoma is justified. When an eye man sees these cases he 
 turns the lids out. 
 
 If trachoma is present he will find small rounded red elevations mostly 
 just inside the margin of the lower lid. There may be small solid red spots 
 in the same location on the upper lid. The lids may be slightly thickened. 
 The eyeball may be involved. A little redness of the inner portion of the 
 eyeball is almost certain to be found. There may be a little matter under 
 the lids. Trachoma in this stage is actively contagious. 
 
 This is the combination that makes it necessary for fathers and mothers 
 to know about trachoma (it is not enough that the physicians know about 
 it), an actively contagious disease, causing very little annoyance and yet 
 inevitably bound to injure the eyes seriously. 
 
 Conditions like those found in Tuscaloosa have been found in so many 
 places in all sections of the United States that no town is justified in thinking 
 trachoma of no importance to its people. 
 
 EYE FATIGUE 
 
 Alger says, "When one stops to think that most people use their eyes 
 almost constantly and that many tasks involve a continuous strain for hours 
 at a time, one begins to understand why vision necessitates expenditures of 
 nerve and muscle energy beyond almost any other function/' 
 
 There are three types of eye fatigue which show themselves in different 
 trades. Gilders and polishers and all others who watch bright surfaces or 
 look at bright lights suffer from eyestrain, which is the result of retinal 
 fatigue. 
 
 Holden tells us that for a long time fatigue from strain on the eye 
 muscles was a student's monopoly. Nobody suffered from eye headaches but 
 the bookworms. Now the students, thanks to glasses, better lighting, and 
 better printing, have almost got out of the class having eye headaches, but 
 certain kinds of workers have moved into it. 
 
 Today there are many trades in which the worker sits hour after hour 
 intently watching some machine. The same picture is being constantly re- 
 peated on the same part of the eye mirror hour after hour. So long as every- 
 thing goes well the worker has nothing to do, but if anything goes wrong, he 
 must see it and see it quickly. To do this he keeps his eye muscles in the 
 same state of contraction all day long. His muscles get tired; his nerves 
 get tired; his brain gets tired. 
 
 The garment workers probably are the most unfortunate of the lot. 
 Their eyes are under a great strain. The muscles which control their eyes 
 are overworked. Usually they work in badly ventilated rooms. The light is 
 even poorer than the air. As Alger says, "If they allow their eye muscles 
 to relax a second it means indistinct vision and that means mistakes in their 
 work, and that means fines and deductions.'' The margin between earnings 
 and the cost of living is not great enough to allow for many fines. 
 
 They need extra good muscles to stand this strain. Nothing in their 
 lives makes for good muscles. Their muscle strain passes into neurasthenia 
 and general tire. Therefore it is that a large part of the garment workers 
 
DANGER TO THE EYES 121 
 
 are neurasthenic. Nothing is more hysteric and neurasthenic than a garment 
 makers' strike. 
 
 The employer whose factory conditions make against mental poise at 
 times feels most keenly the effect of that lack of poise. Whenever an employer 
 thinks his employees are most hysterical, it is well for him to inquire if the 
 conditions of his employment do not make for hysteria. 
 
 Miner's nystagmus, a jerking of the muscles which move the eyeballs, is 
 the result of another kind of eyestrain. Cohen found that 45 per cent of the 
 German lithographers and 51 per cent of the typesetters suffered from pro- 
 gressive nearsightedness. In addition, he found that 10 per cent of the blind- 
 
 Fig. 61. — In Every Normal Eye There is a Normal Blind Area. Close one eye and gaze 
 steadily at the cross. Hold the paper ten or twelve inches from the eye Move it to and 
 from the eye. At the proper distance the white spot will not be seen. 
 
 ness in Germany developed out of this variety of shortsightedness. Ordi- 
 nary shortsightedness tends to be automatically corrected as age advances. 
 
 DANGER TO THE EYES 
 
 Nature intended that man should see. For the purpose a most intricate 
 piece of apparatus was made — the eye. No machine made by man is so 
 elaborate or so perfectly put together. This machine is made in duplicate. 
 It is covered well and provided with a well-nigh perfect dust removing ap- 
 paratus. To serve it twelve muscles are provided. Of the twelve important 
 nerves which come off directly from the brain, one-third, or four, are for the 
 service of the eyes. 
 
 As we start off, or soon after, we are endowed with good eyes. How do 
 we preserve the asset given us ? If we work at certain occupations we ruin it. 
 
 The eye suffers from some industrial poisonings. Probably the worst 
 of these is that from wood alcohol. Wood alcohol is now used for many pur- 
 poses. In some its presence is not suspected. For instance, Tyler reports a 
 whole room of girls who had eye trouble from shellacking pencils. 
 
 Alger gives other industrial poisons harming the eyes, such as chemicals 
 used in making rubber, explosives and anilins. Tobacco and lead workers' 
 also suffer from poisoning of the eye nerve. 
 
 The eyes are mechanically hazarded in all dusty trades. Among those who 
 suffer are the men who work over emery wheels, and also the metal and stone 
 
122 THE EYE 
 
 polishers. Masons and plasterers usually suffer from lime in the eyes. Flour 
 mill employees have eye trouble; so do hop pickers. 
 
 An exceedingly bad eye condition is that which develops in workers 
 around arc lamps and other highly intense lights. These lights produce 
 many violet and ultraviolet rays. The lens and the outer coats of the eye 
 take up most of these rays, but some get through, and such destroy the visual 
 purple faster than it can recover. 
 
 There results a condition of fatigue akin to snow blindness. The retina 
 may fall away. The nerve may be destroyed. 
 
 Closely akin are the eye troubles of stokers, bottle-makers and glass- 
 blowers, as the result of the intense light of the open fires or the molten 
 glass. One observer found 40 per cent of the bottle-makers in one establish- 
 ment had beginning cataract, even though the great majority of them were 
 less than forty years old. The left eye, the one nearest the fire, was the 
 more affected. Heat seems to be more important than light in causing glass- 
 blowers' cataract. 
 
 The lens of the eye differs from the lens of a microscope in that it is 
 soft and gelatinous. The eye, being a combined microscope, telescope, and 
 several other kinds of scope^ must have a lens which for one work can be molded 
 into the form best for a microscope and for another use into the form best 
 for a telescope. To mold it, special muscles are provided. 
 
 However, a lens which has not been fairly treated will age. It ages by 
 passing from a gelatinous-like mass into a solid mass. It may finally pass 
 into almost a stony mass. 
 
 This aging is called cataract. The importance of cataract from the 
 health and efficiency standpoint is well understood. 
 
 There is need that attention be called to the fatigue of eye, of body and 
 of mind which come while the cataract is in the making — the season when 
 no eye specialist can tell that a cataract is to come next Christmas or next 
 fall. While the man is developing this condition of extreme wear, it will be 
 certain that he is suffering from other forms of fatigue. 
 
 SMITH CATARACT TREATMENT 
 
 Out of India has come the most used and the most discussed operative 
 procedure for the eye of this century. According to the old methods cataracts 
 were not operated on until the sight had been lost. An English army surgeon, 
 Colonel Smith, working in India, devised a method which makes it possible 
 to operate on green cataracts as well as on old opaque ones. 
 
 The following is the usual history : A man past middle life notices that 
 his vision is failing. He goes to see his family physician, who examines 
 his urine and finds it normal; then makes a physical examination and finds 
 nothing wrong, and then sends him to an eye specialist. The eye specialist 
 tells him that he has a cataract, and nothing can be done until the cataract has 
 ripened. A year or so later, after the man has been unable to work for 
 months or years, he is ready for operation. 
 
 That was the old way. The Smith way is to operate upon a cataract as 
 soon as it begins seriously to disturb the vision. Whenever the sight gets 
 
SMITH CATARACT TREATMENT 
 
 123 
 
 20-70 or worse the eye is ready for operation. A man with a vision of 20-70 
 sees well enough to work ; his general health is good ; he is in no sense disabled. 
 
 The old operation removed the cataract and left the capsule. The Smith 
 operation removes the cataract in its capsule. 
 
 Smith was stuck away at a remote point in India. Cataract was a com- 
 mon complaint. The people were poor. They could not carry the burden 
 of blindness from cataract while awaiting the ripening. They must be oper- 
 ated on as soon as the vision became impaired. 
 
 Furthermore, they could not lay up for after-treatment. The operation 
 must be one that required little or no after-treatment. The Smith operation 
 was devised to meet these requirements. 
 
 Smith has operated on more than 30,000 cataracts. In the Punjab there are 
 20,000,000 people, and 25,000 cataract operations are done each year. Ninety 
 
 INTERNAL RECTUS 
 MUSCLE 
 
 EYE LID 
 
 OPTIC NERVE 
 
 EYE LID 
 
 INFERIOR 
 OBLIQUE MUSCLE 
 
 Fig. 62. — Outside of Eyeball. Muscles which move the eyeball upward, downward, out- 
 ward, inward and obliquely. 
 
 per cent of them, or about 22,500, are done by the Smith method. Most of the 
 eye men in India are using this method. 
 
 For some reason cataract is unusually prevalent in India, as has been 
 known for years, and the eye men in India have had the richest experience 
 in the world. Furthermore, the experience with this operation has extended 
 over several years. 
 
 Those who read this volume are not interested in the finer technical 
 points of operations or the ordinary points of advantage of one operation over 
 another. They are interested, however, in a procedure that does away with 
 the old time months or years of near-blindness while waiting for the 
 cataract to ripen. 
 
 If this procedure can make good, the man with the cataract need not 
 lose more than a month all told from his work, waiting for operation and 
 after-care combined. The word of men who have performed the operation 
 25,000 times is that it has made good. 
 
 For a number of years eye specialists from all over the world have been 
 going to India to learn the method. Many of them are in the United States 
 
124 THE EYE 
 
 doing the operation as occasion offers. Some have done more than 500 of 
 these operations — not a Smith record, but a rich experience as cataract experi- 
 ences in this country go. 
 
 SQUINT 
 
 Strabismus (squint) exists whenever the two eyes are not directed toward 
 the same object. Normally the action of the ocular muscles is such as to 
 keep both visual lines always directed to the object under regard and, although 
 each eye receives its own image, only one object is perceived by the brain, 
 because the images are formed on the same corresponding parts of the retina. 
 
 If, owing to faulty action of one or more of the ocular muscles, one eye 
 deviates and the visual lines cease to be directed toward the same object, two 
 
 Fig. 63. — Far-sighted (hyperopic) Eye. Focusing Parallel Rays of Light Behind Retina 
 at a Convex Glass (1) is required to Converge the Rays (dotted line) so They Will 
 Focus Exactly in the Retina at r. 
 
 images of the same object are seen, but on nonidentical parts of the retina^ 
 and the result is double vision. 
 
 To avoid this inconvenience patients for the most part soon learn to ignore 
 or suppress the image formed in the squinting eye, the result usually being 
 that this eye becomes defective. This power of suppressing the false image 
 is learned most easily in early life, and hence the necessity for early treat- 
 ment of squint to avoid this. 
 
 Squint may be either paralytic or nonparalytic. Nonparalytic squint in 
 children may be either congenital or acquired. The general causes of ac- 
 quired squint are imperfect vision in one eye from opacities of the cornea or 
 diseases of the choroid, retina, or optic nerve, rendering it unable to par- 
 ticipate in binocular single vision. 
 
 Causes of paralytic squint may affect either the muscles themselves, the 
 nerve trunks, or the nerve centers. Lesions of the nerve trunks are most 
 frequent and are caused by syphilis, rheumatism, hemorrhage, tumors, alco- 
 holism, influenza, and other acute diseases. Paralytic squint may be congeni- 
 tal. In the early stages of paralytic squint the treatment will depend upon 
 the cause. 
 
 ISTon-paralytic squint is more common and occurs in early childhood. It 
 is convergent; that is, one eye turns in toward the nose. The defect is 
 manifested early in life — in fact, when the child begins to use his eyes for 
 near vision, looking at picture books, etc. The majority of such children 
 develop a squint before the age of three. 
 
 As a rule the squint develops slowly, and the parents are not the first 
 
SQUINT 125 
 
 to notice it. They generally assign as the cause an illness such as measles or 
 the imitation of a squinting companion. 
 
 In some cases we observe the squint only when the child gazes on a 
 near subject. In others the squint is constant, but more marked when the 
 focusing power is brought into play or when the child is tired. Most chil- 
 dren who see equally well with each eye often squint with either indifferently. 
 
 Contrary to the common belief, children seldom "grow out" of it. If 
 neglected, the squinting eye usually becomes blind from disuse. Neglected 
 "cross eyes" are responsible for many blind eyes in adults. 
 
 If prescribed sufficiently early, correct glasses accomplish cures in many 
 of the cases. Even very young children can wear glasses without danger. 
 
 The treatment by glasses, 
 which is so efficacious in the 
 young, is naturally much less 
 so in older patients who have 
 had squint for some years, and 
 then operative interference is 
 necessary. 
 
 The condition where the 
 eye turns out is rarely seen in 
 young children and mostly de- "* 6i - Foc ^ e Ze^Z !£" " A ""^ 
 velops at puberty or later — in 
 
 fact, when myopia or nearsightedness is progressing. In the majority of 
 cases, when once developed, nothing short of operation is any good. 
 
 Cross eye and cock eye are varieties of squint. A person has squint if, 
 when he looks at an object, one eye is directed toward that object while the 
 other is aimed in another direction. Normally, the muscles of the two eye- 
 balls work together so that both eyes aim at the same object. Under these 
 circumstances, the light rays carry the image to the same spot on the retina of 
 each eye. The imprint of these images is carried by the optic nerve to the 
 visual area in the brain in such a way as to merge them as one image. The 
 brain sees a single picture. 
 
 Sometimes the balance of power between the opposing muscles for the 
 eyeball is lost. If the muscles on the nose side are too strong the eye "crosses." 
 Sometimes one, sometimes both eyes "cross." If the outside muscle is too 
 strong the eye turns out. 
 
 The picture on the retina is the image of the picture at which that par- 
 ticular eye is aimed. When a cross-eyed person looks at a thing he aims 
 one eye at it. The image on the retina of that eye is a picture of the object 
 viewed. But the other eye is aimed at something else. On its retina there 
 is a picture of the object it is viewing. The optic nerves send in two pictures 
 to the sight center in the brain. The sight center can only record one of 
 them. 
 
 When rays of light enter the eye they pass through the lens and from 
 there to the dark chamber to the retina. The dark chamber has a shutter. 
 The shutter is the iris. The hole in the shutter is the pupil. 
 
 Syphilis of the eye affects especially the shutter, the iris. Inflammation 
 of the iris is called "iritis." While the spirochetes of syphilis may locate in 
 any part of the eyeball they show a liking for the iris. 
 
126 THE EYE 
 
 Syphilis of the eye causes blindness, though it is less important than 
 gonorrhea from this standpoint. Physicians are able to diagnose syphilitic 
 iritis from the appearance of the eye as seen with proper instruments. If 
 there is a doubt a Wassermann test will establish the diagnosis. The con- 
 stitutional treatment for syphilitic iritis is that of syphilis elsewhere in the 
 body. 
 
 PINK EYE 
 
 Pink eye is frequently the result of a scratch from dust or some other 
 foreign body. At the season of the year when the wind and dust are spread- 
 ing infection of all kinds there are many cases of sore eyes. In most cases 
 only the mucous membrane lining the lids and covering the eyeballs is in- 
 volved. The eyes are red and there is a discharge that sticks the lids to- 
 gether in the morning. They feel heavy and burn, but there is no actual 
 
 pain. There is a sensa- 
 tion as though there 
 were sand in the eye. 
 In many cases only one 
 
 V ■***^- * _. _ ^ I \ ^^^^^^l e y e * s mv °l ye d at first, 
 
 but soon the infection 
 goes over to the other 
 
 Fig. 65. — Near-sighted or Myopic Eye Focusing Paral- e y e * 
 
 lel Rays from a Distant Object at f in Front of If the eyes are kept 
 
 Retina. A Concave Lens (1) Will Cause Parallel d &nd fpee from dig . 
 
 Rays to Diverge, as from a Near Object (r), and so . 
 
 Focus Exactly on the Retina at b. charge the inflammation 
 
 will be over in from four 
 to ten days. The discharge from such an eye is infectious. People who 
 have pink eye should not use towels or handkerchiefs that may later be used 
 by another person. Failure to observe this precaution is the reason why this 
 condition "makes the rounds." It frequently does this in schools, boarding 
 houses, and business institutions. 
 
 There is a serious side to attacks of pink eye. Occasionally the cornea or 
 clear part in front of the eyes becomes involved, and ulcers form. The ulcers 
 of the cornea are very grave because the scars they leave interfere with vision. 
 
 Inflammation of the inside of the eye is sometimes associated with pink 
 eye. The danger signals warning us of one or more serious conditions are 
 pain, dimness of vision, and swelling. Any one of these three should make 
 us go at once to a physician competent to treat diseases of the eye. 
 
 When pink eye is caused by a spark from a cigar or a piece of hot ash, a 
 drop of olive oil or castor oil will usually relieve the .pain until medical advice 
 can be had. 
 
 Cannot Dissolve Cataract. — P. J. H. writes: "For several years, as the 
 result of hemorrhages of the retina, there has been a bluish or grayish 
 matter just inside the pupil of my right eye, causing total blindness in 
 that eye. Recently I met a physician who said that he had a liquid which 
 was to be dropped in the eye twice daily and by this method cataracts and 
 similar growths were absorbed. He does not claim that it does the work 
 in all cases, but that it is effective in a large percentage of cases, and that 
 
PINK EYE 127 
 
 it is harmless. By this method he claims the lens is saved, whereas by an 
 operation for cataract it is removed. Do you know anything about this 
 method? If so, is it harmless and is it advisable to take the treatment? 
 This physician seems to be honest. 
 
 "2. How can one determine whether a physician is honest or a quack? 
 
 "3. I am going South to stay for some time in or near pine woods. 
 Have been told that in those regions the wood tick, if it gets on a person, 
 causes a fever that is always fatal. Is this so and what should one do to 
 avoid itf 
 
 Reply. — 1. No liquid has any such power. Drops to dissolve cataract 
 and absorb retinal hemorrhage are a fake. Furthermore, they have been 
 exposed and denounced as frauds any number of times. 
 
 2. One way is to read the exposures of frauds in the newspapers and 
 
 N*-'1* 
 
 h 
 
 Fig. 66. — Far-sighted (hyperopic) Eye Showing the Focusing of Rays from Near 
 (n) and Far Objects (h.h.) Behind the Retina. 
 
 to clip and preserve the items. This paper has a fairly extensive card 
 index of frauds and quacks, and we will answer inquiries about any that 
 we have on our list. The American Medical Association has a better list 
 of frauds than ours, and they are willing to answer inquiries as far as 
 they can. 
 
 3. The bite of the ordinary wood tick is never fatal. You have in 
 mind the spotted tick found in a small area in Montana. To grease the 
 "bite" with butter kills the tick and helps the bite. This is enough to do. 
 Many of our correspondents have sent us their remedies. These have 
 appeared in the Tribune. 
 
 Trachoma. — E. B. writes: "Will you kindly publish a cure for tra- 
 choma; also the symptoms and results, if not cured?" 
 
 Reply. — Trachoma is a chronic inflammation of the covering of the 
 eye and lining of the lids. It is the result of an infection. It is con- 
 tagious. 
 
 Most of the cases of granular sore eyes or granular lids are cases of 
 trachoma. 
 
 After the lids have been mildly inflamed for a long time the scar tissue 
 begins to contract and deform them. They may turn in; whereupon the 
 eyelashes scratch the eyeball or turn out. 
 
 No home treatment is of service in bringing about a cure. Some 
 physicians treat trachoma by scraping away the granulation; some by local 
 applications of antiseptics and caustics. 
 
 To prevent it, when you must associate with people who have it, be 
 certain to use individual face bowls and face towels and hand towels. 
 Keep your hands very clean. 
 
128 THE EYE 
 
 Granular Lids. — Mrs. A. F. writes: "1. What is the cause of granulated 
 eyelids? 2. Is yellow oxid of mercury in ointment applied to the lids 
 heneficial? 3. Is there any danger of mercuric poisoning from using it in 
 the eyelids of a healthy child of 3 years? k- What causes dandruff? 5. 
 What removes dandruff and causes it to disappear permanently?" 
 
 Eeply. — 1. Granulated lids is a term loosely used. Frequently it means 
 trachoma — an infectious disease. Find out if your child has trachoma. 
 
 2. Ointment of yellow oxid of mercury is good for many affections of 
 the lids. 
 
 3. No. 
 
 4. Some cases mean that the scalp has not been kept clean enough. 
 Other cases are due to some skin germ not 
 identified. The very bad cases in babies, 
 sometimes called dandruff, are due to faulty 
 nutrition. 
 
 5. Frequent washing, followed by the use 
 of a little grease and good brushing, will rem- 
 Fig. 67. — Simple Hyperopic edy many cases. Eesorcin ointment is service- 
 Astigmatism Shown in Sue- able in others ; sulphur in others. 
 ceeding Figure Corrected 
 
 by a Convex Cylindrical Floating Spots.— E. C. M. writes: "For 
 
 Glass. In astigmatism the , 7 777 -, 7 
 
 curve of the lens or cornea is t' ie ^^ ^ en years 1 have been troubled With 
 irregular and uneven. black floating spots and rings hefore the 
 
 eye. I have been wearing glasses for four 
 years, but they do not do away with the spots. My work is that of book- 
 keeping and of course my eyes are at constant strain. Will my eyes in 
 time get worse with more spots or is there no danger in them? I am also 
 troubled with catarrh in the nose and throat. Has this an effect on the 
 eyes? Has the stomach anything to do with the eyes?" 
 
 Eeply. — Floating spots before the eyes are of no consequence. They 
 occasion unnecessary worry. Exercise proper care to have the light fall 
 on your books right, adjust your glasses as they need to be adjusted from 
 time to time, and you will be doing all you can to preserve your eyes. 
 It is not probable that your eyes are affected either by your nose or your 
 stomach. 
 
 Rings Before the Eyes. — J. S. R. writes: "I have been annoyed by 
 small rings and double lines in front of my eyes. They flow in front of 
 my sight. There is one set of rings within a double line, and whenever 
 I look on white objects I always see this as a large spot dancing in front 
 of me. What must I do to get rid of these?" 
 
 Eeply. — There is nothing that you can do. No harm will come from 
 them. Pay no attention. They will never injure your sight. 
 
 Cause of Infant Blindness. — M . H. writes : "The baby of my friend, a 
 neighbor, had sore eyes at birth and became blind. A doctor has told me 
 that it was no doubt the result of a venereal infection. He said that a 
 great many innocent young wives are infected by their husbands, and 
 abdominal operations are sometimes necessary to save their lives. He 
 quoted Dr. Joseph Price of Philadelphia as saying that 95 per cent, of his 
 abdominal operations on women — usually innocent women — are for such 
 infections. If this or a tenth part be true, what shall we do to protect our 
 
PINK EYE 129 
 
 daughters? The great majority of your readers, like myself, are entirely 
 ignorant of such dangers" 
 
 Reply. — Your informant is probably correct. The baby is blind because 
 of an infection of its eyes with gonococcus. To prevent this, the eyes of 
 newly born babies should be washed in a weak silver solution soon after 
 birth. Twenty-five per cent of blindness is from this cause. A large per- 
 centage of young girls [1 month to 10 years old] are infected [innocently, 
 so far as they are concerned] by this coccus. The remedy is: (1) birth 
 registration; (2) routine washing of the eyes of the newly born with 
 silver solution; (3) reporting of venereal disease like other forms of 
 contagion; (4) education of the public as to the harm of venereal dis- 
 eases; (5) the control of prostitution along the lines recommended by the 
 Chicago Vice Commission. 
 
 Eye Drops for Baby. — S. C. writes: "In one of your articles last 
 summer I noticed that you prescribed a boric acid solution and nitrate of 
 silver for treatment of a baby's eyes at time of birth. Will you please give 
 directions as to just how to use this treatment, how strong the solution of 
 boric acid should be, etc.V' 
 
 Reply. — Drop one drop of silver nitrate solution into each eye. Follow 
 immediately with a drop of salt solution. Do not use the same dropper 
 for the two solutions. This procedure is to be carried out within two 
 hours after birth. After that, if the eyes need cleaning, use a boric acid 
 solution. Drop this from a piece of cotton held close to the eye. Use fresh 
 cotton or cloths for each eye. Strength of solution — Nitrate of silver in 
 distilled water, 2 per cent (solution must be fresh) ; salt solution — table 
 salt in boiled tap water, 1 to 2 per cent; a level teaspoonful of boric acid 
 to a quart of boiled tap water. Many boards of health now furnish eye 
 drops ready to use. 
 
 To Prevent Blindness. — J. T. wants to know what solution should be 
 dropped into the eyes of a newly born babe to prevent it from going blind. 
 
 Reply. — As soon as the baby is born it should be cleaned. Use separate 
 cloths, or cotton, for the head. Clean the eyes with fresh sterile gauze. 
 Do not clean one eye with a piece that has touched the other eye. Separate 
 the lids and drop one drop of a 2 per cent solution of silver nitrate in 
 each eye. See that the eyes are cleaned each day with a saturated solution 
 of boracic acid and clean sterilized gauze. 
 
 May Need Glasses. — A. B. writes: "Will you kindly describe the con- 
 dition known as retinal hemorrhage? Do the eyes discharge blood? My 
 eyes are often bloodshot, with the 
 lids slightly inflamed, especially in 
 the morning. At such times they 
 
 are quite sensitive, but there is no j^ / ;/ \^^ t • / 
 
 discharge of water or pus. There ""*"^3r~- «*»A 
 
 is sometimes pain over or in the 
 eyes; otherwise I am free from 
 headache. The sight is not im- 
 paired. What causes this condi- FlG ' 68.-Simple Hyperopic Astigmatism. 
 tion?" 
 
 Reply. — 1. The retina is in the back of the eyeball. It is the part of 
 the eye in which are located the delicate nerves of sight. The front of 
 the eye is a mechanical apparatus for the purpose of properly throwing 
 the light on the retina. The blood vessels in the retina are delicate. If 
 
130 THE EYE 
 
 one of these small vessels breaks, a little blood pours into the retina, mak- 
 ing a hemorrhagic speck. The speck can only be seen with a special 
 instrument. It usually consists of a drop of blood, or less. The eyes do 
 not bleed. 
 
 2. A thorough examination would probably show that you need glasses. 
 
 Bloodshot Eyes. — L. H. S. writes: "What causes bloodshot eyes and a 
 burning sensation in those organs? What would you suggest as a remedy? 
 Would glasses give relief?" 
 
 Reply. — Bloodshot eyes and a burning sensation in the eyes are symp- 
 toms. They mean need of glasses more frequently than anything else. 
 When your eyes are properly examined for glasses the oculist will find any 
 other cause if any is there. 
 
 Tears Symptom of Closed Ducts. — Sheldon writes: "About a month 
 ago I took cold sleeping in a draft. I felt at once that it had settled in 
 my left eye, as it became watery and gave me a great deal of trouble. 
 My doctor thinks the tear duct is closed and insists that it should be 
 operated upon. It troubles me most in the open air. What are the symp- 
 toms of closed ducts?" 
 
 Reply. — The tears overflow. In most cases the operation is simple, 
 consisting of repeated passing of a probe. 
 
 Glasses for Astigmatism. — L. M. B. writes: "Will you kindly inform 
 the writer if there is any cure for astigmatism of the eyes?" 
 
 Reply. — Glasses that fit will cure the defect in vision. An astigmatic 
 eye is one shaped somewhat differently from a normal eye. 
 
 Operation for Cataracts. — S. A. writes: "My mother is 65 years old, 
 She has somewhat recovered from general illness, caused by hardening 
 of the arteries, and, though she is better, she complains of rheumatic pains 
 and a numbness of the limbs and stomach. Is there any help for this 
 condition? She also has cataracts on her eyes, and in one is about totally 
 blind. Should she have it operated upon now or wait till she is stronger? 
 Would the operation be done successfully at the state eye and ear infirmary 
 on Adams Street, Chicago?" 
 
 Reply. — 1. Have her keep her teeth clean. If she has any sore throat, 
 have her physician see that that is cleared up. Keep her in the open air; 
 have her take exercise. Massage will help. Have her eat enough meat to 
 build her up. 
 
 2. Have her wait until she is in good physical condition. Cataracts 
 commonly are allowed to harden, or ripen, before they are removed. It is 
 not an operation that one need be in a hurry about. 
 
 3. Yes. 
 
 Failing Sight. — Paxton writes : "I know a man whose sight is failing, 
 though he is not 50 years old. He has chewed tobacco and been a drinker 
 to some extent, had led a bad life and had a vile disease several times. 
 Is this disease responsible for the condition of his eyes and do you think 
 he can be cured? Glasses do him no good." 
 
 Reply. — I guess the "vile disease which he has had several times" is 
 the one which does not cause blindness in the way described by your letter. 
 That one causes the eyeballs to suppurate and ulcerate, and blindness to 
 
PINK EYE 131 
 
 come in a few days. The vile disease that sometimes causes blindness to 
 develop slowly is not a disease that one "has several times." Tobacco not 
 infrequently causes the sight to fail. It produces a paralysis and, finally, 
 an atrophy of the main nerve of the eye — the seeing nerve. My advice 
 to him is to see a good eye specialist. If his eyeball is getting senile — 
 and he is just at the right age for that — proper glasses will fix him up. 
 If it is tobacco amblyopia, he should get better if he quits chewing. 
 Whisky makes no difference except that it makes his eyes old before their 
 time. 
 
 Tears Best Eyewash. — E. R. writes: "What is tetter than boric acid 
 water to strengthen the eyes? Which is the better to take the first thing 
 in the morning, hot or cold water?" 
 
 Eeply. — 1. No sort of eyewash will strengthen your eyes. Eyewashes 
 only wash the outer coat, or conjunctiva. At that the tears, a weak solu- 
 tion of salt, are better than any man-made eyewash. The structures that 
 are of consequence are deep in the eye beyond the reach of washes. 
 
 2. Either is good. Perhaps cold is better. 
 
 Cataract "Ad." Untrue. — H. F. A. writes: "A doctor advertises that 
 he can cure cataracts by what he calls a dissolvent treatment. Is this 
 possible without injury to the eye itself?" 
 
 Reply. — No. 
 
 Treatment of Styes. — R. J. G. writes: "Please tell me the cause of 
 and cure for styes. My daughter, about 6, and myself, 37, are bothered 
 frequently in this way. Do they denote weakness of any kind?" 
 
 Reply. — Styes are caused by infection of the edge of the lid with pus 
 cocci. Some disturbance in the general health or some error of refraction 
 may be the predisposing cause. In the early stages the eyelash which runs 
 through it should be pulled out and an application of strong carbolic acid 
 or tincture of iodin made to the diseased area. If this fails to effect a 
 cure it may be necessary to have it lanced to let out any pus which may 
 have accumulated. Warm applications or hot stupes are then made to 
 relieve the pain and hasten suppuration. An application of mercurial 
 ointment rubbed over the diseased part promotes recovery and has a ten- 
 dency to prevent recurrence of the disease. Usually it is wise to have 
 your family doctor or an oculist treat the disease, especially where there is 
 a tendency to recur. Where the stye occurs as a result of a lowered state 
 of health efforts at correction are to be made by giving suitable tonics. 
 Where it results from errors of refraction suitable glasses are to be used. 
 
 Infection Causes Stye. — Mrs. F. wants to know the cause of stye on 
 the eye. Also, whether it is, as a great many people declare, helpful. Last 
 week she had a small stye on the lower lid. Now one is coming on the 
 upper lid. 
 
 Reply. — A stye is due to an infection o| the root of an eyelash or of 
 an eyelid gland by a pus coccus. It is not different from a small boil. It 
 is not helpful in any sense. Eye-strain contributes to it indirectly; un- 
 clean lashes and lashes which should be removed are another factor. 
 
 Oculists are like other people — some honest, some not. They average 
 better than the run of men. 
 
 You must exercise care in selecting your oculist as you do in selecting 
 
132 THE EYE 
 
 your milkman, grocer, or husband. If you need glasses you should wear 
 them. 
 
 Strained Eyes. — Mrs. M. M. writes : "I am SJf years old and am having 
 trouble with my eyes for the first time. I am cooking on an oil stove. The 
 room is small and is heated by an oil stove. I cook two meals each day by 
 oil lamp,, making six burners lighted at one time. I am poor and do wash- 
 ing every day. Two children depend on me. Do you think the kerosene is 
 the cause of my trouble f 
 
 Reply. — Six burners would use up a lot of air and pour a lot of car- 
 bonic acid into the room. Unless you ventilate well this would be trying 
 on your general health. It would not hurt your eyes especially, however. 
 If the light is poor and you strain your eyes you may be harming them. 
 Your age is about right for the development of senile changes in the eye, 
 principally long-sightedness. See if glasses will not relieve you. 
 
CHAPTER XI 
 
 The Ears 
 
 THROAT 
 
 Dl\uri HEAT> 
 
 AN EARLY SIGN OF DEAFNESS 
 
 The ordinary method of hearing is that in which sound waves strike the 
 ear drum and the impulse is transmitted by the bones of the ear to the place 
 where bony movement irritates certain delicate nerves. The irritation of 
 these nerves is carried to the brain, where the impulse is recorded as a sound. 
 
 Impulses can be carried to these nerves by bones other than these small 
 bones of the ear drum. In fact, the bones are in touch with each other so 
 that some little 
 sound impulses can 
 travel to the ear 
 from far - away 
 places. We can 
 hear a little with 
 our hands and our 
 feet; we can hear 
 still more with the 
 bones nearer the 
 ear bones. 
 
 Bournier offers 
 the following test 
 
 for the extremely early stages of failing hearing: The foot of a vibrating, 
 deep-toned timing fork is held against the elbow or wrist. If the hearing is 
 normal, the vibrations are felt, but no sound is heard. If the hearing is 
 beginning to fail, the sound of the vibration will be heard through the bone. 
 
 The theory is that when the ear drum begins to thicken up and ear drum 
 hearing loses some of its acuteness, the indirect or bone hearing becomes 
 somewhat more acute to compensate; that when this test shows bone hearing 
 to be more delicate than normal, it is a sign that ordinary hearing is going 
 away a little. 
 
 This sign probably would not hold good for the deafness of old age. 
 Its field is those who, by reasons of neglected earaches in childhood, or by 
 reason of thickening of the drum, or other changes in the middle ear, are 
 getting deaf before their time. 
 
 The methods of testing the hearing are simple. There are elaborate 
 devices and expert examiners, but no one need wait for either of these. In 
 a perfectly still room, ascertain if the watch tick can be heard at two feet, or 
 a whisper at eighteen feet. Try each ear with the other closed. Learn if a 
 tuning fork held an inch from the ear can be heard for eighty seconds. 
 
 133 
 
 Fig. 69. — Sketch Indicating Connections Between Exter- 
 nal and Middle Ear, Mastoid Cells and Throat and 
 Nose Cavity. 
 
134 THE EAES 
 
 These are simple tests and can be made without much apparatus. They 
 are not exact but they give one a fair idea as to whether his ears are losing 
 accuracy. If he remembers, or if he learns, that, as a child, he had many 
 earaches or many attacks of sore throat, or was a mouth breather, it is ad- 
 visable for him to take stock of his ears at his annual inventory. 
 
 If the man is of a deaf family, it is also well to take stock. Deafmutism 
 is hereditary. The laws of its inheritance are pretty well worked out. 
 
 Deafness developing in middle life also runs in families. The reason 
 for that has also been worked out. It is because certain families have more 
 earaches in childhood and certain of these families are disposed to neglect 
 the earaches of their children. 
 
 EARACHE 
 
 Deafness belongs in that group of conditions in which interest is so 
 rapidly awakening — the conditions which produce inefficiency. Dr. Alexander 
 Graham Bell is behind the Volta bureau for the increase and diffusion of 
 knowledge relating to the deaf and its monthly publication, the Volta Review. 
 
 In this bureau there is a card catalogue relating to 4,471 marriages of 
 deaf mutes. Analytical study of these shows that as to 2,Q42 sufficient data 
 are in hand to make the information on the card of value for study. Of these 
 2,342 marriages resulted in hearing offspring. In 300 some of the children 
 could hear and some were deaf mutes. 
 
 Studies of people who become hard of hearing in middle life show that 
 this condition has a little disposition to run in families. 
 
 We grow deaf because of infections of the middle ear. The infection 
 travels to the middle ear from the nose. When bacteria and the poisons of 
 bacteria are absorbed by the lining of the nose they are carried to the adenoid, 
 or pharyngeal tonsil, and to the eustachian tonsil. 
 
 The first of these is near the duct to the ear and the second is near it. 
 For this and other reasons many colds end in earache. 
 
 Certain families are more subject to colds than others. This is partly be- 
 cause of inherited susceptibility and partly because of the habits of the 
 family. Certain families are more subject to earaches as a result of colds 
 than others. 
 
 The customary way of treating an earache is to pour some oil into the 
 external canal. As this does no good we may say that the customary way 
 of treating earache is to do nothing for it but to wait for nature to cure it. 
 This nature does satisfactorily, so far as the immediate result is concerned. 
 But the ear is a delicate organ. It cannot be slammed around promiscuously 
 and repeatedly without being harmed. 
 
 These earaches leave a little thickening behind. When to this thickening 
 the changes of age are added the party grows deaf. Absolutely to lose the 
 hearing from this cause is unusual. We speak of it as "getting hard of hear- 
 ing." As was said a while ago, this condition runs in families. 
 
 Nobody can afford to neglect earaches. In spite of this people will con- 
 tinue to pour in some oil or laudanum, and let it go at that. 
 
 Some people can afford it better than others. If a man belongs to one 
 of those families wherein they get hard of hearing at about 50 years of age 
 
WHAT THE MOTHER OF A DEAF CHILD OUGHT TO KNOW 135 
 
 he can be certain that he cannot afford the earache, however safe it may be for 
 others. 
 
 REEDUCATION OF HEARING 
 
 A large number of people are partly incapacitated by poor hearing. "As 
 soon as one does not hear the human voice well, he does not hear any longer, 
 because it tires him to listen ; he isolates himself as far as his hearing is con- 
 cerned until he relapses into a deafness more and more complete." 
 
 This condition parallels that of the rheumatic cripple who quits trying. 
 
 Some day parents will watch their children's earaches so well that this 
 procession of people hard of hearing at 50 because of earache at 10 will stop. 
 But, for the present, we have to 
 deal with their forty-year-after deaf- 
 nesses. 
 
 When I go into the workroom 
 of Dr. McMillan of the Board of 
 Education I find instruments for 
 testing the acuteness of hearing, 
 just as I see other means of testing 
 the acuteness of vision. 
 
 Dr. Maurice of France has de- 
 vised an instrument for reeducating 
 the hearing. This he describes in 
 the Annals for Nose, Throat, and 
 Ear Diseases. He does not get much 
 help from massaging the drum of 
 the ear with a little air pump, be- 
 cause he says it vibrates the drum 
 at low speed, while in hearing the 
 sounds vibrate the drum at high 
 speed. 
 
 The instrument invented by Dr. 
 Maurice is called the kniesiphone. There are several other devices in use 
 for the same purpose. Instruments of this type are to be used under medical 
 direction. 
 
 The patient himself can do a good deal in the way of reeducating his 
 hearing. Listening to sounds is of service. Talking machines can be made 
 use of. 
 
 I think I can see where a thinking person could devise a method of 
 self-help making use of a dictaphone. The telephone can be made use of. 
 There is an advantage in using those instruments, such as a telephone ear 
 piece, dictaphone tips, or a stethoscope, instruments in which the impulse 
 is transmitted to the ear drum by a column of air. 
 
 Fig. 70. — Section of Left Ear and a Por- 
 tion of the Skull Showing External 
 Canal Ear Drum, Middle Canal Ear 
 Drum, Middle and Internal Ear and 
 Tube to Nose and Throat. 
 
 WHAT THE MOTHER OF A DEAF CHILD OUGHT TO KNOW 
 
 In the first place, she ought to know that to meet the situation honestly 
 is the only policy that means efficiency and happiness for her child. The 
 
136 THE EARS 
 
 ostrich head-in-the-sand policy is selfish. It is a manana policy, and, like all 
 manana policies, it costs more than it comes to. 
 
 In the next place, she should know that she should begin to teach her 
 child to read lip movements soon after it has passed its first birthday. 
 
 Some time ago a mother wrote me that she had been delaying the 
 instruction of her child because she had heard that speech deficiencies work 
 themselves out, that the power of speech came around in time. 
 
 Not only does delay make teaching more difficult, but there is the added 
 danger that the child may have acquired social habits that it will be difficult 
 to break. 
 
 In his book on the subject Wright advises, first, that a careful examina- 
 tion of the ears and speech organs, sight, and mental state be made by a 
 competent physician; then, that instruction be begun when the child is about 
 15 months of age. 
 
 The next step in instruction is to talk to the baby in clear, distinct tones, 
 without exaggeration of lip movement or facial expression. The mother 
 should watch the baby's eyes ; she should speak to him only when she has his 
 attention. The meaning of words, sentences, commands, and entreaties should 
 be taught by association, as in the case of children who hear. 
 
 Until the child is about three years old no effort should be made to teach 
 him to talk. I am writing now about wholly deaf children. Miss Torrey 
 says in the Volta Review that even the slightly deaf should be taught lip 
 reading. The education in speech of a slightly deaf child should begin at the 
 usual time for teaching babies to talk. 
 
 During the first three years of the life of a deaf child it is enough to teach 
 him to read the lips, to train his mind, to inculcate companionship and social 
 instincts, and to develop the body. 
 
 Speech should be taught even to the wholly deaf and the children of low 
 intelligence. The best authorities are agreed that these children should be 
 taught to talk with the vocal organs and not, even in part, with the fingers. 
 
 Wright holds that if the mother is intelligent and the home is good 
 the child should not go to school until he is at least 5 years old. After that 
 age the child will learn faster in school than at home. 
 
 Some don'ts given by Wright are: 
 
 Do not consider the deaf child as different from other children. 
 
 Do not cease talking to him. 
 
 Do not speak to him with exaggerated facial movements. 
 
 Do not exempt him from the duties, tasks, and obedience properly de- 
 manded of all children. 
 
 Do not let him grow selfish. 
 
 Do not let him grow indifferent. 
 
 Do not be in haste. 
 
 Do not show impatience. 
 
 LIP READING 
 
 A very large number of people have a tendency to become hard of hearing 
 as they pass middle life. A fair proportion of these a few years later are 
 more than hard of hearing; they are deaf. 
 
LIP BEADING 137 
 
 The largest element in causing this infirmity is infection of the nose, 
 throat, or ear in early life. Deafness developing in middle life runs in fam- 
 ilies, partly as a matter of inheritance and partly because it is the custom 
 in certain families to neglect earaches and colds. 
 
 Some of the hard of hearing settle down into a dull insularity — keeping 
 away from people, avoiding lectures, missing church, reading, sewing, or knit- 
 ting all day long — oversensitive. Some undertake to keep in the current by 
 using trumpets and hearing accessories of one sort or another. Some try to 
 get along by having those around them talk in a loud tone or with mouth 
 to ear. 
 
 Miss Torrey thinks that the way to avoid all this is to learn lip reading. 
 She says lip reading ought to be considered the first resort of even the slightly 
 deaf, if the case is beyond medical relief. A reputation for being deaf causes 
 people to avoid deaf people or to dread trying to talk with them, or to talk 
 to them in a loud voice, or in a manner otherwise unnatural. 
 
 To avoid this she advises that those in whom deafness is coming on learn 
 lip reading as soon as incurable deafness is diagnosed. A good method of 
 beginning is by the study of some book, such as Miss Yale's "Formation and 
 Development of English Elementary Sounds." 
 
 The Volta Review contains a wonderful story by Mrs. Jelks. Her little 
 girl at two years of age had an attack of scarlet fever which left her entirely 
 without hearing and with no capacity for spoken speech. 
 
 The mother has trained her to speak perfectly. She can interpret the 
 spoken words of children around her. In school, in play, in the walks of her 
 young life, she is a part of the life around her. She began lip reading and 
 speaking with a study of Miss Yale's book. 
 
 In beginning it is advisable to spend some time before a mirror studying 
 the position of the mouth when uttering different words. 
 
 There are two principal systems of lip reading, the Mullerwalle and the 
 Nitchie. As Mr. Xitchie says, these are teaching methods; the student must 
 pay special attention to the practical ; that is, actually to make the sound and 
 note the positions of the vocal organs. 
 
 "It is always difficult for a deaf man or woman to find a position. Why 
 not read the lips before deafness becomes so noticeable that the work is 
 affected? The results of the training, in alertness, absolute concentration, 
 and quickness of perception, become an asset which is valuable in any line 
 of work." 
 
 Perforated Ear Drum. — C. W. L. writes : "I am 21 years old and since 
 I can remember have been unable to hear with my right ear. When a 
 child I was troubled with earache. Upon consulting a physician I was 
 advised that there was a hole in the ear drum and that nothing could be 
 done for it. Would a patent ear drum restore my hearing in this earV 
 
 Keply. — Evidently when you were a child an infection spread from 
 your nose to your ear and pus discharged through the drum. The cause is 
 plain. The ear drum cannot be restored, but you will be able to find an 
 apparatus which will improve your hearing. Try those offered for sale 
 until you find the one which gives you the best results. Be careful not to 
 buy without a guarantee and do not buy one that does not give results 
 after several days' trial. 
 
138 THE EAES 
 
 Cotton in Ears Harmless. — J. K. writes: "Some time ago I ashed you 
 if cotton put in the ears at night to shut out the noise was injurious to 
 the ears if the habit was kept up continually, and you have not replied. 
 Will you please do so?" 
 
 Eeply. — It will not harm you to put cotton in your ears before retiring. 
 
 Your Physician Will Determine. — H. E. K. writes: "Our little girl of 
 seven years has been troubled with earache, and upon examination we find 
 that adenoids are just coming. Are they the cause of the earache, and 
 should they be removed at once? One ear has been lanced. Is it the 
 safest to operate on the ear?" 
 
 Reply. — Suppuration of the middle ear as shown by earache and sup- 
 puration means infection extending from the tonsils or adenoids. The 
 focus of infection must be cleaned up. Your physician will determine if 
 operation on the ear is also needed. 
 
 Remedy for Earache. — L. W. H. writes: "Kindly advise a remedy for 
 earache of a child five years old, who is bothered at times with tonsillitis." 
 
 Reply. — A hot salt bag to the ear is better than medicine dropped in the 
 ear. But why not go after the real trouble — the tonsillitis ? 
 
 Approach of Deafness. — M. W. writes: "What measures can be taken 
 at home to ward off the inroads of deafness in approaching age?" 
 
 Reply. — Something can be accomplished by removal of any contribut- 
 ing causes in the nose, throat, or ear. However, results are generally 
 unsatisfactory. The trouble is that deafness after middle age is usually 
 due to neglected throats in youth and that puts help out of reach. 
 
 See Ear Specialist. — Miss B. writes: "By what means can a girl of 
 26 be relieved of head noises? They have lasted for four years, and at 
 times become perfectly maddening. I had hardened ear wax and adenoids 
 removed three years ago, so there are no obstructions. Inflating the ears 
 gave no relief." 
 
 Reply. — There are many causes of head noises and the cure of a given 
 case depends on the cause. Although you have had more than one search 
 for the cause in your case, it has not been found, and you should continue 
 your search. See the best ear specialist available. 
 
 Partial Deafness Hereditary. — I. C. 0. writes: "Is partial deafness 
 ever hereditary? In a family of ten children three were slightly hard of 
 hearing from no apparent cause. The mother of this family was the same 
 way. One of the girls is about to be married. Do you think her children 
 will have the same trouble?" 
 
 Reply. — 1. Yes. 
 
 2. Some of them will. This subject is well covered in Bell's "Study of 
 the Inheritance of Deafness." 
 
 Running of the Ear. — D. E. A. writes: "Is there a cure for running 
 of the ear without an operation? Is there anything that could be done at 
 home to cure? Does it affect the eyes?" 
 
 Reply. — Running of the ears sometimes stops of itself. To keep the 
 ears clean will help. However, one is not justified in neglecting running 
 
LIP HEADING 139 
 
 ears, even when the running stops spontaneously. The condition is gen- 
 erally the result of infection which has spread from the throat to the ears. 
 It is the usual cause of deafness. The way to prevent deafness is properly 
 to cure these infections. When, ten years later, deafness is discovered 
 nothing can be done. 
 
 To Prevent Deafness. — Monmouth wants to know whether coffee causes 
 deafness. Does catarrh cause it? What will relieve severe headaches? 
 
 Eeply. — 1. No. 
 
 2. Infections which spread from the nose to the ear thicken the ear 
 drum and cause deafness. To prevent deafness one must take care of the 
 nose and throat. 
 
 3. There are many kinds of headaches. Follow your physician's in- 
 structions to get rid of them. 
 
 Meniere's Disease. — M. E. V. writes: "What is Meniere's disease? 
 Is it incurable? Is it dangerous to follow one's vocation if suffering from 
 this disease? Is it possible to help oneself by fasting, etc? Does this 
 disease cause throbbing in the ears?" 
 
 Reply. — 1. Meniere's disease is a disease of the semicircular canals — a 
 part of the internal ear. These canals have to do with maintaining the 
 body in a steady equilibrium. When the canals are diseased there is dizzi- 
 ness and a disposition to fall. 
 
 2. (a) Some cases are incurable, others are curable; others show a 
 tendency to remain at a standstill, (b) Depends on the person and his 
 work. 
 
 3. Yes. Even in those cases in which cure is not possible, one can gain 
 much by readjustment. Sometimes diet helps. A milk diet benefits some 
 cases. 
 
 4. There are different causes of throbbing. Meniere's disease is one 
 of them. 
 
 Lip Reading. — R. writes: "Please let the deaf know of the advantages 
 of lip reading. If persons who are losing their hearing would start to 
 learn lip reading promptly they would be gainers. I have been taking 
 lessons for about four months and am able to understand members of my 
 family and many outsiders without hearing their voices. I am gradually 
 learning to forget my defect, and human intercourse is becoming more a 
 pleasure than a torture. The Yolta Bureau, Washington, D. C, will furnish 
 names of teachers of lip reading. Some of the public schools have evening 
 classes in lip reading." 
 
 Ringing in the Ears. — P. E. G. writes: "What causes and what is the 
 best remedy for the singing, roaring sounds in the ears of so many Chicago 
 people? I am asked so often to talk a little louder. I know people who 
 have paid large sums of money to specialists, with no good results. Would 
 mullein oil, Haarlem oil, or any of the oils be of benefit, or warm water 
 forced in with a few drops of glycerin?" 
 
 Reply. — The ringing in the ears and the deafness which develop in 
 middle age are the results of the neglect of throats and noses in youth. 
 Generally nothing can be done and those inconvenienced go from specialist 
 to specialist, trying to get some help. Haarlem oil, mullein oil, and reme- 
 dies of that type will do no good at all. Occasionally a sufferer will find 
 
140 THE EAES 
 
 some relief from surgical or mechanical procedure, but the best the average 
 person can do is to content himself as best he can, resolving that he will 
 not allow his children to suffer from the same neglect. 
 
 The next generation will have much less deafness than ours, even 
 though the dinning of continued noises is making hearing generally less 
 acute. 
 
CHAPTEK XII 
 
 Rheumatism 
 
 Rheumatism is a term frequently used to cover almost every kind of 
 ache or pain. The disposition among medical men now is to limit its use 
 rather sharply to inflammatory rheumatism. 
 
 Inflammatory rheumatism is an inflammation of a joint accompanied by 
 fever and general aching. These inflammations are due to infection of the 
 joint by bacteria which have got into the body at some distant point, have 
 found their way into the blood, and have been thrown out of that fluid into a 
 joint. 
 
 Some of these rheumatisms, so-called, are due to venereal disease bacteria, 
 others to the germs of the pneumonia group. Most cases of acute inflamma- 
 tory rheumatism are due to germs — sometimes one kind, sometimes another — ■ 
 which get into the blood through the throat. 
 
 In its relation to old age the principal interest in rheumatism lies in its 
 effect upon the heart. When the germs are traveling from the throat to the 
 joint they pass through the heart. Some stop. Acute heart disease, in the 
 course of rheumatism, is always dreaded, but it is more important to know 
 that a heart can be crippled by rheumatism and not show it until months and 
 sometimes years have passed. 
 
 There is a group of joint affections akin to rheumatism, yet very different, 
 called rheumatoid arthritis, or arthritis deformans. To illustrate : A woman 
 about 50 years of age notices her fingers are becoming crooked and the bones 
 larger at the joints. Perhaps she notices that the skin over the joint is tense 
 and shiny. Without causing much pain, her disease progresses until her 
 hands are badly deformed. This is a type of rheumatoid arthritis which is 
 easily told from rheumatism. 
 
 From this type the disease merges into another — one which causes pain 
 and at times fever. Much oftener than the other type it begins in younger 
 people. Having begun, it progresses until the joints are twisted, gnarled, de- 
 formed, and locked. 
 
 Whether the sufferer be in tne one group or in the other, somewhere in the 
 body, and usually ic the nose or mouth, there will be found a focus of mild — 
 very mild — infection. Nearly always it is in or around the teeth. It may be 
 in decayed teeth, but more frequently it is in the gums — the usual cause is 
 pyorrhea. 
 
 Lambert states that in 172 cases where special search was made for an 
 infection focus 141 had badly decayed teeth or the teeth had dropped out. 
 
 The man with rheumatism, should have his mouth, throat, and nose ex- 
 amined to locate the focus of his trouble. 
 
 The man with beginning rheumatoid arthritis should seek the focus of 
 trouble in his teeth and gums. 
 
 141 
 
142 RHEUMATISM 
 
 Most of the people who have aches and pains are not rheumatic ; they are 
 gouty. Among the gouty aches Paget puts muscle pains, lumbago, sciatica, 
 neuritis, some headaches and neuralgia. 
 
 To these Dyce Duckworth adds such maladies as deep-seated pains in the 
 bones and spine, obstinate patches on the skin, and inability to digest richly 
 cooked foods. There is an inflammatory joint type of gout — rich man's gout, 
 if you please — but the cases are few. 
 
 Our especial interest is in the forms of atypical gout so much in evidence 
 in the spring, the gouty aches and pains which make people call for spring 
 medicines — blood purifiers. 
 
 Just as the true rheumatic is the field from which most of the heart dis- 
 ease is recruited, the gouty is that from which arteriosclerosis (hardening of 
 the arteries), high blood pressure, apoplexy and chronic Bright's disease draw 
 their subjects. 
 
 While we sympathize with the inconvenience of lumbago and other gouty 
 aches, gout as a cause of apoplexy, paralysis, and Bright's disease is of much 
 more importance. 
 
 Living to avoid gouty aches and pains is so simple! Its simplicity makes 
 it difficult, because the doing of simple things does not accomplish results un- 
 less there is persistence — and persistence is a rare virtue. 
 
 What is simpler than to eat no more than you can burn up by exercise 
 and work, and to exercise and work enough to burn up all that you eat ? 
 
 What is simpler than to follow the example of the fireman who puts on 
 more coal than the fire can burn? He knows that he will partially smother 
 the fire, get too much ashes, and make black smoke. What does he do about 
 it? He shakes down the fire, gets rid of the ashes, and opens the drafts so 
 as to feed more air. 
 
 The man who has a gouty headache takes a purgative and walks two 
 miles. Up to this point he follows the example of the fireman. But a good 
 fireman does not habitually overstoke or neglect the draft. And there is 
 where his example is not followed. The gouty subject, feeling better again, 
 eats out of balance, exercises but little, and breathes foul, warm, dry air. 
 
 FORMS OF RHEUMATISM 
 
 The acute inflammations of the joints with swelling and fever are called 
 acute rheumatism. These are due to infection of the joint or joints with any 
 one of several germs. Some of these germs are violent in their local effects, 
 some are violent in their general poisoning, but not destructive locally ; others 
 are mild both generally and locally. 
 
 Therefore, no two cases of rheumatism can be judged by the same stand- 
 ard. Those who suffer from this kind of so-called rheumatism should : 
 
 1. Secure proper treatment for the general and local symptoms. 
 
 2. Discover the type of infecting germ causing this particular attack. 
 
 3. Discover the point where the infection is getting into the tissues, 
 whence it is carried to the joints. 
 
 4. Remember that rheumatism of this type is largely responsible for the 
 heart disease of later years. 
 
"FULL OF RHEUMATISM" 143 
 
 5. Eat lightly during the attacks, eat well between them. Red meats are 
 of much service between attacks. 
 
 What is called chronic rheumatism is another group into which a dozen 
 different diseases are commonly thrown. Some of them are nerve diseases, 
 some are infections, some are the effects of senility. They are caused by a 
 dozen different causes, and what is good for one harms another. A good il- 
 lustration is that chronic deforming change in joints called deforming arthri- 
 tis, which leaves them twisted, gnarled, and stiff. 
 
 Some of these cases are due to infections through the tonsils or elsewhere ; 
 some are due to nerve disease. 
 
 To cut these people off from meat, to send them around to oaths and 
 cures, is just as foolish as anything can be. In this group called chronic 
 rheumatism there is need for analysis. Some are helped by baths, others not; 
 some need more food, some less. 
 
 In between these comes a great medley of pains in joints, muscles, and 
 nerves that people loosely call rheumatism. They are milder than the fever 
 kind of rheumatism. Some of these are mild infections. A good illustration 
 is the growing pains in children, usually due to mild infections. 
 
 The proper treatment of this group is to find and clean up the point 
 where the infection is getting in. 
 
 The largest part of the cases usually called rheumatism and belonging to 
 this class are really gout. These cases are suffering from bad habits. The 
 quantity of food which they eat is too large, or it contains too much proteid, 
 especially meat ; or they are constipated, or they are not good heat makers, or 
 some part of their body is susceptible to chilling, or several or all of these 
 combined. These are the people who are benefited by baths, by cures, by diets, 
 by massage, by flannel binders, and the like. 
 
 Such measures relieve symptoms in a satisfactory fashion. Sufferers do 
 not get permanent relief until they eat less food, eat less meat, exercise more, 
 retrain the susceptible parts of their bodies by local cold baths. The man who 
 does not go deeper into his condition than to call it rheumatism will waste a 
 lot of time and may do himself a good deal of harm. 
 
 No form of so-called "rheumatism" should be allowed to run. It may lead 
 to bad consequences. The bad habits of the gouty forms should be corrected 
 and kept corrected. There must be no "falling from grace." The infection 
 forms must have their causes removed. We are greatly at sea when it comes 
 to the nerve forms. 
 
 Why not quit talking about rheumatism as though it were one disease? 
 Why not speak of a case as an acute, subacute, or chronic infection of a joint, 
 or the joint change in a certain nerve disease, or a painful gout of a certain 
 muscle, nerve, or joint? 
 
 "FULL OF RHEUMATISM" 
 
 Old people are generally "full of rheumatism." What "full of rheuma- 
 tism" means, scientists are not agreed on. In fact, probably half a dozen 
 pathologic conditions are thrown together in the condition called "full of 
 rheumatism." There is acute inflammatory rheumatism, gout, rheumatoid 
 
144 RHEUMATISM 
 
 arthritis, Heberden's nodes, Dupuytren's contraction, Marie's ringers, senile 
 arthropathy, muscular rheumatism and neuritis. 
 
 The sufferer may have any one of several things in mind. He may refer 
 to the knobs around the joints and the crooks in his fingers. He may refer 
 to periodical attacks of inflammatory rheumatism. He may have in mind a 
 persisting soreness in his joints with creaking. He may refer to a general 
 muscular stiffness with a marked tendency to develop soreness and pain upon 
 slight exposure to changes of temperature or out of the ordinary exertion. 
 
 The acute inflammations need one treatment. The remainder of the group 
 needs another. Attacks of acute inflammatory rheumatism become less fre- 
 quent as men become old. 
 
 The reason is plain. Old men are less liable to infections than young 
 ones, and we now know that acute inflammatory rheumatisms are due to infec- 
 tion. The infection is usually through the throat or nose. 
 
 Old people who are "full of rheumatism" should throw away their pocket 
 pieces — their buckeyes and potatoes — and have their tonsils, gums and upper 
 breathing apparatus put in good order and thus maintained. Saundby says : 
 
 "If elderly patients follow the rules of hygiene, temperance in diet and 
 regular exercise, they will suffer little, if at all, from goutiness and its various 
 manifestations/' 
 
 If you were to ask a dozen doctors which of the symptoms that make 
 up a "full of rheumatism" group are due to gout and which to other causes, 
 you would get close to a dozen answers. Then let us broaden Saundby's state- 
 ment so as to make it: If elderly patients follow the rules of hygiene, tem- 
 perance in diet and regular exercise, they will suffer little. 
 
 As it is, elderly people suffer much. What are, then, some of the policies 
 to follow? 
 
 To go to the baths once or twice a year, when feasible. 
 
 To take massage, exercises and osteopathy from time to time. 
 
 To spend some time every day "suppling" the muscles and joints. 
 
 To wear plenty of warm clothes. 
 
 To get some fresh air every day. 
 
 To eat good plain food, but with discretion and moderation. 
 
 While some meat may be best for them, the quantity should be much less 
 than taken by younger people. Meats should not be highly tasty. Meat broths 
 and meat teas should be avoided. 
 
 Just that part of the meat which is cooked out of beef and into the broth 
 in boiling is harmful. 
 
 GROWING PAINS 
 
 Some time ago, while I was in a drug store in Eochelle, Illinois, "killing 
 time" between trains, a woman came in. She had two children tagging along. 
 She called for a fifty-cent bottle of rheumatism cure. She said she had found 
 it fine for growing pains. Her children were accustomed to much drugging 
 and looked the part. They were typical, spindling, pale medicine takers. It 
 was not necessary to listen to the woman or to see the purchase to know that. 
 
 The mother paid her half-dollar and went on her way with her bottle of 
 sure cure for growing pains. Had she gone into her yard and thrown a half- 
 
ARTHRITIS GERM INFECTION 145 
 
 dollar at a post she would have missed the post and lost her half-dollar. That 
 is just what she did in the drug store. IV hat she had got had not cost the pro^ 
 ducer a tenth of a dollar and it was worse than useless to the child who took 
 it — so she lost her half-dollar. She also missed the post, and that is what 
 counts most. 
 
 She had been relying upon medicine to cure rheumatism in her children. 
 They did not hare rheumatism. "Growing" pains are not growing pains. The 
 woman had learned that much. She had taken one step. Neither are growing 
 pains rheumatism. They are infections. The infection finds entrance through 
 the mouth. The mother had not taken that step. She had heard enough to 
 get by the growing-pain stage, but she had stopped there. 
 
 Nature had partly cured her children. The mother was satisfied with the 
 cure and told the druggist so. She did not tell the druggist that such curing 
 as was done had been accomplished by nature. She had not found that out. 
 She had not even learned that cure of rheumatic pains in children is a poor 
 makeshift; that children properly cared for would be prevented from having 
 pains. She had wasted her 50 cents, but, far worse than that, she had missed 
 the post. 
 
 Those children should have had their tonsils and adenoids put in order. 
 They should have been living the laws of hygiene. She was not thinking much 
 about right living for her youngsters, because her limited experience told her 
 that fifty cents' worth of medicine would ease the growing pains. Filling 
 their stomachs with medicine, she was bringing up a pair of pasty, flabby 
 youngsters trained to run to the medicine cabinet. 
 
 We have well developed, active, and efficient departments of public hy- 
 giene. Thinking people know these to be the best agencies used by government 
 for the promotion of social efficiency. There is no organized agency for the 
 promotion of personal hygiene. Such effort as there is is individual and 
 sporadic. In consequence, the yellow wrapper and the lurid picture still hold 
 the field. In consequence, mothers are still throwing half-dollars at posts and 
 children are growing up pasty, spindle-shanked, and perpetually dope-hungry. 
 
 ARTHRITIS GERM INFECTION 
 
 It is now generally agreed that many of the so-called "rheumatisms" are 
 caused by germs. The proof as to ordinary inflammatory rheumatism has been 
 accumulating for a long time. In the last few years the proof as to rheuma- 
 toid arthritis has been piling up. 
 
 In the Journal of the American Medical Association Dr. Billings says 
 that his opinion is that the deforming joint changes usually found in middle- 
 aged people and known as rheumatoid arthritis are due to infection with a 
 germ. The germ usually gets into the blood through the mouth or tonsils or 
 nose. It sometimes gets in through suppuration elsewhere in the body. 
 
 A chronic appendicitis, or an old pus tube, or an infected gall-bladder can 
 cause it, as well as can catarrh and pyorrhea, bad teeth, and foul tonsils. It 
 can be caused by an old gonococcal infection of the prostate gland and certain 
 tubes running through it. 
 
 This being true, the person developing rheumatoid arthritis, instead of 
 
146 
 
 KHEUMATISM 
 
 searching for some springs to go to, should search for the old spring within 
 him, the spring of pus hidden away in some pocket in his insides and pouring 
 germs into his blood. 
 
 This spring, being found, should be cleaned up whenever possible. Most 
 of the cleaning up will have to be surgical. The teeth, tonsils, nose pus sac, 
 or offending tissue, wherever it is, should be made clean or else removed. 
 
 Using vaccines made from the germs found present, Dr. Billings has dis- 
 covered, helps some. Then follows an important point. Good food, sunshine, 
 fresh air, massage, and rest can do a great deal to increase the capacity and to 
 decrease the suffering of the person with deformed joints. 
 
 The custom has been for the person with a developing arthritis to ruin 
 
 Chicago Health Department. 
 Fig. 71. — Cross Section (A) of The Head of a Normal Child and (B) of One Whose 
 Tonsils and Adenoids have Enlarged so as to Block the Nasal Air Passage, 
 Thereby Making a Mouth Breather of Him (B). 
 
 his digestion with salicylates and iodicls; to ruin his vitality by strict dieting, 
 abstaining from meat and other nutritious food; to ruin his pocketbook run- 
 ning around to springs, and finally to lose confidence in everybody and every- 
 thing, to come to the conclusion that he has an incurable disease, and then 
 to lapse into helpless, hopeless invalidism. 
 
 To drain the pus sacs and to clean up the dirty areas is the proper treat- 
 ment for those who are in the earlier stages. It is well for the other group to 
 know that it does not follow that its members should become helpless merely 
 because they cannot be cured. 
 
 It is well for the doctor to get the idea in his head that people with in- 
 curable diseases are doubly in need of help; and arthritis patients, living hy- 
 gienic lives and properly directed, will gain greatly in efficiency, as well as in 
 comfort. 
 
 PEOPLE WITH STIFF LEGS 
 
 Any injury to, or infection of, a joint is liable to leave the joint stiff. 
 The everyday man is still wrestling with the question : Which came first, the 
 
PEOPLE WITH STIFF LEGS 147 
 
 hen or the egg. When the cynic would floor the bacteriologist for the count 
 he asks : "Whence came the first bacillus ?" 
 
 These busy little debaters have nothing on the anatomists who try to an- 
 swer the question: Which came first, the muscles to move the joints or the 
 joints to be moved by the muscles ? 
 
 On this question, among anatomists, there are two hostile camps. But 
 whichever came first, they both agree that, with all the ordinary joints, unless 
 movement is kept up the joints will grow stiff. The ends of the adjacent 
 bones will be bound immovably together. 
 
 The tissues that make up the joints are low grade tissues. They have 
 little power to resist germs. When germs are floating around in the blood 
 the liver will pick up its share and more, and so will the kidneys. But these 
 organs pitch them out instantly. 
 
 However, when germs come the way of the joints the poor tissues there 
 have no power to resist. Some form of infection results. Among these infec- 
 tions are some that are commonly termed rheumatism. 
 
 The low grade tissue of a joint, when inflamed, can do but one thing, and 
 that is to pour out a sticky fluid. This fluid is about the same as the fluid 
 which binds together the two sides of a cut. 
 
 If the inflamed joint is neglected, this fluid glues the ends of the bones 
 together. As time goes on, the union becomes stronger. 
 
 At first, to limber up the joint causes some pain, but it can be accom- 
 plished. After a while the adhesions are so strong that operation is required 
 to break them up. 
 
 Even if movement in a joint is not entirely lost from an attack, it will 
 be noticed that after each attack the range of movement is more limited than 
 before. All of which results from improper personal hygiene. 
 
 It is proposed that when the joints are acutely inflamed the ends of the 
 bones shall be kept apart by weights, as in fractures ; that, after an attack of 
 rheumatism or other infection of the joints, massage, baths, and exercises be 
 continued until full movement is established — to employ a term used by the 
 Germans, that the cure be completed. 
 
 Surgical procedures, though, are always halfway houses. In time, men 
 will know enough to cure cancers without cutting them out and to do things 
 in better ways than by surgical procedures. 
 
 The direction of the present-day effort is toward the germs. Some are 
 injecting antiseptic solutions into the joint, some are using vaccines ; some are 
 working on antitoxins. 
 
 Now that people are losing faith in charms such as buckeyes, are no longer 
 depending on red flannel underwear, are no longer afraid of red meat, are no 
 longer chasing a climate cure, things will look up. 
 
 Effort expended on the hygiene of the gates through which rheumatism 
 gets in, while the doctors perfect the method of curing that which has got in, 
 will banish rheumatism. 
 
 Another of the rheumatism fetiches that we have chased when we should 
 have known better was the climate cure. Eheumatics are walking interrogation 
 points in their search for a climate that cures rheumatism. 
 
 There is none such. The English army is stationed in every portion of 
 the world. Troops drawn from the same stratum of society are scattered from 
 
148 EHEUMATISM 
 
 the tropics to the arctic. Some are at sea level and some at high altitudes. 
 Some are in humid countries and others in the desert. 
 
 The daily routine of these groups is pretty much the same, at least, it is 
 much more uniform than is that of the different peoples of the different lands. 
 The rheumatism rate is about the same. 
 
 Hirsch, in his geographical pathology, tells us that rheumatism is every- 
 where that man is. Perhaps there is a little less liability in hot climates ; per- 
 haps there is a little less liability in the warm months, but the difference is 
 slight. 
 
 There are hot countries where the records show a great deal of rheuma- 
 tism, and in India and Algeria there is more rheumatism in warm weather 
 than in cold. 
 
 The rheumatism rate given by Hirsch among British troops in Canada is 
 35.9 and in the West Indies, 38.4. 
 
 These facts have been known since the Civil War, and yet, because the 
 people generally have not known them, a lot of people have wasted a lot of 
 energy chasing a good rheumatism climate. 
 
 However, it seems to me that in what are known as chronic rheumatic 
 conditions, there has been most of loose firing and general waste of gunpowder. 
 The custom is to call almost every persisting pain rheumatism, particularly if 
 it be a leg or arm or a back pain. Likewise almost every ailment of a joint has 
 been and still is called rheumatism. 
 
 Hippocrates and the Arabian physicians thought all rheumatisms, aches, 
 pains, joint affections, and catarrhs were the same thing. About 1600 the 
 physicians separated these affections into two groups — rheumatism and ca- 
 tarrhs. About 1800 they divided rheumatism into two groups — one, the acute 
 rheumatic fever; the other, the disorder which twists and gnarls the joint — • 
 rheumatoid arthritis. 
 
 It was more than one hundred years ago that rheumatoid arthritis was 
 found to be in nowise related to rheumatism. Yet nine people out of ten who 
 have twisting fingers and locking joints think they are rheumatics. 
 
 They have been the round of the springs and baths ; they have gone with- 
 out red meat for months ; they have tried all the medicines and methods rec- 
 ommended for rheumatism, and it has all been wasted. 
 
 A hundred years ago there were those who had found out that rheumatic 
 measures did not help these people. But there have been no popularizers to 
 tell the people about these things and so they have not learned them. 
 
 Rheumatoid arthritis probably in time will be divided into two or more 
 diseases. The proper way to handle the rapidly crippling disorder that de- 
 velops in people usually before middle life will be found quite different from 
 the proper way to handle the slowly progressive disease that starts in old men 
 and women and that enlarges and twists their fingers and toes throughout the 
 remainder of their lives. 
 
 The first variety is probably an infection taking place through the gums 
 in many instances, and through some part of the mouth or nose in most in- 
 stances. The infecting gum is not one of those causing rheumatism. The in- 
 fection is not even in the joint. 
 
 In rheumatoid arthritis the trouble is in the bone. The heads of the bones 
 enlarge, and secondary changes occur in the joints. 
 
HYGIENE VERSUS RHEUMATISM 149 
 
 In a normal joint everything is arranged in an extremely orderly fashion. 
 Everything has a place and keeps to that place exactly. There is no surplus 
 tissue. Every part is cut to fit. 
 
 If there is an excess of fat elsewhere over the joint it dimples down to 
 bone and sinew. The tendons run in nicely adjusted sheaths. - 
 
 The joints are lined with a smooth membrane. The membrane is arranged 
 as a closed, self-oiling sac. 
 
 The ends of the bones grow larger than their shafts and they take just the 
 shapes that best fit them for their functions. 
 
 In rheumatoid arthritis there is an exceedingly mild, long continued in- 
 flammation in these bone ends. For months nothing is noticed except a little 
 tenderness. Then it is noticed that the joints are getting larger, which means 
 that the bone ends are getting larger. 
 
 HYGIENE VERSUS RHEUMATISM 
 
 There are many generally held opinions about rheumatism and allied dis- 
 orders of the joints that do not jibe with the known facts. Some of these 
 popular ideas are not in accord with the facts that have been known for a long 
 time but that the people have not heard about, probably because the doctors 
 would not talk to the people about them and nobody else thought they had 
 any right to do so. 
 
 For instance, there is acute inflammatory rheumatism — the kind that 
 makes the joints swell and throws the patient into a fever. Before the present 
 rheumatics were born as good an authority as Hirsch, an author whose books 
 are still standard, wrote : 
 
 "Then, years ago, I conjectured that rheumatic fever is a specific, in- 
 fective disease. . . . Today rheumatic fever has an assured place among the 
 acute infective fevers." 
 
 This was written somewhere about 1870. Yet there are rheumatics who 
 have been shunning red meat for these forty years. 
 
 Acute rheumatism is an infection. The bacteria causing it may get into 
 the blood stream through almost any part of the body. Some of the organisms 
 that cause it are extremely prone to get in through the tonsils. 
 
 However, acute inflammation of the joints may result from different bac- 
 teria, just as the lungs may be inflamed from tubercle bacilli or from pneu- 
 monia cocci. Some of these are never known to get into the tonsils. For in- 
 stance, the germs of venereal disease are especially liable to cause rheumatism. 
 
 When one is subject to rheumatism, it is advisable to have the tonsils put 
 in order and kept in order, but, with some people, that is not enough. The 
 overhauling must not stop until every gateway for infection has been put in 
 order. 
 
 The proper treatment of acute inflammatory rheumatism is on the basis 
 of infection. Salicylates to relieve the pain are all right. They make life 
 more endurable ; possibly also they limit the injury done by the infection, but 
 they do not run to the root of the trouble. 
 
 Plenty of water to drink and the use of cathartics also serve their pur- 
 pose. They rid the body of poison and increase resistance. 
 
150 BHEUMATISM 
 
 Some of the best physicians now advocate treating rheumatism surgically. 
 They say that the joint is infected; that the bones of an infected joint will 
 grow together and stiffen the joint unless precautions are taken. Therefore, 
 they put the limb up in a splint. The splint they prefer is one that pulls the 
 ends of the bones apart. 
 
 This method not only separates the bones, but it also overcomes the spas- 
 modic pulling of the muscles — the source of much of the pain. After the 
 trouble begins to subside they massage and exercise the joint. 
 
 Then it will be noted that the ends of the bone, instead of meeting 
 squarely end to end, come together at an angle. The joint can no longer be 
 made perfectly straight. If it be the index finger, it will be noticed to be 
 crooked at its last joint. 
 
 The seat of the trouble lies not in the joint; it is in the end of the bone. 
 As that enlarged, the joint had to shift itself somewhat; the ligaments and 
 tendons were gradually pushed around into new places. 
 
 Perhaps after a while the joint became completely locked, but this process 
 was different from the rheumatism process which affects the joint but leaves 
 the bone alone. 
 
 So rheumatism has nothing to do with these gnarling chronic processes 
 and when we go after these on a rheumatism basis we gain nothing. On 
 the other hand, we have started on the right track when we quit the wrong 
 track. At last we have made a beginning, and that is something. 
 
 Is there anything that can be done for rheumatism ? Yes ; much can be 
 done in the way of both prevention and cure. Skilled care will bring most 
 men through an attack without any damage to his heart, kidneys or joints, 
 even employing remedies for the relief of symptoms and allowing nature to 
 cure the infection. 
 
 In addition, the vaccines for rheumatism have approached perfection 
 closely enough to have found their way into quite general use. 
 
 There are many who think the surgical treatment already referred to 
 gives results that are all that can be desired. 
 
 Much the more important side of the matter, though, since it concerns 
 more people, is the answer to the question: Can rheumatism be prevented? 
 Again the answer is yes. The person who has proper regard for personal 
 hygiene will lessen the number of attacks of rheumatism and may wholly 
 escape. 
 
 The first effort at personal hygiene should be to locate and clean up his 
 focus of infection. It may be his tonsils or his gums. It may be a sinus, 
 opening from his nose. 
 
 Hippocrates thought rheumatism and catarrh were identical. In some 
 cases of catarrh there is infection of one or more cavities. The pus drips into 
 the nose and comes to be known as a catarrhal secretion. 
 
 The so-called "catarrh" is a chronic infection of this cavity. At times bac- 
 teria will absorb from this cavity, circulate for a brief period in the blood, and 
 then locate in some joint and set up a case of rheumatism. 
 
 Using the terms rheumatism and catarrh loosely, there was reason for be- 
 lieving the two diseases to be closely akin. The more accurate information of 
 our day brings some conditions called catarrh and some conditions called rheu- 
 matism back again to kinship. 
 
HYGIENE VERSUS RHEUMATISM 151 
 
 In those cases where the gateway of infection cannot be located or, "hav- 
 ing been located/' cannot be cleaned up, personal hygiene can still help out. 
 If chilling is prevented the organisms may not absorb or, having absorbed, 
 they may not locate in a joint. 
 
 The wearing of woolen underwear, of warm footwear, the use of rainproof 
 clothes and shoes — such procedures cause the proper organs to eliminate the 
 bacteria from the blood and prevent them from locating in the joints. 
 
 Personal hygiene finds no more 'promising field than among the rheu- 
 matic families. Such need not be perpetually up against it. They can throw 
 away their buckeyes. 
 
 Causes of Rheumatism. — J. J. C. asks what causes rheumatism. 
 
 Reply. — Acute inflammatory rheumatism, which is, I judge, what you 
 have in mind, is due to an infection. The infection travels to the joint 
 through the blood. It may enter through one of several places, but the 
 usual place where it gets in is the tonsils. A man having acute inflam- 
 matory rheumatism should have his throat examined, and then have what- 
 ever treatment may be found necessary directed to his throat. Nothing 
 is gained by dieting in this form of rheumatism. Red meats are not harm- 
 ful. What is called chronic rheumatism is a group of joint diseases. 
 Sometimes what is called chronic rheumatism will be one of these. Some- 
 times it will be another. Some of these are benefited by change in diet. 
 Some are not. 
 
 Rheumatoid Arthritis. — M. E. W. writes: "What is rheumatoid ar- 
 thritis? If the blood in the small veins settles in little circles and spots 
 on the legs, between the hips and knees, and back of both knees in spots 
 larger than a silver dollar, causing a stiffness in the legs, what is the 
 probable cause?" 
 
 Reply. — 1. Rheumatoid arthritis is a chronic inflammation of the joints 
 and the tissues around them, resulting from a mild, long continued infec- 
 tion. In its most frequent form it is the condition seen in middle-aged 
 people, especially women, causing the fingers slowly to stiffen and crook. 
 A much more severe form is that which twists the joints and locks them. 
 The infection gets in through the gums and tonsils. 
 
 2. The dilation of the small veins under the skin, especially of the legs, 
 is frequently found in women. It is of no consequence; does no harm; 
 does not stiffen the legs, and does not lead to ordinary varicose veins. 
 
 Rheumatism and Climate. — P. P. writes: "Will you kindly answer 
 the following questions: 1. What climate in the United States is best for 
 one afflicted with rheumatism? What climate is worst? Is the rate of 
 rheumatic cases high at and near Chicago? 2. If a person had inflamma- 
 tory rheumatism during the winter of 1910-11 and had now about recov- 
 ered from the effects, would he be apt to have another attack this winter? 
 3. What is the value of 'medicated' woolen underclothing which is recom- 
 mended by some doctors for rheumatism? What is the best underwear for 
 a person subject to rheumatism to wear? l+. Should a person bothered with 
 rheumatism wear rubbers during the winter months? 5. Should a person 
 who has had two bad attacks of inflammatory rheumatism during the last 
 five years have his tonsils removed? Both cases of inflammatory rheu- 
 
152 RHEUMATISM 
 
 matism were preceded by tonsillitis. 6. Is not the percentage of the cases 
 of rheumatism in this section of the country on the increase? 7. Is rheu- 
 matism hereditary? 8. What is the benefit of mineral baths for rheuma- 
 tism? 9. What is the best diet for a person troubled with rheumatism?" 
 
 Reply. — 1. There is but little rheumatism in the tropics. A warm, 
 moist climate such as that of Georgia, Alabama, and Mississippi has some 
 advantages, particularly during the late winter and for northern people. 
 But climate is of secondary importance. As rheumatism is not a report- 
 able disease it is impossible to do more than guess whether Chicago's rate 
 is high or not. 
 
 2. Yes. 
 
 3. The "medicated" part is rank foolishness. Woolen underwear is 
 proper. 
 
 4. Yes. 
 
 5. Yes. 
 
 6. There is no way to tell. The statistics from army posts give infor- 
 mation as to the amount of rheumatism amongst soldiers in different parts 
 of the country and in different years. Conclusions from this as to con- 
 ditions among the general population would be valuable. 
 
 7. No. 
 
 8. Mineral baths such as Benton Harbor, Mount Clemens, and Martins- 
 ville will benefit certain kinds of so-called "rheumatism" and be of no serv- 
 ice in others. I should say that what you call rheumatism is an infection of 
 your joints by a germ which gets in through your tonsils. Baths will not 
 help you any during an attack. They will help the soreness that stays 
 after. 
 
 9. A good nutritious diet containing meat is proper between attacks 
 in the kind of trouble indicated by your letter. Muscular rheumatism, 
 non-inflammatory rheumatism, rheumatic pains — the gouty type — do better 
 on a low protein diet. 
 
 Troubled with Rheumatism. — E. M. writes: "Will you please inform 
 me whether raw fruit is beneficial in case of rheumatic trouble, and how 
 about beer, whisky, or wines?" 
 
 Reply. — 1. Strongly acid fruits should be avoided in the first stages. 
 2. Alcoholic beverages of any kind should be avoided. 
 
 Rheumatoid Arthritis Treatment. — R. writes: "What is arthritis? Is 
 it curable? What are its symptoms? Does a person afflicted with it have 
 to abstain from drink (alcohol)? What is the best remedy?" 
 
 Reply. — 1. Arthritis means inflammation of a joint. Rheumatism is 
 one form of arthritis, gout another. No doubt what you have in mind is 
 rheumatoid arthritis. 
 
 2. If this is what you have in mind, some cases can be cured; some 
 cannot. The efficiency of the incurable cases can be lowered by neglect. 
 
 3. Pain in the joints, slow enlargement, gradual locking. 
 
 4. A little more need of abstaining than a well man has. 
 
 5. Have tonsils, teeth, and nose put in good order, and kept so. Exer- 
 cise, massage, nutritious food, vaccines. 
 
 Meat and Rheumatism. — 8. J. writes: "I am a woman of 61 years. 
 I have had rheumatism for several years, especially in my knee, and have 
 gouty fingers. I have always been inclined to be anemic. Will beef in 
 
HYGIENE VERSUS RHEUMATISM 153 
 
 moderate quantities cause rheumatism? Will meat cause either rheuma- 
 tism or cancer f" 
 
 Reply. — 1. No. 
 
 2. It will not cause cancer. A high meat ration is not good for people 
 with certain types of rheumatism. A small meat ration will not harm 
 anybody. A diet made up largely of sour milk in its different forms, 
 cheese, vegetables, and fruits is of some service in some cases of thickening 
 joints in elderly people. 
 
 Flannel No Rheumatism Cure. — Subscriber writes that medicated red 
 flannel underwear is a cure for rheumatism. 
 
 Reply. — In the good old days our fathers wore red flannel underwear 
 and pretty nearly all had rheumatism. The red flannel cure for rheuma- 
 tism has had its tryout and has gone the way of the buckeye. Of course, 
 the medicated feature is a straight fraud. Old rheumatics are better off 
 when warmly clad. Flannel underwear is warm. That is the only virtue. 
 
CHAPTER XIII 
 
 Gout 
 
 THE GOUTY DIATHESIS 
 
 Men earn their diseases. 
 
 This, however, does not mean that nothing contributes to a man's diseases 
 but his own acts. A sick man may try to make his sickness individual, to pul 1 
 away from his fellows like a sick dog that crawls under the house, but he can- 
 not escape this fact — that disease is social, and, whether contagious or not, its 
 effects can never be closely limited to the man who is sick. Nor is it a con- 
 tradiction of the opening statement to say that one generation can no more 
 escape the imprint of its predecessors than one individual can stand alone. 
 
 Just as no sick man can stand apart, no generation, from the sickness 
 standpoint, can fail to influence its successors. Dispositions toward obesity, 
 cancer, apoplexy, feeble-mindedness, deafness, heart disease, consumption — 
 called diatheses — are passed on in family strains. They are inherited. One of 
 these, called by Duckworth the arthritic diathesis — the disposition to have 
 rheumatism and gout — is an inherited tendency. 
 
 A man with a gouty diathesis is subject to sore throat, rheumatism, and 
 a variety of gouty pains. Such are families where there is a disposition toward 
 apoplexy, heart disease, high blood pressure, arteriosclerosis and chronic 
 Brighfs. 
 
 But no man has the right to "lie down" because of his individual or fam- 
 ily disposition. Such information should guide him in his method of living. 
 
 A man whose family "runs to consumption" can eat as much as he wants, 
 and frequently should eat more than he does. Life insurance figures show 
 that fat men are not very liable to consumption. 
 
 It is known that a man of the gouty type who has contracted consumption 
 stands a fair show of curing it. Certainly there seems to be an antagonism 
 between the gouty habit and consumption. 
 
 Knowledge of these things increases rather than decreases personal re- 
 sponsibility. If a man, knowing that consumption is in his family strain, 
 neglects colds or ventilation, he earns that disease. If a man, knowing that 
 apoplexy, heart disease, or rheumatism is in his family strain, does not regu- 
 late his life accordingly, he earns the attacks which come. 
 
 Being of a gouty type, there is the greater reason why he should have 
 clean tonsils and teeth, why he should eat and drink temperately and keep 
 himself fit. 
 
 As spring comes tradition, to which we are all slaves in some measure, 
 says that we should take spring medicine and blood purifiers. In olden times 
 we went to the woods and dug up sassafras root or gathered some other kind of 
 aromatic herb from which we brewed teas tasty and strong, therefore good. 
 
 154 
 
THE GOUTY DIATHESIS 155 
 
 It was noticed that the members of the family who got most out of the 
 blood purifier were those who went into the woods to dig for the herbs. When 
 herb doctors brought their goods to our doors both herb doctors and herbs fell 
 into disrepute. 
 
 Now herb sellers never prosper, druggists begrudge shelf room to spring 
 medicines, and blood purifiers never go except where fortunes are spent in ad- 
 vertising them. 
 
 There were reasons for the rise and fall of spring medicines. The rise 
 was because there is and always has been a need that the human animal, 
 housed all winter, should be unhoused in the spring; the fall, because their 
 advocates got their wires crossed. They held on to the herbs and abandoned 
 the exercise and outing of a day in the woods. 
 
 In the early spring people have a lot of skin eruptions which may be 
 loosely termed as "gouty/' Usually these do not show until the "shank" of the 
 winter, and they get better as the weather opens up in the spring. 
 
 A few hours or, at most, a few days in the moist, outside air, a few rounds 
 of good muscle exercise, a few "lathering sweats" and the bad effects of im- 
 proper living during the winter are washed out, not of the blood but of the 
 tissues. To drink plenty of water along with the exercise is a proper pro- 
 cedure, and it does neither good nor harm to flavor the draught with sassafras 
 and call it sassafras tea. 
 
 While a few days of right living in the spring cures the eruptions, heals 
 the skin and makes it soft, takes out some of the joint creaks and pains, and 
 is generally to be recommended as a better procedure than drinking herb teas, 
 blood purifiers, and spring tonics, it should not be forgotten that it is, after 
 all, only a cure and, therefore, does not go to the heart of things. 
 
 A better way to prevent gouty aches and pains and shin eruptions in the 
 spring is to live lightly through the winter. 
 
 Even though spring penance remove the visible expression of winter sin 
 Old Man Gout sets the senility peg forward a hole. 
 
 Lessened contagion and improved environment are moving the life period 
 called old age to the farther side of 70; are setting the old age death mark 
 beyond 90. On the other hand, venereal diseases, lead poisoning, gout, and 
 rheumatism are doing their best to move them toward the period of middle life. 
 
 The fight to postpone senility will make great headway as rheumatism is 
 prevented through shielding against infection and gout through simpler, more 
 wholesome living. 
 
 In 1911 Mr. Eittenhouse of the Equitable Life Insurance Company pub- 
 lished an interesting statistical study showing the growing importance of gout, 
 Bright' s disease, and heart disease from the life insurance standpoint. 
 
 He estimated the number dying in the United States in 1909 from these 
 diseases as 235,660, as against 126,744 from consumption. He says: 
 
 "It seems to me that the life threatened by apoplexy is just as much worth 
 saving as the life threatened by tuberculosis. The loss of adult American life 
 through the more important noncommunicable diseases has increased with 
 extraordinary rapidity. Allowing for the increase in population, about two 
 persons die now where one died thirty years ago from preventable or post- 
 ponable diseases of the heart, arteries, kidneys, and brain, which usually affect 
 a person in the most valuable and effective years in life." 
 
156 GOUT 
 
 The principal reason for this increase is that so many of the population 
 who formerly died in infancy, yonth, and early maturity are now living to the 
 age of risk from heart and kidney disease. 
 
 Let us imagine the citadel of long life surrounded by a series of hedges. 
 As some of the outside of these — infant mortality, typhoid, contagion, con- 
 sumption — have been cut away, the thorn trees called rheumatism and gout 
 loom constantly larger. 
 
 Gout. — M. M. C. writes: "What is the hest kind of diet for one who 
 suffers with gout, and what should be avoided? Is it incurable in a man 
 past middle age? What diet is best for a woman who has enlargement of 
 the liver and weak stomach?" 
 
 Reply. You should decrease the amount of food you eat by, say, 10 
 to 20 per cent. Quit eating big, heavy dinners. Swear off. Make up the 
 deficiency in ordinary food taken by eating fruit freely. I should advise 
 the same course for the woman with an enlargement of the liver and a 
 weak stomach, though much more important than the above is my advice 
 to both of you to go to your physician and find out what is the matter 
 with you. Gout, enlargement of the liver, weak stomach are all loosely 
 used terms and cover a good many different conditions, some important, 
 some not. 
 
 Lumpy Fingers Show Gout. — H. E. R. writes: "Will you tell me what 
 causes small lumps, which become sore, to form on the joints of the fingers, 
 and if there is a simple remedy for them?" 
 
 Reply. — My guess is that these are manifestations of gout. If so, so far 
 as the present lumps are concerned, nothing will cause them to disappear. 
 By changing your diet and your general method of living you will be able 
 to stave off the development of additional lumps. 
 
 Diet in Gout. — C. P. L. writes: "I am a sufferer from gouty fingers. 
 Kindly indicate a diet that might prevent an increase of the trouble. If 
 sweets are forbidden, is honey included?" 
 
 Reply. — Decrease the quantity of food eaten. Double the quantity of 
 water consumed. Reduce the quantity of meat to one-third your present 
 ration. Increase the quantity of fruit and vegetables. Eat sweets and 
 honey, but with the same temperance that applies to other foods. Do not 
 tolerate constipation. Exercise in the open air. 
 
 Rheumatism and Gout. — D. V. writes: "What is the difference between 
 inflammatory rheumatism and gout? Does diet affect one who is subject to 
 either of these complaints? Is the climate of Chicago much worse than a 
 warmer and drier one for people who are inclined towards rheumatism?" 
 
 Reply. — 1. Inflammatory rheumatism is probably a bacterial disease. 
 The waste products found in the tissues during the disease are secondary 
 in character. It usually occurs in those between 15 ,and 30. Heredity is 
 not a factor in its causation. Several joints are involved. Gout is dis- 
 tinctly a perversion of nutrition. Heredity is a strong factor. It is a 
 disease of advanced age. The pain is usually localized in the big toes. 
 
 2. Diet does not play much of a part in the production of rheumatism. 
 Gout is caused by dietetic disturbances, chiefly the defective oxidation of 
 proteids. Alcohol and rich and highly seasoned foods are important causes. 
 
THE GOUTY DIATHESIS 157 
 
 Malnutrition and bad hygienic surroundings cause what is classed as "poor 
 man's gout." 
 
 3. A climate warmer and drier than that of Chicago would be beneficial 
 to those who are strongly rheumatic. 
 
CHAPTEK XIV 
 
 Diabetes 
 
 It will come as a surprise to some who read this article that diabetes is 
 not a kidney disease. In diabetes, sugar produced elsewhere in the body is 
 excreted by the kidneys. It greatly irritates them, and, through this irrita- 
 tion, it causes the secretion of large quantities of urine — quarts or gallons 
 instead of pints. This, of course, means an enormous increase in the work 
 of the kidneys, and, under this strain, kept up for years, the kidneys may 
 give way and Bright's disease result. 
 
 But diabetes, while it may eventually cause kidney disease, is not a kidney 
 disease — diabetes means sugar in the urine, a symptom of a disease elsewhere 
 in the tody. 
 
 It may be caused by gluttonizing, gourmandizing, eating more food than 
 the liver can handle. It may be caused by brain tumor. It may be caused 
 by disease of the pancreas. Here are three abnormalities, each characterized 
 by diabetes. 
 
 The pancreas, called the sweetbread, is a gland which secretes a part of 
 the digestive juices. In addition to the duct portion, it contains small islands 
 of ductless glands that secrete a substance poured directly into the blood. 
 This secretion turns sugars into harmless substances. When there is not 
 enough of this secretion, the sugar is not changed, but stays in the blood as 
 sugar, and, so long as they have the vitality to do the extra work, the kidneys 
 separate it out. 
 
 If a man's diabetes is of the first kind, say the liver kind, all that he 
 has to do is to eat and live sensibly. In fact, the liver kind of diabetes, par- 
 ticularly in a sensible person past middle life, is of no particular consequence. 
 All that he need do is recognize that thereafter he must "sing a slender song," 
 and, doing so, he may live to a round old age — say eighty or a hundred years. 
 
 But the last type — those due to deficient secretion of the pancreas — are 
 much more serious. They require the most skillful medical control — and 
 control is a fine word to use in speaking of diabetes. 
 
 Diabetics are subject to infections. A boil becomes a carbuncle — one boil 
 develops a crop. A cold develops into pneumonia; consumption follows an 
 exposure which an ordinary man would have no trouble with. 
 
 This serves to introduce a phase of another most interesting question — 
 what causes infection ? Of course, the infecting germ is necessary — that needs 
 no emphasis — but that is not all. Why is it that germs in the skin of a healthy 
 man do not infect at all or cause a boil at most, while in a diabetic they cause 
 carbuncles, gangrene, and blood poisoning? Diabetes heightens susceptibility 
 to blood poisoning, to pus cocci, and to consumption germs. An ordinary 
 infection in a diabetic will cause the production of highly poisonous acetone 
 bodies. This hypersusceptibility is not peculiar to those having islands of 
 disease in their pancreas, 
 
 158 
 
DIABETES 
 
 159 
 
 Acromegalics, cretins, those having Addison's disease and, in small meas- 
 ure, those having- goiters, are more subject to infections and infections are 
 more frequently fatal than in those with normal secretions. 
 
 The sign by which the diagnosis is generally made is the presence of sugar 
 in the urine. The test for sugar is so easily applied that the diabetic com- 
 monly judges of his condition by the amount of sugar in his urine. 
 
 WHOLE M/LK S/f/M M/LK 
 
 FUEL VALUE- 
 
 E 
 
 PPOTE/n: 3.3 
 
 'ARBOPY£>PATES:5. 
 
 UNSWEETENED 
 CONDENSED M/LK 
 
 TE/At:3.A 
 
 *AP0o#y/>PAr£s:5.t 
 
 FUEL VALUE. 
 
 310 CALORICS PEP POUND 
 
 (65 CALOP/ES PEP POUA/&. 
 
 BUTTERMILK 
 
 fat:9. 
 
 WATEP: 
 9IO 
 
 ASP: 17 
 
 FAT.'O 
 ASH: 0.7- 
 
 780 CALOPIES PEPPOUPO 
 
 PP0T£/N:30 
 
 WB0PYDPAT£$;4A 
 
 UT£/A/:2.S 
 PBOPyDPAT£S:4i& 
 
 FUEL VALUE: 
 
 FUEL VALUE: 
 
 □ 
 
 160 CALOP/ES PEP POUN& 865 CALOP/ES PEP POUND 
 
 Farmer's Bulletin, 363, U. S. Dept. of Agriculture, Chart 11. 
 
 Fig. 72. — Food Values of Milk. 
 
 The test for sugar is to add a few drops of urine to one-half an inch of 
 hot Fehling's solution in a test tube. If the solution turns to a yellow, muddy, 
 opaque liquid, sugar is present. The diabetic comes to know that the amount 
 of sugar present can be gauged by the number of drops of urine required to 
 produce the change in color. He judges of his condition by the amount of 
 sugar in his urine. This is a good enough sign by which one's condition can 
 be judged in an ordinary, slowly progressive case of diabetes. However, it is 
 good judgment for the diabetic to keep in touch with his physician and to 
 report to him at stated intervals for a careful, complete examination. 
 
 Because the diabetic watches the sugar in his urine he frequently gets 
 some wrong ideas as to the origin of sugar in the urine and the importance of 
 sugar as an article of diet. 
 
 The kidneys do not manufacture sugar. They merely remove sugar 
 from the blood. The blood of all people contains sugar. In a normal person 
 
160 DIABETES 
 
 the sugar of the blood is burned into carbonic acid. Sugar is manufactured 
 everywhere in the body. Some of it is made from starch ; some from fat, and 
 some from protein. Some of it is absorbed as sugar from the food; some is 
 taken in the food as starch and converted into sugar by the digestive appa- 
 ratus. The surplus sugar is stored as glycogen. Some of the blood is made 
 from glycogen, the stored sugar surplus. 
 
 When the sugar in the blood is in excess and the sugar appears in the 
 urine, the common way to begin treatment is by cutting off that part of the 
 sugar excess which comes from the diet. The articles cut out are honey, 
 sugar, ordinary flour or bread, biscuits, rusks, toast, arrowroot, oatmeal, 
 cracked wheat, potatoes, tapioca, sago, beans, turnips, carrots, parsnips, as- 
 paragus, artichokes, squashes, beets, corn, rice, hominy, cabbage, lettuce, figs, 
 grapes, prunes, apples, pears, bananas, jams, syrups, sweet pickles, chocolate, 
 cocoa, liquors, wines, beer, liver, and oysters. 
 
 The foods which are eaten are meat, poultry, game, bacon, ham, fish, eggs, 
 cream cheese curd, buttermilk, cream, butter, olive oil and fats of all kinds, 
 sauerkraut, lettuce, sorrel, mushrooms, cress, spinach, chicory, celery, cucum- 
 bers, mustard, sour pickles, lemons, oranges and nuts, gluten breads — those 
 kinds that contain only a small percentage of starch — bread crusts, milk and 
 alkaline mineral waters. 
 
 On the one hand food is not the only source of sugar, and on the other 
 the diabetic diet may be so low in heat and energy units that the tissues of 
 the body are burned to supply the deficiency. Therefore some diabetics do 
 better when given a diet that is more liberal in starches and sugars. 
 
 Old diabetics, especially those with a tendency to acid coma, need some 
 starch and sugar in their diet. Some of them can be shielded by giving them 
 a very large amount of fat, butter, olive oil, cod liver oil, cotton seed oil, fat 
 meat. Some get relief by adding two apples to the daily ration. Some need 
 oatmeal, and some potatoes cooked with the jackets on. 
 
 Diabetes — Cause and Diet. — M. L. F. writes: "Will you kindly advise 
 the real cause of diabetes and the best course to pursue to cure same? Am 
 a middle-aged woman formerly of stout and healthy constitution." 
 
 Reply. — 1. Diabetes may be caused by overeating — eating more than 
 the liver can handle. It may also be caused by a diseased pancreas or 
 tumor of the brain. 
 
 2. The diet is the most important thing to be considered in treating a 
 case of diabetes. The food should be nourishing and at the same time as 
 free from carbohydrates — sugars and starches — as possible. Try the fol- 
 lowing : 
 
 Breakfast 
 
 Four prunes cooked without sugar. 
 Fresh bran muffins, with plenty of butter. 
 Oatmeal with lots of cream. 
 Coffee. 
 
 Lunch 
 
 Poached egg on toasted bran muffin, buttered. 
 
 Crackers (diabetic) and a bit of cheese or some fresh rhubarb. 
 
 Tea or milk with plenty of cream. 
 
DIABETES 161 
 
 Occasionally chocolate, sweetened with saccharin, or buttermilk. 
 Rhubarb sweetened with saccharin and glycerin, after it is cooked (use 
 saccharin sparingly). 
 
 Dinner. 
 
 Any meat except liver. 
 
 Fish of all kinds. 
 
 Vegetables — Cabbage, cauliflower, asparagus, green beans, lettuce, rad- 
 ishes, olives, celery, tomatoes. 
 
 Desserts — Custards, made with very rich milk; strawberries, fresh. 
 Sour orange and grapefruit. Eresh peach cobbler, batter made with gluten 
 flour. 
 
 Cheese, any kind. 
 
 Nuts, any kind except chestnuts; often peanuts are excluded. 
 
 A diabetic should never allow himself to get ravenously hungry. This 
 is one of the great dangers that he faces, as it may cause him to overeat 
 or eat the wrong food. One is about as bad as the other. If a diabetic 
 feels the need of food between meals he can with safety take an eggnog 
 with all the cream in it he can stand, or cup custard. It is a good plan to 
 make up custards, baked in little brown bowls (individual) and keep on 
 ice to eat between meals when hungry. A glass of buttermilk or nuts will 
 often relieve a sense of hunger. A diabetic should, by all means, hava 
 medical advice. 
 
 Possibly Diabetes. — C. D. H. writes: "What is the cause of passing so 
 much urine? I have to get up five and six times every night. I am 
 troubled a great deal with my back and it gets so sore at times I can 
 scarcely bear the weight of my clothing on it. I have always been a very 
 light eater, but of late I am hungry all the time. I never seem to get 
 anything that satisfies my hunger." 
 
 Reply. — Have your urine examined for evidence of diabetes. 
 
 Diabetes Sometimes Curable. — J. H. writes: "Is diabetes a curable 
 disease? Give a list of things a diabetic may eat. How many years may a 
 person 52 years old expect to live? Is medicine any good as a curative for 
 diabetes? The patient lost twenty pounds before the disease was sus- 
 pected." 
 
 Reply. — 1. Some cases are curable, some are fatal, and some run on 
 indefinitely. 
 
 2. A diabetic can eat anything. He should eat sparingly of foods that 
 contain much sugar and starch — for instance, bread, pastries, desserts, 
 and potatoes. However, your question cannot be answered in this space. 
 Get a cookbook for diabetics or von ISToorden's small book on diabetes. 
 
 3. Ordinarily a diabetic 52 years old can count on many years of life. 
 Rapid loss of flesh is a bad sign. 
 
 4. As a cure, little; to relieve symptoms, medicine is of service. 
 
 Diabetes and Bacillus Bulgaricus. — F. M. asks: "What curative value 
 has 'Bacillus bulgaricus' in diabetes?" 
 
 Reply. — I do not think it has any. I have seen an abstract of Metchni- 
 koff's paper read in Paris in June and think those who have written me 
 misunderstood his article. At most, this bacillus would help only that 
 kind of glycosuria due to eating more sugar and starch than the system 
 
M% DIABETES 
 
 could convert. It would not help in cases of diabetes due to nerve, brain, 
 pancreas, or to some liver changes. 
 
 Symptoms of Diabetes. — C. K. writes: "1. What are the symptoms of 
 diabetes? 2. Does continued sitting affect the kidneys and are fruits and 
 sugar injurious to the kidneys? 3. What is the best diet for persons with 
 kidney trouble? If. What causes a steady ache in the small of the back 
 and spells of weakness and faintness?" 
 
 Reply. — 1. Sugar in the urine, frequent urination, large quantity of 
 pale, heavier-than-water urine. There are many other symptoms. These 
 are the more frequent and the easiest recognized. 
 
 2. No, as to both questions. 
 
 3. There are many different kidney troubles. The two most frequent 
 are Bright's disease and diabetes. For Bright's disease the caution is 
 against overeating, especially overeating of meats. For diabetes, against 
 overeating, especially overeating of starch and sugar. 
 
 4. The most frequent cause of backache is nervousness and nerve tire. 
 Sometimes Bright's disease causes backache. The causes of weakness and 
 faintness are many and varied. To try to say what causes them with you 
 would be as risky as traveling in a flying machine. 
 
 Examination of Urine for Diabetes. — P. 0. L. writes: "Please tell me 
 the symptoms of diabetes/' 
 
 Reply. — Any physician or laboratory and some druggists can examine 
 for diabetes. The tests are simple. The most reliable symptom is the 
 presence of sugar in the urine. A large quantity of urine is a symptom of 
 some value. Repeated boils or carbuncles suggest the possibility of dia- 
 betes. 
 
 Stages of Diabetes. — M. W. writes: "1. Is diabetes a liver trouble or 
 disease? 2. When the sugar deposit is thirty-four grains to the ounce, is 
 the condition serious? S. What is acetone? When this stage is reached, 
 is it the last in this disease? k> What are usually the last or serious devel- 
 opments? 5. When developed between the ages of 50 and 60, is it rapid or 
 slow in progress? 6. Is it hereditary? What seems to be the most general 
 cause of this trouble?" 
 
 Reply. — 1. Diabetes is the term usually used to cover all conditions that 
 result in sugar in the urine. Sugar in the urine may result from disease 
 of the brain or pancreas or from some of the disturbances of liver function. 
 Therefore some cases of diabetes are due to liver trouble. 
 
 2. Yes ; or it may easily become so. 
 
 3. Acetone is the result of acid fermentations due to incomplete oxida- 
 tion of albumin. It represents an advanced, though not necessarily the 
 last, stage of the disease. 
 
 4. Marked susceptibility to infections — acidoses — profound intoxication 
 with the products of incomplete oxidation. 
 
 5. Usually slow. 
 
 6. (a) Some families suffer from it more than others. Strictly speak- 
 ing, it is not hereditary, (b) Overeating. 
 
 Not Diabetes Symptom. — A. M. W. writes: "Does a smarting and ach- 
 ing after urinating indicate diabetes? Is diabetes curable? Ought one to 
 follow some diet, and what should it be? For many years my ears have 
 
DIABETES 163 
 
 rung. My hearing is acute. What occasions those sounds? Is there any 
 connection between them and frequent expectoration of a clear mucus f 
 Some days the expectoration is almost constant. Isn't it weakening to 
 expectorate so frequently? I appear to have the average health and com- 
 pare favorably with others except for the ills I mention, which may be 
 reducing my vitality." 
 
 Eeply. — 1. No. 
 
 2. Some cases are. Most cases are not bad, but one can learn to live 
 with diabetes and thus live out his full expectancy. 
 
 3. If one has diabetes he should have his physician outline his diet and 
 then supervise both as to diet and general habits. 
 
 4. Probably some infection which traveled to your ears years ago. 
 
 5. Probably, I think. 
 
 6. No. Your physician will probably find nothing of importance wrong. 
 
 Testing for Sugar.- — F. E. F. writes: "How is urine tested for the 
 presence of sugar?" 
 
 Reply. — By heating about a dram of Haines' solution and adding a few 
 drops of urine. Sugar turns it yellow or reddish yellow. Iodin is not 
 used. Albumin is tested for by placing about an inch of pure nitric acid 
 in a test tube and floating some urine on it. If albumin is present a white 
 solid ring forms at this line of contact. The specific gravity is taken with 
 a special apparatus called the urinometer. Casts, pus, and blood are found 
 by microscopic examination. These are the more usual and simpler tests. 
 
 Buttermilk in Diabetes. — B. M. C. writes : "Is a quart of buttermilk a 
 day too much to be taken by an invalid who has diabetes and hardening 
 of the arteries and is unable to take exercise of any kind, being seated 
 almost the entire day?" 
 
 Eeply. — If he takes neither meat nor vegetables in addition — no. If the 
 quart of buttermilk is a part of a fairly liberal diet — yes. 
 
 Diabetes not Hereditary. — K. K. writes: "Will you kindly tell me 
 something about diabetes? Is it hereditary? Is it contagious? Is it liable 
 to be contracted by both sexes? What are the first symptoms or stages? 
 Is one 68 years old liable to have it?" 
 
 Reply. — 1. Diabetes is not a hereditary disease. Certain races are more 
 susceptible to it than others. In essence it is caused by long continued 
 nervous strain, which results in a disturbance of the pancreas and liver. 
 The kidney symptoms are secondary. 
 
 2. It is not a contagious disease. 
 
 3. Both sexes suffer from diabetes. It not infrequently happens that 
 man and wife are both affected by it. The relationship is not clearly under- 
 stood. 
 
 4. The first symptoms are increased thirst and sometimes increased 
 appetite, a larger amount of water passed through the kidneys than usual, 
 emaciation, and itching of the skin following. 
 
 5. It is possible to have diabetes at the age of 68. Diabetes in a person 
 63 is not grave. The younger the diabetic the graver the outlook. 
 
 Diet and Diabetes. — L. M. writes: "1. Can diabetes be cured in its 
 early stages? 2. What bread should one eat? 3. Is saccharin injurious?" 
 
164 DIABETES 
 
 Keply. — 1. Diabetes is a symptom present in several different condi- 
 tions. Some are curable; some tend to persist indefinitely without doing 
 great harm; some are incurable and rapidly progressive. The outlook in 
 any given case must depend upon the conditions of that case. 
 
 2. Do not accept any diabetic bread merely because it is advertised as 
 such. Insist upon a statement as to the amount of starch present. Do not 
 try to do without starches entirely. Know how much you are eating and 
 keep your starch diet below your danger line, or, better still, your harm line. 
 
 3. It is. However, if you are a diabetic and must have sweets, saccharin 
 is less injurious than sugar. The best plan is to learn to do without sweet 
 tasting foods and drinks. 
 
 Teeth in Diabetes. — J. G. 0. writes: "I am a diabetic and for the last 
 
 five years have used saccharin as a sweetener for such food as requires it. 
 I have an excessive deposit of tartar on my teeth, and consequently must 
 fight pyorrhea constantly. Is it not dangerous to use saccharin continually 
 as I do? Does it contribute to the tartar deposits? What can I do to pre- 
 vent the tartar deposits and pyorrhea?" 
 
 Keply. — 1. The referee board of the Department of Agriculture has 
 decided that saccharin is harmful. Use none, or the minimum quantity. 
 
 2. No. 
 
 3. There is nothing to do except to visit your dentist for treatment of 
 your teeth and gums at regular intervals. By intelligent care, a diabetic 
 can live to a ripe old age. By intelligent care, also, pyorrhea can be held in 
 check for many years. 
 
CHAPTEE XV 
 
 Pellagra 
 
 No other statement made at the recent meeting of the American Public 
 Health Association was so important as that of the Public Health Service 
 that the pellagra situation had been solved, that is, from the public health 
 standpoint. As I understand the Service's position it is this: 
 
 Pellagra is caused by a diet out of balance in certain directions. It can 
 be prevented by the habitual use of a properly balanced diet. Where in a 
 given closed community, for instance a hospital, pellagra is found to be pres- 
 ent to a considerable degree, the disease can be banished by a rearrangement 
 of the diet. In an open community, ordinary town and country life, the dis- 
 ease can be eradicated according to the degree of change in diet which the 
 people can be induced to make. 
 
 So much for the position of the Public Health Service on the positive 
 side. On the negative side it holds that the disease is not contagious nor com- 
 municable; that it is not spread by flies or insects of any sort; that it is not 
 caused by eating cornmeal; that it is not the result of living in insanitary 
 houses. 
 
 As to the ability of a change in diet to cure the individual case of pella- 
 gra, that depends on the stage of the disease and other factors. On that point 
 the Service had but little to say. Its work is with public health, not personal 
 health, and still less with curative medicine. 
 
 The changes in the diet recommended by Dr. Goldberger to prevent 
 pellagra consist essentially in increasing the amounts in the daily diet of 
 good fresh meat, peas, and beans. 
 
 "The eventual eradication of pellagra from our South will depend largely 
 on the successful introduction of common dried legumes into the winter 
 dietary. A valuable step in this direction would be an increase in the cultiva- 
 tion of some of the varieties of peas and beans and their preservation in the 
 dried state for winter consumption. The farmers of the far south are plan- 
 ning to decrease greatly the cotton acreage in 1915. They are investigating 
 other crops. Under the stimulus given by the Public Health Service in ad- 
 vocating this preventive for pellagra, there should be a large demand for peas, 
 beans, fresh meat, milk, and eggs/' 
 
 Cornfield peas grow well in most portions of the South. They are a 
 good winter dish. Perhaps Mexican frijoles will also suit the southern soil 
 and climate. 
 
 Incidentally it occurs to me that the Public Health Service should in- 
 quire as to the amount of pellagra among the frijole-eating Mexicans. 
 
 Although the Public Health Service concerns itself with the problems of 
 public health, in the main it can never keep closely within its field, nor keep 
 
 165 
 
166 
 
 PELLAGRA 
 
 wholly out of other fields. The fields of public health, personal hygiene, and 
 curative medicine constantly overflow one into the other. 
 
 Along with Goldberger's recommendations of a certain diet list for those 
 who would avoid pellagra there goes a detailed diet list for those who have 
 the disease and would be cured. 
 He says: 
 
 "The patient should be given and urged to take (if necessary, tube fed) 
 an abundance of fresh milk, eggs, fresh lean meat, beans, and peas (fresh and 
 dried, not canned). 
 
 "Milk. — Fresh milk alone, 
 or in alternation with butter- 
 milk, should be given freely. An 
 adult should be urged to take 
 not less than a pint and a half 
 to two pints in twenty-four 
 hours. 
 
 "Eggs. — Fresh eggs should 
 be allowed freely. In addition 
 to the milk and meat an adult 
 should take not less than four 
 eggs a day. In certain of the 
 severer forms it may be neces- 
 sary to give the eggs in the form 
 of albumin water. 
 
 "Meat.— The meat should 
 be fresh, lean meat. Whether 
 all fresh meats are equally valu- 
 able in treatment we do not 
 know; future studies will have 
 to determine this. Our experi- 
 ence has been with beef alone. 
 This may be served as scraped 
 beef, as a roast, or as steak. 
 Where mastication is painful, meat juice may be given instead. An adult 
 should be urged to take at least half a pound of lean meat a day in addition 
 to the milk, eggs, and legumes. It may be necessary in some instances to 
 work up gradually to the point where these quantities can be taken. 
 
 "Legumes. — We have been much impressed with the favorable results 
 following the use of beans and peas alone. The beans and peas should be fresh 
 or dried, not canned. A palatable pea or bean soup should be prepared and 
 may be given freely. In addition to or in alternation with the soup the beans 
 or peas should be served and eaten in any one of the other well-known 
 forms. 
 
 "In cases presenting only moderate or no gastro-intestinal symptoms there 
 may be added in restricted amounts oatmeal, rice, and barley as cereals, pota- 
 toes and onions as fresh vegetables, fresh or dried (not canned) fruits, and 
 wheat or rye bread or biscuits." 
 
 Fig. 73. — Buffalo Gnat, accused by some author 
 ities of spreading Pellagra. (After H. Garman.) 
 
DIAGNOSIS AND TREATMENT OF PELLAGEA 
 
 167 
 
 DIAGNOSIS AND TREATMENT OF PELLAGRA 
 
 In a paper read before the last meeting of the Associated Fraternities of 
 America, Dr. Cloyd of the Woodmen of the World said that in 1911 pellagra 
 was responsible for about three-quarters of one per cent of the deaths amongst 
 
 tGMGRAMCE OF 
 IATURAL 
 lLTH LAWS 
 
 DEFECTIVES ARE REPRODUCINGTHEIR 
 KIND MORE RAPIDLY THAN THE NORMALS 
 
 TO PREVENT THE CONTINUANCE OF SUCH 
 CONDITIONS WE MUST HAVE THESE - 
 
 SANITARY LIVING- 
 
 CONDITIONS FOR 
 
 RLL CLA55ES 
 
 SOCIAL CENTER 
 AUDIENCE ROOM 
 FOR THE 
 COMMUNITY 
 
 WHERE THE PEOPLE 
 CAM MEET SOCIALLY 
 
 i 
 
 nicwenn STATE 
 
 Fig. 74, 
 
168 PELLAGRA 
 
 the members of that order ; that in America there were nearly 10,000 known 
 cases of the disease ; that while it was not contagious, no nurse nor physician 
 nor other person having ever been known to contract the disease either in this 
 country or in Europe from contact, nevertheless pellagra is spreading rapidly 
 in all parts of the United States. 
 
 He thought that there is — and beyond question he is right — a great need 
 that physicians learn how to recognize pellagra when they see it. 
 
 A few years ago one of the great diagnosticians of a northern city, while 
 visiting in a southern state, carefully studied a typical pellagra and made a 
 diagnosis of glossitis. That there was inflammation of the tongue — glossitis — 
 was true, but that was present as one of the symptoms of pellagra. 
 
 This able man was so struck by the red tongue present in the case that 
 he saw that he made a diagnosis of inflammation of the tongue. Other men 
 have seen nothing beyond red, cracked skin in some case or other and have 
 made diagnoses of sunburn, eczema and like diseases. Others have called 
 pellagra diarrhea, and still others have not been able to see beyond the mental 
 state and have diagnosed cases of pellagra as melancholia. 
 
 The moral is that both physicians and people must be on the alert for 
 pellagra as an underlying cause of certain symptoms any one of which in a 
 given case may stand out like Gibraltar. 
 
 A very red, fiery, and painfully burning tongue is quite characteristic. 
 The sensation of burning is felt all down the throat and gullet to the stomach. 
 Diarrhea is generally present. It may alternate with constipation. The stools 
 are very offensive. The breath is highly offensive. In my experience, these 
 digestive symptoms from mouth to intestines are the most uniformly present 
 and most characteristic. 
 
 The skin symptoms consist of a bright red sunburn with thickening, 
 roughening, scaling of the skin. As the skin scales off it leaves behind a pig- 
 mentation similar in appearance to that of sunburn, and also similar in its 
 distribution — the hands and forearms, the face, neck, and upper chest. The 
 line between the affected and unaffected skin is sharp as is sunburn. When 
 one passes his fingers over the affected skin it feels "as if sand were in the 
 skin." 
 
 The nervous symptoms from nervousness through melancholy to insanity 
 are usually later and of less diagnostic value than the digestive disturbances 
 and skin changes. 
 
 As to treatment we quote Dr. Cloyd from the Western Review of No- 
 vember, 1912: 
 
 "The diet should be easily assimilable and highly nutritious. Meats, as a 
 rule, agree with pellagrins and form an important part of the diet; eggs can 
 generally be used to advantage ; milk is useful when it agrees, but as it often 
 does not, peptonized milk, buttermilk, etc., should be used. Vegetables and 
 cereals also can be given freely. Corn in all forms should be avoided until 
 the corn theory of the etiology of the disease is disproved. The diet should be 
 adjusted to the individual case, always remembering that the problem of the 
 bodily upkeep in pellagra is of basic importance and should never be lost 
 sight of from the beginning of the management. 
 
 "General hygienic treatment is of great importance. Plenty of fresh air, 
 quiet and pleasing surroundings, rest, and regularity in daily habits are es- 
 
DIAGNOSIS AND TREATMENT OF PELLAGRA 
 
 169 
 
 sential. Frequent baths are important in the treatment of pellagra ; hot and 
 cold baths, simple and medicated douching, moist or dry rubs accompanied by 
 special massage, have proved their worth. The special methods chosen must 
 be adapted to the individual case. 
 
 "Drugs are used in pellagra to treat the special symptoms as occasion 
 arises. No specific treatment has yet been found. For general constitutional 
 treatment arsenic in some form is generally used. 
 
 "At the present time the measure that promises the greatest amount of 
 success is removal of the patient to a high, cool altitude. The proof of this 
 is found in the fact that most incipient cases clear up in winter. Patients sent 
 
 £ £7 IT! ' ^ D\SerA5t\i 
 
 State Board of Health, Jacksonville, Fla. 
 
 Fig. 75. — Alert as to Contagion in His Cattle — Indifferent as to Contagion in His 
 
 Own Family. 
 
 to Asheville, North Carolina, and Tate Springs, Tennessee, have nearly all 
 been benefited. I do not know of any patients who have been sent to the 
 mountains of Colorado or the west, but it appears to me that a residence in 
 that region ought to be tried." 
 
 What shall the pellagrin do? First, change his diet. Eat more protein 
 and less starch.. Second, live more hygienically. These he can and must do. 
 If he can he should do the third — seek out the base of some perpetually snow- 
 clad mountain. As the season progresses he should climb, keeping always 
 above the snowline. 
 
 Concerning Pellagra. — P. J. wants to know some of the symptoms of 
 the beginning of pellagra and other information concerning the disease. 
 
 Reply. — Pellagra is widely spread. There is much of it in Chicago and 
 in the surrounding states, as well as in the South. Physicians in the South 
 have learned how to recognize it in the last few years. Physicians in this 
 part of the country (the Middle West) have not learned how to diagnose it 
 until it is so far advanced that the subjects have had to be placed in insane 
 
170 PELLAGRA 
 
 asylums. The reports of cases in Illinois have come from the Dunning 
 institution and from the state asylums, particularly Bartonville. 
 
 Something should be done to let people know what symptoms point 
 toward pellagra. Most cases begin with a persisting heartburn. This is 
 followed by diarrhea. If a man has a persisting heartburn and a diarrhea 
 which keeps up, he had better see a doctor and get an examination. One 
 of the things which he should ask is: Does this mean pellagra? About 
 the same time the mouth gets red and raw areas are sometimes seen. The 
 gums get sore. The tongue is red and patchy. The patient begins to lose 
 weight. The patient is "blue" and melancholy. He thinks that his friends 
 are not treating him right and that his family is going back on him. 
 
 The eruption starts on the hands and face. At first it looks like an 
 ordinary browning from the sun. Later it looks like a deeper sunburn. 
 Sunburning in a person who has not been exposed to the sun enough to 
 burn should always excite suspicion. One of the first diagnoses made in 
 South Carolina was a man who sunburned brown in the summer, and he 
 had not been out enough to account for it. But the doctor was not suspi- 
 cious. In midwinter he turned up with a bad sunburn. His physician got 
 suspicious, studied him more carefully, and made a diagnosis of pellagra. 
 
 A diagnosis in an early case can only be made after a careful study 
 of the case. That is the work of the doctor. 
 
 The part of the patient is to get suspicious and go to a doctor if there 
 is a heartburn which keeps up, a continued diarrhea, persisting sore, red 
 gums, persisting red, splotchy tongue, blues, sunburn out of season or not 
 explainable by exposure. 
 
 Symptoms of Pellagra. — H. T. W. writes: "What are the most pro- 
 nounced symptoms of pellagra?" 
 
 Reply. — 1. Digestive system — Fiery red tongue, burning pain extend- 
 ing from the mouth to the stomach, diarrhea, offensive stools, offensive 
 breath. 
 
 2. Skin — Sunburn on the hands and forearms, on the face and on the 
 chest. The sunburn is usually limited to the exposed parts of the body. 
 It usually looks like an ordinary sunburn. It may come without any 
 exposure to the sun. 
 
 3. Mental symptoms — Those of melancholia, mental distress, mental 
 weakness, some delusions. 
 
 The digestive symptoms generally come first and predominate. The 
 skin symptoms next. The brain symptoms last. Every case has some of 
 the above symptoms; few have all of them. 
 
 Cause of Pellagra. — 8. writes: "What is the cause of pellagra? What 
 is the length of time one generally lives after the first symptoms? Would 
 you advise doctoring with home doctors or not? Is there such a thing as 
 eating certain hinds of food and being protected from it? Do people have 
 pellagra in a cold climate?" 
 
 Reply. — 1. The cause is not certainly known. 
 
 2. Some say two years. Some cases live longer than that. Many die 
 rather quickly after they know of the disease. 
 
 3. Your home doctors know about pellagra better than anybody else. 
 Beware of pellagra cures. 
 
 4. The Public Health Service says so. Ask Congressman Humphreys to 
 get the public health report of October 23 for you. 
 
 5. Yes. 
 
DIAGNOSIS AND TREATMENT OF PELLAGEA 171 
 
 Warnings of Pellagra. — D. A. writes: "Will you please give the symp- 
 toms of pellagra? Can a person have the disease without feeling some ill 
 effects? Is there any other disease similar to it?" 
 
 Reply. — What you want to know is what symptoms should cause you 
 to suspect pellagra and investigate further. 
 
 1. A persisting red sore tongue. 
 
 2. Burning in the esophagus or gullet. 
 
 3. Sunburn without adequate cause. Generally speaking the sunburn 
 is in the ordinary locations of sunburn — the neck, chest, shoulders, and 
 forearm. 
 
 4. Sense of weakness for which there is no other cause. 
 
 5. Persisting indigestion. 
 
 Any one of these symptoms should cause you to investigate the possi- 
 bility that you have pellagra. The disease is often confused with other 
 diseases. 
 
 Thousands of Cases. — 8. W. R. writes: "Will you kindly advise 
 whether there has ever been an authentically diagnosed case of pellagra in 
 North America? I should also like to have you state what the disease is 
 and its cause" 
 
 Reply. — Yes, many thousands. Several die of it each year in Chicago. 
 They are so registered in the Bureau of Vital Statistics. Some were diag- 
 nosed by a man who had seen a great deal of pellagra in the United States 
 and abroad. Its cause is not determined. The symptoms fall into three 
 groups: Those which affect the digestive apparatus, those which affect 
 the brain, and those which affect the skin. 
 
©HAPTEK XVI 
 
 Beriberi 
 
 This disease is of no direct interest to the people living within the United 
 States. To us it is a medical curiosity. Few of our people have it. Never 
 in our history have many people had it. There is no likelihood that they will 
 ever have it. Then why take the trouble to learn about it ? 
 
 There are several reasons. We see in the fight against beriberi one of the 
 conquests of preventive medicine. From a study of the proved facts about 
 beriberi we get some facts that are of value on the general food situation. 
 
 Finally, beriberi is somewhat like pellagra and infantile scurvy, and the 
 fight against beriberi may teach us something about these other diseases. 
 
 Since we took possession of the Philippines the United States army has 
 maintained a small native army known as the Philippine Scouts. These 5,200 
 natives are scattered in small companies throughout the islands. Although 
 widely scattered, they are fed a uniform ration provided by the government. 
 
 The government spent six years in trying to develop a plan to combat 
 beriberi. 
 
 In 1908, 618 cases and in 1909, 558 cases of this disease developed in this 
 small army. Some of these cases died, and some were invalided on account 
 of disability. 
 
 By 1910 the army authorities had matured their plan, and in that year 
 they got it going in earnest. In 1910 the number of cases dropped to fifty. 
 In 1911 there were three cases; in 1912, two; in 1913, none, and in 1914 (the 
 first six months), one. 
 
 Out of each 1,000 scouts in 1908, 121 were disabled from beriberi — about 
 one-eighth of the entire command. Out of each 1,000 in the last four years 
 twenty-eight were disabled per year — about one for every 4,000. The last death 
 of a scout from beriberi occurred in 1911. In that year there was one death 
 from this disease. 
 
 The largest number of admissions to the hospital for this disease in any 
 month was in January, 1909 — 138. The last month in which more than one 
 case was admitted to the hospital for beriberi was August, 1910 — two cases. 
 No case was admitted to the hospital from June, 1912, to April, 1914. 
 
 There has been no case of beriberi among white troops serving in the 
 Philippines since January, 1910. 
 
 The United States army has succeeded in the last ten years in entirely 
 controlling a group of very important diseases, not only in its own ranks but 
 in the communities over which it has had control. These diseases are yellow 
 fever, smallpox, typhoid fever, and beriberi. These four diseases have been 
 absolutely wiped out in the various divisions of the army. If the army has 
 been able to wipe out these diseases, it will be able to wipe out others. 
 
 What we are more interested in is the next proposition. If the army can 
 
 172 
 
BERIBERI 
 
 1*3 
 
 wipe out these diseases, then civil populations can wipe them out. They have 
 already wiped out yellow fever. When will they wipe out smallpox and 
 typhoid ? 
 
 Furthermore, the army has demonstrated its ability greatly to lessen 
 pneumonia, malaria, and venereal disease. The reports from Panama show 
 that it has been able to lessen pneumonia to one-half and malaria to one-tenth 
 of its former rates. The statistics of the army itself show that it has lowered 
 the venereal disease rate to one-third of its former rate. 
 
 If the army has accomplished 
 this much with pneumonia, why 
 should we not begin? If malaria 
 is lessening the price of land in 
 Mississippi and malaria can be con- 
 trolled, why does not Mississippi 
 control it? 
 
 The army ration in use by the 
 Philippine scouts when beriberi was 
 so prevalent consisted of fresh beef, 
 twelve ounces; flour, eight ounces; 
 baking powder, one-third of an 
 ounce ; rice, twenty ounces ; potatoes, 
 eight ounces; coffee, roasted and 
 ground, one ounce; sugar, two 
 ounces; vinegar, salt and pepper. 
 
 In place of fresh beef one of 
 the following was substituted at 
 times: bacon, eight ounces; canned 
 meat, eight ounces; canned or fresh 
 fish, twelve ounces. In place of the 
 
 flour and baking powder, hard bread, eight ounces, was substituted at times; 
 in place of the potatoes, eight ounces of onions. 
 
 Instead of twenty ounces of polished rice were substituted sixteen ounces 
 of Filipino rice No. 2 or Sargon rice. These are undermilled or unpolished 
 rices. In place of potatoes they used camotes, eight ounces, and mongos, four 
 ounces. Camote is a vegetable akin to the sweet potato; mongo is a species 
 of pea. The coffee ration was cut in half and half an ounce of ginger root 
 was issued. The use of Filipino No. 2 rice continued until June, 1911. 
 
 Since June, 1911, the ration in use has been the following: fresh beef, 
 twelve ounces ; flour, eight ounces ; baking powder, one-third ounce ; unpolished 
 rice, twenty ounces; potatoes, eight ounces; coffee, roasted and ground, one 
 ounce; sugar, two ounces; vinegar, eight one-hundredths gill; salt, two-thirds 
 ounce; black pepper, one-fiftieth ounce. 
 
 At times in place of fresh beef eight ounces of bacon or eight ounces of 
 canned meat, or twelve ounces of fish, fresh or canned, was used; in place of 
 the flour, eight ounces of bread; in place of potatoes, eight ounces of onions 
 were used. 
 
 While twenty ounces of unpolished rice was the allowance, the authorities 
 insisted that not over sixteen ounces be drawn, but that some other vegetable 
 food be substituted. For instance, in place of four ounces of the rice they ad- 
 
 Virginia Health Bulletin. 
 
 Fig. 76. — A Good Type of Dry Earth Privy. 
 Door raised to show bucket. 
 
174 BERIBERI 
 
 vised sixteen ounces of beans. They required that as much use as possible be 
 made of such native products as camotes, mongos, and squash. 
 
 The essential difference between the diet under which the men got beri- 
 beri and that under which they escaped it was in the rice. The difference was 
 not so much in the amount of rice eaten nor in the proportion of rice to the 
 other foods in the different diets. The difference was in the quality of the 
 rice. 
 
 The men developed beriberi when they ate high grade polished rice. They 
 did not get it when they ate undermilled or unpolished rice. The Filipino No. 
 2 rice evidently contained a good deal of rice mills. 
 
 Major Chamberlain of the United States Army, who was in charge of 
 the beriberi work among the scouts when this change was being effected, says : 
 
 "Filipino No. 2 rice was unsightly and consequently aroused opposition 
 among the men. Ginger root could not be made popular. Therefore the 
 ration was changed on May 8, 1911, to that shown in table 4 (the last given), 
 which has continued in force to the present time. 
 
 "This ration obviates the practical disadvantages of the preceding one, 
 yet embodies all the features important for beriberi prevention, viz., use of 
 unpolished rice in an amount not exceeding sixteen ounces and compulsory 
 consumption of sixteen ounces of beans. The beans used are ordinary dried 
 navy beans, for which mongos may be substituted. 
 
 "The undermilled rice is of the highest grade, has a white pericarp, is 
 palatable and not unsightly in appearance, and contains 0.4 per cent of phos- 
 phorus pentoxid." 
 
 In the opinion of Dr. Chamberlain the phosphoric acid of rice is not the 
 element which prevents beriberi, but it is present in that portion of the outside 
 of the rice berry which is necessary if beriberi is to be prevented. Therefore 
 to determine the amount of phosphoric acid present is the easy way to tell 
 whether the rice will cause beriberi or not. 
 
 The vitamin necessary to prevent this disease is contained in considerable 
 quantity in the hard white outer layers of the berry. 
 
 Let no one understand that rice causes beriberi. It is treated rice which 
 does it. No food is better for beriberi than unrobbed rice. 
 
 Other foods which have been shown to produce beriberi are fine wheat 
 flour, white wheat bread with or without yeast, macaroni, ship biscuit, sago, 
 hominy, cornstarch, various breakfast foods, and potatoes. 
 
 Do not get the idea that eating a mixed ration in which there is fine 
 wheat bread will cause beriberi. It will not. If the diet consists of white 
 bread entirely, or largely of it, or if there is nothing in the ration to supply 
 the something which was taken from the wheat berry in the milling process, 
 beriberi develops. 
 
 Another fact which has been well established is that prolonged cooking 
 and cooking at high temperatures destroys the vitamins which prevent beriberi. 
 If a food substance which in the 'raw state contains barely enough vitamins 
 is cooked at a high temperature above 250 or is boiled at a lower temperature 
 for a long time, enough cf its vitamins will be destroyed to put it into the 
 class of foods capable of producing beriberi. A temperature of 200 does not 
 affect it. The substance which prevents scurvy in babies is destroyed by a 
 temperature of 200. 
 
BEEIBERI 
 
 175 
 
 In a general way what ice learn from the work with beriberi is that we 
 have been in the habit of ov err e fining and overpreparing our foods, We have 
 got too far away from nature. We shall be better off if we backtrack a little 
 on the route by which we have come up from the cave man. 
 
 While it is not necessary that we should grub roots with our fingers, 
 crack nuts with our teeth, and eat raw meat, we shall be somewhat more 
 
 Fig. 77. — Framework for Model Privy House. Such a house is not necessary, but can be 
 conveniently and cheaply built about the privy box. The latter is the all-important part 
 of the privy. 
 
176 BERIBERI 
 
 resistant to disease and somewhat freer from what the doctors call "diathesis" 
 if we eat more bran with our cereals, our rice, and our flour; more peeling with 
 our fruit, more fiber with our meat, and more fresh vegetables and fruit, and 
 if some time during the day we eat some suitable article of diet in the. raw 
 state. 
 
 Beriberi begins with a loss of appetite, headache, a mild fever, pain in the 
 stomach and a sense of weight in the chest. The disease progresses unevenly. 
 It gets worse for a while and then lets up, gets better and then gets worse. 
 
 There are four varieties of the disease. In the mildest form there are pain 
 in the legs, swelling of the ankles, weakness in the muscles of the legs, and 
 finally a loss of sensation below the hips. In the atrophic form the weakness 
 of the leg muscles is followed by paralysis and muscular atrophy. The 
 muscles shrink up somewhat as in infantile paralysis. Patches of skin on the 
 legs lose all sensation. In other areas there are neuralgic pains. There is 
 generally dropsy in the feet. 
 
 In another variety dropsy of the legs overshadows the wasting. The 
 dropsy may be elsewhere in the body, as well as in the legs. In this variety 
 palpitation of the heart and difficult breathing are prominent symptoms. 
 
 In the fourth variety the prominent symptom is weakness, accompanied 
 by great disturbance of the heart. The heart disturbance takes the form of 
 palpitation. Breathing is difficult. 
 
 As a result of the deficiency in the diet there is inflammation of certain 
 nerves. Just which nerves are most inflamed determines which symptoms are 
 most prominent. In most cases the involved nerves are those which run to 
 the legs; therefore, in most cases the prominent symptoms are paralysis of 
 the legs, wasting of the leg muscles, dropsy of the legs, and a division of the 
 skin of the legs into painful areas and areas in which there is no feeling. 
 
 The symptoms of pellagra are very different from those of beriberi. The 
 nerves and organs involved differ from those of beriberi. And yet when we 
 analyze more closely, when we study the phenomena which lie below the sur- 
 face, there is a good deal of similarity between the diseases. 
 
 The present trend of opinion is that the cause of pellagra lies in freak 
 diets. The Public Health Service is advising that the disease be prevented by 
 changing the diet. One of the changes which it recommends is that more 
 beans and peas be eaten. With this exception the changes in diet recom- 
 mended for pellagra are not those recommended for beriberi. 
 
 Infantile scurvy is a condition of great importance. There are cases in 
 which the baby is very definitely sick. The more important group of scurvy 
 cases are the babies who are not definitely sick. They teethe slowly, are slow 
 about sitting alone and crawling. They seem weak in the back. More fre- 
 quently than otherwise they are fat. 
 
 These are very mild cases of infantile scurvy. As in the case of beriberi, 
 they need some change in their diet. Generally they need less fat and more 
 starch. What is more important, they need orange juice, prune juice, per- 
 haps lemon or lime iuice, perhaps some apple, and possibly some potato. 
 
PEEVENTION" OF BEEIBEEI 
 
 177 
 
 PREVENTION OF BERIBERI 
 
 The Japanese, in preparing for the war with Eussia, decided that they 
 would prevent preventable disease. They were a small nation; Eussia was a 
 large one. Preventable disease was four times as destructive as bullets. If 
 they were to prevent preventable disease and the Eussians were to follow prece- 
 dents, their army would be as effective as an army four times as great. They 
 would whip the Eussians by preventing preventable disease — simple enough! 
 
 j f ^m m 
 
 plank sides 
 
 farfl, F,i/ 
 
 
 Fig. 78. — A Good Cheap Privy. 
 
 They overlooked one disease; they classed beriberi as a nonpreventable. 
 Ninety-seven thousand of their troops had this disease. As a sick soldier re- 
 quires another soldier to wait on him, that meant nearly 200,000 troops made 
 ineffective. 
 
 Beriberi is a baffling disease. It is an inflammation of the nerves. As a 
 result of the nerve changes, the sick person has dropsy, becomes weak and 
 eventually dies. 
 
 There is a little beriberi scattered around the United States, but not 
 much. We never thought much about it until we became imperialistic. 
 When we took over coolies and laborers of similar standards of life we took 
 over beriberi. 
 
 We put our students to work on it at once. Those diseases of the other 
 fellow, his wife and his children, interest us greatly. x\fter beriberi we went 
 with hammer and tongs. 
 
 It baffled the best specialists we had. Some said a bacillus caused it. 
 Others said it was due to a monotonous diet of rice. 
 
 Each side could show that the other side was wrong, but it could not 
 
178 BEEIBERI 
 
 show it was right. The bacteria advocates showed in turn that each chemical 
 in rice was incapable by its presence or absence of causing the disease. 
 
 Wow the rice group has won. That it has proved its position is generally 
 accepted. Beriberi is due to taking rice deprived of a delicate ferment pres- 
 ent in the bran. It is caused, not by eating rice, but by eating polished rice. 
 If the rice is not polished it can be fed indefinitely without harm, or, if a little 
 bran is added, the harm is escaped. 
 
 If beriberi subjects, in the early stages, are given a little of this bran, 
 they recover from the disease. It has been proved many times on fowls, and 
 is now being applied to men. 
 
 It is proposed to change the eating customs of the rice-eating people, at 
 least to the extent of having them eat undermilled rice. 
 
 Why did the chemical escape the earlier analyses ? They were for phos- 
 phorus, carbon, proteins, carbohydrates, and similar gross substances. No- 
 body thought of looking for this delicate ferment in the bran, and, besides, 
 it was present in a minute homeopathic dose, a grain to a barrel or a similar 
 laughable dilution. 
 
 Major Hess of the army tells us that the Japanese discipline was equal 
 to their preparedness. It has been recently decided that they shall eat under- 
 milled rice, and they will thus prevent the disablement of 97,000 of their 
 troops. 
 
CHAPTEE XVII 
 
 Scurvy — Scrofula — Rickets 
 
 SCURVY 
 
 "In scurvy there is a swelling around the eyes over which the skin has the 
 color of a bruise, and a pale face which looks bloated." There are rheumatic 
 pains. The gums swell and the teeth become loose. The breath is about 
 as offensive as after salivation. There is nosebleed and there is bleeding from 
 the gums. The hemorrhage may be profuse. There are small hemorrhagic 
 patches in the skin. Meanwhile the rheumatic symptoms become much worse. 
 
 Such is old-fashioned scurvy. Some of the soldiers of '61 remember it. 
 Some sailors have seen it, but few of the ordinary run of people know this 
 picture. Yet a large part of the population will have a "touch of scurvy" 
 every year before May. 
 
 With some it will go no further than repeated spells of bad breath ; with 
 others a multitude of vague aches and pains variously called rheumatism, 
 sciatica, lumbago, gout; with others there will be attacks of sore gums; with 
 others the face will be pale and a little bloated, with dark circles and slight 
 bloats around the eye ; with others there will be patches of skin eruption. 
 
 To call these conditions scurvy is to exaggerate. To say they are touched 
 with scurvy is perhaps as good as any way to put it. 
 
 Babies are prone to scurvy. The gums swell, become spongy and sore. 
 Sometimes there is a soreness and swelling of the thighs. Barlow says : 
 "Sometimes there develops a rather sudden swelling of one eyebrow, with 
 puffiness and very slight staining of the upper lid." 
 
 With babies, as with grown children, a touch of scurvy is much more fre- 
 quent than the fully developed disease. 
 
 An investigation of 134 epidemics of scurvy, going back 400 years, shows 
 that the disease is one of winter and spring. In the ordinary forms of scurvy 
 and near-scurvy it is also true that "spring is the proper season for scurvy 
 and next to it would come winter." This is because of the weather as much 
 as it is because of the difference between winter and summer foods. 
 
 One of the first men to write about scurvy, Lind, thought the wet and 
 cold of the spring months were responsible for this disease. He put great 
 stress upon the amount of the disease among common sailors, "whose clothes 
 were frequently drenched and whose sleeping bunks were usually damp." 
 
 In 1795 Blane drew up the English regulations for provisioning ships 
 which won for the English navy the sobriquet of "lime suckers/' but which also 
 ended epidemic scurvy in that navy and indirectly brought the disease under 
 control in the civilized world. Since that time there has been a universal 
 opinion that the food of winter and spring has been the cause of scurvy in 
 those seasons. 
 
 179 
 
180 SCUKVY— SCKOFULA— BICKETS 
 
 Everybody is agreed with the opinio?! of Hirsch that in the causation of 
 scurvy "diet is the alpha and omega/' So far as scurvy in babies is con- 
 cerned the opinion of the American Pediatric Society, rendered some twenty 
 years ago, was that "the farther a food is removed in character from the 
 natural food of a child the more likely its use is to be followed by the develop- 
 ment of scurvy." 
 
 The above statements are true of touches of scurvy as well as of developed 
 scurvy. After a person has been living on a meat and bread diet for several 
 months and has developed a touch of scurvy it is necessary in order to cure 
 him to go a little further in the dieting line than would have been necessary 
 had the intent been to prevent alone. In other words, the diet must act as 
 a cure as well as a preventive. 
 
 The consensus of opinion is that the vegetable acids and carbonates are 
 the chemicals in vegetables and fruit which prevent scurvy. 
 
 Most of the diets put out as proper for certain diseases are without scien- 
 tific basis. Here is one of the few exceptions. Scurvy, including touches of 
 scurvy, is to be cured by diet and practically by diet alone. 
 
 A long while ago Hirsch printed the following as the grains per ounce 
 of carbonate of potash in certain foods: 
 
 Large potatoes 1.875 Beef (salted) 0.394 
 
 Small potatoes 1.310 Onions 0.333 
 
 Lime juice 0.852 Wheat bread 0.258 
 
 Lemon juice 0.846 Cheese (Dutch) 0.230 
 
 Unripe oranges 0.675 Flour (best) 0.1 
 
 Mutton (cooked) 0.673 Oatmeal 0.054 
 
 Beef (raw) 0.599 Eice 0.1 
 
 Peas 0.529 
 
 The best foods for scurvy, according to this list, are potatoes, lime juice, 
 and lemon juice. 
 
 While we are not all agreed as to just what chemical does the work, 
 there is a general agreement that it is some chemical found in fruits and 
 fresh vegetables. Among fruits the best are lemons, oranges, and grapefruit, 
 though all fruits are good. Among vegetables those heading the list are 
 potatoes, watercress, cabbage, lettuce, and sauerkraut. 
 
 Of course, babies cannot go so far as sauerkraut. Usually they must 
 stop with orange juice, prune juice, and perhaps some of the older ones can 
 take lemon or lime juice. 
 
 Well-cooked potatoes may come along after the infant has been trained 
 to digest starches, with oatmeal gruels and crackers. 
 
 Some of the old-time reports on vegetables and scurvy are interesting. 
 Herr says that in the Army of the Potomac in the winter of 1862-63 there 
 was much scurvy. Fresh vegetables could not be had at all. After a great 
 deal of difficulty the soldiers got a small stock of potatoes and cabbages. 
 The beneficial effect of even this small supply was marvelous. 
 
 In the siege of Paris in 1871 "it was when the supply of fresh vegetables, 
 particularly of potatoes, failed that the disease broke out." 
 
 The amount of scurvy has greatly lessened in the last few centuries. 
 Drawitz wrote in 1647: 
 
SCURVY 181 
 
 "All mankind will soon be scurvied, for most children are conceived in 
 scurvy and born with it." 
 
 In the sixteenth century vegetables were so few, Hirsch tells us, that 
 when Catherine of Aragon, wife of Henry VIII, wanted a salad for her table 
 she had to send her gardener to Holland to get it. 
 
 In that meat-eating age scurvy was rife, not directly because of the 
 abundance of meat but indirectly because of the scarcity of vegetables and 
 fruits. 
 
 It would be proper to say that the railroads cured the worst of the 
 scurvy situation. Cold storage deserves about as much of the credit. Truck 
 gardeners and fruit growers are entitled to their, share. 
 
 However, those who read this volume are especially interested in the 
 personal side. "How can I get through this winter and early spring without 
 skin eruptions, rheumatic pains, puffy face, and the other signs of a touch of 
 scurvy ?" 
 
 The first requisite is to eat fruit for breakfast. Especially should the 
 Southern people substitute fruit for some of the meat in their heavy biscuit- 
 steak-waffles breakfast. Two fruits should be eaten each morning — one raw 
 and one cooked. 
 
 The best raw fruits are oranges, limes, lemons, grapefruits, pineapples, 
 and apples. In addition cooked apricots, apples, peaches, pears, baked 
 apples, or other fruit should be eaten. As soon as the berries come in the 
 spring scurvy goes out. 
 
 An excellent plan is to keep apples handy. A plate of well washed 
 apples should be in the sitting room. Indoor workers will do well to eat at 
 least one apple during the day and one before retiring at night. 
 
 If apples are not to be had there is a good substitute — the turnip. Every 
 farmer can go into winter quarters with plenty of turnips. A nice raw turnip 
 is about as palatable for most people as a raw apple. Eaw turnip is no more 
 apt to give stomachache than is a raw apple. 
 
 Winter is the season of the year when raw carrots are good for the 
 complexion. A muddy complexion characterizes scurvy unless profuse hemor- 
 rhage has changed it to a ghastly color. 
 
 Eaw carrots, by preventing and curing spring touches of scurvy, may 
 prevent some muddiness, some pumness, and may cure up some spring 
 blotches. 
 
 An excellent preventive of scurvy, not in good standing with some 
 people, is collards. This vegetable, sometimes called winter collards because 
 it stands the cold well, is found in the gardens of most negroes in the South. 
 It is worth a great deal to health that the winter-bound negro laborers, 
 living on a narrow diet, can have a mess of collards, the great scurvy killer, 
 once or twice a week. 
 
 Eaw vegetables are better than cooked from the scurvy standpoint. There 
 is some reason for thinking that there are ferments — delicate chemical sub- 
 stances — present in raw vegetables and essential for health, and that these are 
 destroyed at the cooking temperature. Probably also the salts of vegetables 
 are washed out in the cooking process, and- these necessary substances are 
 thrown away with the cooking water. 
 
 A good vegetable soup containing carrots, parsnips, potatoes, turnips, 
 
182 
 
 SCURVY— SCKOFULA— RICKETS 
 
 okra, and onion is healthy. Above we gave the usual list of vegetables pre- 
 scribed by physicians — potatoes, cress, cabbage, lettuce, and sauerkraut. 
 To it we have added carrots, turnips, okra, parsnips, and collards. 
 
 We can also say a good word for greens of all sorts. Spinach is the 
 most popular. It is easy to carry spinach in cold storage, and in consequence 
 this top finds its way into market all through the winter. 
 
 Just as good are mustard, turnip, and beet greens. Asparagus, cauli- 
 flower, kohlrabi, and Brussels sprouts are in the same class with cabbage. 
 Many people gain by making a soup of the water in which these vegetables 
 have been cooked. Tomatoes and all other forms of tart vegetables and fruits 
 are good means of warding off scurvy. 
 
 SCURVY, HOW TO KNOW IT AND WHAT TO DO ABOUT IT 
 
 Scurvy in babies develops when they are 10 to 14 months old. Some 
 younger and some older ones have it, but those are the months of greatest 
 danger. It will be noticed that this is just the time of life when the baby has 
 been taken off fresh breast milk and has not yet got on a diet containing 
 vegetables and fruits. 
 
 Poupart's Ligament Group 
 Perineum 
 Genitalia 
 
 Buttocks (internal aspect) 
 Lumbar region 
 
 Saphenous Group 
 Foot 
 Knee 
 Leg 
 Buttocks (external aspect) 
 
 Fig. 79. — Diagram of the Gland Groups in the Groin and the Regions Which Should 
 BE Examined for Sources of Infection When These Glands are Enlarged. 
 
SCURVY, HOW TO KXOW IT AND WHAT TO DO ABOUT IT 183 
 
 The disease begins usually as follows : A fat but trail and flabby baby 
 is feverish and fretful for a few days. Then it will be noticed that the 
 child's limbs are so painful that it cries out when they are moved. The 
 bones are swollen, sore, and tender. The skin over the areas of tender bone 
 may be swollen and glossy. 
 
 The gums are boggy and painful. Some children thought to be "teeth- 
 ing" have scurvy. There may be pin-point or pin-head hemorrhages in the 
 skin or the lining of the mouth, or there may be bleeding from the gums, 
 the nose, or the bowels. 
 
 In grown people the symptoms are about the same. I once saw a stone 
 quarry worker brought into Dunning so 
 pallid and orange tinted that he looked 
 perniciously anemic. He suddenly bled 
 like a consumptive with a hemorrhage — 
 an extreme condition one seldom sees in 
 our day. 
 
 The baby having scurvy must have 
 fresh food. Orange juice, almost a neces- 
 sity with city babies, becomes not almost 
 but altogether a necessity when scurvy de- 
 velops. Lemon juice, peach juice, apricot 
 juice, prune juice are also good. Eaw meat 
 juice and a baked potato with plenty of 
 good -gravy are better than medicine out 
 of a bottle. 
 
 A good doctor, anxious to do every- 
 thing that should be done, will probably 
 give the baby some iron and arsenic. If 
 scurvy develops in a baby fed on sterilized 
 or pasteurized milk, it is wise to change to 
 a high grade, clean, fresh, cold raw milk, 
 and such milk in a, large city means prop- 
 erly certified milk. In the country or in 
 smaller cities milk from a good cow kept 
 on the lot fills the bill. 
 
 For the cure of scurvy in grown persons the principles of treatment are 
 the same, more latitude, however, being allowable. For instance sauerkraut 
 and beef tea are fine for grown people with scurvy, but not for babies. 
 Three pints of good fresh milk contain as much citric acid as one ounce of 
 lime juice, and therefore milk is good, and so are pickles and all sorts of 
 fruit and vegetables. 
 
 Nansen prevented scurvy among his men by feeding them meats, dried 
 fish, potatoes, and all sorts of dried and preserved vegetables and fruits, 
 marmalade, condensed milk, preserved butter, and desiccated soups; as bever- 
 ages they got tea, coffee, cocoa, beer, and lemonade. 
 
 Some explorers have escaped scurvy by eating all the rats available, and 
 by feeding on fresh dog from time to time. When we are disposed to grow 
 discontented with the results of the battle against disease it is reassuring to 
 think of scurvy. 
 
 Y" 
 
 I 
 
 c* 
 
 
 1 p 
 
 
 / f^ 
 
 
 /w 
 
 
 ; 
 
 ] 
 
 
 i 
 
 yl 
 
 
 
 a 
 
 
 
 A 
 
 % 
 
 
 ul 
 
 "^ 
 
 
 Fig. 80. — Location of Lymph Glands 
 Which Frequently Enlarge. 
 
184 SCURVY— SCROFULA— RICKETS 
 
 We read of the Crusades, and of how scurvy beat back expedition after 
 expedition, or we come down to 1780, and read of how Admiral Geary's chan- 
 nel fleet was obliged to put back to England because 2,400 of the crew were 
 down with scurvy. Let us compare this with the experiences of the present 
 day. A family physician practicing among the average families in a town of 
 fifteen or twenty thousand may go through his professional life without see- 
 ing a case of scurvy. 
 
 May Be Scurvy. — J. B. J. writes: "What is the cause of the gums 
 becoming sore, also bleeding, and the spaces between the teeth increasing? 
 A dentist says this is not pyorrhea. 1 am 28 and have never had any 
 trouble with my teeth before. The gums seem to be falling away from the 
 teeth. What would you advise?" 
 
 Reply. — Assuming that your dentist is right and you have not pyor- 
 rhea, you may have scurvy or some form of poisoning, such as mercury, 
 lead, or phosphorus. Your trade may help you to an opinion as to the trade 
 poisoning. You may get lead poisoning from drinking charged waters. 
 
 Scurvy is the most likely of the group. Many people get moderately 
 scurvied in winter. 
 
 SCROFULA 
 
 Strauss tells us that scrofula was so named because when the neck swells 
 up in that disease it looks like the neck of a pig, and "scrofa" means pig. 
 The Bureau of Animal Industry finds that practically every pig that has 
 tuberculosis has enlarged glands in the neck. In most carcasses the tubercular 
 glands in the neck are about the only evidence of tuberculosis in the body. 
 
 However, this relationship between scrofula and tuberculosis, and par- 
 ticularly between scrofula and the usual location of tuberculosis in pigs, is 
 not the reason why the disease was called scrofula. 
 
 Another name for scrofula was "king's evil/' The royal families were so 
 frequently scrofulous in those early days that the disease came to be regarded 
 as a morganatic hallmark of royalty. 
 
 We see that they were trying to hitch scrofula up with all sorts of rela- 
 tions because they did not know of the real relation of scrofula to tubercu- 
 losis. About 100 years ago it first began to occur to scientists that scrofula 
 and tuberculosis were the same disease, but the information in hand was so 
 slight and the methods of examination so crude that the men who tried to 
 find out if the two diseases were one came to the conclusion that they were 
 not. 
 
 About half a century ago Villemin proved that scrofula was tuberculosis, 
 but the proof was but slowly accepted. Even Virchow, the master medical 
 mind of his day, rejected Villemin's proof for a long time. 
 
 Practically everybody now agrees with the view expressed by Osier that 
 scrofula is not a disease of itself but only a special form of tuberculosis 
 peculiar to children. 
 
 In Strauss' history of the controversy over scrofula and tuberculosis we 
 find many points touched upon that are now in the limelight as parts of the 
 Friedmann plan of cure. 
 
 Scrofula, meaning piglike, has some new claims to accuracy. Like pigs, 
 
RICKETS 185 
 
 children get it by "following" cows; the tubercle bacilli are swallowed with 
 the food, and the food usually eaten raw is milk. They are absorbed and 
 go into the blood. The lymph glands filter them out. The blood is saved, 
 but the lymph glands are badly punished, in fact may die. The bacilli may 
 never get into the system. Sometimes they get by and set up an ordinary 
 consumption. 
 
 Behring and Harbitz think a great deal of the consumption is due to 
 bacilli that have escaped from the glands. Other authorities cto not give this 
 route of infection so much prominence. 
 
 In scrofula, in addition to the enlargement of the glands of the neck, there 
 is trouble in the mouth, nose, and throat. A dis- 
 tinguished Frenchman, Velpean, once wrote : 
 
 "The patients, even the physicians, get engrossed 
 with the swelling in the neck and forget the condi- 
 tions in the mouth, tonsils, teeth, nose, and throat 
 which lie back of the neck condition." 
 
 This is as true today as it was when Velpean \ » / 
 
 wrote it. x, J S 
 
 Scrofula is not what it used to be. The old, ' * 
 
 , n -I-, o i Fig. 81. — Shape of the 
 
 eternally running sinuses are seldom seen. Such scull in Ricketts. 
 
 neglect would not be tolerated now. Their day 
 
 ended when Fenger taught surgeons to dissect away carefully every bit of 
 
 tubercular gland in the neck. 
 
 At the present day cases are seldom neglected badly enough to make the 
 Fenger operation necessary. Many of them are stopped now before any op- 
 eration is necessary. Those that need operation seldom need the more radical 
 operation. 
 
 Having come so far, we should go a step farther and cease using tuber- 
 cular milk. 
 
 RICKETS 
 
 Once upon a time one physician — a children's specialist — went through 
 the wards of a municipal hospital closely examining the children. He found 
 that 70 per cent of the children showed signs of rickets. A few days later 
 another children's specialist went over the same lot of children and found 
 only 5 per cent of them showed signs of rickets. 
 
 A well-developed case of rickets no physician would fail to discover, 
 but there are signs of rickets which might be overlooked by anyone, and 
 others about which one person would hold one opinion and another person an- 
 other. For medicine differs not from law or business or weather prognostica- 
 tions in that in all of them, as in everything else, men differ. 
 
 A physician who cannot diagnose diphtheria until the patient chokes, 
 or typhoid until flies crawl over the eyes, or smallpox until the smallpox odor 
 develops, is not much of a doctor, certainly is not worth his pay. And it is 
 with rickets much as it is with other diseases — the serviceable time to find it 
 is when it is beginning. 
 
 This is less true of rickets than of most diseases. Neglect does harm, 
 but the harm can often be remedied. For instance, rickets is the cause of 
 
186 
 
 SCUEVY— SCEOFULA— RICKETS 
 
 bowlegs. There is not one bowlegged grown person for every five bowlegged 
 children. Why? The legs have got straight. Eidlou says this statement is 
 not true. 
 
 Unless the bone changes in a case of rickets are bad, they will clean up 
 if the conditions which caused them are removed. Therefore a mother who 
 notices that the baby is bowlegged or pigeon breasted need not be down- 
 hearted. With a little intelligent direction and proper attention on her 
 part the conditions will disappear. 
 
 I think that we have all noticed that bony deformities are less often 
 seen than formerly. Amongst the young we seldom see badly twisted spines 
 
 and legs badly bent. 
 Stiff joints and hunch- 
 back should disappear 
 in another generation, 
 and as they go into the 
 discard bowlegs, pigeon 
 breast, rosary chest, the 
 ricket-caused group, 
 should lead the way. 
 
 The bones of a 
 child contain much car- 
 tilage and little lime. 
 As lime stiffens the 
 bones the child learns 
 to use its limbs for 
 walking. The two proc- 
 esses go hand in hand. 
 Wise nature keeps 
 either from getting ahead of the other. Not so in rickets, where the cartilage 
 part of the bone continues to grow, in fact overgrows, but the deposit of lime 
 salts does not keep pace. Thereupon the bones become like what we know 
 commercially as whalebone, in that they bend in whatever direction any 
 force drives them. The legs bow, and the arms would bow, too, if the child 
 tried to stand on them. In fact, they do bow in four-legged animals suffering 
 from rickets. 
 
 The ribs take on unnatural curves, curves that make the lungs more sub- 
 ject to consumption, and in the thumb-sucking child the palate arches up and 
 the teeth are thrown out of line. 
 
 Fiq. 82. — Cranial Contours (comparative) — Anteropos- 
 terior — Circumference — Transverse. The upper fig- 
 ure represents the hydrocephalic head and the lower figure 
 represents the rachitic head. 
 
 HOW TO KNOW RICKETS AND WHAT TO DO FOR IT 
 
 A good sign is that the baby does not teethe right. Sometimes the teeth 
 come too early; usually they come too late. When they come they crumble 
 easily. If the year-old baby has no teeth or if teething starts and then no 
 teeth come for several months the baby is rickety. 
 
 Sweating of the head is a suggestive sign. If a mother notices that the 
 baby's pillow is soaked with sweat she should look closely for other evidences 
 of rickets. 
 
HOW TO KNW RICKETS AND WHAT TO DO FOE IT 187 
 
 Another sign is marked slowness in walking, particularly if the baby 
 has been nursed by a badly run-down mother or has been eating condensed 
 milk or cereals. 
 
 That he is fat is no sign that he is free from rickets. On the other hand, 
 fat, fine-looking babies are frequently 
 rickety, particularly when they are soft 
 and flabby looking. 
 
 The very foods which fatten babies 
 • — sugared condensed milk, cereals, sweets 
 — also cause rickets. These out-of -bal- 
 ance foods sometimes cause overfatness, 
 sometimes rickets, and sometimes both 
 conditions, side by side, in the same baby. 
 
 Following much the same mental 
 process as the mother does when she 
 thinks her fat baby is a healthy one, she 
 thinks a sweaty forehead means only 
 that her baby is fat — when it really 
 means rickets. 
 
 A rickety baby is liable to have a Daniel Webster head. A broad, over- 
 shadowing forehead with a flat top may mean hydrocephalus, or water on 
 the brain, or one or two other congenital conditions. Xine times out of ten 
 a large, square forehead in a baby means rickets. The head sign of rickets 
 most frequently found is a slow-closing fontanel. Instead of being %xl 
 
 Fig. 83. — "Pigeon Chest." 
 
 Fig. 
 
 84. — Round Type of Chest. Incip- 
 ient disease in right side. 
 
 Fig. So. — Flat Type of Chest. Ex- 
 pansion in one year, coincident with 
 marked improvement. 
 
 inch at one year of age, it measures 1x2 inches. Instead of closing at eighteen 
 months, it does not close for two or three years. 
 
 "Pot belly" is a rickets sign. So is peevishness, a mental irritability not 
 otherwise explainable. Generally speaking, these are early signs and the 
 mother who is shrewd enough to find them and change the baby's feeding 
 in time never sees the development of bony deformity. Otherwise, presently 
 the baby is found to be bowlegged or, what is of much greater importance, 
 the baby, instead of being barrel-chested, is pigeon-breasted; or else, by the 
 
188 
 
 SCUEVY— SCEOFULA— RICKETS 
 
 side of the breastbone, and about one inch away on each side, there is a 
 row of beady knobs. Or the skull becomes irregular and distorted, the fore- 
 head large and square, and thin places appear here and thick ones there. 
 
 While the legs usually bow out, they are liable to twist in any direction. 
 
 A baby found to be rickety should go under medical direction. Not that 
 medicine does much good, for, while phosphorous preparations help and symp- 
 
 Fig. 86. — Bulging Backward on Ac- 
 count of Scoliosis. Correction of 
 scoliosis. 
 
 Fig. 87. — Marked Shrinkage of Left 
 Lung, Due to Postpneumonic Em- 
 physema. Restoration of normal pe- 
 rimeter in three months by exercises. 
 
 tomatic treatment is called for, the main things to do are hygienic. The indi- 
 cations are, change of milk — to get it purer and richer; drop some starch 
 and sugar out of the diet; to bring about better home conditions. These are 
 the things that need to be done — and that means medical direction. Going 
 first to one doctor for a bottle of medicine, and then to another for some 
 powders is not medical direction. 
 
 Cause of Rickets. — M. E. T. writes: "What is the cause of rickets? 
 How can rickets be prevented? What are the symptoms? What is the 
 cause and what are the symptoms of infantile scurvy? 
 
 Eeply. — 1. Eickets may be caused by one of several things. It may be 
 caused by several things operating together, and usually is. The cause that 
 
 o 
 
 Fig. 88. — A. Nearly Normal Stomach. B. Dilated Stomach. 
 
 found in rickets. 
 
 A condition frequently 
 
 overshadows all others, however, is poor food. The usual fault with the 
 food is that it contains too much sugar and starch and not enough fat. 
 In other words, the child gets too little cream and too much cereal and 
 
HOW TO KNOW EICKETS AND WHAT TO DO FOE IT 189 
 
 bread. Other causes are overheated and overcrowded living and sleeping 
 rooms, dark rooms, rooms opening out on dark and dirty alleys, poorly 
 constructed and ill-ventilated apartments, basements, and the like. Some- 
 times the mother must work and the baby must be left with children who 
 feed it mildly spoiled milk, watery milk, too much cereal. 
 
 2. By correcting such conditions as named above. 
 
 3. Scurvy is caused by eating too much stale food and not enough fresh 
 food, especially good fresh milk and fruit juice. Older children suffer 
 from scurvy when they do not get vegetables and fruit. The symptoms are 
 about as follows : The baby is feverish and fretful for a few days. Then 
 it will be noticed that the child cries out when its limbs are moved. Exam- 
 ination shows the bones to be 
 swollen, sore, and tender. The 
 skin over these areas is swollen 
 and glassy. The gums are boggy 
 and painful. There may be hem- 
 orrhages in the skin or lining of 
 the mouth. There may be bleed- 
 ing from the gums, the nose, or 
 the bowels. 
 
 Child Has Rickets.— C. A. M. 
 
 writes: "Our hoy, 19 months old, 
 was horn with a slight curve in 
 
 the lower part of his limbs. This FlG - 89.— Shape of Head in Rickets. 
 
 was harely noticeable, however, 
 
 until he started to creep, or hitch, and this doubled one leg under the other, 
 so that, after four months, one leg is badly curved. He has been walking 
 for two weeks "and both limbs curve outward at the knee. He has some 
 stomach trouble and is rather nervous. We have given him for the last 
 year almost entirely malted milk, which agrees with him. Cows' milk is 
 tabooed, as he cannot digest it; also it causes constipation. Aside from 
 the legs he is perfect physically and is plump. What would you advise in 
 regard to the limbs?" 
 
 Reply. — You should take the boy to a children's specialist. He is 
 rickety, and probably has been for months. That he has not walked until 
 nearly 19 months old suggests rickets; that his bones are so soft that they 
 bend under pressure proves it; that he is "perfect physically and plump" 
 (except for the curves in his bones) does not disprove it. Babies that get 
 a good deal of starch and sugar are apt to be plump and rickety. Certainly 
 the child has indigestion, which is partly responsible for the rickets. 
 
 Not Much Difference. — Mrs. L. A. R. writes: "From the viewpoint of 
 the mothers regaining strength and of the child's well-being, which is the 
 best time of year for a child to he horn? Will you also tell me if a child 
 ever inherits a tendency to rickets?" 
 
 Reply. — 1. I have read several discussions of the subject. They have 
 been based on average weights and rate of growth of a large number of 
 children. It has not seemed to me that there was much difference. Spring 
 babies are pretty certain to be at the breast the first summer and with 
 trained stomachs during the third. So they have but one cow's milk sum- 
 mer. Therefore they are less liable to the baby's greatest hazard, summer 
 complaint. 
 
190 
 
 SCURVY— SCKOFULA— KICKETS 
 
 2. Yes. Some children are born with rickets, 
 disposition toward it. 
 
 Some are born with a 
 
 Treatment of Rickets.— J. A. V. writes: "Please tell me the best treat- 
 ment for a child 17 months old who has symptoms of rickets/' 
 
 Reply. — Vegetables, fresh food, fresh rich milk. However, if your child 
 shows signs that you think mean rickets have your physician see it, make 
 certain of the diagnosis, find out where the regimen has been wrong and 
 tell you what to change. 
 
 Might Be Rickets. — Mrs. J. E. A. writes: "My grandson, 1+ years old, 
 sweats dreadfully, even on cold nights. Sleeps in a gown only and in room 
 
 Fig. 90. — Bowlegs. 
 
 Fig. 91. — Knock Knees. 
 
 with open doors and windows. In half an hour after going to bed his 
 pillow will be perfectly wet, or even the mattress, without a pillow. His 
 parents are perfectly healthy, and he is well, though he has a delicate look. 
 He is not a strong child. Can you suggest the probable cause and a rem- 
 edy?'' 
 
 Reply. — When a young child sweats profusely at night, especially if 
 the pillow is made wet, one thinks of rickets. Is he bowlegged? Has he 
 digestive disturbance? The cure for rickets is fresh air and sunshine, a 
 diet rich in meat, meat juice, butter, fruit, and vegetables, proper atten- 
 tion to diet, cold baths, followed by brisk rubbing and iron tonics. Have 
 your physician decide whether he is rickety or scurvied. 
 
 Curvature of the Spine. — E. S. writes : 
 follow as a result of English disease? 2. 
 ever have children?" 
 
 "1, Does curvature of the spine 
 Can a woman who has had both 
 
 Reply. — 1. English disease is a name sometimes given to rickets. 
 In a bad case of rickets the spine may curve. Bowlegs is a curving of the 
 leg bones due to rickets. Pigeon breast and rosary chest are conditions 
 resulting from unnatural curving of the ribs from rickets. Some years ago 
 I saw spinal curving in some Lincoln park baby animals resulting from 
 
HOW TO KNOW BICRETS AND WHAT TO DO FOR IT 191 
 
 rickets. However, little spinal curvature is due to rickets, certainly not 1 
 per cent. The usual cause is bone tuberculosis. 
 
 2. Women with spinal curvature, women who have had rickets, and 
 women who have both conditions can conceive. Whether or not they should 
 is dependent upon how strong and vigorous they are and how great the 
 deformity is. The deformity is no bar to bearing children, provided the 
 lower half of the trunk is roomy enough. That point should be decided on 
 by good medical advice. 
 
CHAPTEE XVIII 
 
 Contagion — Disinfection 
 
 Time was when epidemics of contagious disease were charged to the wrath 
 of God. Others thought they were due to devils. This was followed by the 
 age in which epidemics were recognized as the material results of material 
 forces acting in a material way. But the opinion and procedure even of that 
 day were tinctured with mysticism. 
 
 CONTAGION AND INFECTION 
 
 The older dictionaries gave quite elaborate and finespun differences 
 between these two groups of diseases. They went further and classified 
 
 communicable diseases 
 into the two groups. 
 The later dictionaries 
 have thrown those old 
 classifications into the 
 wastebasket. I hope 
 the people have done 
 the same. There are 
 only a few of these 
 communicable diseases 
 and there is no par- 
 ticular trouble in re- 
 membering how each 
 is communicated. Try- 
 ing to classify them 
 will not help any. 
 
 Smallpox is spread 
 by persons ill with 
 smallpox or just re- 
 covered from it. The 
 rule is to isolate the 
 smallpox patient and 
 for every person to 
 keep away from him. 
 A person properly vaccinated is permitted to violate this rule. 
 
 Chickenpox is spread by persons who have or very recently have had the 
 disease. 
 
 Diphtheria is spread by persons who are ill with diphtheria or who 
 
 192 
 
 
 1908 
 
 1909 
 
 1910 
 
 1911 
 
 1912 
 
 1913 
 
 1914 
 
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 OOPWG COU* 
 
 V 
 
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 > 
 
 700 
 
 
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 '••' % 
 
 V 
 
 
 
 
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 JWO 
 
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 New York State Board of Health 
 Fig. 92 
 
 Decrease of Contagious Diseases in New York 
 State. 
 
ON EEPOETIKG CONTAGIOUS DISEASES 193 
 
 have ordinary sore throat due to the diphtheria bacillus or whose throats 
 harbor diphtheria, but who are not sick. The rule is to isolate not only 
 those with diphtheritic membranes in their throats, but all who have diph- 
 theria bacilli in their throats. 
 
 Scarlet fever is spread by those who have the disease typically or 
 atypically. As we do not know the germ of scarlet fever, a good deal of 
 uncertainty prevails as to how long the disease is contagious. The shrewdest 
 guess is that it is contagious as long as the throat is sore or the tonsils are 
 swollen and boggy. The rule is to isolate the patient whether he is seriously 
 ill or is not seriously ill. 
 
 Measles is spread by those who have the disease. We must not forget 
 that the disease starts when the fever, aching, and cough begins. The erup- 
 tion is merely an incident. Some patients do not have it at all. The rule 
 is to isolate and to begin the isolation early. In measles times every child 
 with a fever, cough, and watery eyes should be isolated. If the disease turns 
 out to be an ordinary cold not much has been lost. On the other hand, 
 measles is most contagious before the breaking out appears. 
 
 Typhoid fever is spread by those who have the disease and by carriers. 
 We know a lot about the typhoid germ. Unlike some of the others it can 
 be carried long distances. It can get on a fly and be carried a few blocks 
 (by the wind) or a thousand miles (by a railroad car). It can get in milk 
 and be carried as far as milk is carried. Eegardless of how far it is carried 
 the trail started with a man who had the disease. 
 
 The rule is to isolate, not absolutely but partially, to keep flies away from 
 the patient and from his excretions, to see that no food, outside of the food 
 for the patient, is prepared by the attendants or in the neighborhood of the 
 sick man; to allow as many visitors as the patient cares to see or his doctor 
 will let him see, but the visitors must be careful of their fingers. 
 
 ON REPORTING CONTAGIOUS DISEASES 
 
 Contagious diseases are preventable. They cannot be prevented after 
 they have occurred, though a lot of people mistakenly think so. When a 
 physician is called in at the onset of typhoid fever or scarlatina he is often 
 asked, "Can't you give some medicine to stop it?" Once a disease, particu- 
 larly a contagious disease, lias set in, it will run its course. It will not only 
 run its course, but it will infect others and cause the same disease in them — 
 unless its spread is checked. 
 
 Before anything can be done to stop the spread of contagious diseases 
 the health authorities must know where the cases now existing are. Without 
 such knowledge nothing can be done. 
 
 The city ordinances require that the physician in attendance, parent, 
 guardian, or the owner of the house where such a case exists, shall report same 
 to the health department. This is to be done just as soon as the diagnosis is 
 made, by telephone, and within twenty-four hours in writing. 
 
 The following diseases are to be thus reported: smallpox, diphtheria, 
 scarlet fever, typhoid fever, tuberculosis, measles, whooping cough, chicken 
 pox, infantile paralysis, meningitis, erysipelas, typhus, pneumonia, mumps 
 
Introduction of 
 Antitoxin Treatment 
 
 1900 '02 '04 '06 'OB '10 U '14 
 
 1885 '87 189 '91 '» '95 '97 
 
 iVeio York State Board of Health. 
 
 Fig. 93. — The Decline in Diphtheria in New York State. 
 
 194 
 
CONTROL OF CONTAGION IN SMALL TOWNS 195 
 
 and any other disease of a contagious character. The penalty for not re- 
 porting cases of contagious diseases to the proper authorities is from $10 
 to $200. 
 
 The prime importance of reporting contagious diseases was recognized 
 and enforced by legal enactment many years ago, even before their contagious 
 character was scientifically proven. In 1782 a law was passed in Naples 
 fining any physician 300 ducats for the first offense, in a case of consumption. 
 If the offense was repeated he was to be banished from the country for ten 
 years. About the same time similar laws were passed in Spain and Portugal, 
 making failure to report such cases on the part of physician or family punish- 
 able by fine and imprisonment. 
 
 If all cases of contagious diseases occurring were reported the matter 
 would not need to be written about. The fact is that many of the most 
 serious cases of diphtheria, scarlet fever, consumption, and typhoid go un- 
 reported. Of the milder contagions, such as measles, whooping cough, chicken 
 pox, and mumps, probably not more than one-fourth are reported. 
 
 The harm done by the unreported cases is incalculable. Each case not 
 reported and not properly cared for is the starting point for several other 
 cases. Much illness and many deaths are due to this one factor. Most 
 doctors do their duty in this respect — all of them would like to do it. 
 
 The discharge from the family's service of an able, honest physician for 
 no other reason than that of having reported a case of contagious disease 
 in the family is an everyday occurrence. A less dutiful and usually a less 
 able physician is called in. 
 
 We know of many physicians who have gained notoriety and patronage 
 because of the fact that they do not report cases of contagious diseases. The 
 inconvenience of quarantine in most cases and perhaps some interference 
 with business in others constitute the objection on the part of narrow-minded, 
 ignorant people to having cases occurring in their families reported. Thus 
 they sow the wind, and the community reaps the whirlwind. 
 
 Stringent application of existing ordinances, sufficient hospitalization 
 facilities for all contagious diseases, and the education of the public are the 
 remedies. 
 
 CONTROL OF CONTAGION IN SMALL TOWNS AND COUNTRY 
 
 In large cities, measles, diphtheria, and scarlet fever are present all 
 the time, and smallpox more than half the time. Small cities and country 
 communities will go for a year or more without a case of these diseases, and 
 then comes a sweeping epidemic. Therefore, the science of fighting con- 
 tagion in the city is one thing, that of fighting it in the country is another. 
 
 This coming and going, this intermittence, is the quality which makes 
 it easy to control contagion in the country, when the community takes 
 an interest in the welfare of its people. 
 
 Closing schools, with all its expensive waste, is a procedure that they 
 have abandoned; communities paralyzed in a business way by epidemics are 
 something which they remember but no longer tolerate. The meningitis 
 experience through which Texas has just passed might have occurred in 
 
6 
 
 H 
 
 ■8 
 
 3-1 
 
 sisvo 
 
 aiguniM 
 
 196 
 
CONTROL OF CONTAGION IN SMALL TOWNS 197 
 
 England a few years ago, but not now. In Germany and England travelers, 
 pleasure and health seekers, and business men no longer shun great districts 
 because of fear of uncontrolled epidemics. 
 
 A country epidemic commonly begins with a case which seems to have 
 dropped down like lightning out of a clear sky. We shall take diphtheria 
 as an illustration. 
 
 When a case appears inexplainably, those who argue that diphtheria can 
 spring up spontaneously can make out a pretty good case (the believers in 
 spontaneous generation are not all dead yet). 
 
 Occasionally this first case will occur among people who are not very 
 clean, and those who believe that diphtheria is a filth disease find support 
 for their position. 
 
 Both are wrong and fairly careful detective work will usually prove it. 
 Occasionally, English health journals print accounts of diphtheria in rural 
 England which show how careful detective work has marked out the train 
 of the itinerant carrier of mild diphtheria, called sore throat. The New 
 York authorities were able to follow the typhoid trail of one woman, and she 
 not sick, over much of New England. 
 
 In this way the Chicago Health Department trailed a typhoid carrier, 
 by cases that formerly would have been called sporadic, from Chicago to 
 Gray's Lake (Illinois) and back again to Chicago. 
 
 Now, when a case of diphtheria, scarlet fever, or measles breaks out 
 in Watseka, Illinois, or What Cheer, Iowa, it is because somebody who carries 
 contagion has been in town recently. At the very earliest, ten days or two 
 weeks elapses from the time the spreader arrives until the first case is diag- 
 nosed. In that ten days, the spreader may have moved on. Therefore, the 
 connection will not stand out plain and easy to see. 
 
 However, if careful inquiry is made, the sick child can usually locate 
 the harming contact as lying between a small number of people — say five. 
 She will remember some person with some suspicious sign. 
 
 Inquiry into the medical history of these, clinical examinations of their 
 throats and skins will generally identify the carrier or a typical case, or will 
 bring out information of a recent exposure of someone who was "a little 
 sick," or had a. "little sore throat/' or a "cold," or a "stomach rash." 
 
 Now, small towns and country schools should have no diphtheria, scarlet 
 fever, or measles — ever. For years to come Chicago must have them always — 
 there is no escape. But not so Pontiac, Illinois, or Edgerton, Wisconsin. 
 
 A few places such as Valparaiso, Indiana, Summit, Illinois, and La 
 Crosse, Wisconsin, have seen what they can do to give security to their people 
 and increase the intervals between epidemics until such time as they can 
 wholly eliminate them. 
 
 How are these intervals to be made longer and the disease finally elimi- 
 nated ? 
 
 First, there must be a central health authority, a health officer who 
 knows some rudiments of epidemiology. Where this is not a workable con- 
 dition, the school principal is an intelligent agent, clearly in touch with 
 the common channels for the spread of infection — the children — and, through 
 them, in a position to know of conditions in the homes. He can be of great 
 service pending a public demand for a special trained health officer. 
 
198 
 
 CONTAGION— DISINFECTION 
 
 Second, cases suspected of being contagious must be reported at 
 once. 
 
 Third, isolation or quarantine must be made as little burdensome as 
 possible. 
 
 Fourth, through the health officers, school teachers, and principals car- 
 riers of infection must be located and controlled at once. 
 
 Fifth, school inspection must be inaugurated and continued until the 
 focus has been stamped out. 
 
 This plan is much cheaper and much more effective than the present 
 plan. In essence, it consists in early and quick action — nipping the weed 
 in the bud, and then following down the stem to the root and digging 
 that up, the plan which has been found necessary with Johnson's grass. 
 i fcgsjw 1 1 1 11 it rv i, .j___jl 3 __j The method which it is sug- 
 
 gested that this supersede is 
 about as follows : A case of scar- 
 let fever breaks out in a family. 
 The well children continue at 
 school. Presently a second case 
 occurs, and the neighborhood be- 
 gins to talk a little about scarlet 
 fever being in town. In two 
 weeks, the third crop of cases 
 breaks out, and the neighborhood 
 is getting badly frightened. 
 
 Ten days later, new cases 
 are developing every day. There 
 are no longer crops of cases. 
 New cases are appearing here and 
 there, the disease is no longer sticking closely to neighborhoods. 
 
 The local authorities call a public meeting; the state board of health 
 is called in; guards are employed; schools are closed; the teachers get a 
 vacation with pay; the town is badly upset; the country around is afraid 
 to come to town to trade ; business is at a standstill. 
 
 About this time the community is thoroughly awakened, and the epi- 
 demic speedily dies out. 
 
 It is always easy to control an epidemic in the country or a small town 
 when effort is made. 
 
 This plan — letting the fire burn until it gets to the business district — 
 is effective enough, but it is too expensive. Ten dollars spent on the first 
 case will accomplish as much as a thousand spent to care for a situation after 
 it is bad. 
 
 Another bad result from letting the first cases drift is that the contagion 
 always spreads to neighboring towns. When smallpox traveled from a 
 Wisconsin town to a farmhouse northeast of Marengo, Illinois, it was reason- 
 ably certain to get to Marengo. When it reached there, it was reasonably 
 certain that some cases would occur along the country roads leading from the 
 infected town, even though the farmers' wives and children kept out of 
 town, and the farmers hauled their milk to the factory and left for home 
 without going uptown to the stores. 
 
 Fig. 95.— How 
 
 One School 
 Fever. 
 
 Spread Scarlet 
 
OXSET AND INCUBATION 199 
 
 ONSET AND INCUBATION 
 
 The incubation period is the time that elapses between exposure to 
 contagion and the development of a disease. In the season of epidemics 
 many people keep asking how long it will be after a case of contagion has 
 been taken out of an office until those in the office may judge that they are 
 safe. 
 
 During this incubation period those who are due to get sick are carry- 
 ing the germs somewhere in their bodies, though what is happening to 
 either the germs or to the hosts is not known. 
 
 The incubation periods of some of the more important diseases are as 
 follows : 
 
 (The figures in brackets are those furnished by Cornell, the others are 
 by Hill.) 
 
 Acute sore throat 2 [ 1 to 3] days 
 
 Diphtheria 3 [ 1 to 10] days 
 
 Scarlet fever 4 [ 2 to 7] days 
 
 Measles 10 [ 7 to 18] days 
 
 German measles 14 [11 to 20] days 
 
 Chicken pox 16 [10 to 18] days 
 
 Smallpox 12 [10 to 20] days 
 
 Mumps 16 [14 to 20] days 
 
 Whooping cough 8 [ 7 to 10] days 
 
 Tuberculosis Indefinite 
 
 The first figure given is the number of days that elapse between 
 exposure and illness in the average case. But disease does not always 
 run on schedule; sometimes it rolls in a day or two early, and sometimes 
 a day or two late. 
 
 The figures in brackets indicate the ordinary limits of these variations. 
 
 If a case develops after a shorter interval than the minimum given, 
 the probability is that there was a prior, though unrecognized, exposure; if 
 later, that there was some other focus of infection. 
 
 In this connection, it is well to know that some of these diseases are 
 infectious during the period of incubation ; for instance, a man with diph- 
 theria has been infectious since the day he became infected, through his 
 three days of incubation as well as through his days of sore throat. 
 
 All forms of contagion begin with fever and general aching. In measles. 
 scarlet fever, and diphtheria there is sore throat in the early stages, about as 
 early as the fever. 
 
 Therefore, in the season of epidemics, a sore throat, fever, and aching 
 should put one on his guard. 
 
 The attack may be nothing more than a cold or a simple sore throat, but 
 it is fairer to the office and fairer to oneself to go home with the first 
 oncoming of the aching and there await a decision as to what the illness 
 is going to be. 
 
 Both measles and scarlet fever oreak out in the mouth before they 
 
200 
 
 CONTAGION— DISINFECTION 
 
 break out on the skin, and diphtheria usually shoivs a membrane on the 
 throat and never, or rarely, any skin eruption. 
 
 Therefore, when this group of contagious diseases is suspected, the 
 mouth is to be watched. 
 
 Smallpox is characterized by a violent aching and high fever, per- 
 sisting for three days. Up to this point almost anybody would be liable to 
 confound smallpox with nearly any fever. Then comes the turn that dis- 
 tinguishes the disease — the fever drops, the aching ceases, and the eruption 
 appears. 
 
 DANGER FROM PETS 
 
 The Montana Board of Health has issued a bulletin warning people 
 against close association with pets. Nobody has arisen to warn animals 
 against close association with people. 
 
 Cy De Vry, in his lecture about the wild animals he has known, states 
 
 that the food of the Lincoln Park 
 (Chicago) animals is better inspected> 
 in fact, averages better, than the food 
 of the people. Anyone who knows 
 Lincoln Park or who sees Mr. De Vry's 
 pictures will know that the animals live 
 in more sanitary homes. 
 
 Why is it, then, that they some- 
 times get consumption? Associating 
 with the people. 
 
 Having given the animals their 
 day in court, we repeat what the Mon- 
 tana authorities tell us. 
 
 Dogs, cats, and parrots can pick 
 up ordinary contagion from those sick 
 with contagion, such as diphtheria, and 
 then give it to others. The teaching is that when a child is sick with con- 
 tagion the animal pets should be excluded from the room until quarantine is 
 terminated, for a dog cannot be fumigated. The further advice is given that 
 kissing dogs, cats, and parrots is liable to spread contagion. 
 
 Animal pets have tapeworms which are frequently spread to man 
 by close contact. A tapeworm requires two hosts, in each of which it 
 passes a different cycle. The worms, which are rather mild tapeworms in the 
 dog, pass through a much more harmful stage in man. 
 
 The hydatid disease in man is due to the man cycle of a lower animal 
 tapeworm. 
 
 There are several varieties of these worms. I have often written that a 
 tapeworm in a man's intestine is of no great consequence. A hog tapeworm 
 or a dog tapeworm in a man's tissue is of great consequence. 
 
 Itch is not nice to think about even when one thinks of catching it 
 from his barber or his friend. It is worse to think of getting itch from a 
 dog. Dogs and cats have several kinds of itch, each capable of transmission 
 to man. 
 
 North Carolina Health Bulletin. 
 Fig 96. 
 
EASY TO CONTEOL CONTAGION 201 
 
 When plague threatens, pets become of increased importance, for this 
 disease is spread by a flea, which, while it prefers the rat, is willing to take 
 up temporary residence on any domestic animal. 
 
 Hydrophobia, would die out if it were not kept going by the lower 
 animals, and especially by dogs. 
 
 So far as consumption is concerned, the lower animals both sin and are 
 sinned against. The dog that pines for its master who is slowly going down 
 with consumption is slowly dying from consumption contracted from him. 
 On the other hand, some cases of human tuberculosis that seem to come out 
 of a clear sky have come from a dog or cat. 
 
 Finally, there is anthrax, a terrible disease in lower animals, capable 
 of causing a terrible disease in man. In fact, one of the names for human 
 anthrax is "wool sorters' disease/' It is so named because men who handle 
 wool and hides get it from what they work in. 
 
 Human beings are not subject to lumpy jaw. If they were they would 
 catch it often from animals. Occasionally glanders is contracted from a 
 pet horse. 
 
 EASY TO CONTROL CONTAGION 
 
 In September, 1910, in East St. Louis, the Board of Education placed 
 drinking fountains on the boys' side of the Horace Mann School. On the 
 girls' side the public drinking cup was continued. The record for the 
 session of 1911 shows 110 per cent more contagion amongst the girls than 
 amongst the boys. In October, 1911, drinking fountains were installed 
 on the girls' side. From that date to February 1, 1912, the records show 
 this excess of 110 per cent has dropped to 20 per cent. 
 
 It is not often that we can observe two groups of people so nearly 
 parallel as these, and therefore the experience in East St. Louis is unusually 
 convincing. 
 
 Contagion is spread in more ways than by drinking cups used in com- 
 mon, and to abolish that nuisance will decrease but not end contagion. 
 Yet here we have a good illustration of what can be accomplished by even 
 a halfway measure. 
 
 Hill tells us that in controlling contagion 100 per cent efficiency of 
 method, while desirable, may not be required; 50 per cent efficiency has 
 often proven effective. Anyone who has had any experience with the rule 
 of thumb, unscientific methods of health department work in the old days, 
 knows that Hill knew what he was talking about. He has spent many 
 years in controlling epidemics and he should know. 
 
 What is the reason? In the first place very few of the bacteria thrown 
 off by those infected survive for even an hour. They are killed by sunlight, 
 by drying, by other bacteria, by numerous agents. It is a general law that 
 bacteria capable of producing disease in man do not thrive outside the 
 bodies of man or other animals. On the other hand but a small per- 
 centage of the people who come in contact with contagion are affected by 
 it. Most people are immune. Some immunity is natural. Most of it is 
 acquired. 
 
 If 100 babies are exposed to smallpox at least 95 will contract the 
 
202 
 
EASY TO CONTROL CONTAGION 203 
 
 disease. But as most of the grown people have been vaccinated one or more 
 times, if 100 adults are exposed not over 5 would get it. 
 
 Or take measles. Expose 100 small children to measles and 95 would 
 get sick. On the other hand 90 out of every 100 grown people have had 
 measles and will not take it again. Change the proportions somewhat 
 and you have the scarlet fever situation. Only about half the people are 
 susceptible to diphtheria at any time of their lives. 
 
 The great majority of people will not contract consumption from 
 casual contact with a consumptive and a large proportion of them are not 
 endangered by close contact with one. 
 
 Most people are not in any danger of developing pneumonia from 
 breathing pneumococci. The coccus does not seem to have that power 
 for them. 
 
 In a malarial country but a small percentage of the mosquitoes which 
 bite people are infected with malarial parasites in just the right stage 
 for transmission. It is for the above reasons that quarantine, disinfection, 
 abolition of drinking cups and other health department methods which 
 are but 50 per cent perfect accomplish such good results. 
 
 The above statements do not mean that a poor health department is 
 as effective as a good one or that any man should take a chance on breaking 
 a health law. It does mean that he can take an occasional chance and escape 
 the consequences. It does not follow that because you get good results 
 from poor work you should not try to get better results from better work. 
 
 Destroying Mold Germs. — H. M. T. asks, the best method of destroying 
 mold germs in a pantry and also suggests that care be taken in wiping the 
 tops of milk bottles before opening. 
 
 Reply. — One of the best ways of preventing the growth of molds in a 
 pantry is to have an abundance of sunlight. Frequently this is not possi- 
 ble, and I judge that it is not in this instance. Another thing to have is 
 cleanliness and dryness. 
 
 All decaying and soggy wood should be removed. Everything should 
 be made very clean. No water should be allowed on the floor or walls. No 
 water, milk, or other liquid should be exposed in the pantry. The drip- 
 ping from the ice box must not be allowed to accumulate; in the pantry. 
 Unslaked lime in pans will help to dry the air. If you can get the air dry 
 enough, mold will not trouble you. The pantry should be aired frequently. 
 Dry days should be chosen for this. 
 
 Disinfection is best done with formalin. Half a pint will answer for 
 an ordinary sized pantry. Sprinkle the walls and floors with water. Soak 
 up the formalin on a sheet, and throw the sheet over a line in the pantry. 
 Shut the door. Using that quantity, it will not be necessary to strip the 
 doors or windows. Leave the doors and windows closed for eight hours. 
 Then throw everything open and air well. 
 
 Your point about washing the milk bottle, including its cover, before 
 opening, is well taken. Milk bottles get pretty badly soiled oftentimes 
 before the milk comes to be used, even when they start out in good 
 shape. If the bottle is carelessly opened dirt will get into the milk. 
 
 How to Fight Epidemic. — X. writes : "Desplaines, Illinois, has a popu- 
 lation of more than 2,000. There are at present thirteen cases- lof scarlet 
 
204 
 
 CONTAGION— DISINFECTION 
 
 HEALTH 
 
 SICKNESS 
 
 PUR& 
 
 FOODS 
 
 COOKED IN 
 
 CLEAN KITCHENS 
 
 OPEN TO PUBLIC 
 
 INSPECTION 
 
 J 
 
 CJ.f. 
 
 DELICATELY 
 ADULTER AT £"0 
 
 ANO 
 
 H lO-HLY 
 CONTAMlNATEO 
 
 — FOOD — 
 
 CMEAPE.R "THAN. 
 THE OTHER KINO 
 
 Fig. 
 
 -At Which Shop Shall We But? 
 
 fever in six different families, 
 schools?" 
 
 Would this justify the closing of the 
 
 Reply. — No. The proper plan of controlling an epidemic of scarlet 
 fever is to put on a school nurse and reopen the schools. The students 
 should be passed upon each morning by the teacher, who sends the suspects, 
 including those who have been absent from school two days or over, to a 
 holding room. There they are seen by the nurse, who sends them back 
 to the schoolroom or into quarantine or to the family physician, according 
 to the circumstances. 
 
 A school nursing service for such a town suffering from an epidemic 
 should not cost more than $150 a month, which is far cheaper than closed 
 schools. In addition it is much the better way to end the contagion. 
 
 The controlled contact of this method is much better than the uncon- 
 trolled contact of playgrounds and streets. 
 
 Danger from Rooms Where Consumptives Have Lived. — I. M. F. writes : 
 "Will you kindly tell me what precaution one should take in moving into 
 an apartment where a tubercular child has formerly resided. Is there 
 any danger?" 
 
 Reply. — There is always danger in moving into an apartment that has 
 been recently vacated by a person with tuberculosis. If the house is well 
 
EASY TO CONTROL CONTAGION 
 
 205 
 
 lighted and aired and is in a good clean condition, with dry walls, the 
 danger is not great. If it does not come up to these requirements it should 
 be avoided. The health department disinfects after tuberculosis. You 
 should not move into a tubercle infected house until such disinfecting has 
 been done. This disinfection should be followed by a thorough cleaning 
 and airing. Certain cities, for in- 
 stance, Asheville, N. C, require that 
 a room that has been occupied by 
 a case of tuberculosis should be dis- 
 infected when the case moves, and 
 that a notice should be fastened on 
 the wall, showing the date of such 
 disinfection. Certainly people who 
 contemplate moving should have 
 some way of knowing whether the 
 room to be occupied is safe or not. 
 
 Fig. 99. — Fly-speck Greatly Magni- 
 fied, Showing Dangerous Germs. 
 
 Contagious Diseases. — A. B. C. 
 
 writes: "Why are children with 
 whooping cough allowed to enter 
 moving picture shows and other pub- 
 lic places? Why isn't some method used to notify the public that children 
 have this dreaded sickness or disease?'* 
 
 Reply. — It is against the law and also against public policy to allow 
 children in the actively contagious stages of whooping cough to go to 
 moving picture shows. The suggestion has been made that children in 
 the later stages of whooping cough should be tagged and allowed to go 
 about doing necessary things. That, however, does not include attending 
 shows. 
 
 School and Contagious Diseases. — L. K. writes: "1. What diseases, 
 contagious or otherwise, bar a child from attendance at school? 2. For 
 what length of time, in each case, should the child be kept away from other 
 children? 3. Should the child upon reentering school present a written 
 permission from the doctor, stating that it is safe for the child to come 
 in contact with other children?'* 
 
 Reply. — 1. Smallpox, diphtheria, scarlet fever, measles, whooping 
 cough, German measles, infantile paralysis, itch, impetigo, cerebrospinal 
 meningitis, venereal disease, open tuberculosis, lice. 
 
 2. Varies with each disease. 
 
 3. Any child who has suffered from any form of contagion should pre- 
 sent himself to the teacher in charge of the room, who refers the question 
 of whether it is safe to allow the child to come back to the school physician. 
 He passes on the evidence. A certificate from the attending physician is 
 advisable, but not necessary. 
 
 Rule of Quarantine. — Working Woman writes: "Is it customary, 
 necessary, or required by the board of health for a working woman or man 
 to stay at home if a young child in the same flat has measles?" 
 
 Reply. — No. Workers are required to room elsewhere during the con- 
 tinuance of quarantine. If the case is in a place where the patient can 
 
206 CONTAGION— DISINFECTION 
 
 be kept entirely away from the members of the household, rooming away 
 is not required. 
 
 Danger of Contagion. — W. F. E. writes: "1. Kindly advise me what 
 the danger of contagion is in regard to scarlet fever, diphtheria, and sim- 
 ilar diseases? 2. Is there danger of contagion by taking money from an 
 infected person, or touching anything which that person has handled? 3. 
 How long would the germs live, or rather how long after being exposed 
 to the disease in that manner can one assume that the danger is past? 4. 
 Is there any danger of contagion from contact with clothes of party from 
 the sicJc house, and is the danger considerable? 5. Is a person naturally 
 cautious about such things apt to worry unnecessarily? 6. If a family has 
 been immune from contagious diseases to date, may it be assumed that the 
 immunity will to a reasonable degree continue, especially when there are 
 young children in the house?" 
 
 Reply. — 1. If ten susceptible young children are exposed in a school- 
 room to scarlet fever or diphtheria, five will get it. If ten susceptible young 
 children are exposed in a schoolroom to measles or smallpox, nine will get 
 it. Contagiousness is greater in some diseases than others. 
 
 2. The danger from passing money or touching objects that they have 
 touched is very slight except in smallpox. 
 
 3. Say two to three weeks. 
 
 4. Some — slight. 
 
 5. Some men worry too much, some are too indifferent — answer depends 
 on the man. 
 
 6. Vigilance is the price of safety. 
 
 FUMIGATION 
 
 In response to inquiries several methods of fumigation appear in this 
 book. In addition, in places the advice not to fumigate is given, while 
 in other places fumigation is approved of, at times by direct statement, at 
 other times by implication. In order to avoid confusion a summary of views 
 is here presented. 
 
 Fumigation as a means of destroying bacteria is losing ground. There 
 are certain communities where it is still employed quite generally. There 
 are many, people who believe in it. There are others who are willing to 
 take all other precautions and to fumigate besides. Under these circumstances 
 it is wise to give methods of fumigating. 
 
 The opinion is very general that formaldehyd is the method to be em- 
 ployed when the purpose is to destroy bacteria. Therefore that is the only 
 method given. Formalin is a trade name for formaldehyd. 
 
 In using formaldehyd it is agreed that the gas is ineffective unless 
 moisture is present. Therefore the instruction to sprinkle freely before 
 using the gas and to have the air as moist as possible is given in all the 
 methods. The old directions were to leave the gas-filled room unopened 
 for eight hours. The tendency is to lessen this time requirement, some- 
 times to as low as four hours. 
 
 Three principal methods of generating the gas are employed: the per- 
 manganate of potash method, the formalin candle method, and the sheet 
 
FUMIGATION 207 
 
 method. Of these the permanganate of potash is 4he best. It has the dis- 
 advantage of requiring some skill in the user. It at least appears more formid- 
 able. The sheet and the candle methods are simpler and they are nearly as 
 effective as the other. 
 
 It will be noticed that the instructions as to the amount of gas to be 
 used vary. Where all cracks are stuffed one pound to each 1,000 cubic 
 feet of air is enough. But stripping paper costs some money and applying 
 and removing it takes time. Stripping is far and away the largest element 
 of cost. Some of the instructions 
 specify that more than one pound 
 per 1,000 cubic feet of gas be used 
 and that the stripping of small 
 cracks be not done. The extra 
 formalin will cost much less than 
 the cost of stripping and the 
 money thus saved can be spent Fig. 100.— The Pot Method of Burning Sulphur. 
 
 for nurses and inspectors. 
 
 When it is a matter of killing insects formalin is ineffective. For 
 that purpose the usual recommendation is that sulphur fumes be used. Sul- 
 phur fumes differ from formaldehyd fumes in that sprinkling must not be 
 done with the former. 
 
 The dry gas is a better insect poison. In the presence of moisture the 
 gas is converted from sulphurous to sulphuric acid, whereupon it destroys 
 fabrics and greatly injures structures. 
 
 In the use of sulphur fumes we have the choice between using less 
 gas in rooms, the cracks of which have been stripped, or more gas where 
 there has been no stripping. 
 
 Hydrocyanic acid gas is very much more efficient than sulphur, but it is 
 poisonous and can only be used by those who have had experience. To the 
 experienced it is safe, simple and efficient. 
 
 WHEN TO FUMIGATE 
 
 It has been several years since Chapin of Providence began agitating 
 against fumigation. The Health Department of Providence was courageous 
 enough to stop fumigating, except after tuberculosis, about six years ago. 
 Hill of London, Ontario, in his valuable booklet, "The Neiv Public Health," 
 comes out strongly for the theory that ordinary contagion cannot be spread 
 by the air; that if the secretions of persons sick with diphtheria and other 
 forms of contagion are made sterile, the disease will not spread; that contagion 
 is not due to filth; is not bred in filth; is not stimulated by filth, and that 
 fighting contagion by fighting filth is wasting ammunition. 
 
 In the Liverpool hospitals scarlet fever, diphtheria, and other forms 
 of contagion have been treated for years in the general wards in beds 'side 
 by side with pneumonia and rheumatism. The patients do not get cross 
 infections, because, the nurses are supremely careful in keeping their hands 
 clean, 
 
208 CONTAGION— DISINFECTION 
 
 DISINFECTION 
 
 For all infectious diseases disinfection should be done. It is important, 
 however, to disinfect the right thing and in the right way. Nature has 
 provided us with the best of disinfectants. When we fail to do our duty 
 nature will supply the deficiency if given half a chance. 
 
 Koch said: "Mere drying will destroy the germ of cholera." It will 
 destroy other germs as well. Sunlight and air, including the drying that so 
 frequently results from sunlight and air, are the common agencies by which 
 nature disinfects. 
 
 In typhoid fever and cholera the germs are carried in the excretions. 
 In these diseases nothing is to be gained by efforts to disinfect the air 
 or anything else except these excretions or things touched by these excretions. 
 
 To disinfect the excretions chlorinated lime, bleaching powder or car- 
 bolic acid solution will work. The solution must be strong enough and 
 the contact must be long enough to accomplish the result. If carbolic acid 
 is used the solution must be at least 5 per cent strength. That means 5 
 per cent after the solution is mixed with excretion. It is well enough to 
 make the solution overstrong and let it go at that. The mixture of excre- 
 tion and disinfectant must stand for half an hour. 
 
 In consumption, pneumonia, and diphtheria the disease is spread by 
 the mouth secretions, including the sputum. To sterilize these secretions 
 heat should be used. It is feasible to burn most of the cloths, handkerchiefs, 
 and napkins that have been used. If it is best to save some handkerchief or 
 other cloth it can be disinfected by boiling. 
 
 If the sputum in cups is treated with a small quantity of concentrated 
 lye and then heated in a moist chamber to the boiling temperature, it will 
 be sterilized and can be emptied in the toilet. 
 
 While the case of infectious disease is active double effort should be made 
 to keep things clean. The air must be kept clean. The windows must be 
 kept partly open all the time and at intervals the room must be aired. The 
 blinds must be up to let in some sunlight. 
 
 No disinfectant can disinfect a room wherein there is a patient. A saucer 
 of disinfectant here and a pan there do no good. After the illness has ended 
 and the patient has been moved the room should be scoured with soap 
 and water, the woolen stuff aired and sunned, and the washable stuff boiled. 
 If you feel you must fumigate use formalin. 
 
 Prior to 1912 the New York City Health Department fumigated with 
 formalin after contagious diseases according to the prevailing customs. In 
 1912 they discontinued formalin disinfection after diphtheria but took the 
 bedding used by the sick person to a central plant where it was disinfected 
 by steam. 
 
 In 1913 the practice of disinfecting bedding with steam after diphtheria, 
 scarlet fever, measles, meningitis, and infantile paralysis was discontinued. 
 
 In 1915 they discontinued the formalin disinfection after contagion. 
 They now stand where Providence has stood for years, except that they 
 do fumigate after tuberculosis only in rare cases. 
 
 The position taken by Providence, New York City and some other up-to- 
 
DISINFECTION 
 
 209 
 
 date cities is that sunlight and air are effective disinfectants. Contagion 
 is seldom spread by the air. Therefore, formalin disinfection of the air 
 is not needed. Formalin gas is not an efficient disinfecting agent for 
 bacteria located on surfaces and in fabrics — therefore, formalin is inefficient. 
 Being unnecessary and inefficient it should not be used. In lieu thereof, 
 sunlight and air supplemented by soap and water are recommended. Supple- 
 menting but not replacing soap and water, disinfectants in solution can be 
 used to wipe off floors and similar surfaces. The best of these is the group 
 of creosote preparations. Of these none is better or cheaper than the com- 
 pound solution of cresol. 
 
 In London, nine-tenths of the contagion is cared for in the contagion 
 hospitals, where there are 10,000 beds. Scarcely any attention is paid to 
 measles. The reason is that measles is only contagious during the first 
 few days. By the time the case is seen, a diagnosis made, the case reported, 
 and the department inspector gets around, the case is no longer contagious. 
 The authorities do not fumigate after measles. 
 
 The position taken by the New York Health Department is that "dis- 
 infection of most effective sort is performed by air and sunlight/' and that, 
 in view of the tendency of contagion germs to die quickly when dried, formalin 
 disinfection is seldom required. 
 
 How to Fumigate. — J. H. S. writes: "Will you give a simple recipe for 
 fumigating? Would it not be well to fumigate any filthy house recently 
 vacated before reoccupying itV 
 
 Keply. — To fumigate, buy one pint of formalin for each 800 cubic 
 feet of air space. Close the large openings, such as doors, windows, 
 ventilators, fireplaces. 
 Sprinkle the floor, 
 walls, and all furniture 
 and bedding with an 
 excess of water. Make 
 things pretty sloppy. 
 Open all closet doors. 
 String clotheslines 
 across the room. 
 Wring sheets in hot 
 water. Put the forma- 
 lin on the sheets, one 
 pint for each 800 feet 
 of air space. Leave the 
 room unopened for 
 eight hours, then throw 
 open the windows and 
 air the house for sev- 
 eral hours. Scrub and 
 clean exceptionally well. 
 
 This airing, scrubbing, and cleaning is the most important part of the 
 process, which, taken together, is called fumigating. If the windows, door 
 cracks, and keyholes are stripped you can use less formalin — say one pint 
 to 1,000 feet of air space. The permanganate method is better, but it is 
 more complicated and less safe. 
 
 Fig. 101. — Room Prepared for Fumigation. 
 (Johnson and Johnson.) 
 
210 
 
 CONTAGION— DISINFECTION 
 
 This fumigation does not kill insects or bugs. A little formalin or 
 other antiseptic poured around does no good. 
 
 Fumigating filthy houses where there has been no contagion is excel- 
 lent, provided we remember that the airing, sunning, scrubbing, and clean- 
 ing constitute the more important part of the process. 
 
 The Grip and Fumigation.— Mrs. M. I. F. writes: "Enough cannot be 
 said, it seems to me, about isolating cases of grip and effective fumi- 
 gation following recovery. Would it not be possible for you to give an 
 exact formula for the use of formaldehyd and permanganate of potassium, 
 so that your readers might feel safe in using it? As it is, few people, save 
 the medical profession and nurses, undertake complete fumigation." 
 
 Keply. — Influenza (or grip) is undoubtedly contagious, particularly 
 at certain seasons of the year. The wide spread of the disease, however, 
 
 
 Fig. 102. — Formaldehyd Sterilizer. 
 
 would make it impracticable to isolate those who are suffering from it and 
 thus infect the houses. The contagion is transmitted by the air and by 
 personal contact. It is doubtful whether houses and clothing carry it. 
 
 Disinfection of houses with permanganate of potash and formaldehyd 
 is done as follows: 
 
 [a] Seal tightly doors, windows, fireplaces, and other openings. 
 
 [b] Freely expose all articles on the premises. 
 
 [c] For every thousand feet of air space use seven ounces of potash 
 permanganate and sixteen ounces of formaldehyd. 
 
 [d] Place a large vessel, one holding about eight gallons, in the center 
 of the room ; deposit the crystals of the potash permanganate in the vessel 
 and pour the formaldehyd over it. One such outfit should be employed 
 for every thousand cubic feet of air space in the house. 
 
 How to Fumigate Room. — H. E. B. writes: "Please tell me how to 
 fumigate a room used by a person with an infectious disease so the pillows, 
 mattress, and clothing will be perfectly safe." 
 
 Reply. — Close all doors, windows, fireplaces, and other openings. Strip 
 all cracks with paper. Strip paper in rolls, for the purpose, is on' the market. 
 
DISINFECTION 211 
 
 Ordinary newspaper and ordinary paste will answer. Sprinkle everything 
 in the room; saturate the air with moisture as thoroughly as possible. 
 String a clothesline across the room; dip several sheets in formalin (use 
 one pint for each 1,000 cubic feet of air), and hang on the line. Leave 
 the room sealed tightly for eight hours. Open the windows and doors wide. 
 Air the room thoroughly for from four to eight hours. Scour all the wood- 
 work with soap and water. Sun the mattress, bedding, rugs, and other 
 fabrics. Boil all towels and other washable fabrics. 
 
 Fumigate the Book. — E. A. H. writes: "Do you think it advisable to 
 take back a medical book that a family borrowed before being taken sick 
 with scarlet fever? One of the children died. I have two small children 
 myself." 
 
 Keply. — You may take the book back with safety if you will leave it 
 opened out in the sun for two days and have it aired well for another day. 
 To feel entirely safe, fumigate it in addition to the sunning and airing. 
 To fumigate: place the book in a tight box, a cubic foot or less in size; 
 sprinkle the book and the inside of the box well; sprinkle two ounces of 
 formalin in the box ; close tight ; leave for eight hours ; air well. 
 
 Fumigation by Gas. — Constant Reader writes: "Is fumigation of house 
 or room with hydrocyanic gas the best method of exterminating all insect 
 life therein? If so, what in brief is the process?" 
 
 Reply. — Do not use hydrocyanic gas for fumigation. It is much too 
 poisonous. Sulphur fumes will kill everything except bedbugs, and it has 
 the advantage of being safe. If the cracks are sealed, to burn two pounds 
 for each 1,000 cubic feet is enough. If the cracks are not tight make it 
 three. 
 
 Fumigation Method. — Mrs. J. S. W. writes: "1. We intend to move 
 into another house, and as a precautionary measure, mother is desirous of 
 disinfecting it. 2. Will cloths saturated with formaldehyd and same evap- 
 orated by placing over a gas heater be an effective method to accomplish 
 this? 3. Or would better results be obtained by placing the formaldehyd 
 in a dish on the heater and vaporizing it in that manner? J/.. Is it desirable 
 to use any other chemical with it? 5. How much formaldehyd should be 
 used for an average size room?" 
 
 Reply. — 1. If there has been no contagion in the house recently you 
 will gain nothing by fumigating. If there has been contagion recently, and 
 there is any danger, the health department will fumigate for you. A good 
 cleaning, airing, and sunning is better for an ordinary household condition 
 than fumigation without these. 
 
 2. Yes. 
 
 3. The sheet method, as suggested in question 2, is the better. 
 
 4. No. 
 
 5. One pint at least for each 100 square feet of floor space. Moisten the 
 floor, walls, and furnishings prior to using formalin. Strip the windows 
 and doors. Leave the room undisturbed for eight hours after fumigating. 
 
 Fumigation of Cars. — J. B. W. writes: "I am a resident of Chicago, 
 passing the winter months in the South. It is almost a daily occurrence 
 to see patients in various stages of tuberculosis arrive and depart, usually 
 in the drawing-room of the Pullman. Have known of persons desperately 
 
212 CONTAGION— DISINFECTION 
 
 ill, in a vain attempt to reach home in the North, dying en route. Witt 
 you kindly inform me, as well as others keenly interested, if there is any 
 law concerning the fumigation of the Pullman coaches, and if so how 
 often is the fumigating done? In other words, what protection has the 
 traveling public against infection from the germs of tuberculosis, typhoid, 
 diphtheria, etc.?" 
 
 Reply. — There is no law, nor is there any regulation of the Interstate 
 Commerce Commission. I think this is a matter on which they could 
 legislate through regulations having the same force as laws. The Pullman 
 company disinfects its cars at frequent intervals, at least it does those 
 which run into central points. What it does with cars making somewhat 
 isolated runs I do not know. 
 
 Fumigation after Consumption. — S. M. J. writes: "Please advise me 
 about moving into a house that has been occupied by consumptives, one 
 dying there." 
 
 Reply. — If the authorities will fumigate, have them do so. If not, do 
 the fumigating yourself. Proceed as follows: 
 
 1. Close all large openings. 
 
 2. Strip the windows, doors, keyholes, and all other minor openings. 
 
 3. Open all drawers, disarrange all bed covers. 
 
 4. Sprinkle everything thoroughly. 
 
 5. Soak sheets in formalin and hang them on ropes. 
 
 6. Use one pint of formalin for every ten feet square of floor space. 
 
 7. Leave the rooms closed for eight hours. 
 
 8. Open the windows and air thoroughly for a day. 
 
 9. Scour all woodwork with soap and water. Boil all washable goods. 
 10. Sun everything for a day or more. 
 
CHAPTER XIX 
 
 Contagious Diseases 
 
 SMALLPOX 
 
 For smallpox as a community disease there are two methods of treat- 
 ment: vaccination and hospitalization. 
 
 For fires as a community ailment there are two methods of treatment: 
 fireproof construction and fire engines. 
 
 To prevent smallpox, most states use both methods. Minnesota and a few 
 neighboring states say, if everybody is vaccinated, there will be no small- 
 pox. It is unjust to make the vaccinated pay for expensive smallpox hospitals. 
 The quickest way to get everybody vaccinated is to make it impossible for the 
 unvaccinated to impose on the vaccinated. 
 
 "We will not support smallpox hospitals/' A thoroughly logical posi- 
 tion — one that will be tenable when knowledge is better diffused and human 
 judgment is better. But as yet we have not reached the stage where 
 all men are judicious enough to make it fit. The peculiarly minded 
 minority so tyrannize the majority that few health officers deem the Min- 
 nesota policy best. 
 
 No one has yet proposed to do away with fire engines and thus force 
 ever} r body to fireproof construction. 
 
 Compulsory vaccination laws have been enforced in every European 
 country for about a quarter of a century. With them this question has not 
 been open for debate, except in England, for about a generation. In Cuba, 
 Porto Eico, Panama, and the Philippines it is also demonstrated, proved, 
 accepted, and no longer discussed. When, however, it is proposed to do as 
 much for the children of Louisville as we have done for the Filipino, there 
 rises up a small but noisy group, shrewd enough to cry out in the name 
 of liberty. License would be a better term, but it is not catchy, and 
 Bellamy has termed this a phrase-catching age. 
 
 In this group there are no men who have had any practical experience in 
 controlling smallpox. That all of those, whether engineers, nurses, or 
 doctors of the different schools who have been charged with the responsibility 
 of handling smallpox are firm believers in the efficacy of vaccination is a source 
 of great concern to the anti-vaccinationists, and, in consequence, they seek to 
 borrow some names to conjure with. Their prize package is Sir Alfred 
 Wallace. 
 
 Now, what are the facts about Sir Alfred that would lead anyone to 
 think that his judgment on this point can be safely followed ? He was born in 
 1823. In 1858 he dreamed out the theory of natural selection almost simul- 
 taneously with Darwin. As soon as he got over the chills he went to 
 
 213 
 
214 CONTAGIOUS DISEASES 
 
 England, got into close touch with Darwin and for fifteen years fought 
 the battle of Darwinism. 
 
 In the middle seventies he renounced religion and in 1881 became a 
 spiritualist and aligned himself against the material and in favor of spirit 
 direction soon thereafter. 
 
 In 1885 he wrote "Forty-five Years of Registration Statistics/' in which 
 he sought to prove that the statistics showed that smallpox was not on the 
 decrease from 1810 to 1885. 
 
 He never had any experience with smallpox or vaccination, disease pre- 
 vention, hygiene, or sanitation, and therefore the conclusions of this old 
 man, honored though he justly was, represent nothing except the conclu- 
 sions of an anti-materialist drawn from the somewhat imperfect statistics 
 of a period when vaccination was 'quite imperfect. It would take more than 
 Wallace to convince the man of the street that there is as much harm from 
 smallpox as there used to be. 
 
 HOW TO CONTROL SMALLPOX 
 
 Controlling smallpox is easy. There is no other disease whose control is 
 so easy. Health officials know exactly what to do. The epidemiology of the 
 disease is so well worked out that any health officer who knows his business 
 can guarantee results. There are a thousand men in the United States who 
 would be willing to enter into a contract with any community to guarantee 
 permanent freedom from smallpox and make the bond forfeitable on failure 
 to make good. 
 
 It has not been long since many people believed disease could be blown 
 long distances. Now we know that disease stays put. Whenever it travels 
 it must have a person, or animal, or insect to carry it. Persons are much 
 the most important of these three carriers or distributors. 
 
 Smallpox was the disease wherein the proof that air could carry disease 
 seemed most convincing. Chapin's book, published in 1910, gives ten pages to 
 a discussion of whether smallpox can be air borne or not. The proof that 
 it is is largely based on observations made in 1881. Opinions based on 
 work done thirty years ago are not of much value. Chapin sums up as 
 follows : 
 
 "The evidence in favor of the aerial transmission of smallpox from 
 hospitals is so slight that it should never influence a municipality in Us 
 selection of a hospital site. The success of Edinburgh, New York, many 
 German cities, and the Pasteur hospital in Paris in caring for smallpox 
 in connection with other diseases and even in the same building with 
 other patients indicates that the theory of aerial infection has little basis 
 in fact." 
 
 Smallpox is spread by close contact with a person who has the disease. 
 Contact such as that common on street cars and railroad trains is suffi- 
 ciently close for some people, but not for all. An unvaccinated milkman 
 delivering milk at the kitchen of the smallpox hospital in Chicago con- 
 tracted smallpox once upon a time. It was never proved that he went into the 
 hospital. 
 
 What secretion spreads the disease we do not know. We have no in- 
 
SMALLPOX 
 
 215 
 
 formation proving it to be scabs or scales on the one hand or nose or month 
 secretions on the other. 
 
 The difficulty in controlling smallpox since 1898 has been the mild cases. 
 When a man has smallpox he has some sort of a sore somewhere on the 
 
 e Your Qioice 
 
 One little 
 V&ccin&iion mark 
 
 OIL 
 
 Ttious&nds Of 5maJlpox Iu5tule5 Like Iheee 
 
 5mallpo}c — {lie mosl loathsome of all diseases. 
 
 [From photograph 6j 
 
 WTINATIGN prevents smallkk 
 
 Irotect the little children, ^ 
 
 De'partwent oj Hea,l1h, Chicago — Edi*e*ticm tX 6ertfc5. ^^ 
 
 Fig. 103. 
 
 body. Even the mildest cases have that. None of the cases end in "colds" 
 or other mild, deceiving forms of sickness. However, the smallpox sores 
 may be so few and the fever and aches which precede or follow them so 
 mild that the man thinks his "blood out of order." It does not occur 
 to him that so mild a disease could possibly be smallpox. He may have 
 
216 CONTAGIOUS DISEASES 
 
 four days of fever and aches and then break out here and there. He 
 feels much better than when he had fever, but his sores are a little too 
 sore for him to go to work, so he visits around for the rest of the week. 
 
 These mild cases are just as contagious as the more violent ones. In 
 fact in the Middle West 90 per cent, of the smallpox is spread by these 
 walkers. 
 
 The incubation period of smallpox is twelve days. That means that 
 the virus which has got into the susceptible man's body rests there for 
 twelve days. What happens during that time nobody knows. 
 
 On the twelfth day the disease starts with a severe chill, high fever, 
 headache, and a bad backache. If it is a malarial country the chances are 
 that the diagnosis will be chills and fever and the treatment will be quinin. 
 
 At the end of the third day or on the fourth day the fever goes 
 down, the headache and backache stop, and the sick man thinks the quinin 
 has broken his chills. 
 
 He may get up and go down to the drug store for a soda or go out and 
 call on his friends. Some friends will call his attention to a little breaking 
 out probably on his forehead; or maybe there is some itching and he 
 notices the eruption when he scratches. 
 
 The eruption feels like a shot under the skin. By the end of the 
 third day the small, red, bullet-like mass is capped by a little water blister. 
 The blister part gets larger each day. 
 
 The blister seems tied down in the middle. By the sixth day of the 
 eruption the blister is full of matter instead of water as at first. 
 
 In the old-style smallpox the eruption usually appears first on the 
 forehead but in this mild disease that came to us from Mexico sixteen 
 years ago the eruption is exceedingly light and may appear first anywhere 
 on the body. Bumps appearing on the scalp, on the soles of the feet, or in 
 the palms of the hands after several days of fever and backache always sug- 
 gest smallpox even though but one or two shotlike spots are present. 
 
 There is not much treatment for smallpox. Good care in a good, airy 
 hospital is the only treatment required. The nurses will see to it that the 
 blisters are not broken and that scratching does not cause secondary in- 
 fection. 
 
 Smallpox is of all diseases the most contagious for unvaccinated people. 
 The vaccinated come and go in a smallpox hospital without thought of 
 contracting the disease. The only persons who contracted smallpox in 
 the Chicago smallpox hospital in twenty years were three unvaccinated 
 boys who got in "unbeknownst." 
 
 One hundred years ago there were people who thought that if a person 
 would keep clean he would not contract smallpox. Nobody who has ex- 
 perience with smallpox has believed this doctrine during the last fifty years. 
 
 LESSON OF AN EPIDEMIC 
 
 The city health authorities advise us from time to time. The organized 
 opposition from time to time advises us to disregard the health department. 
 The man of the street would like to know whose advice to take. 
 
 On November 13, 1913, I read that twenty years ago, on November 13, 
 
SMALLPOX 217 
 
 1893, Health Commissioner Eeynolds of Chicago prophesied: "We shall no 
 doubt have a great deal of smallpox this winter/ 5 
 
 I thought my readers would like to know whether Dr. Eeynolds knew 
 what he was talking about. It might help them to decide whether to accept 
 or reject present day advice. 
 
 Turning to the records I found that a case of smallpox came to Chicago 
 on June 12, 1893. There was one death in June, one in August, one in 
 September, four in October, and two in November. 
 
 On November 14 Dr. Eeynolds wrote to Albert Lane, superintendent 
 of Chicago schools, of the impending storm. On November 17 Archbishop 
 Feehan sent out a circular letter advising vaccination. 1893 closed with a 
 record of 140 cases and 23 deaths. 
 
 In December, 1893, the mayor and health commissioner began com- 
 municating with the council about the condition. The council did not 
 act until April, 1894. 
 
 The record for 1894 is awful. The department treated 2,332 cases 
 of smallpox in the hospital that year. There were 1,033 deaths from the 
 disease. During the year forty people dead from smallpox were found 
 in abandoned houses. Whether the unfortunates were deserted while still 
 alive there was no way of knowing. 
 
 The official report says that for a while in May the cases came so 
 fast that the clerks could not keep the record straight. The record for the 
 first portion of the year was : 
 
 January — 176 cases, 29 deaths. 
 
 February — 219 cases, 55 deaths. 
 
 March— 276 cases, 100 deaths. 
 
 April — 321 cases, 157 deaths. 
 
 May — 518 cases, 253 deaths. 
 
 By May the town was in a wild alarm. The health department was 
 given a free hand. The council voted it 500 vaccinators. Additional hospital 
 facilities were secured. Provision for the present smallpox hospital was 
 under way. In May alone 586,500 free vaccinations were done. In all, 
 1,200,000 free vaccinations were done on Chicago's 1,500,000 people. Seventy 
 thousand free vaccinations were done on the 185,358 children of the public 
 schools. 
 
 By June the wave had reached its crest. The record of its gradual sub- 
 sidence is as follows : 
 
 June — Cases 191, deaths 171. 
 
 July— Cases 82, deaths 57. 
 
 August — Cases 112, deaths 53. 
 
 September — Cases 82, deaths 31. 
 
 October — Cases 105, deaths 40. 
 
 November — Cases 120, deaths 51. 
 
 December — Cases 130, deaths 42. 
 
 The 1895 report shows that the disease was still exacting toll in that year. 
 In January, February, and March there were 112 deaths; in April, May, 
 and June, 31 ; in July, August, and September, 12. 
 
 The epidemic ended twenty-seven months after the first case occurred, 
 twenty-two months after Dr. Eeynolds issued his warning, seventeen months 
 
218 CONTAGIOUS DISEASES 
 
 after the city council had heeded the warning. One thousand two hundred 
 and eleven lives had been lost. 
 
 Going back to the reports issued in the beginning we find that the com- 
 missioner was horrified when he discovered so large a proportion of the 
 people unvaccinated. He said that the proportion of unvaccinated was 
 greater than at the beginning of the great epidemic in 1883. That epi- 
 demic began in April, 1880, ended in June, 1883, and cost 2,561 lives. 
 
 The only hope of shortening that record and lessening the rate was to 
 excite public interest. This Dr. Reynolds went at in earnest. In spite of the 
 help given him by the pulpit and press interest commensurate with the 
 need was not excited until April. By summer the backbone of the epidemic 
 was broken but, snakelike, the tail lived on for more than a year. 
 
 Lord God of Hosts, be with us yet, 
 Lest we forget! Lest we forget! 
 
 HOW PUNISH THE WEAK SISTER? 
 
 In April, 1912, smallpox appeared at Niagara Falls, New York. A study 
 of the reports of the Public Health Service and of reports of the State Board 
 of Health shows that the disease has been continuously present there since. 
 The report of the Public Health Service shows that for the week ended May 
 31, 1913, five cases were reported. 
 
 When a town or city with an organized government continues to have 
 smallpox developing during the hot weather it is a sure sign that the govern- 
 ment is failing to make use of some of the measures for control that succeed 
 elsewhere. 
 
 The same government reports showed that smallpox was present in 
 Evansville, Indiana, early in the summer of 1912. During the summer and 
 fall new cases were appearing from time to time. The public health report 
 dated June 20, 1913, says that "during the week ended June 14, 1913, nine 
 cases of smallpox had been notified in Evansville, Ind., making a total of 818 
 cases reported since October 1, 1912." 
 
 In January, 1911, I was traveling in southern Illinois on an Illinois Cen- 
 tral train running to Evansville. I overheard the brakeman telling of a case 
 of smallpox which had been in his next door neighbor's home for ten 
 days or two weeks. They had taken the case out the day before. He did not 
 think much of the brand of protection used in Evansville. 
 
 At the present day the control of smallpox is so satisfactory that when 
 a community continues to develop cases, particularly when a hot season passes 
 without letup in the cases, it is certain that something is wrong. 
 
 I am informed that the anti-vaccinationists are the public enemies 
 who are giving Evansville a bad reputation and endangering communities 
 within railroad reach of Evansville. I am informed by the secretary of the 
 State Board of Health that the opposition has made use of injunctions and 
 other obstructive legal machinery. 
 
 I have before me clippings from the Evansville papers that show 
 where the reason for Evansville's disgrace lies. 
 
 A Dr. Kunath writes about "this smallpox 'scare' sent out by the 
 
SMALLPOX 219 
 
 Board of Health, their false representations and threatening dictations." 
 Another is headed : "Protest at Board Order — Delegation of Anti-vaccina- 
 tionists at Mayor's Office; Members of the Physio-mental and Anti- vaccina- 
 tion Society Called on Mayor Heilman, Demanding the Eesignation of the 
 Board of Health." 
 
 It is plain that these communities are not suppressing smallpox, because 
 they are not making use of all the necessary measures. They are not doing 
 so because of the obstructive tactics of well meaning but misguided people. 
 They are to be pitied. Perhaps to pity them is punishment enough. 
 
 THE TWO NIAGARAS 
 
 Smallpox was imported into Xiagara Falls, Xew York, on April 5, 1912. 
 There is no compulsory vaccination ordinance in that town. There is a 
 good deal of anti-vaccination sentiment extant. The percentage of unvac- 
 cinated people among their population is above the average. 
 
 There are two methods of controlling smallpox — isolation and vaccination. 
 Niagara Palls officially depends on isolation alone. The vaccination done 
 is on individual initiative. 
 
 Let us see if Xiagara Falls, Xew York, has shown efficiency in handling 
 smallpox. The records of the Xew York State Health Department show that 
 cases of smallpox have been reported from Xiagara Falls each month since 
 April, 1912. 
 
 The highest number of cases was 18 in February, 1913, the lowest 1 in 
 October, 1912. The total number of cases up to Xovember 8 was 113. The 
 state record shows 132 cases up to October 1 and the government record for 
 three weeks in October and one in Xovember shows 11 additional cases. 
 
 It will be noticed that the epidemic kept up straight through two hot 
 seasons. Smallpox disappears in hot weather under any effort at suppression 
 worth while. 
 
 As Xiagara Falls, Xew York, has only 30,000 inhabitants, we get a better 
 idea by saying that had Chicago had the same rate it would have meant 
 14,000 cases but in order to form an intelligent judgment it is advisable 
 to have a city for comparison. 
 
 Immediately across the river from Xiagara Falls, Xew York, is that other 
 summer resort, Xiagara Falls, Ontario. Smallpox was imported into this 
 city in February, 1913. It developed in the Tremble House near the Michigan 
 Central depot. At first the health authorities tried isolation and vaccination 
 by moral suasion. The city council voted down a compulsory vaccination 
 ordinance. 
 
 The provincial board of health made its arrangements to quarantine all 
 Canada against Xiagara Falls, Ontario, whereupon the city general council 
 voted the proclamation for vaccination. Seventy-five per cent, of the popula- 
 tion obeyed the proclamation. The school children were vaccinated. The 
 epidemic was speedily stopped. By May Xiagara Falls, Ontario, was free from 
 the disease. In all they had had 45 cases. 
 
 In one town the epidemic lasted three months in all. About one month 
 after vaccination got under way in earnest the epidemic was broken. In 
 the other town the epidemic is at the present writing in its twentieth month 
 
220 CONTAGIOUS DISEASES 
 
 and still hangs on. They will either change their method or the disease 
 will hang on indefinitely. 
 
 Twenty years ago smallpox epidemics in cities of 500,000 inhabitants 
 kept up for several years. In the last ten years no large city has had 
 an epidemic keep up through the hot weather. Towns of 30,000 find it easy 
 to end a smallpox epidemic in two or three months. And yet here in this 
 twentieth century, in the Empire State, is a community which has had this 
 millstone around its neck for some time including two hot seasons and 
 which seems helpless. 
 
 The disease is very mild. It is costing no lives but it must be costing 
 business something. Such a record of inefficiency among thinking people 
 is a reflection on the business acumen of the business people. What's the 
 use of building spotless show factories in such a place ? 
 
 The figures cited above were obtained from the United States Public 
 Health Service, the New York State Department of Health, and the Ontario 
 Provincial Board of Health. 
 
 COST OF PROTECTION 
 
 An expert in the handling of smallpox would willingly enter into a 
 contract with any community to protect it against smallpox. 
 
 The terms of a contract for a city of 100,000 inhabitants would be 
 about as follows: The community would require that every child be vac- 
 cinated before reaching two years of age and should be revaccinated once every 
 ten years. In case a person with smallpox enters the town every person 
 brought in contact with the case would be required to be revaccinated. 
 The community would pass the laws and compel their observance. The 
 expert would do the vaccinating, diagnose, treat and care for the cases. He 
 would figure the cost of the vaccine at $500 a year. Properly organized 
 the service could be rendered for $2500 a year. A city thus protected would 
 require no hospital. If we figure $2000 as the hazard in view of his 
 guarantee we would say that the cost of guaranteed protection against small- 
 pox would be $5000 a year or 5 cents an inhabitant. 
 
 VARIOLOID 
 
 In earlier years the term "varioloid" was used to denote an attack of 
 smallpox that had been modified and rendered mild by a vaccination that did 
 not fully protect. The term is one that works mischief because it leads to 
 the belief in the uninformed that the disease is something different from 
 smallpox and not contagious. 
 
 Varioloid is nothing more or less than smallpox. It is now known that 
 neither smallpox nor so-called varioloid occurs in the vaccinated; and the 
 scar noticed in the old days in varioloid cases was not from vaccination but 
 from infection of the site of vaccination. 
 
 Finsen Method Has Failed.— W. G. K. writes: "I remember reading 
 some years ago that the late Dr. Finsen claimed to have discovered 
 that if a smallpox patient was kept in a room lighted by a nonactinic 
 
SMALLPOX 221 
 
 light he would not be sick much, would recover quickly, and not be pock- 
 marked. In other words, he claimed that it was the actinic qualities 
 of white light (that acts on the salts of silver) that make practically 
 all the trouble to the person sick with the disease. I have asked several 
 physicians at different times, but they have seemed to know nothing 
 about it. The fact that a persons face, which is not protected from the 
 light, is worse marked than other parts of the body, would incline a 
 person to think there is something to it. If the theory has been proved 
 correct, it should be given wide publicity" 
 
 Reply. — The method was tried extensively in Chicago. It has failed. 
 Smallpox is now so mild that there is not much need of improving the 
 methods of treatment. In December, 1912, 769 cases with twenty-one 
 deaths were reported. Twenty of the deaths were in Texas ; Hunt County, 
 Texas, had sixty cases and eighteen deaths. Until the Texas type gets up 
 this way no treatment, except rest and care, seems to be needed. 
 
 No Smallpox Danger. — A. H. writes: "Is it perfectly safe to har- 
 vest and distribute promiscuously for use ice from a body of water that 
 receives the sewage from a city that has had from twelve to twenty 
 cases of smallpox for a year past? From November to March there is no 
 current except what runs from the sewers/' 
 
 Reply. — Smallpox is not spread in that way. Therefore danger from 
 smallpox would be no reason why the ice should not be used. There 
 would be danger from typhoid unless the body of water is large. Aside 
 from the danger, people do not enthuse over eating frozen sewage. 
 
 Mild Form of Smallpox. — A. M. writes: "Please state if there is a 
 rash called Cuban itch and a home remedy for it. Our doctor seems to 
 know nothing about it and his remedies do no good. Is it contagious?" 
 
 Reply. — Soon after the Spanish War smallpox came in from Mexico. 
 It was a mild form and was called Cuban itch by some people. The 
 Cubans do not know of Cuban itch. What is sometimes called Cuban 
 itch is smallpox. 
 
 Two Distinct Diseases. — M. M. C. writes: "There is trouble with 
 smallpox in my city, caused largely by the fact that doctors are first 
 diagnosing it as chickenpox, especially cases in children. Are these two 
 distinct diseases, or the same? Is smallpox so contagious that it can be 
 carried in the clothes of one well person from the bedside of the patient 
 to another person, or does it take actual contact with the patient himself 
 to contract the disease?" 
 
 Reply. — 1. Smallpox and chickenpox are not the same. It is a safe 
 bet that the children referred to had smallpox. 
 
 2. Rather close contact is required. A person who had not been in 
 contact with a case of smallpox cannot be infected by a well person who 
 has been in such contact. 
 
 If the town will enforce universal vaccination the disease will be 
 under control reasonably soon. 
 
 VACCINATION 
 
 In 1901 the Chicago Health Department issued the following vac- 
 cination creed: 
 
222 CONTAGIOUS DISEASES 
 
 After many years of experience with Smallpox and Vaccination, the Chicago 
 Department of Health hereby declares: 
 
 FIRST. — That true Vaccination — repeated until it no longer "takes" — 
 ALWAYS prevents smallpox. NOTHING ELSE DOES. 
 
 SECOND. — That true Vaccination — that is, vaccination properly done 
 on a CLEAN arm with PUKE, potent lymph and kept perfectly CLEAN and 
 UNBKOKEN until the scab falls off naturally— never did and NEVER WILL 
 make a serious sore. 
 
 THIRD. — That such a Vaccination leaves a characteristic scar, unlike 
 that from any other cause, which is recognizable during life and is the ONLY 
 conclusive evidence of a Successful Vaccination. 
 
 FOURTH. — That no untoward results ever follow such Vaccination. On 
 the other hand thousands of lives are annually sacrificed through the neglect 
 to vaccinate— a neglect begotten of LACK OF KNOWLEDGE. 
 
 Although cases of smallpox come to Chicago frequently the disease has 
 never made any considerable headway since the health department began 
 actively using this creed to educate the people. In the fifteen years 
 since this creed was promulgated no scientist has disproven any part of it. 
 No community which has followed it has had any serious trouble with 
 smallpox. Certain communities that have had smallpox and have tried 
 to control their epidemics by other means have had to come to vaccination 
 methods as embodied in this creed before they were able to control their 
 epidemics. 
 
 Discovery of Vaccination. — Dr. Edward Jenner of Berkeley, England, 
 had heard that dairymaids were liable to catch "a certain sore called 
 cowpox found occasionally on the teats of dairy cows/' Furthermore, he 
 heard that a dairymaid who had had cowpox could not have smallpox. 
 He investigated the subject. By experimenting he proved that one who 
 had recently had cowpox could not be inoculated with smallpox. 
 
 Jenner told Hunter his opinion in 1770 and in 1798 he published it. 
 The experience of the last 116 years has proven that Jenner was right. 
 Everywhere in all lands where people study and know the fact is appre- 
 ciated. 
 
 As a good shower of rain renders dead grass non-combustible and 
 thus stops a prairie fire, so vaccinating the population ahead of smallpox 
 stops the epidemic by rendering the people immune. 
 
 Jenner's discovery was made before the days of bacteriology. In recent 
 years the bacteriologists discovered the scientific basis for vaccination against 
 smallpox. Applying the same principles they have discovered effective methods 
 of vaccination against other diseases — for example, typhoid fever and lock- 
 jaw in man, cholera in hogs and blackleg in cows. 
 
 Production of Smallpox Vaccine. — A sound calf proven free from all 
 forms of disease is inoculated with cowpox vaccine. The side of the belly is 
 cleaned, made aseptic and shaved. It is then scarified and inoculated with 
 vaccine. The vaccinated area is kept free from dirt. When the vaccina- 
 tion begins to take the exuding lymph is gathered up, ground in sterile 
 mortars and mixed with glycerin. The glycerinated lymph is generally 
 marketed in sealed glass tubes. Before it is used it is proven free from 
 lockjaw and ordinary pus bacteria by laboratory tests. Glycerinated vaccine, 
 
Before ^ After 
 
 S^IALLP 
 
 Criminal negligence defaced 
 this beautiful child for life. 
 
 A lit+k 5C^r 
 on +he &rnrz 
 will prevent 
 ihous&ndsof 
 sc^rs on the 
 fa.ee. 
 
 A pock-marked 
 
 T&CCZ is 2xO- 
 
 ineffaceable 
 b&dge: of - 
 i^nor&nce or 
 nec^Iech, 
 
 VACCIMTIOA 1 p P fl^j5 5/1ALLP0X 
 
 Profed - the Children — 
 
 Proteci Yourself* 
 
 KATHERINE HELD WHITE -I9f4 
 
 Chicago /fea/£fr Depart/neat, ^ducationaS 'Poster tSercef. /Y£ £0<9' 
 
 Fig. 104. 
 
 223 
 
224 CONTAGIOUS DISEASES 
 
 properly ripened and kept in a cool, dark place, will remain potent for several 
 months. 
 
 Properly inoculated into a person susceptible of having smallpox it 
 will cause a vaccination sore. It will not cause tuberculosis, syphilis, lockjaw 
 or blood poisoning. Tubercle bacilli cannot live in glycerin. Syphilis is not 
 possible because cows do not have syphilis. If the vaccinated man develops 
 lockjaw or blood poisoning it is because the bacteria responsible got into the 
 vaccination wound from his clothes. If the arm becomes very much in- 
 flamed and the sore suppurates it is because of pus infection after vac- 
 cination. 
 
 The vaccination blister is typical in appearance. Suppurating wounds 
 do not protect against smallpox. Very bad arms do not protect against 
 smallpox. 
 
 A vaccination scar shows typical pits. These pits can be made out for 
 years. Unless the scar shows them there is no way of knowing that the 
 person is protected against smallpox except by trying to vaccinate him again. 
 If he has a typical scar less than ten years old he will not have smallpox. If 
 he has a scar without pits he cannot be certain that he is immune unless 
 several attempted vaccinations have failed to take. 
 
 Between 1899 and 1914 the Chicago Health Department observed 
 2,588 cases of smallpox; 2,218 of these had never been vaccinated. Of the 370 
 remaining a few had typically pitted scars but the vaccinations had been 
 done years before and there had been no revaccination. In most of the 370 
 the scars were atypical as well as old. None of the 156 persons who died of 
 smallpox had ever been vaccinated. 
 
 When to Vaccinate. — Vaccination may be done at birth or any time 
 thereafter except when suffering from an acute disease. It may be done 
 after exposure to and infection by smallpox. One so infected will not come 
 down with the disease before twelve or fifteen days, as vaccine works much 
 faster than that. A vaccination soon after exposure to the disease, if well done, 
 will take and protect the patient against the disease. 
 
 Every child should be vaccinated before it is weaned, for it is as much 
 the duty of parents to protect their child against smallpox as it is to 
 protect it against the evils of cold or hunger. 
 
 One vaccination will frequently protect for a lifetime, but it is found 
 that vaccination will generally take twice in a lifetime, once in childhood and 
 again in adult life. 
 
 As there is no way to measure immunity to smallpox except by vac- 
 cination, it is well to try a vaccination again, especially if exposed to the 
 disease. If the vaccination will not take smallpox will not take. 
 
 Where to Vaccinate. — As most people are right-handed, vaccination is 
 generally done on the outside of the left arm near the shoulder. 
 
 It is well to keep the arm reasonably quiet while it is sore and any 
 limitations to the use of the arms causes less inconvenience in the left arm than 
 in the right. 
 
 Before the days of pure vaccine and antisepsis there were many large 
 scars on vaccinated arms due to infections that were eyesores to the ladies and 
 consequently there sprang up a desire for vaccination on the leg. These vac- 
 cinations are objectionable because the wound cannot so easily be kept 
 
SMALLPOX 225 
 
 quiet or clean, as the swish of the skirts is apt to infect it with the dirt 
 of the streets. 
 
 How to Vaccinate. — First, clean the arm with soap and water and then 
 sterilize with alcohol. Then scratch the outer skin with a dull needle making 
 a place about an eighth of an inch in diameter. It is not necessary to draw 
 blood in vaccinating. A little oozing will do no harm but bleeding may 
 wash away the vaccine lymph. 
 
 After the scarification is done the vaccine is put on the denuded sur- 
 face and allowed to dry before the arm is covered. The wound should not be 
 handled at any time and will rarely need to be covered. Sometimes a 
 clean, loose piece of linen or gauze may be fastened to the sleeve to act as 
 a cushion over the wound but at no time should the arm be bandaged or have 
 adhesive straps to hold a shield or covering over the wound. If the wound 
 should become infected it must be treated as any other infected wound. 
 If a shield is placed over the vaccination it should be removed within twelve 
 hours. The only object of a shield is to save time. Glycerin dries slowly. 
 
 Smallpox, before the days of vaccination, was a very common disease. 
 Those persons whose features were not pockmarked were the exception. 
 No class was exempt. Queen Mary of England died of smallpox in the 
 year 1694. 
 
 Perhaps the most striking and forceful comment ever made upon 
 the disease and its prevention was by Lord Macaulay when discussing the 
 death of Queen Mary in his History of England. He said : 
 
 "That disease over which science has since achieved a succession of glori- 
 ous and beneficent victories was then the most terrible of all the ministers 
 of death. The havoc of the plague had beerj far more rapid; but the 
 plague had visited our shores only once or twice within living memory; 
 and the smallpox was always present, filling the churchyards with corpses, 
 tormenting with constant fears all whom it had not yet stricken, leaving on 
 those whose lives it spared the hideous traces of its power, turning the 
 babe into a changeling at which the mother shuddered, and making the 
 eyes and cheeks of the betrothed maiden objects of horror to her lover/' 
 
 Anti- vaccinationists. — In spite of the facts that are open for the 
 perusal of all, there are still people who style themselves anti-vaccinationists, 
 and who from time to time get into the limelight. They are always people not 
 willing to learn the facts or not capable of understanding, and some of them 
 may be quite normal in other respects. It is probable that there will ever 
 be some of their kind, for there is always someone to take the opposite side 
 of every question. The anti-vaccinationists can only flourish where there 
 is no smallpox in a community, and, thanks to vaccination, that is most 
 of the time. An outbreak among those who have neglected vaccination 
 always puts the anti-vaccinationists to flight until the sad occasion is for- 
 gotten. 
 
 Vaccination is not compulsory in the Ignited States except that it is 
 generally required of children before admittance to the public schools and 
 of men before admission to the army. 
 
 In times of freedom from smallpox communities neglect vaccination, there 
 is no propaganda continually preaching it, doctors neglect to urge it and medi- 
 cal colleges become slack in teaching it with the result that in time there is 
 
226 CONTAGIOUS DISEASES 
 
 a large number susceptible to smallpox. Then the disease is somehow 
 introduced. Everybody gets vaccinated and the disease is eradicated. There 
 is rarely any serious objection to vaccination when smallpox is present. 
 Indeed it can safely be said that vaccination is more broadly accepted than 
 is religion, for there we have dissenters, too. 
 
 How to Vaccinate. — Z. writes: "A friend lives in the country, where 
 she and her children often meet neighbors, but where it is difficult to 
 see a doctor. If fresh vaccine points were sent to her, would it be 
 advisable for her to vaccinate her family? She is intelligent, but with- 
 out special training as a nurse or in medicine. What is the process?" 
 
 Reply. — 1. If the danger of smallpox is imminent, yes; otherwise she 
 had better call a doctor. 
 
 2. Scrub the skin clean with soap and water and then with alcohol. 
 Sterilize a needle in alcohol. Scratch a place one-third the size of the 
 nail of the little ringer. Scratch deep enough to cause oozing, but not 
 bleeding. Break the ends from the vaccine tube. With the small bulb 
 express the lymph on the oozing area. Keep the sleeve up until the 
 lymph has dried. Wrap a clean handkerchief lightly around the arm. 
 Keep the clothes extra clean, keep the skin extra clean for two weeks. 
 
 If the vaccination is taking, the arm will get sore five days after the 
 scarification. Unless it does, the vaccination has done no good. Vac- 
 cinate on the arm. Use one tube for each person. The cost of vaccine to 
 large purchasers is three to five cents a point. At retail price it should 
 not exceed ten cents. Some people never take but once; some once every 
 twenty years; some once every ten years. Occasionally a person is found 
 who will take again after five years. 
 
 Experts and Theorizers. — W. A. B. writes: "England passed a com- 
 pulsory vaccination act in 1853, insuring the vaccination of 98 per cent, 
 of all children born. Nevertheless, twenty years afterwards the country 
 suffered the worst epidemic in its history, in which 8,000 vaccinated 
 children under five years of age died of smallpox." 
 
 Reply. — It is unsafe to draw any conclusion from experiences of 
 thirty-eight years ago. I know of no health officer anywhere in the 
 world, charged with the responsibility of preventing smallpox, who does 
 not use vaccination. These men have had large experience. I do not 
 believe that anyone would hesitate to give his opinion greater value 
 than the opinions of men who, so far as this proposition is concerned, 
 are merely speculators and theorizers. 
 
 Blood Test for Vaccination. — E. F. P. asks: "Has the blood ever been 
 examined after vaccination against smallpox has taken effect? If visible 
 changes are produced are they the indication for how long a time vaccina- 
 tion is a preventive of smallpox?" 
 
 Reply. — The blood has been carefully examined after vaccination 
 against smallpox. There are no visible changes. There is no way known 
 at the present time to measure immunity against smallpox except the 
 clinical way. 
 
 The clinical way is to try vaccination. If it fails, say twice, in a 
 person previously successfully vaccinated, immunity can be inferred. This 
 is the method of testing immunity employed by health departments. 
 
SMALLPOX 
 
 227 
 
 Anyone immune as shown by this test is allowed to visit in the wards 
 of the smallpox hospitals. This does not tell how long the immunity will 
 last. Nor is there any way of telling except by clinical experience. Seven 
 
 Department of Health: City of Chicago-1910 
 
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 Fig. 105. — Localized Epidemics of Typhoid Due to Milk; 1910 and 1911. Each 
 small circle represents a case. 
 
 years is a safe limit of trust in immunity from vaccination. Some people 
 will remain immune for, say, twenty years. Most people will be immune 
 for ten years. But the safe assumption is that immunity from vaccina- 
 tion does not last more than seven years. 
 
228 CONTAGIOUS DISEASES 
 
 Smallpox and Vaccination. — V. A. M. writes: "Some parts of the 
 Illinois valley have the misfortune to have threatened epidemics of 
 smallpox. Are there any serious objections to vaccination? Can it be 
 the source of other diseases? At what distance can the contagion be 
 transmitted — that is, how close to an affected person can one venture 
 with safety? Do fresh air and sunshine kill the germ? What precau- 
 tions are advised in addition to vaccination or to those who object to itf 
 What constitutes 'exposure' to it?" 
 
 Eeply. — 1. No. 
 
 2. No. 
 
 3. If successfully vaccinated recently he can sleep in the bed with 
 him with safety. If not, he should stay at least two hundred feet from a 
 case, or from anyone who has been in contact with a case, except that 
 the person in contact knows how to disinfect his hands and his clothes, 
 and has done so. 
 
 4. Yes. 
 
 5. No precautions are required except vaccination. 
 
 6. Contact with a case, touching him or his clothes or getting within 
 a short distance (say five feet) of him. Two hundred feet is an extra 
 precaution. Unvaccinated communities sooner or later pay the price. 
 
 Amputation and Vaccination. — E. T. writes: "My little boy was suc- 
 cessfully vaccinated a year ago. A few months ago he had an accident 
 and lost his left arm (where the vaccination scar was). Shall I have him 
 vaccinated again? If so, where?" 
 
 Reply. — A successful vaccination changes the entire body so that 
 it is protected. He need not be vaccinated again for six years. He is 
 in no danger from smallpox. Get a certificate from the vaccinator. 
 Use this as your proof. 
 
 SCARLET FEVER 
 HOW SCARLET FEVER SPREADS 
 
 Scarlet fever spreads from mouth to mouth and the mouths cannot be 
 very far apart either, in point of time or in distance, else the disease will 
 not spread. 
 
 Every hour that elapses from the time the secretion leaves the mouth 
 of the sick and until it gets to the mouth of the catcher gives sunlight, 
 air and drying a chance to kill the contagion. Every hand, every cloth, every 
 table that it touches bars it away from its chance of getting to the mouth 
 which it can harm. It is no aeroplane or flying machine; it must be bodily 
 carried from sick to well. 
 
 In some German and English hospitals which treat scarlet fever in the 
 same large room with children convalescent and sick from other diseases, 
 there is a wall six feet high between the scarlet fever and the other cases. But 
 what gives the result is that no hand, no thermometer, no towel, nothing of 
 any sort which touches a scarlet fever case touches any other case until 
 it has been sterilized. The isolation, from the scientific standpoint, is com- 
 plete^ — and complete scientific isolation is what is essential for the control 
 of scarlet fever. 
 
SCARLET FEVER 223 
 
 The death rate in hospitals is always lower than in homes. It gives 
 the well children a chance to escape catching the disease. But it is a waste 
 without warrant to have a hospital for scarlet fever alone. 
 
 When a community with a smallpox hospital has no smallpox, but does 
 have scarlet fever, let the hospital be used for the disease they have. It is 
 safe. The hospital will not spread scarlet fever, smallpox, diphtheria, measles 
 or whooping cough. The building, the room, the bedding, can be used first 
 for one and then for another. It may be necessary to change the nurses, 
 physician and attendants, but not the building. 
 
 DEVELOPMENT OF SCARLET FEVER 
 
 Six days after exposure a child in whom scarlet fever is developing 
 will have a rise of fever and a sore throat. One day later a fine scarlet 
 rash appears in most cases. Usually the rash fades in seven days and scaling 
 of the skin begins in eight days. The throat is red and sore while the rash is 
 out and it continues red, swollen and boggy for days after the rash has dis- 
 appeared. 
 
 The great mistake which we make in handling scarlet fever is in paying 
 too much attention to the rash and too little to the throat. Many of the 
 cases never develop a rash at all, but they do get the sore throat. The throat 
 is the thing to watch. 
 
 When the patient is recovering again we have judged by the rash and the 
 scaling as to when the quarantine should end. Again the throat's the thing. 
 Watch the throat. 
 
 In trying to decide what spreads contagion, we have searched the 
 "scales." Again the throat's the thing to watch. Recent moist mouth dis- 
 charges, mouth spray, sputum, and "droolings" convey the contagion. 
 
 We know little about the germ which causes scarlet fever. We know less 
 about experimental scarlet fever than we do about experimental measles. But 
 from the practical standpoint we know this much: 
 
 A patient having scarlet fever is infectious from the first sore throat 
 to the time when the tonsils are no longer boggy and swollen and all discharges 
 from the nose, ears, and throat have stopped. 
 
 People who have been in contact with cases can occasionally spread the 
 disease through their mouth and nose secretions. 
 
 Cases with sore throat and without rash can spread the disease as readily 
 as those who have had it. 
 
 Dried secretions are not very apt to spread the disease. 
 
 SCARLET FEVER AND HOT HOUSES 
 
 About the first of January a man told a friend he was going south for 
 the remainder of the winter. The friend casually asked, "Are you going 
 away to escape the cold ?" "No," replied the first speaker, "I am going away 
 to escape the heat. Houses in New York in winter are too hot to live in. 
 I am going to Florida where the outside air and the rooms are cooler 
 than the rooms in New York." 
 
 The business man in Chicago spends more than three-quarters of each 
 
230 CONTAGIOUS DISEASES 
 
 twenty -four hours inside a house — and houses are warmer in winter in Chicago 
 than in Xew Orleans. 
 
 School children in Chicago live in air which is several degrees warmer 
 than that of school and living rooms in Xew Orleans. 
 
 When we know this we do not wonder that there are few deaths from 
 scarlet fever in Xew Orleans,, Richmond, or any southern city. 
 
 I wonder if the public generally knows that the scarlet fever death 
 rate mounts as we go north from Mobile with a rate of 3 per 100,000 to 
 5.3 in Memphis, to 9.6 in Louisville, to ISA in Chicago, to 30.2 in St. Paul, 
 and possibly a higher rate in Canadian cities. 
 
 Scarlet fever is a cold weather disease, because houses are hot when the 
 scarlet fever weather is cold. 
 
 It is a cold climate disease, because children are closely housed in the 
 cold climates. The moral is that when living rooms are as cool in the upper 
 Mississippi valley in February as they are in Richmond, the scarlet fever 
 rate will begin to drop and as the number of foci of the fever decreases the 
 drop will continue. 
 
 The moral, so far as the individual child is concerned, is that it be kept 
 out of hot rooms. 
 
 The moral for a child sick with scarlet fever is that it be kept in a cool, 
 well ventilated room. 
 
 In the spread of scarlet fever the throat secretions are of great importance. 
 Possibly scaling skin is of some importance. But do not forget hot rooms 
 and staying indoors. 
 
 MYSTERY OF SCARLET FEVER 
 
 Scarlet fever is a disease of mystery. Strange to say, its cause re- 
 fuses to be discovered in spite of the large amount of money that has been 
 spent on it and the great amount of brains and energy employed in scarlet 
 fever research. Xo bacillus has been found which is the cause in diphtheria 
 and no filterable virus as in measles. 
 
 That the infection gets into the nose and throat, that poisons circulate 
 in the blood and thereby reach the skin and kidneys as well as structures 
 which react less to them, that after a certain time the disease ceases to be 
 active whereupon the badly poisoned cells are shed — these observations 
 are so easily made that they are not disputed. That the disease belongs in 
 the group of contagions of the type caused by microorganisms is but little 
 questioned. 
 
 For some reason atmospheric temperature plays a prominent part in it. 
 It abounds in winter and decreases in hot weather but enough lingers 
 to carry the seed over from winter to winter. In climates where the outside 
 air is cold and the room air is hot. the scarlet fever rates are high. In 
 those such as Xew Orleans, where the outside air is balmy and the room 
 air is frequently too cool for comfort the scarlet fever death rates are not 
 high. The mothers of Kentucky. South Carolina, and Mississippi know 
 nothing of the dread of scarlet fever felt by the mothers of Wisconsin 
 and Minnesota. 
 
 It has been suggested that in the gulf states the people have scarlet fever 
 
SCAELET FEVER 231 
 
 so mildly that it is not called scarlet fever. It is only the rare and highly 
 exceptional case that develops symptoms that mark it plainly as scarlet fever. 
 It is only the rarer epidemics in which the cases are typical. 
 
 Scarlet Fever Incubation. — JR. W. S. writes: ''Would you kindly 
 state the period of incubation for scarlet fever? Is scarlet fever con- 
 tagious during the first stages of the disease? Can dogs or cats act as 
 carriers of the disease?" 
 
 Eeply. — 1. Usually three to four days; occasionally one day; occa- 
 sionally one week. 
 
 2. Yes. 
 
 3. Possibly. 
 
 Definition of Scarlatina. — J. W. W. a: rites: "Will you please tell me 
 the difference between scarlet fever and scarlatina?" 
 
 Reply. — The first is the English name, the second the Latin name 
 of the same disease. There is absolutely no other difference. One does 
 not describe a mild and the other a severe form of the disease, a wrong 
 belief that leads many to neglect proper quarantine precautions in what 
 they think is the milder form. 
 
 Reporting Scarlet Fever. — Anxious Mother writes: "My baby has 
 had scarlet fever for the last three weeks and has started to peel very 
 slightly on his head, feet, and knees. Let me hnow where the contagion 
 lies, because I have another child o 1 * years old. I keep him- out of the 
 house, but he comes every day and begs to be let in. Would I do any- 
 body harm if I should take a walk in the evening and talk to people 
 standing a little distant from me? My doctor has not reported the case. 
 Should I report it now to the board of health and must I be locked in 
 for six weeks more?" 
 
 Reply. — You should insist upon your doctor reporting the case to the 
 health department, or you should report it and the department will send 
 out someone who will tell you just what to do, and will also disinfect 
 your house when the child is well. The quarantine generally lasts from 
 four to six weeks from the beginning of the disease. If you report it 
 now your quarantine will last but a short time and you will know that you 
 have not been the means of spreading the disease. If you keep away 
 from your other child and do not let him come home until the house has 
 been disinfected the chances are he will not get it. 
 
 Obey Health Board. — Mrs. W. P. C. writes: "My family has been in 
 quarantine for seven weeks, owing to scarlet fever, and the child who 
 had it is still scaling off on the feet and on the hands. She has scaled off 
 three times already. I wish to know if this last scaling is dangerous, 
 and if it would be all right for the family to get out of quarantine." 
 
 Reply. — If the throat and nose are well, if there is no discharge from 
 the ears, the peeling may be disregarded. By all means obey the in- 
 structions of your health board, charged as it is with the responsibility 
 of protecting your community. But call its attention to the more recent 
 writings on the subject; for instance, Chapin's "Sources and diodes of 
 Iniection/' or Hill's articles in the Canadian Public Health Journal, 
 
232 CONTAGIOUS DISEASES 
 
 Scarlet Fever in School. — "Interested Neighbor' writes: "At the 
 Langland school there have been several cases of scarlet fever, and it 
 seems to be spreading more every day. There have been cases of children 
 peeling in school. This is from the doctors own lips. Now, if you go 
 to a house where there is a scarlet fever case, you tack a sign on the 
 door, and all but those in attendance must leave or you quarantine them. 
 Since there have been three cases found in school, I propose the closing 
 of the school and having it thoroughly fumigated/' 
 
 Reply. — To close a school and disinfect it as a method of preventing 
 the spread of scarlet fever is not good practice. When it has been tried 
 it has failed. Scarlet fever is spread by people, not by desks and walls. 
 Children "peeling" in school are the spreaders. A good quarantine and 
 close inspection will control the epidemic. 
 
 Hot Baths in Scarlet Fever. — H. M. B. of St. Louis writes us advo- 
 cating the use of almost continuous hot baths in the treatment of scarlet 
 fever. He illustrated its benefit by relating many severe cases, some in 
 his own family, which rapidly improved and subsequently recovered 
 following the repeated use of hot baths. The baths are given as hot as 
 the hand can bear. He concludes by asking how can a better, surer 
 treatment be devised? 
 
 Reply. — Hot baths in scarlet fever will be of great service. It will 
 remain one of the best agents until the scarlet fever germ is discovered 
 and some form of specific treatment is worked out. That will be a better 
 way — it is not yet in sight. 
 
 Scarlet Fever Danger. — J. R. W. writes: "Is there any danger of a 
 child contracting scarlet fever from another child with whom it has 
 played in the open for several days before the disease was known? Is 
 there a safe treatment to immunize the child if there is any danger of 
 contracting the disease?" 
 
 Reply. — 1. If you mean before the child was feverish and "broken 
 out," no. If you mean that the throat was sore, the eruption out, the 
 patient with fever and pains but no diagnosis made, yes. 
 
 2. No. 
 
 Scarlet Fever Contagion. — S. F. writes: "Would there be any danger 
 of taking scarlet fever by passing through the entrance of a flat build- 
 ing when the family in the lower flat have the disease?" 
 
 Reply. — No. 
 
 Disinfection After Scarlet Fever. — F. J. H. writes: "What is the 
 latest and most approved method of fumigation, particularly where 
 scarlet fever is prevalent? That the use of formaldehyd is not effica- 
 cious has been many times demonstrated in families where one or more 
 children — not exposed originally — were taken away from home until 
 after the disease had run its course in the case of the patient quaran- 
 tined and then brought home after the quarantine had been lifted and the 
 premises pronounced thoroughly fumigated, only to come down with the 
 disease within ten days after returning home. Will any method of fumi- 
 gation which will destroy the fever germ or render it innocuous be harm- 
 less to insect life confined in the same room or rooms?" 
 
DIPHTHERIA 233 
 
 Reply. — Formalin is the best disinfectant. It does not kill insects. 
 Sulphur fumes do kill insects, but are not so effective as a fumigating 
 agent. The fact that cases of scarlet fever have developed after children 
 had come back does not mean that the houses were not properly disin- 
 fected. It means that the houses were disinfected before the patients 
 were safe. Sometimes the patients were still scaling. Usually they still 
 had running ears or nose discharges or swollen tonsils. It is the partly 
 cured patients, not the houses, which spread disease. 
 
 Contagiousness of Scales and Disinfection. — S. T. 0. writes: "(1) Is it 
 generally accepted that scarlet fever is not contagious during the desqua- 
 mation period? (2) What is now considered the test way to disinfect a 
 room after a contagious disease?" 
 
 Reply. — (1) No. The better posted physicians hold that the scales do 
 not spread the disease. By reason of throat secretions the patient may 
 be, and often is, infectious during the scaling period. 
 
 (2) Thorough washing, sunning, and airing. Now that New York has 
 stopped fumigating, other cities will probably stop also. 
 
 Scarlet Fever Aftermath. — G. M. writes: "(1) Does scarlet fever leave 
 any ill effects and, if so, what? (2) How long after recovery may a patient 
 play tall, swim, or dance safely?" 
 
 Reply. — 1. Yes. Some of the more important are deafness, Bright's 
 disease, heart disease, and rheumatism. Bright's disease and infection 
 of the ears generally follow promptly; rheumatism moderately so, but 
 heart disease is generally not recognized for several years afterward. 
 
 2. Let him be guided by his feelings. Have him start easily and in- 
 crease the task as fast as his soft, mushy muscles will allow. 
 
 DIPHTHERIA 
 
 Diphtheria is due to the diphtheria bacillus. This bacillus was discovered 
 by Klebs thirty years ago. Seven years later von Behring discovered anti- 
 toxin, and eleven years later, in 1894, Roux made practical use of this sub- 
 stance in treating the disease. 
 
 We know the cause of the disease and its every habit. We know the 
 remedy, how to make it, and how to use it. We have had this information for 
 from nineteen to thirty years. Yet there is some diphtheria. 
 
 We think there is an appalling amount, and maybe there is; but 
 the middle aged people will tell you that the present amount is trivial as com- 
 pared with that in the '80s and '90s. Why diphtheria is still with us 
 will be told later on. 
 
 The diphtheria bacillus enters the body at some one of the openings. 
 It does not belong in the human body, and it ventures in with great fear 
 and trembling. __ 
 
 There are four openings into the body. The diphtheria bacillus rarely 
 enters any except the nose and mouth. The nose as the port of entry is of 
 little importance as compared with the mouth. The bacillus can be carried 
 in with the inspired air. 
 
 The usual method of entry is from the fingers, pencils, toothpicks, spoons, 
 
234 CONTAGIOUS DISEASES 
 
 toys, handkerchiefs, and towels to the month. The bacilli that stop in the 
 front part of the month are washed ■ out by the saliva. Those that get 
 into decayed teeth, into folds in the lining membrane, and into the pits 
 in the tonsils stay where they locate. 
 
 The bacillus rarely gets farther in than the tonsils. Occasionally it gets 
 into the windpipe ; rarely it gets into the bronchial tubes ; still more rarely it 
 gets into the lungs. It may travel down the esophagus or gullet to the 
 stomach, but that is exceedingly rare. 
 
 We see that the bacillus does not venture far into the body. It can only 
 travel a few inches down or up these natural tubes. Of course, a diphtheritic 
 patient is swallowing bacilli constantly, but those swallowed are killed by 
 the body juices. 
 
 The bacilli do not get into the blood. They secrete poisons which are 
 absorbed, but the bacillus itself never gets into the blood stream. The bacilli 
 do not travel far in the lymphatics. It is rare for them to get into the lym- 
 phatics at all, but those that get in are stopped by the nearest lymph glands. 
 
 One of the ways of telling diphtheria is the swelling of the glands on the 
 outside of the face and neck. 
 
 These glands swell because they are working hard to neutralize the diph- 
 theria toxin and to filter out the pus cocci that get in through the diphtheria 
 wound. 
 
 We have said that there are four gates into the body. The gates having 
 been passed, there are three routes beyond — the tubes, the blood vessels, and 
 the lymphatics. 
 
 We have said that the bacillus has no capacity to travel up or down 
 the tubes. When it starts toward the blood vessels and lymphatics it is 
 quickly stopped. What is the reason? 
 
 The diphtheria bacillus is a most virulent germ. It se.ars as a red hot 
 iron whatever surface it touches. When it locates in a pit in the tonsil it 
 kills every cell in its neighborhood. 
 
 When a red hot iron sears a surface a healing serum quickly oozes 
 out. When the diphtheria bacillus sears the surface a healing serum also 
 oozes forth, but the bacillus cooks and coagulates this serum as well as the 
 cells. 
 
 This coagulated, gray, dirty, bleeding membrane, called the diph- 
 theritic membrane, is composed of coagulated serum and cells. This clot 
 stops up the lymphatics and blood capillaries and walls off the diphtheria 
 bacilli. 
 
 That is the reason why the diphtheria bacillus stays on the surface where 
 it locates and does not travel far. But, though caught in this net, it does 
 not die or become inactive. 
 
 The diphtheria bacillus secretes a poison called diphtheria toxin. This 
 poison enters the lymph channels. The lymph glands remove as much of 
 it as they can. The blood dilutes it. 
 
 The solution of toxin as it circulates in the blood is not so violent 
 because not so concentrated as where it entered. By the blood it is carried 
 to the different parts of the body. 
 
 It poisons whatever it touches, but it poisons certain cells more than 
 others. It markedly poisons the heart, its nerves, and its nerve center. 
 
DIPHTHEEIA 235 
 
 In consequence the pulse is rapid out of proportion to the amount of fever, 
 and paralysis of the heart is an occasional result. 
 
 It poisons the nerves, and in consequence the weakness is out of pro- 
 portion to the fever. Paralysis due to neuritis, or an overpoisoned nerve, is 
 an occasional result. 
 
 The amount of poisoning not only depends on the patient and on the 
 bacillus, but it is also greatly influenced by the location of the bacillus. 
 If it is on the tonsil that gland protects the balance of the body. The 
 tonsil is one of the best places to have diphtheria. 
 
 On the other hand, the nose is a bad place to have it. The poison 
 is poured right into the blood when the disease is in the nose. 
 
 The windpipe is a bad place to have diphtheria, not because of the 
 large amount of poison absorbed but because of the danger of choking. 
 The space between the vocal cords is so small that not much room is left 
 when a diphtheria membrane is present. 
 
 The diphtheria poison is moderately hard on the kidneys. Acute 
 Bright's disease is occasionally present, but it is not of as much importance 
 as it is in scarlet fever or pneumonia. . 
 
 In diphtheria the disease generally starts within two days of the 
 exposure. There is pain in the throat. This pain is much less than in 
 ordinary follicular tonsillitis. There is some fever, 99° to 101°, but it also is 
 much less than in follicular tonsillitis. There is some general aching, but 
 that also is less than in the less severe forms of sore throat. 
 
 When the tongue is pressed down the back of the throat is red and a 
 gray membrane is seen. A little later the glands of the neck around the 
 ear and the angle of the jaw are seen to be swollen. The pulse is ten beats 
 higher than one would expect with a fever of that degree in a child of 
 the age of the patient. If the disease extends into the windpipe the child 
 will show signs of obstruction to breathing. 
 
 This is about as much as can be said about the way to know diph- 
 theria when one sees it. 
 
 When eighteen years ago it became the rule to make a microscopic 
 examination of the throat the microscope commonly showed that these 
 "sensed" diagnoses were right. It was not for some years that the other 
 side of the picture began to show up. 
 
 That other side was this: A large part of the sore throats that the 
 clinical diagnosticians had said were not diphtheria the microscope showed 
 to be diphtheria. 
 
 When the physicians began to run down the cause in every case of diph- 
 theria they soon came to the conclusion that sewer gas, garbage dumps, leaky 
 drains, and bad gutters could not cause the disease. When these causes were 
 ruled out they were left hanging in the air. 
 
 The day of mysteries was past. A cause must exist. To find that cause 
 they began to examine the throats of all the people who had been in con- 
 tact with the sick one for several days before the illness began. 
 
 This search led to a discovery. The discovery was that the diphtheria 
 bacillus often caused follicular tonsillitis, the tonsillitis with the white 
 patches in the throat. 
 
 Soon it was found that the diphtheria bacillus could cause the simple 
 
236 CONTAGIOUS DISEASES 
 
 sore throats without any membrane or patches of any sort. Soon aftei 
 this it was found that the diphtheria bacillus could be present in the throat 
 without causing any soreness or any symptoms of any sort. 
 
 The conclusion was that the only test that could be depended on was the 
 bacteriological test. 
 
 This does not work the hardship that one might think. To make a 
 throat culture is easy. Laboratories to examine these cultures are every- 
 where. The states now provide laboratories with branches in different places. 
 The cities now provide laboratory facilities with branches scattered every- 
 where. 
 
 In addition a large percentage of the physicians are equipped to examine 
 for this bacillus. If a town has not an equipment at the city hall it could 
 easily and inexpensively provide one in the public school. 
 
 Some would object to doing this work in the public school on the 
 ground that it would endanger the pupils. The objection is theoretical. A 
 few epidemics among laboratory workers are on record, but the number is 
 small and the deaths have been few. 
 
 I think it was Havelock Ellis who wrote of the disadvantage of having 
 a cure for a disease. It had sometimes operated to cause a spread of the 
 disease. The knowledge that one could be cured made people less careful 
 to avoid it. 
 
 The people of today cannot understand the dread of diphtheria that 
 prevailed up to ten years ago. They are still afraid of it, but the fear has 
 diminished to the point where it has ceased to be much of a deterrent. 
 
 Antitoxin has been reducing the death rate, but it has been pulling 
 against a fearful load. There are more cases of diphtheria now than 
 there were twenty years ago. 
 
 Several years ago health departments inaugurated a policy that has 
 made the control of diphtheria more difficult. For several years it has been 
 the policy to inject the children in the family with about 1,000 units of 
 antitoxin each. This makes it impossible for them to contract diphtheria for 
 about a month or perhaps for six weeks. In the meanwhile the sick child will 
 be well and the danger will be past. 
 
 The plan works all right so far as that family is concerned, but it works 
 all wrong so far as the neighborhood is concerned. 
 
 Antitoxin prevents the child from getting sick with diphtheria. It 
 does not prevent diphtheria germs from getting into his throat and stay- 
 ing there for six weeks or more. 
 
 Antitoxin, as its name implies, is an antitoxin and not an anti-bacterial 
 substance. 
 
 In the old days the family tried mighty hard to keep the well children 
 away from the sickness. They sent them away at considerable expense or 
 got some neighbors to take them, or kept them well away from the sick 
 children even for weeks after the illness. 
 
 They did not need watching to see that they carried this out. They 
 knew that if it were not carried out it meant other sick children. 
 
 Now they give a prophylactic dose of antitoxin, and they know the 
 children to be fairly safe. They are therefore less careful in carrying out 
 quarantine. 
 
DIPHTHERIA 237 
 
 Within the last year or less von Behring, the man who discovered anti- 
 toxin in 1890, discovered a way of vaccinating against diphtheria that 
 he claims protects not only the children in the family but the children 
 of the neighborhood. 
 
 When the health department inspectors get out to run down a diphtheria 
 epidemic now they examine bacteriologically the throat of every person 
 who has been thrown with the sick one. They have been doing this now 
 for several years. 
 
 They have discovered several things. One is that after diphtheria has 
 been diagnosed and quarantine has been established the sick person rarely 
 gives it to anybody. So long as he is lying in his bed violently sick he 
 does not infect anybody. 
 
 Another is that those dead of diphtheria do not infect anybody. The 
 present method of embalming and of conducting funerals in deaths from 
 contagion amply protects the community. 
 
 Another discovery is that diphtheria is spread by convalescents. The 
 most important discovery is that the great bulk of the diphtheria is spread 
 by persons who are but mildly sick, and especially by persons whose sore 
 throats look just like ordinary, everyday sore throat. 
 
 So far as the treatment of the disease is concerned, there is but one 
 procedure of any consequence. That is to give plenty of antitoxin. The anti- 
 toxin is given to neutralize the toxin. 
 
 As' the amount of toxin increases each day of the disease, the dose of 
 antitoxin must vary with the stage of the disease, not the size or age of 
 the patient. 2,000 units may be enough and usually is enough if the throat 
 has been sore less than a day. 
 
 It would be much too little for the second day and would be of no serv- 
 ice on the third day. 
 
 5,000 units is little enough on the second day, and 10,000 on the third. 
 If the patient is choking it will be necessary to use a tube in the larynx. 
 
 ALMANAC TALK ON DIPHTHERIA 
 
 On diphtheria, the Virginia Almanac speaks as follows: "Thirty 
 Years Ago and Now. Around the tea table, after the custom of the sex, 
 they had been discussing the maladies of their children. 
 
 " 'It's simply wonderful,' said the distinguished authoress, 'what science 
 has done to overcome diphtheria. I remember, thirty years ago, when I 
 was a child — yes, quite small, thank you — one of my sisters had membranous 
 croup. It came very suddenly and brought terror to our hearts. In twenty- 
 four hours my sister was dead. 
 
 " 'Now — just think of the contrast ! My little boy had diphtheria last 
 winter, and. when the doctor said it was a very bad case, my heart sank. 
 I had not forgotten that other tragedy in the family. But he gave the 
 child antitoxin at once, and, in a few hours, the boy was practically well. 
 
 " 'Of course, ladies, much depended on giving the antitoxin promptly, 
 but to tell you the truth, I had far rather for my child to have diphtheria 
 than measles or whooping cough/ 
 
 "Diphtheria is an acute, contagious disease, due to a germ which 
 
238 CONTAGIOUS DISEASES 
 
 comes from patients who have the disease. Within three days after the 
 patient is exposed the nose, the throat or larynx becomes inflamed, and 
 is gradually covered by a 'membrane/ or grayish patch. Without anti- 
 toxin the course of the disease is very severe, and may be accompanied by 
 heart failure or paralysis. The mortality varies much, ranging as low 
 as 50 per cent, in very severe forms. 
 
 "Antitoxin is a sure cure for diphtheria, but its efficiency is directly in 
 proportion to the promptness with which it is used. Any delay means danger; 
 long delay means death. 
 
 "Isolation is necessary to prevent the spread of diphtheria. Mild cases 
 and cases which show no outward symptoms spread the disease. No case 
 is allowed under the law to leave the premises until an examination shows 
 the germs to have disappeared from the throat. 
 
 "Antitoxin is to diphtheria what sunshine is to snow. 
 
 "A syringe of antitoxin is better than volumes of advice. 
 
 "The physician who delays giving antitoxin b'elongs with the man who 
 waited till the house burned down to put out the fire. 
 
 "A sore throat in diphtheria season is as suspicious as a strange negro 
 in a hen house. 
 
 "Great epidemics from little sore throats grow. 
 
 "Take no more chances with diphtheria than with a coiled rattler." 
 
 Carriers of Diphtheria. — B. B. of Flat Bock, III., writes: "We are 
 having an epidemic of diphtheria. Babbits are found dead in many 
 places. It is charged that rabbits carry the disease. Is there anything 
 in this?" 
 
 Reply. — From time to time it has been claimed that the lower 
 animals, and particularly chickens, spread diphtheria. Bacteriological 
 studies have not confirmed these claims. My advice to you is to have a 
 local physician inoculate a test tube from the throat of a dead rabbit 
 and then send the rabbit and the tube to the State Board of Health, 
 Spring-field, 111. But the chances are at least 99 out of 100 that the 
 diphtheria in Flat Rock is being spread by people. Quarantines should 
 be established at once. Every person found with diphtheria bacilli in 
 his throat should be quarantined whether sick or well. Probably as 
 much diphtheria is spread by "carriers" — that is, people who are well but 
 who have bacteria in their throats — as by people who are definitely sick. 
 If, say, ten people came in contact with a case of diphtheria somewhere 
 about four of them would get the disease, about four would be "carriers" 
 for a few weeks, and about two would wholly escape. Concentrate your 
 control on people. Incidentally investigate rabbits. 
 
 What Croup Is. — F. B. writes: "I am one of nine children, none of 
 whom ever had croup, so I know nothing of it. My wife is always warn- 
 ing me about what to do if our children get it. Does the eating of heavy 
 food at night have anything to do with itf" 
 
 Reply. — Croup is an ordinary cold located in the windpipe, with 
 some swelling and some nervous spasm as a complication. The air 
 tubes are irritated by the "cold," and they contract and become smaller 
 in certain places. 
 
 Certain nervous children develop this feature when they catch cold. 
 Other children do not. It is often a family peculiarity. 
 
CROUP IN CHILDREN 239 
 
 The eating of heavy food at night might have some indirect effect. 
 
 Croup should not be confused with diphtheria, which it often re- 
 sembles. Many children die with diphtheria because their disease was 
 called croup for the first few days. 
 
 To Get Rid of Bacilli. — L. B. writes: "Please inform me how to 
 get rid of diphtheria bacilli. We have a case in our family" 
 
 Reply. — Various methods have been used. One is to apply some 
 violent antiseptic to the crypts of the tonsils. Nitrate of silver, iodin, 
 and carbolic acid have been used for the purpose. A wash of antitoxin 
 and a dry antitoxin powder have been used. 
 
 Either the health department or your family doctor can help you. 
 A good discussion of the subject can be found in the Journal of the 
 American Medical Association. The paper was read by Professor Albert 
 of the University of Iowa. Professor Ravenel of the University of Wis- 
 consin and a gentleman from the University of Minnesota reported cures. 
 
 CROUP IN CHILDREN 
 
 Time was when we spoke of membranous croup as a separate disease. 
 It is now known that membranous croup is due to diphtheria. The term 
 "croup" is now used to mean an ordinary cold — nose, throat, or bronchial 
 tube cold — accompanied by an element of spasm. The very important point 
 to determine is whether the croupy child has diphtheria. If it has diphtheria, 
 antitoxin must be given quickly and the child must be isolated. 
 
 If it is an ordinary croup, antitoxin should not be given; isolation need 
 not be strict. The tendency will be to overmedicate, overnurse, and overcare 
 for the sick one. Pretty important point to decide, then, is it not? The 
 important questions to answer quickly are these: 
 
 Is there diphtheria in the neighborhood? 
 
 Is there much sore throat among the child's playmates? 
 
 Are there kernels in the neck? 
 
 Can anything be seen on the tonsils ? 
 
 Is the child subject to croup? 
 
 Is this attack of croup acting like other attacks? 
 
 Ordinary spasmodic croup is not so serious as it seems. A good 
 dose of salts followed in four hours by a dose of castor oil should be given. 
 Ordinary care for a common cold, carried out in a well ventilated, well 
 warmed room, will be all that is needed for the ordinary case. 
 
 Croup is usually overtreated. The children are made worse by being 
 fussed with too much. They are wrapped up too much and the sick room 
 is sealed too tightly. 
 
 If the breathing gets very tight give a teaspoonful of sirup of ipecac. 
 This can be repeated if necessary. The important point to decide is which 
 of these cases is suspicious enough of diphtheria to make it imperative 
 to have a throat culture. We will make headway when parents can and 
 do make throat cultures. 
 
240 CONTAGIOUS DISEASES 
 
 MEASLES 
 
 Bulletin 109 of the Census Bureau tells us that in 1910 measles caused 
 a death rate of 12.3 per 100,000 population in the registration area. It 
 further says it is true that many deaths assigned to other causes are due 
 to the unfortunate consequences of this disease. 
 
 In nursing babies it is more fatal than diphtheria or scarlet fever. 
 Health officers have more trouble holding a measles epidemic in check 
 than one from any other disease, simply because people are not afraid 
 of measles. If fear does harm in some directions, lack of it does harm in 
 others. 
 
 Whether it be measles or money, diphtheria or riding on the train, 
 scarlet fever or running a store — fear that leads to intelligent precaution 
 is to be applauded. Fear that leads to useless worry is to be condemned. 
 
 Measles begins with a fever and the other symptoms of a severe cold. 
 Four days later the eruption comes out; after two days it fades away, the 
 fever goes, and convalescence is established. When this, the normal course, 
 is interfered with it is because, secondarily, an infection of the lung 
 (pneumonia), or of the kidney (acute Bright's disease) has come on. The 
 germ gets into the nose and from there goes into the blood. The germs 
 are spread from the time the first symptom starts until the fever drops. 
 
 The important point to remember is that it is contagious before there 
 is any symptom which is clearly distinctive — during that four days before the 
 breaking out comes. Therefore, all children with colds and fevers should be 
 excluded from the schoolroom and isolated at home. 
 
 Dr. Chesley of the Minnesota Health Department says that when an 
 epidemic of measles is on the children of the public schools should be 
 superficially examined each day. Children in the incubation stage of measles 
 will show measles patches in the back of the mouth in advance of any eruption 
 on the skin. 
 
 The superficial examination which he recommends consists of observa- 
 tion as to red eyes, coryza and patches in the mouth. 
 
 Perhaps a still better plan in time of measles epidemic would be to 
 exclude all children with acute colds from schools for four days. 
 
 To close the schools is a bad method of controlling measles. 
 
 Measles Not Universal. — Anxious Mother writes: "Why does Chi- 
 cago go to the expense it does, if the measles is a universal disease and 
 all children should have it? What is there to this disease or its after- 
 effects to make the city so careful?" 
 
 Reply. — Measles is not a universal disease. Most careful' mothers, 
 living in towns with good government and good public sentiment, raise 
 part of their children and some raise all their children without their 
 having had measles. The measles death rate in the North is about 
 two-thirds as high as that of scarlet fever. In the South it is higher. 
 These are two sufficient reasons. 
 
 In Cases of Measles. — W. H. W. writes: "1. In case of measles in a 
 school, but one case being found, what procedure would you follow to 
 prevent an epidemic? 
 
MEASLES 
 
 241 
 
 "2. In case of measles in a home, is it necessary that the children 
 be kept in the house, that is, off the sidewalk about the house and away 
 from adults or other children who have had the measles? 
 
 "3. May children who have had measles and are in the second week 
 of convalescence take walks about the residence part of the town pro- 
 
 !!T 
 
 1111 
 
 km 
 
 ;""""M'-ininn 
 
 
 Fig. 106. 
 
 vided these children are not allowed to come in contact with or associate 
 with anyone who has not had the measles?" 
 
 Eeply. — 1. If it is the first case in town or in the neighborhood 
 exclude the child. Exclude all children who have ordinary colds during 
 two weeks following the exclusion of the case. If a crop of cases devel- 
 ops after this first contact close the school. If the epidemic has run 
 beyond this stage closing the school accomplishes nothing. 
 
 2. Yes, except as to the nurse. The nurse must keep away from 
 everyone except the sick child. The isolation must start with the first 
 sneezing, the onset of the disease, and be kept up until the fever has 
 gone. 
 
 3. Yes. 
 
 Conveying Measles. — C. H. S. writes: "1. Can a third person who 
 has had measles convey the disease to others if living in a home where 
 
242 CONTAGIOUS DISEASES 
 
 the disease exists? 2. Is it safe for children (who have had measles) to 
 continue attending school from a home where younger children are suf- 
 fering from this disease where no isolation is observed? 3. Is a dis- 
 charging ear ever caused by teething in the child?" 
 
 Reply. — 1. Yes, if he comes in contact with the case. 
 
 2. No. 
 
 3. No; a discharging ear means infection has traveled from the 
 throat to the ear. Discharging ears in children is the usual cause of 
 deafness in old people. 
 
 Susceptibility to Measles. — S. H. writes: "A young woman who 
 grew to womanhood without having the measles, although she was ex- 
 posed many times to the disease, thinking she was immune, visited a 
 house where there was a case of measles. Later her throat became sore, 
 but no rash broke out. A doctor said she had measles. Do you think 
 his judgment was correct?" 
 
 Reply. — Probably, yes. Occasionally a person has measles a second 
 time. Occasionally a person seems to be immune to measles for years 
 and then becomes susceptible. More frequently the reverse is true. I 
 have known of persons never vaccinated failing to contract smallpox on 
 one exposure and later contracting it from a less intimate exposure. 
 
 Time of Contagion in Measles. — M. writes: "After the eruption in a 
 case of measles has disappeared, how long is there danger of contagion 
 (1) from the patient; (2) from the attendant or nurse; (3) from the sick- 
 room where ordinary cleanliness is observed but no fumigating is done?" 
 
 Reply. — (1) The present day teaching is that the danger is greatest 
 before the eruption, in the fever and coughing stage; is not very great 
 after the eruption appears; is slight after the eruption fades; and has 
 disappeared entirely by three days after the fever and breaking out has 
 gone. 
 
 (2) The nurse who covers her clothes with a gown and washes her 
 face and hands as she leaves the sickroom is not dangerous during the 
 illness and certainly not after the illness has subsided. Unless she fol- 
 lows this plan scrupulously she is about as dangerous as the patient. 
 
 (3) Ordinary cleanliness does not accomplish much. If the room 
 and its contents are scoured with soap and water and then thoroughly 
 aired and sunned the danger will be ended as soon as the process is fin- 
 ished. 
 
 Open Window No Danger. — L. M. writes : "(1) If a person visits a house 
 where there is a case of measles and comes in contact with the case, how 
 long afterward would that person be likely to spread contagion? (2) 
 Would he be safe after a month? (3) Does the health department insist 
 on fumigation after a case of measles? (k) M Are people in quarantine 
 allowed to have windows open, and [fr] is there any danger of contagion 
 as in cases of scarlet fever, etc., in passing a house where the window is 
 open?" 
 
 Reply. — 1. A day or less. 
 
 2. Yes. 
 
 3. Some do; some do not. 
 
 4. [a] Yes. [b] No. 
 
WHOOPING COUGH 243 
 
 German Measles. — L. S. L. writes: "1. Have German measles any 
 connection with common measles? 2. Are they contagious? 3. If so, 
 after what period is danger from contagion passed? Jf.. Can they he 
 spread by others than the person affected? 5. Are cases quarantined in 
 Chicago, or are persons living in same house prevented from going 
 about?" 
 
 Reply. — 1. No. 
 
 2 and 3. Yes, about seven to ten days from first symptoms. 
 
 4. Possibly also by "close contacts." 
 
 5. If they are not in contact with the sick, no. 
 
 WHOOPING COUGH 
 
 A Harvard professor has found the germ of whooping cough. That 
 discovery by itself is of no more importance than the discovery of the 
 South Pole. What will make the discovery worth while will be for scientists 
 to grow this germ and watch it as a farmer does his pigs. Presently the 
 scientists will be able to tell us all about the habits of this germ; then 
 some simple, working, everyday methods of microscopic diagnosis will be 
 published. 
 
 When these methods come into general use we will, no doubt, find that 
 many cases of whooping cough never whoop and that some of the cases that 
 now develop like lightning out of a clear sky will be explainable on the 
 ground of contact with carriers or with atypical cases. Then the scien- 
 tists will inject the germs into some susceptible animals and, next, they 
 should get a curative serum, and, eventually, a preventive vaccine. 
 
 In the meanwhile, the methods of controlling whooping cough all 
 down the line are crude and unscientific. If it is cure, there is nothing 
 to do but let them whoop it out. If it is diagnosis, the only certain sign 
 is the whoop. When that is present anybody can diagnose the disease, and, 
 when it is absent, nobody can. One man's guess is as good as the next man's. 
 When it comes to handling the disease from the standpoint of prevention, 
 the same crudity and uncertainty prevails. 
 
 Fortunately, practically all the grown people have had it either in a 
 plain or a masked form and they are not susceptible to it. Children after 
 babyhood are not endangered by it. 
 
 The disease is a monumental bluffer. An affected boy may be whoop- 
 ing so as to frighten his mother stiff one minute and the next he will be 
 turning a handspring. But nursing babies are killed by it, and by the 
 thousand. 
 
 Out of this difference in the susceptibility of various groups of people 
 has grown a suggestion that should prove of great value in controlling 
 this disease and of some value in controlling other diseases. It is to tag the 
 patient rather than the house. Say tag both the patient and the house 
 from the time the diagnosis is made until ten days later, then let the child 
 go out with the tag conspicuously displayed. 
 
 In old Bible times they followed that plan with the leper. A con- 
 spicuous card reading: "I have whooping -cough" in these days should be as 
 
244 CONTAGIOUS DISEASES 
 
 efficacious as the cry of "Room for the leper" in the days when men could 
 not read. Under such a plan the babies could be kept away from the 
 "whoopers" and the "whoopers" would get well quicker by reason of air 
 and exercise. Under this plan attention would be concentrated on the 
 person and taken from the house. All experience demonstrates the advan- 
 tage of such a shift of attention in controlling smallpox, scarlet fever, 
 diphtheria, infantile paralysis, meningitis, and measles, as well as in whoop- 
 ing cough. 
 
 The Census Bureau reports that the whooping cough death rate in 1910 
 in the registration area was 11.4 per 100,000 people of all ages. It further 
 says that, as with measles, these figures give no idea of the real harm 
 from whooping cough, since the deaths of children from whooping cough 
 are frequently recorded as from pneumonia and other complicating dis- 
 eases. When we remember that whooping cough kills none excepting nurs- 
 ing babies, and then compute how small a part of the total population is 
 under two years of age, we can understand the mothers' dread of this 
 malady. 
 
 It starts as an ordinary cough and, for ten days, cannot be told 
 from a simple bronchitis. About the sixth day the cough gets worse and, 
 by the tenth, whooping begins. 
 
 The germ is found in the nose and throat secretions from the first 
 coughing spell until the whooping gets under way. After that state (whoop- 
 ing) is established, it is not possible to find the germ which is held to be 
 specific. 
 
 Since it is not very dangerous to any except nursing babies the first 
 essential is to keep nursing babies away from it. Whooping cough quaran- 
 tine is usually pretty poorly carried out. There is little hope of a good 
 quarantine. This is all the more reason why a nursing baby should be care- 
 fully shielded. The epidemiologic points to be noted are : 
 
 1. All children with coughs should be kept away from all coughing 
 children. 
 
 2. All babies should be scrupulously kept away from all coughing 
 children. 
 
 3. The isolation (quarantine) of cases of whooping cough should begin 
 as soon as the cough starts (ten days before the whooping begins) and be 
 kept up for two weeks and sometimes three. 
 
 4. It is doubtful if it is necessary to continue the quarantine until 
 the whooping stops — at least the latest literature is to the effect that 
 quarantines can be terminated before the whooping stops. 
 
 In measles there are cases that never break out, and in whooping cough 
 there are cases that never whoop. However, these cases are just as "catching" 
 as any. 
 
 Quit listening for the whoop. It is just a detail. It kills no child. 
 Medicines to stop it do not succeed and would do no good if they did. 
 Attention should be concentrated on saving the child from secondary pneu- 
 monia or other secondary effects. 
 
 Whooping Cough Contagious. — Mrs. E. L. J. wishes to be enlightened 
 concerning contagion of whooping cough. 
 
WHOOPING COUGH 245 
 
 Reply. — Whooping cough is extremely contagious during certain 
 stages. It is moderately contagious when the cough starts and up to the 
 time when the whooping starts. It is highly contagious during the 
 whooping stage. It is moderately contagious for about one week after 
 whooping stops. Occasionally there is danger of contagion for a few 
 weeks after whooping has stopped, say four weeks. These delayed in- 
 fections are difficult to provide against. It is not reasonable to confine 
 the sick person until all danger of delayed infection is past, ^specially 
 is this true in scarlet fever and whooping cough. The quarantine should 
 be continued so long as contagion can be reasonably expected. 
 
 Authorities are pretty well agreed that persons who have been in 
 close contact with a case of whooping cough can transport the con- 
 tagion. A whooping child spreads secretion rather more actively than 
 a child with any other form of contagion. Nevertheless, remember that 
 the sick child as a spreader is first in importance. Those in close con- 
 tact form a bad second. 
 
 Whooping cough does not persist three months. A child with a cough 
 persisting three months after a whooping cough started has had, say, 
 six weeks of whooping cough and six weeks of some other infection. 
 The child is not capable of spreading whooping cough then. But the 
 family doctor should determine why the cough persists. 
 
 Incubation Period. — Mrs. I. B. E. writes: "Will you please tell me: 
 (1) Is it possible for a child to get whooping cough in four or five days 
 after being exposed? Also, do you think it possible for a child to get 
 the disease by playing in the open air? (2) When a child just across 
 the street has it also, if the child with whooping cough is playing in his 
 yard? (3) Do they cough up a thick yellow mucus? (4) Sow long is 
 the disease considered contagious?" 
 
 Reply. — (1) The usual time is a week to ten days. Four to five is 
 too short a time. (2) If the child stays on his side of the street there 
 is no danger, provided the people and the things in contact with the 
 child also stay on their side of the street. (3) Yes. (4) For about a 
 week or ten days. The contagion is pretty well over when the whooping 
 starts. 
 
 Whooping Cough Danger. — J. R. K. writes: "Is there no way of 
 preventing heartless people from traveling with children — of their own — 
 who are suffering from whooping cough? When I boarded a Fere Mar- 
 quette railroad train at Holland, Mich., last month a minister of the 
 gospel, wife, and two small boys also got on the train and occupied four 
 seats in a parlor car. The younger of the two boys, k or 5 years old, had 
 as severe a case of whooping cough as I have ever seen or heard. The 
 older child had had it, was still coughing, but not whooping. There were 
 no less than six other children passengers in that car. One young 
 woman, about 20, had never had the disease, and when the mother sug- 
 gested that they find seats in another car, the mother of the whooping 
 child laughed aloud as though it was a huge joke. 
 
 "The colored porter told me that he had never had it and that he 
 had two babies at home who would be exposed, should he contract the 
 cough. It seems to me that such criminal selfishness and thoughtless- 
 ness are absolutely inexcusable in anyone, but especially so in one call- 
 ing himself an apostle of all that is highest in life." 
 
246 CONTAGIOUS DISEASES 
 
 Eeply. — The laws prohibit people with contagion from traveling. 
 The case is covered by the municipal ordinances of most of the towns 
 through which the road runs; also by the state laws of the three states 
 traversed and by the national laws. Furthermore, the conductor of a 
 train has a certain amount of police power over persons on his train. 
 
 I suggest that you report the facts, including the name of the parents, 
 to the Health Department of Chicago. 
 
 Should you have a similar experience appeal to the conductor at 
 once. Whooping cough ceases to be contagious before the whoop ceases. 
 You may be safe. 
 
 Shouldn't Go to School Yet. — J. C. K. writes: "My little boy has 
 had whooping cough for several weeks. There will be days when 
 he does not cough at all, but a cold, or dampness in the weather, seems 
 to affect him, and he will cough almost as hard as ever, throwing up his 
 food and spitting up white mucus. He will whoop at such times also. 
 Now, please tell me how long shall he be kept out of school. Until the 
 cough stops, or has he passed the time when he can give it to others'?" 
 
 Reply. — The regulations of the Health Department provide that he 
 must stay out until he quits whooping. As he vomits when he coughs, 
 clearly he should not go to school. Most authorities say the danger of 
 contagion has ended at eight weeks. 
 
 Whooping Cough and Quarantine. — S. A. E. writes: "1. Is whooping 
 cough a quarantine disease in Illinois, and is there a penalty for not 
 placing such cases in quarantine? 2. Should such cases be allowed on 
 the street and in school in any case? 3. How long is the disease con- 
 tagious? What are its dangerous aspects?" 
 
 Reply. — 1. It is. The state board leaves the details to local health 
 departments. If the local department fails to control a situation the 
 state board will step in to assist or to take charge if circumstances 
 warrant. 
 
 2. Children with whooping cough should not be allowed on the 
 streets or in school when the disease is starting before the whoop begins. 
 After the whoop stage has developed the contagiousness of the disease 
 rapidly decreases. The practice of health departments with respect to 
 this stage varies. Some demand from one to two weeks' quarantine in 
 the house after the onset of the whoop stage. Some departments tag 
 the whooping children and then permit them on the streets. 
 
 3. The chief danger is from pneumonia. The death rate from this 
 disease is high in children under 2 years of age. 
 
 Duration of Whooping Cough. — A. J. L. writes: "1. Kindly advise me 
 what to use to cure or check the whoop of a child 5 years old with 
 whooping cough. 2. Can one catch whooping cough more than once? 
 S. How long does it usually last?" 
 
 Reply. — 1. Nothing is of much service. 
 
 2. Yes, it is possible, though very improbable. 
 
 3. The contagion is greatest before the whooping begins. The evi- 
 dence is that there is not much danger of contagion after the case has 
 run three weeks, 
 
MUMPS 247 
 
 Whooping Cough Treatment. — M. K. writes: "Will you kindly let me 
 know if there is any way to prevent a child from getting whooping cough, 
 and also what will help one -that has it already?" 
 
 Reply. — If a child is kept away from whooping cough in its early- 
 stages he will not have the disease. A child having whooping cough should 
 be kept away from other children, should have plenty of fresh air, should 
 be kept clean, and should be otherwise kept in good condition. Many 
 remedies for the cure of whooping cough have been proposed; none has 
 been proved. 
 
 City Will Fumigate. — L. writes: "A family with two children, who 
 have whooping cough, moved from the apartment adjoining ours a week or 
 ten days ago. The apartment is to he occupied next week, and it has not 
 been fumigated. Ought this to be done? Will the City of Chicago do it?" 
 
 Reply. — Yes and then cleaned and aired. The city will do it. 
 
 MUMPS 
 
 Health departments do not regard mumps as of much importance. 
 Mothers are not so certain about that. Superintendents of children's homes, 
 asylums, and hospitals and principals of boarding schools and academies 
 know that the disease at intervals is a source of great worry. 
 
 Early in the year 1911 an epidemic of mumps developed in the New York 
 Hebrew Infant Asylum. Dr. Hess thought perhaps a method of protection 
 which had been used to cure certain diseases and to prevent others might 
 be made use of; at least it was worthy of trial. 
 
 The method consists in the injection of one or two teaspoonfuls of blood 
 from a person recently recovered from mumps into a person who has been 
 recently exposed to the disease. 
 
 Mumps is a highly contagious disease. It has a long incubation period. 
 About eighteen days elapse between exposure and the onset of the disease. 
 Therefore, when any person who has never had mumps is exposed the 
 chances are that he will have the disease, but that it will not show itself 
 for eighteen days. If the injection can be given, therefore, within a short 
 time after the exposure, there is ample time for it to get in its work as a 
 protector. 
 
 At the time the test was made there were 153 children in the home. Of 
 these 135 were susceptible to mumps. 20 of the susceptibles were injected. 
 None of the 20 susceptibles developed mumps, although all were exposed to 
 it. Of the noninjected children 44 got the disease. 
 
 This test shows that under the conditions which prevail in children's 
 homes, mumps, once it gets a foothold, may be expected to attack about 
 half the children who have not already had it. But by this injection 
 method the disease can be stopped at once. 
 
 The method consists of injecting about one-half to two teaspoonfuls 
 (6 to 8 c. c.) of blood under the skin of the child to be protected. The 
 blood is drawn from one child and immediately injected into the other. 
 It can be drawn from a child in whom the mumps swelling has not completely 
 subsided without harming either the sick or the well child. Perhaps it is 
 
248 CONTAGIOUS DISEASES 
 
 better to draw it from children who have been convalescent for ten days or 
 two weeks. 
 
 Perhaps the blood of children who have had mumps two years before 
 is protective. On that point Dr. Hess was not certain, nor could he say how 
 long the protection lasted. 
 
 I am sure that this method of protection will not be of interest to the 
 average mother. It will be of great interest to those in charge of children's 
 institutions. Perhaps some physicians will use it to protect other children 
 of a family in which a case of mumps has developed. 
 
 Dr. Hess suggests that the same method be employed against measles. 
 Health departments regard measles as of much importance. 
 
 CHICKEN POX 
 
 Chicken pox is essentially a disease of child life, although no age 
 is exempt. It affects babies at the breast and is rarely met with after the 
 tenth year. Grown-ups are seldom attacked even when they have escaped the 
 disease in childhood. 
 
 Chicken pox is the mildest and least important of the eruptive fevers, 
 usually with no complications, although the kidneys are sometimes affected 
 and sometimes erysipelas appears. 
 
 The disease may occur in one family only but is usually epidemic, spread- 
 ing rapidly through families, schools, and institutions. The fact that it 
 spreads so rapidly shows the contagion is readily diffused through the air to 
 all parts of the room and that personal contact of the well with the sick usually 
 means transmission of the contagion. 
 
 That the contagion is short lived is shown by the fact that the disease 
 is not readily transmitted from home to home and from school to school. 
 
 The period of incubation is generally fourteen to sixteen days. 
 
 Chicken pox begins with a marked rise in temperature, headache, 
 nausea and, in some instances, chilly sensations. The temperature may rise 
 to 103, or in severe cases even to 105. There is generally loss of appetite. 
 
 The rash, which is the characteristic symptom of the disease, appears 
 about the same time that the fever does. In some cases it may even precede the 
 appearance of the fever. It usually appears on the head, face, and trunk. 
 The rash looks like small water blisters with red areas about them. 
 
 It is important that the child should not scratch, as scars may result. 
 Washes to allay the itching should be used. The child's hands should be kept 
 clean, and the nails trimmed short, or, better still, white muslin mittens 
 should be worn. 
 
 In the treatment of the disease care should be exercised to control 
 carriers. To accomplish this those who come in contact with the disease 
 should always wash the hands thoroughly after coming in contact with the 
 infection. 
 
 Carriers are not of much more importance than such conveyers as spoons 
 and towels. Sunlight, air, and drying will help much to destroy the in- 
 fection; hence the importance of keeping the room in which the patient 
 is being nursed in hygienic condition. 
 
INFANTILE PAEALYSIS 
 
 249 
 
 The medical treatment consists in controlling the symptoms with such 
 simple remedies as are necessary to keep down the fever and prevent con- 
 stipation. Children should be kept in the house until the rash begins 
 to dry and form scabs. They should not be allowed to go to school or be with 
 other children until the skin is perfectly clear. 
 
 INFANTILE PARALYSIS 
 
 Anterior Portion 
 of Cord 
 
 The statement made by Dr. Eosenau at the Congress on Hygiene, that 
 he had succeeded in infecting monkeys with infantile paralysis by means 
 of flies, increases our interest in this insect. 
 
 The virus of infan- 
 tile paralysis is excep- 
 tionally resistant. In the 
 sick person it is found in 
 the brain substance, the 
 nose secretion, in the 
 mesenteric glands — the 
 lymph glands near the 
 intestines — and some- 
 times in the blood. 
 
 Its presence in the 
 mesenteric glands is ex- 
 plained as follows : It is 
 secreted by the mem- 
 brane of the nose and 
 mouth and becomes a 
 part of the saliva. It is 
 swallowed into the stom- 
 ach whence it passes into 
 the intestines. The di- 
 gestive juices of the 
 stomach and intestines 
 have no power to destroy 
 the virus — therefore it 
 passes through their 
 walls and can be recov- 
 ered from the mesenteric 
 glands. 
 
 When these glands 
 are macerated the virus 
 
 prepared from them will cause the disease when injected into well monkeys. 
 This proves that the virus is exceptionally resistant, for, it will be remem- 
 bered, snake poison and many other poisons are made harmless by the 
 stomach and intestinal juices. 
 
 The virus of infantile paralysis passes through the smallest pored filter 
 used. It stands heat, drying, sunlight, and chemical disinfectants much 
 better than does the ordinary disease-causing organism. When a child has had 
 
 Iowa Health Bulletin. 
 Fig. 107. — Atbophy of the Spinal Cord After Infan- 
 tile Paralysis. Zones a and b show shrinking of the 
 horns and general lessening in size of affected half of 
 the cord. 
 
250 
 
 CONTAGIOUS DISEASES 
 
 the disease, the nose secretions remain capable of causing the disease for 
 weeks and sometimes as long as for six months. 
 
 The fly which Dr. Eosenau found capable of spreading the disease is 
 the stable fly. This fly breeds in stable manure and lives in it and around 
 animals. It will not eat ordinary food under ordinary circumstances. 
 Eosenau noted that he had been unable to get them to eat anything but 
 blood or to drink any water. Nuttall of England said he had succeeded 
 in getting them to eat grape juice. 
 
 The practical significance of this observation is that it will prove diffi- 
 cult to poison or to catch this fly. Fly paper and fly poisons do not appeal 
 to its palate and it may prove suspicious of fly traps. Eosenau suggested 
 that this fly might get, and probably did get, its dose of virus by sucking the 
 blood of the sick and that the infection by it of the well 
 may be by biting or by regurgitation on human food. 
 
 That the fly does not serve as a simple mechanical 
 carrier of germs, as flies do for typhoid and consumption, 
 was proved by the interval of time between cases. From 
 the time the sick monkey was bitten by a fly until the 
 bitten monkeys got sick was three weeks. The virus dur- 
 ing some of that three weeks was living, changing, develop- 
 ing, in the fly. When the right time comes the fly belches 
 up the virus as a cow belches up her cud. This habit of 
 belching up the contents of the stomach belongs to flies 
 as much as it does to cows. 
 
 There is greater danger that a milk wagon driver 
 will spread infantile paralysis than that one will spread 
 scarlet fever when a child has that disease, since scarlet 
 fever is seldom spread by well people and infantile paraly- 
 sis frequently is. 
 
 If one hundred people are brought in contact with 
 infantile paralysis fifty of them will go to bed sick with 
 the disease. The other fifty will keep well themselves, but 
 they will spread the contagion right and left through their 
 nose and mouth secretions. The contagion having got into 
 the nose secretions, it remains there for two to four months. 
 Infantile paralysis is visually a disease of small cities, 
 towns, and country neighborhoods. It does not often cause 
 much trouble in the large cities. 
 
 So much as a basis for suggestions as to what must 
 be done to prevent its spread. First, it must be made a 
 quarantinable disease. The quarantine must be enforced. Nobody in contact 
 with the sick person should be allowed out of the quarantine. Nobody in 
 contact with the sick person should be allowed to sell, distribute, or handle 
 milk or any other food. Children from the affected homes should not be 
 allowed to attend school. The convalescents and the contacts must be quaran- 
 tined for four months after the disease or the exposure. After death or after 
 convalescence has terminated in a case the house should be disinfected, but 
 no one should lose sight of the fact that contacts and not infected houses are 
 the chief sources of contagion, 
 
 owa Health Bulletin. 
 
 Fig. 108. — Diagrams 
 Showing Areas in 
 Cord Most Af- 
 fected by Infan- 
 tile Paralysis. 
 
INFANTILE PAEALYSIS 251 
 
 Flies should be killed, especially around stables. 
 
 A state board of health fearing an epidemic should send a communication 
 to every physician and newspaper asking that cases of infantile paralysis be 
 reported at once. Upon the receipt of the report of a case an officer of the state, 
 except when the local health department is active, alert, and well informed, 
 should go at once to the locality and institute proper measures of control. 
 School principals should see to it that no convalescents and no contacts, no 
 children from infected homes, come to school until it is safe for them to do so. 
 
 It is always easy to end a local epidemic promptly, but the measures 
 of control must be efficient and compelling. A white-livered quarantine leaves 
 the community afraid and uneasy for months. A school principal who is 
 firm can make his school safe. A state administration can protect the 
 people of its state. All down the line the question is : Will they? 
 
 116 
 
 4 and under 
 
 Age Periods 
 
 
 5-9 
 
 
 10-19 
 
 
 20-29 
 
 ■nsm 16 
 
 
 30-39 
 
 HBBHH 12 
 
 
 Over 40 
 
 Vermont Bulletin. 
 Fig. 109. — Age Distribution of Cases of Infantile Paralysis. 
 
 The Chicago Department of Health has issued a valuable leaflet contain- 
 ing "information in case of infantile paralysis." As safeguards against 
 spreading the disease it suggests : 
 
 "The windows and doors of the room in which the patient stays should 
 be screened against flies and other insects. 
 
 "Allow none but the necessary attendants in the patient's room. 
 
 "Allow no visitors in the house. 
 
 "Other children in the family must stay at home; must not go to 
 public places such as school, church, parks, or theaters. Isolation must be 
 maintained for four weeks. 
 
 "Flowers brought to the sick should not be thrown out, but placed in 
 disinfecting fluid or burned. 
 
 "The nose and mouth of the nurse or others who are compelled to come 
 in contact with the patient should be thoroughly washed out before leaving 
 the sickroom, using freely a 2 per cent, solution of peroxid of hydrogen or 
 1 per cent, menthol in oil. 
 
 "Disinfect all dishes, utensils, bedding, towels, napkins, clothes, hand- 
 kerchiefs, clothing, books, papers, and remnants of food before removing 
 them from the room. Sweep and clean room with a cloth wet in a disin- 
 fecting solution. Do not use a broom unless frequently dipped in a disin- 
 
252 
 
 CONTAGIOUS DISEASES 
 
 fecting solution, and use while wet. Avoid dust in the sickroom. It is 
 believed that dusty rooms, dusty houses, dusty streets are important factors 
 in spreading this disease." 
 
 INFANTILE PARALYSIS EXERCISES 
 
 For the treatment of infantile paralysis by exercise of the upper ex- 
 tremities, upper arm and shoulder muscles, Dr. Wright recommends the fol- 
 lowing : 
 
 "Shoulder region: 
 
 1. The patient lies on his back with the arm at the side and shrugs 
 the shoulders, bringing them as nearly up to the ears as possible. 
 
 January 
 
 ■ 
 
 1 
 
 
 
 February 
 
 
 
 
 
 March 
 
 
 
 
 
 April 
 
 
 
 
 
 May 
 
 ■ 
 
 i 
 
 
 
 June 
 
 July 
 
 
 
 
 
 
 
 8 
 
 
 August 
 
 
 
 
 September 
 
 
 October 
 
 
 
 
 
 8 
 
 
 November 
 
 
 
 
 December 
 
 m 
 
 2 
 
 
 Vermont Bulletin. 
 Fig 110. — Seasonal Distribution of Infantile Paralysis. 
 
 a. With the assistance of the physician, who grasps the patient's arm 
 above the elbow and uses it as a lever to raise the shoulder while the 
 patient aids the movement by trying to contract the muscles. 
 
 b. Without outside help. 
 
 c. With resistance from the physician, who pushes down on the point 
 of the shoulder with one hand. 
 
 2. The patient sits erect with the arm hanging at the side and raises 
 the shoulder as high as possible. 
 
 a. With the resistance of gravity alone. 
 
 b. With the added resistance of the physician's hand pressing down 
 on the point of the shoulder. 
 
INFANTILE PAEALYSIS 
 
 253 
 
 Upper arm: 
 
 1. The patient lies on his back with the arm at the side and moves 
 it sideways upward along the table until it stretches above his head. 
 
 a. With assistance under the elbows. 
 
 b. Without outside help. 
 
 c. With resistance above the elbows. 
 
 2. The patient sits erect with the arm at the side and raises it straight 
 sideways until it is stretched vertically above his head. 
 
 a. With the resistance of the weight of the arm. 
 
 b. With the added resistance of the physician's hand pushing down 
 just above the elbow. 
 
 Forearm : 
 
 1. The patient sits with the inner side of the whole arm resting on the 
 table and bends the elbow by sliding the forearm along the surface of the 
 table. 
 
 a. With assistance on the back of the wrist. 
 
 b. By unaided contraction of the muscles. 
 
 c. With resistance on the front of the wrist. 
 
 2. The patient sits with the elbow resting on a cushion and raises the 
 forearm until the hand touches the shoulder. 
 
 a. With the resistance of gravity alone. 
 
 b. With added resistance on the front of the wrist. 
 
 Other positions than those above referred to can be worked out for the 
 special parts and the muscles exercised after the same general plan. The 
 main thing, when practicing the exercises, is to see to it that the patient 
 does not cheat himself and that he does the actual work. The exercises 
 should be gone through with at least once each day." 
 
 Causes of Physical Disability of 721 Crippled Children, Birmingham, Eng- 
 land, 1911 
 
 Tubercular disease . . 
 Infantile paralysis . 
 
 Rickets 
 
 Congenital deformity 
 
 Apoplexy 
 
 Birth palsy 
 
 Accident 
 
 Scoliosis 
 
 Scattering 
 
 Total 
 
 Cripples 
 
 Number 
 
 Per Cent. 
 
 285 
 
 39.5 
 
 175 
 
 24.3 
 
 73 
 
 10.1 
 
 71 
 
 9.8 
 
 33 
 
 4.6 
 
 25 
 
 3.5 
 
 25 
 
 3.5 
 
 13 
 
 1.8 
 
 21 
 
 2.9 
 
 721 
 
 100. 
 
 WHAT THE MOTHER OF A CRIPPLED CHILD OUGHT TO KNOW 
 
 Dr. Orr of Nebraska estimates that there are 250,000 crippled children 
 in the United States. Beeves in his "Care of Crippled Children" quotes a 
 
254 CONTAGIOUS DISEASES 
 
 Birmingham (Eng.) estimate that 25 per cent, of the crippled children are 
 crippled as a result of infantile paralysis. As a matter of fact, the percentage 
 varies from year to year and in different portions of the country. 
 
 If the estimates are correct (and infantile paralysis has been unusually 
 active during the last fifteen years), the number of children in the country 
 crippled as the result of this disease is 62,000. 
 
 It is important that mothers should know that infantile paralysis starts 
 with a fever, and that no signs of paralysis show in the early stages of the 
 disease. It oftens happens that mothers do not suspect infantile paralysis 
 to be the cause of their children's mild symptoms, even when infantile 
 paralysis is in the neighborhood, until the muscles begin to shrink. 
 
 It is more important that the mother know that the great wasting 
 of the muscles after infantile paralysis is not necessary. The disease is 
 located in the spinal cord and not in the muscles. The muscles waste after 
 the disease, not during it. By beginning passive motion, manipulation, and 
 electricity just as soon as the fever goes down and while the child is still 
 sick and by keeping it up steadily wasting of the muscles can be prevented. 
 Good medical care in the height of the disease is of some service. Good 
 care as the disease subsides is of very great service. 
 
 To my mind it is important that the mothers know that, after the 
 limbs have wasted, they cannot be restored. The best that can happen is 
 that by braces in most cases and by operation in others some control of the 
 limbs is possible. For this service there are good hospitals, dispensaries and 
 schools. A list of these is to be found in Beeves' "Care of Crippled Children." 
 
 The reason for putting stress upon this phase of the subject is that I hear 
 from so many mothers who, grasping at straws, carry their children long dis- 
 tances and spend much of their money because of letters of solicitation in 
 which wild promises of impossible cures are made. 
 
 It is important that the mothers of children crippled by infantile paralysis 
 know the importance to their children of play in the open air. 
 
 The figures from Birmingham show that 10 per cent, of the cripples 
 are such by reason of rickets. The percentage seems higher than in the 
 United States, unless we count the cases of bowlegs and knock-knees and 
 very thin chests as crippled from rickets. 
 
 It is important that a mother know that mild degrees of deformity 
 from rickets will pass away under good food and good hygiene. A thin 
 chest can be flattened out by exercises begun early and persisted in. Bob 
 Fitzsimmons is an illustration of what a knock-kneed, "wabbly-legged," prob- 
 ably rickety person can develop into. None other of the cripples responds 
 so well to good food and good hygiene. Some of the worst cases can be 
 straightened out by operation. 
 
 Whether or not a crippled child is to suffer from neglect rests very 
 largely with the mother. 
 
 Infantile Paralysis. — A. L. writes: "What is the cause of meningitis 
 in a child one year old? A child was nursed by its mother, who was in 
 good health. This child was apparently well until about eight months old. 
 It lived until fifteen months, but did not do well after eight months, always 
 refusing food of all kinds/' 
 
INFANTILE PARALYSIS 255 
 
 Reply. — This child probably had meningitis or infantile paralysis. 
 These diseases are due to germs. The germs are different from each other, 
 but they spread in the same way and cause diseases that are a good deal 
 alike. 
 
 Infantile paralysis is the more probable in the case of a baby eight 
 months old. This disease has been spread rather widely in this country 
 during the last five or six years. There has been a good deal of it in Eau 
 Claire, Wisconsin, Mason City, Iowa, and in certain parts of the East. 
 Fortunately in Chicago there has not been much. It is contagious. The 
 germ gets into the nose. Usually it does not do any harm, but occasion- 
 ally it gets through the nose and into the nervous system. 
 
 The preventive measures to take are: First, to keep away from all 
 children having the disease or having been in contact with those having 
 had the disease; to see that all children that have been in contact with it 
 have their noses carefully looked after and kept very clean. 
 
 It is wise to be on your guard against very mild cases just as much as 
 against severe ones. 
 
 Infantile Paralysis Infectious. — C. W. writes: "Is infantile paralysis 
 either contagious or infectious? How long after commencement of the 
 disease is it until it is safe to let other children associate with the patient?" 
 
 Reply. — 1. It is. 
 
 2. Usually the nose secretions are infectious for several months. 
 
 Clothing and Infantile Paralysis. — A. B. writes: "Is there danger of 
 contagion if one child should wear clothing of another who has had infan- 
 tile paralysis?" 
 
 Reply. — If the clothing has been properly fumigated, cleaned, sunned, 
 and aired, it is permissible; otherwise, not. Investigation of flies as car- 
 riers of infantile paralysis has not gone far enough to warrant anyone in 
 abandoning fumigation and cleaning as means of control. 
 
 Spread of Infantile Paralysis. — J. H. writes: "Can you offer any ex- 
 planation of the increase of what is known as infantile paralysis? Is it 
 possible that the prevalence of the disease is in any measure due to the 
 now common use of the low, springless vehicles, known as go-carts, some 
 of them collapsible, which have almost superseded the high cabs in which 
 the little ones used to be taken on their outings? It always has seemed 
 to me that the so-called go-carts, because the occupants ride so near the 
 ground, inhaling, as they must do, the dirt and dust, and because this class 
 of vehicle is rarely fitted with springs and must shake up the babies merci- 
 lessly, could not be otherwise than bad for the young child. Am I right?" 
 
 Reply. — Infantile paralysis is a germ disease. It has been quite preva- , 
 lent for several years. 
 
 The main factor in its spread is the nose secretion of those who have 
 had it and who have been in contact with it. Few of those who have had 
 their noses infected with the organism get the disease. They go about 
 feeling well but capable of spreading it. They are known as carriers. It 
 has been held that their nose secretions get into the dust, and in that way 
 dust causes it. Thorough street sprinkling is one of the methods used to 
 stop epidemics of the disease. 
 
 Nevertheless, I do not think your suggestions are very good. Shaking 
 from lack of springs on the buggy can have no effect. There is practically 
 no difference between the amount of dust two feet above the ground and 
 
256 
 
 CONTAGIOUS DISEASES 
 
 four feet above, particularly where the vehicle in question raises as little 
 dust as a baby carriage. 
 
 The cause of the 
 increasing f r e- 
 
 quency of infantile 
 paralysis is an in- 
 creasing number of 
 carriers. By the 
 way, infantile par- 
 alysis — so called — 
 affects people of all 
 ages. 
 
 The statements 
 relative to infection 
 of the nose and car- 
 riers apply with 
 equal truth to cere- 
 brospinal menin- 
 gitis. 
 
 Care of Infantile 
 Paralysis. — A. A. L. 
 writes: "There are 
 two cases of infantile paralysis in our town. Should such cases be quar- 
 antined? Are there any other measures that can be followed by the public 
 to prevent an epidemic?" 
 
 Eeply. — 1. Yes. The quarantine should include not only the patients 
 but all well persons in contact with the sick ones. The difficulty in han- 
 dling epidemic infantile paralysis is due to the large percentage of persons 
 who become carriers — that is, well themselves, but capable of infecting 
 others. The quarantine should be long continued. 
 
 2. Keep flies away from the sick especially. Kedouble 
 the efforts to screen out flies. The theory that biting flies 
 spread infantile paralysis has lost ground in the last year, 
 but play safe by guarding against flies. Report the con- 
 ditions to the state board of health and ask it to get an 
 inspector in the field. Infantile paralysis epidemics come 
 to an end speedily when a vigorous board of health gets 
 busy. 
 
 Massachusetts State Board of Health. 
 
 Fig. 111. — Braces to Prevent Deformity After Infan- 
 tile Paralysis. 
 
 Massachusetts State Board of Health. 
 Fig. 112. — Shoes to Prevent Deformity after Infantile Paralysis. 
 
CEREBROSPINAL MENINGITIS 257 
 
 CEREBROSPINAL MENINGITIS 
 
 HOW CEREBROSPINAL MENINGITIS IS SPREAD 
 
 Cerebrospinal meningitis and infantile paralysis are a good deal alike 
 from the clinical standpoint. Meningitis affects the covering of the spinal 
 cord. Infantile paralysis affects certain nerve cells in the cord itself; that 
 is, the main effects of the germ are spent on these structures. At the same 
 time the poisons of each germ in some measure poison all the cells of the 
 cord in each instance. That is the reason so many symptoms of infantile 
 paralysis are also found in meningitis. 
 
 From the epidemiologic standpoint also they behave a good deal alike. 
 Nevertheless, they are separate diseases having different germs. 
 
 Cerebrospinal meningitis is usually due to a coccus much like the pneu- 
 monia coccus in its shape, size, and general behavior. Inflammation of 
 the coverings of the brain and cord not infrequently results from the pneu- 
 mococcus. In some epidemics of meningitis they find the pneumococcus to 
 be the cause. In most of them the meningococcus is responsible. 
 
 The disease is spread by the nose secretions. Sneezing, coughing, speak- 
 ing, even breathing, throws the secretion into the air from which it speedily 
 settles on everything around. From the nose the bacteria get into the mouth 
 and thence are spread by the mouth secretions. The germs get into the body 
 through the nose, where they lie. 
 
 It is but a short distance, much less than an inch, to the covering of 
 the brain. If the germs make this journey they cause meningitis; others 
 wise not. 
 
 Most people who take in meningitis germs do not have meningitis. 
 Some do not get sick at all; some call their illness a cold; some, rheuma- 
 tism; some, sore throat; some, malaria. 
 
 There is little in the sickness to make anyone — patient, family, friends, 
 or, doctor — think the case one of meningitis. 
 
 Other cases have some nerve symptoms but they are not prominent. A 
 quick witted, alert physician might be able to diagnose meningitis in these 
 cases but if he does he is called an alarmist. 
 
 The proportion of atypical cases of meningitis to typical cases is about 
 five to one. The large number of atypical infections is responsible for the 
 general uncertainty as to what to do in an epidemic. 
 
 A case will be treated in a hospital ward and no one catches it; the 
 nurses, internes, doctors, and other patients escape. One is sick in a family 
 of children; it does not spread to the other members of the family. 
 
 The explanation is that the others have had the infection but it has 
 caused no disease or it has caused some minor sickness that was overlooked. 
 
 Persons spread meningitis; things do not. 
 
 EPIDEMIC MENINGITIS 
 
 About every so often a case of epidemic meningitis occurs in every 
 community and at long intervals it breaks out into a regular epidemic. 
 Meningitis does not behave just as measles does. It will jump about in a 
 
258 CONTAGIOUS DISEASES 
 
 town skipping whole blocks. As a matter of geography it is hard to under- 
 stand. If a health officer takes a map and on it spots the cases in a scarlet 
 fever epidemic it is easy to show the effects of contacts. Meningitis skips 
 from one place to another so that a spot map shows nothing of foci infection. 
 
 The reason is that meningitis is a good deal like pneumonia in some 
 particulars. In each of these diseases the germs get into the nose and 
 throat. In each of them the average person who gets the germ does not 
 get the disease; in each of them well persons carrying the germs can com- 
 municate it to others; in each of them recovery from the disease does not 
 mean that the germ disappears from the throat and nose. All of which 
 means that it is much more difficult to isolate cases of meningitis than cases 
 of smallpox or scarlet fever. 
 
 The epidemiologic rule is that in times of epidemic all people should take 
 especial pains to keep the nose and throat clean. All cases should be well 
 isolated not only during the attack but subsequently until the coccus dis- 
 appears from the nose secretion. 
 
 Why the coccus in one instance stays on the surface and in another 
 gets through and into the blood or into the membranes which cover the 
 brain we have no idea. 
 
 We have a few observations as to why the pneumonia coccus in one 
 man stays on the membrane and in another gets into the blood and is 
 carried to the lungs; but we do not know enough about it to be of any 
 practical service. With meningitis we are still poorer in exact knowledge. 
 
 There is a practical point that grows out of the little we know and 
 that is that when a person has meningitis or pneumonia or has recovered from 
 either, the nose and throat secretions for years thereafter should be burned 
 or boiled — otherwise the carrier may harm his family or friends. 
 
 CEREBROSPINAL FEVER 
 
 In the popular mind this disease and infantile paralysis are commonly 
 confused. For this confusion two facts are responsible. The two diseases 
 affect the central nervous system and both are spread by carriers and aborted 
 cases rather than by the out and out sick. 
 
 In cerebrospinal fever there is fever, vomiting, unconsciousness, stiff- 
 ness of the neck, bowing of the back, and sometimes an eruption. In in- 
 fantile paralysis wasting of the muscles is liable to follow the acute disease. 
 In cerebrospinal fever an eye is liable to shrivel up or some other special 
 sense organ will lose its power to work. 
 
 Generally an epidemic begins in the autumn with some case that has 
 been infected in some unknown and undiscoverable way. Soon there are 
 other cases and still others until the community is peppered with them. 
 No connection between these cases can be discovered. 
 
 When health officers begin active work to control the disease they com- 
 monly examine the nose secretions of every person who has been in contact 
 with the cases. They examine the nose secretions of every school child. If 
 the community is very much alarmed the officers may examine every nose 
 in town. 
 
 The disease is due to an easily discovered coccus. This coccus secures 
 
EEYSIPELAS 259 
 
 entrance to the nose. It multiplies in the nose secretions. Sometimes some 
 of these cocci travel from the nose to the covering of the brain. The distance 
 is less than an inch and the paths are not difficult to travel. 
 
 The persons in whom this happens have the disease. As they quickly be- 
 come violently sick and as the coccus dies quickly on towels, sheets, and 
 other articles the sick persons do not spread the disease to any extent. 
 
 If the coccus does not spread to the brain the infected person walks around 
 infecting others. He may think that he has a cold. He may be entirely well 
 so far as he can notice. 
 
 Eosenau says that 70 per cent, of the exposed have meningococci in 
 their noses. Thayer found in the Texas epidemic that 60 per cent, of the 
 persons with cocci in their noses were well people and most of the other 40 per 
 cent, were but slightly sick. 
 
 Fliigge found that ten cases were caused by healthy carriers for every 
 one that was caused by a case of cerebrospinal fever. Cases of fever have 
 cocci in their noses for the first fourteen days of the disease. Park 
 could not find them there after the sixteenth day. 
 
 When the disease appears in a community the cases should be promptly 
 reported to the health department. The department should isolate and quar- 
 antine them. It should make a systematic examination of the nose secretions 
 of the people, starting with the families of the sick, then taking the physicians, 
 then the school children and finally examining the community generally. 
 
 The carriers should be kept under observation. The people generally 
 should be advised to keep their noses and throats clean. 
 
 ERYSIPELAS 
 
 The pain of erysipelas is described as burning. The infected areas of 
 the skin are fiery red. Quite naturally the disease was thought by the 
 ancients to be a form of fire. Involving the skin, plainly in view, easy to see, 
 and burning like fire, it was one of the first diseases to be noted. Be- 
 ginning with Hippocrates every medical writer of antiquity knew erysipelas. 
 Beference to it is found in Arabian, Egyptian, Greek and Eoman literature. 
 It was doomed to be named for some saint and the doubtful honor fell to 
 St. Anthony. 
 
 As the disease had so many of the earmarks of a visitation of anger, it 
 followed that in the days when the gods and men were supposed to be 
 constantly mixing in one another's affairs erysipelas was held to be a visitation 
 of the wrath of the gods. 
 
 When this era of thought gave way to that of even more vague specu- 
 lation nearly every condition of climate, race, sky, earth, and environment 
 in every sense was at one time or another accused of being the cause of 
 erysipelas. At last with the development of the germ theory of disease there 
 came the discovery in 1883 that the cause of erysipelas was a coccus. 
 
 When Justinian began his work in the Eoman forum no library was 
 large enough to hold the Eoman law. When he left it the libraries were 
 useless, for Eoman law was a matter of a single book. When Fehleisen's dis- 
 covery had been established it was in order to burn the shelves of books con- 
 taining the speculations about erysipelas. What makes the difference worth 
 
260 
 
 CONTAGIOUS DISEASES 
 
 while is the difference between the disease now and prior to 1883. Fifty years 
 ago erysipelas was one of the scourges. Now it is a disease of no special im- 
 portance. 
 
 In Hirsch's "Handbook' ' there is a record of sixty-seven severe epidemics 
 of erysipelas in the United States between 1822 and 1880. 
 
 In 1854 Oliver Wendell Holmes wrote: 
 
 "We suppose smallpox or cholera would not cause greater consternation 
 
 (Cross Section through Living Room.) 
 
 Fig. 113. — Massachusetts Hospital School for Crippled Children. Cross section of 
 two-story monitor roof cottage, showing false roof and ceiling ventilation transoms in both 
 stories, which prevent drafts and defy storms. (Reeves' "Care and Education of Cripple 
 Children.") 
 
 in many neighborhoods than the appearance of that violent type of erysipelas 
 known from a prominent sign as black tongue, but even when unaccom- 
 panied by this feature the disease is much dreaded in the western states. 
 From what we have seen and read and heard of it no part of the earth has 
 suffered more from epidemic erysipelas than Illinois, Indiana, Missouri, and 
 parts of Tennessee and Iowa. It has raged with great violence on the 
 plains on the route to California, has been very common and of grave type 
 in Santa Fe, and in California it is a frequent and much dreaded disease." 
 Hirsch says: "Just as it has been met at all periods in the history of 
 mankind, erysipelas occurs in all parts of the world," To which should 
 be added, in all races and in every environment, 
 
EBYSIPELAS 261 
 
 Even when speculation as to its cause was most vague, when every 
 circumstance of soil and climate was being accused of being the cause of 
 erysipelas, there was one observation on which everybody was agreed that 
 should have led the way out of the wilderness. It was that hospitals were 
 great foci for the disease. 
 
 It was observed that "the headquarters of the disease have always been 
 found in self-contained places occupied by a considerable number of per- 
 sons, most of all in hospitals, and next to them in lying-in hospitals, found- 
 lings' hospitals, lunatic asylums, educational institutions, and the like." 
 
 Certain wards in the Hotel Dieu (general hospital) in Paris were notori- 
 ous as wards from which erysipelas radiated, as well as St. Bartholomew's at 
 London, Frederick's Hospital at Copenhagen, the University clinic at Mar- 
 burg and Bellevue at New York. In that day if a hospital was known 
 at all it was known as an erysipelas center. 
 
 In the Lyons hospital prior to 1867 "the severest operations had been 
 performed without erysipelas occurring, but from that date onward the 
 larger number of cases operated on were attacked with erysipelas." 
 
 Conditions were so bad that the medical wards fought shy of the surgical 
 wards lest the infection spread to them and maternity hospitals had to keep 
 as far away as possible. 
 
 In the Civil War it was found that the wounded cared for in tents 
 and improvised hospitals got on better than those housed in the best hos- 
 pitals in the country. The authorities sought the explanation in overcrowd- 
 ing and in lack of cleanliness. 
 
 In the Middlesex Hospital it was noticed that nearly every case placed in 
 either of two beds in a ground floor ward developed erysipelas. It was 
 found that these two beds were placed one on each side of a window which 
 opened out on the "common dusthole of the hospital, so that the effluvia from 
 it entered the window and traveled directly to them." 
 
 I remember when a professor in Bellevue reported that there was 
 no way to disinfect certain erysipelas wards in that hospital, that the in- 
 fection was in the walls, and that the only remedy was to tear down the 
 building. 
 
 However, then it began to be observed that there was some erysipelas in 
 clean hospitals. Pujos, reporting upon St. Andre's at Bordeaux, a model 
 institution, said that even the cleanest and best constructed wards did 
 not escape erysipelas entirely. Volkmann reported that hospitals salubrious 
 to the point of luxury had epidemics of erysipelas. 
 
 It was plain that while dirt had to do with erysipelas it was a secondary 
 and not a main factor. In that day everything around the hospital was 
 charged with responsibility for spreading the disease. The essential was 
 overlooked — the people themselves. 
 
 Soon after Fehleisen's discovery was accepted attention began to center 
 on people. ISFow we know that erysipelas is spread by people, not by things. 
 Acting on this information, a line of precedure is followed which has ended 
 the terrors of the disease. The statements of Oliver Wendell Holmes 
 sixty years ago have a Munchausen flavor to the man who cannot remember 
 beyond 1880. 
 
 At the present time there are no erysipelas wards in the old sense. 
 
262 CONTAGIOUS DISEASES 
 
 Contagious disease hospitals have erysipelas wards to which are carried cases 
 of erysipelas for safekeeping in order that the community may be spared. In 
 these wards the attendants are careful to sterilize their clothes and their 
 hands. The ward is kept clean and the ventilation is good. In conse- 
 quence the ward never infects other wards or the neighborhood of the 
 hospital. 
 
 The surgical wards never develop erysipelas. A case of erysipelas in a 
 maternity ward would cause a trial of the attendants by the proper au- 
 thorities. No longer do the medical wards of a hospital shun the surgical 
 and obstetrical wards. The case is reversed. The attendants in the surgical 
 and maternity wards are always on guard to prevent erysipelas or any 
 other form of sepsis from overflowing from the medical wards to them. 
 To surgeons and obstetricians erysipelas is no longer a bogy. 
 
 The medical man has not mastered the situation so well. Epidemics are 
 few and individual cases are rare. The expectation is that a person having 
 erysipelas will get well. In 1909 there were but 130 deaths from erysipelas 
 among Chicago's more than 2,000,000 people. 
 
 The disease has lost practically all of its terror. Nevertheless it can- 
 not be said that the medical man has met his problem as well as the 
 surgeon and the obstetrician have met theirs. 
 
 Erysipelas is due to a chain coccus called the streptococcus of erysipelas. 
 This coccus gets through the skin through a wound. A wound barely large 
 enough to be seen is amply large enough to allow the entrance of the coccus. 
 The most frequent site of the entrance is the edge of the nostril and the 
 most frequent wound is a small chap-fissure. The rule is that the fissure does 
 not attract attention until it begins to burn from the erysipelas infection. 
 
 The chance that one will become infected is low in summer. In Septem- 
 ber the number of cases begins to increase. As the cold weather comes on and 
 people are herded closely together, the chance of erysipelas increases. The 
 increase mounts markedly in February and continues through March and 
 April. In April the maximum is reached, and the spring and summer decline 
 begins. 
 
 If a person has had the disease once his liability to it is somewhat 
 increased. 
 
 The cocci, having found entrance through the wound, locate in the lymph 
 spaces immediately below the skin. They spread rapidly in these lymph 
 spaces. A patch on the nose the size of a clime can spread to involve 
 the entire head within a day. 
 
 Generally speaking, the spread is slower. It is easy to note the rate 
 of spread as the irregularly raised red line travels across the skin. 
 
 The poisons from the coccus are carried to all parts of the body. These 
 poisons cause headache, general aching, fever, rapid pulse, and delirium. 
 
 White blood corpuscles are charged with the task of fighting the in- 
 fection. A blood examination shows a great increase in these white cells. 
 The physician who wants to know what sort of a fight his patient is putting 
 up examines the blood and forms his opinion largely on the number and 
 variety of the white blood cells found. 
 
 Strange to say, the cocci have not much tendency to travel into the 
 deeper parts of the body. Occasionally they get into a joint causing what 
 
YELLOW FEVER 263 
 
 formerly was called rheumatism, but they do not go much beyond that. 
 They do not travel to the heart to cause heart disease nor to the kidney to 
 cause Bright's disease. 
 
 When a person recovers from erysipelas he recovers completely. No 
 trace of disease is left behind. 
 
 The fever may be high, the pain great, the delirium considerable. The 
 person may appear to be gravely ill and yet complete recovery can usually 
 be expected. The skin may be so swollen that the features are obliterated 
 and yet no suppuration occur. 
 
 The lymphatics open into the blood vessels. They are designed to pick 
 up material from the tissues and discharge it into the Hood stream. 
 
 Why is it that these lymph vessels do not discharge the streptococci into the 
 blood stream ? Why does not heart disease follow erysipelas, as so frequently 
 happens after scarlet fever, pneumonia, and some forms of rheumatism? 
 
 The reason is that the cocci are different. Because they hang together in 
 chains, they are called streptococci. Many of the cocci which cause rheuma- 
 tism are streptococci. The pneumonia coccus may form chains. The germ 
 of scarlet fever may be a streptococcus. This means that, because a group of 
 bacteria is alike in that they hang together in chains, it does not follow 
 that they are alike in other particulars. Erysipelas, though due to a 
 streptococcus, is not usually followed by heart disease. 
 
 Recovery after erysipelas may be expected. There is no specific treat- 
 ment for the disease. Some day we shall have a remedy which will kill 
 off the cocci in the lymphatics, but that time has not come. 
 
 If the opinion be formed that a man with erysipelas can get along 
 without medical attention harm will result. Symptoms demand treatment. 
 There is need for counsel as to how to sterilize the hands and clothes of at- 
 tendants, as well as how to conserve the vitality. 
 
 Diseases of this group are more in need of skilled medical service than 
 those diseases for which specifics are known and no special skill is required 
 to administer them. 
 
 YELLOW FEVER 
 
 LAST YELLOW FEVER REGION 
 
 Yellow fever is a memory with us. If by chance it were to come to 
 this country few physicians would know it from malaria and other fevers. 
 Probably not one physician in a thousand ever saw a case of yellow fever. 
 Yet at one time it went up the Atlantic seaboard to Maine and up the 
 Mississippi Valley to Cairo. 
 
 In 1693 the disease was in Boston and the New England states. On 
 October 16, 1749, Benjamin Franklin wrote from Philadelphia to his mother 
 in Boston: 
 
 "Pray tell us what kind of a sickness you have had in Boston this 
 summer? Besides the measles and flux, which have carried off many 
 children, we have lost some grown persons by what we call yellow fever, 
 though that is almost, if not quite, over, thanks to God, who has preserved 
 all our family in perfect health." 
 
264 CONTAGIOUS DISEASES 
 
 In 1900 Guiteras wrote that yellow fever was never absent from Havana, 
 Vera Cruz, and Eio. Each one of these places is now free. The only fever 
 foci left lie just below the Panama Canal Zone. However, from these places 
 the disease is liable at any time to reach the United States. 
 
 Yellow fever is caused by the bite of a mosquito that has been in- 
 fected by previously biting a person suffering from yellow fever. 
 
 About five days after the mosquito bite yellow fever comes on with a rush. 
 In its beginning there is nothing of the gradual stealing on of typhoid fever. 
 The fever is highest at the start. There is usually a chill and the aching in 
 the head and back is fearful. The pulse is not so rapid as the fever would in- 
 dicate and it gets slower day by day even though the fever is staying nearly 
 the same. The face is flushed and note this: a little jaundice comes within 
 the first twenty-four hours. 
 
 Another point of importance is that early in the disease the urine con- 
 tains albumin. 
 
 The disease is called yellow fever because of this peculiar lemon-yellow 
 jaundice. After about three days there is a let-up for a day and then 
 comes the second stage of fever — the stage of collapse, of shock, of black 
 vomit. 
 
 It is not an easy disease to diagnose. Some of the most violent fights 
 I have ever known were fights over the diagnosis of yellow fever and that, 
 too, by well trained men of broad experience with yellow fever. At autopsy 
 the boxboard liver is so characteristic that the contending diagnosticians 
 generally let the autopsy liver settle the argument. 
 
 I hope that we may never again have yellow fever in this country. We 
 have kept cholera out of the country since 1873 and we have been almost as 
 successful with plague. Our influence has been great enough to banish the 
 disease from all Central American countries. Eio and the eastern portion 
 of tropical South America have been cleaned up. 
 
 The little fringe of infected country along the north and northwest coast 
 of South America is the last stronghold of yellow fever in the world. If 
 that can be cleaned up simultaneously yellow fever will disappear for all 
 time. As it is, we know just how to control the disease, just what to do and 
 what not to do. 
 
 In the light of all this the only chance for yellow fever to disturb us is 
 for it at some time or other to get a good start on us because our young and 
 middle-aged physicians have never seen yellow fever and our old ones have 
 forgotten it. 
 
 Cause of Yellow Fever. — F. R. K. writes: "Will you publish the facts 
 about yellow fever? First, is it contagious without the bite of the mos- 
 quito? Second, give the name of the army surgeon who demonstrated that 
 the mosquito was the carrier of the disease, and the conditions connected 
 with the surgeons death." 
 
 Eeply. — 1. Yellow fever cannot be contracted except through the bite 
 of an infected mosquito. 
 
 2. The army surgeons who made this demonstration, using their own 
 persons as well as the persons of other volunteers for the purpose, were 
 Prs. Reed, Carroll, Lazear, and Agramonte. Dr. Lazear died from yellow 
 
MALARIA 
 
 265 
 
 fever due to experimental infection by the bite of an infected mosquito. 
 The theory that mosquitoes conveyed yellow fever had been advocated for 
 several years prior to the demonstration referred to above by Dr. Carlos 
 Finlay of Havana. 
 
 MALARIA 
 
 CAUSES OF MALARIA 
 
 The word "malaria" means bad air, and the disease was so named because 
 it was supposed to result from miasmas which exuded from the soil into 
 the air. 
 
 We now know that the disease is caused by the bite of a mosquito that 
 has previously bitten a person sick with malaria. 
 
 Only one variety of mosquitoes can carry malaria, the anopheles. Only 
 the female anopheles is a ma- 
 laria host. In the spring the 
 percentage of infected mosqui- 
 toes is small. At the height 
 of the season not over 25 per 
 cent of the anopheles are in- 
 fected. 
 
 If a man is bitten by a 
 mosquito at night there is more 
 than an even chance that the 
 mosquito is not an anopheles; 
 in the day the chances are 
 fifty to one. If the night 
 biter were an anopheles, 
 there are four chances to one 
 that the female was not in- 
 fected. 
 
 The reason is not far to 
 seek. A man with violent 
 malaria has one parasite to 
 about 100,000 red cells. If his 
 malaria is not violent, he does 
 not have one parasite to 10,- 
 000,000 red cells. 
 
 There is a pretty good 
 chance that Mrs. Mosquito will 
 fill up with blood drawn from a malarial man and not get a single parasite. 
 
 Then, many of the parasites taken in by mosquitoes die without evolving. 
 Many infected mosquitoes die in less than ten days. The great majority of 
 infected females which live longer than ten days after infection never get a 
 chance to bite a susceptible man. 
 
 In Ross's "Prevention of Malaria" the probabilities of each phase of in- 
 fection are worked out mathematically in a most interesting way. It is his 
 opinion that not over one twenty-fourth of the female anopheles stand any 
 
 Fig. 114. — Adult Female Mosquito, Showing Parts. 
 
266 
 
 CONTAGIOUS DISEASES 
 
 chance of infecting men. Nevertheless, proper planning to control malaria 
 includes procedures to prevent mosquitoes from biting sick people, and also 
 to prevent infected mosquitoes from biting well people. 
 
 Infected people must stay behind screens during the night hours. The 
 screening must be eighteen to twenty meshes to the inch and free from holes. 
 Gorgas tells us that an ordinary carpenter will not put a screen in so that it is 
 mosquito proof. Men have to be especially drilled before they will take the 
 pains necessary. 
 
 The well may take some risks from leaky screens ; the malarially infected 
 must be kept behind screens that work. 
 
 Fortunately, after gorging, mosquitoes do not try so hard to get out as 
 they tried to get in. If the screens have leaked the. blood-gorged females can 
 be killed the next morning. This is early enough, if the person bitten is sick 
 and the mosquitoes are the newly infected parties. If the person bitten was 
 well and the mosquitoes biting were infected, the next morning is not early 
 enough. The deed was done, the chapter closed at the time of biting. 
 
 Mosquito repellants are of little service against malaria mosquitoes. Doty 
 tells us that to smear the face and hands with oil of citronella, one ounce, and 
 liquid vaselin, four ounces, will keep the pests away for a while, but that it 
 will not last through the night. 
 
 A good community policy is one that encourages the people with malarial 
 fevers to come into the hospitals. The community can be certain of the screen- 
 ing in the hospital. The chances are that the poorer people sick at home will 
 be in unscreened rooms. 
 
 DAY-BITING MOSQUITOES 
 
 Fortunately for us, the mosquitoes that carry disease are a timid lot. The 
 bold buccaneers, the day biters, the loud singers, and the awe-inspiring, ele- 
 phantine gallinippers, none of these carries disease. They 
 are nuisances; they cause irritating bumps; they even lay 
 the foundation for blood poisoning through skin scratched 
 raw, but they do not transmit either malaria or yellow fever. 
 The yellovj fever mosquito is a city cousin, but as timid 
 and diffident as a "sissy" The malarial fever mosquito is 
 insistent and bold enough in the hours of darkness, but 
 harmless as an owl in the daytime. But even an owl, when 
 half starved, will try to kill in the day sometimes. 
 
 All winter anopheles (malarial mosquitoes) have been 
 hibernating in cracks around houses and barns, under floors, 
 anywhere to rest unobserved, asking only to be kept fairly 
 warm and let live. Now that the warmer weather has 
 come, their blood runs warm and hunger quickens. They 
 fly out of their hiding places and search for food. Hunger 
 makes them bold. 
 
 During the first month of mosquito time, anopheles 
 are day biters. As they are numb from cold at night they 
 are practically exclusively day biters. 
 
 They bite some people who have been having chills occasionally through 
 the winter. The malarial organisms in the blood of those people have been 
 
 Fig. 115. — Larva. 
 
MALARIA 267 
 
 having a hard time keeping alive. Their blood home for the winter has been 
 about as "poor pickings" as mother mosquito has had. 
 
 However, once those parasites get into mother mosquito they quicken into 
 life; they take on snap and ginger; they are full of fight. 
 
 Mother mosquito will live to see only a few warm spring days. Death is 
 waiting for her around the turn. Ten days are required for those parasites 
 to change into young, vigorous, aggressive fellows. Can it live out the ten 
 days ? There is one chance in ten it will. 
 
 Can it live on a few days more and bite some in whom these parasites 
 can live vigorously? There is one chance in twenty of that, say a combined 
 chance of one in two hundred. So there is danger from day-biting mosquitoes 
 in the spring, in the first month of mosquito weather. 
 
 For the continuance of the malarial succession, two brood ovens have been 
 run during the winter. The one is the poor, neglected man, white or black, 
 who has been chilling occasionally all winter. He is much the more important 
 of the brood ovens. 
 
 The other is the mosquito stock, the few that crawled into cracks last 
 fall and that now pour out, crazed by hunger, by hunger made bold. 
 
 TO CONTROL MOSQUITOES 
 
 Malaria can be controlled without controlling mosquitoes. The yellow 
 fever mosquito abounds in the Mississippi Valley as far north as Cairo, Illi- 
 nois, but there has been no yellow fever for years because the mosquitoes are 
 not infected. All through Illinois and Indiana, all along the Wabash, malaria 
 mosquitoes (anopheles) abound, but there is little 
 or no malaria, because the mosquitoes are not 
 infected. 
 
 Routing malaria is much easier than rout- 
 ing mosquitoes. Let him who croaks that routing 
 malaria is an impossible task, because of the 
 difficulties of controlling mosquito breeding, 
 learn another song. 
 
 Mosquitoes constitute the right wing of the 
 battle line. The fight against that wing must 
 be strenuously waged, but, when the colors have 
 
 been captured, the wagon train burned, and the war brought to an end, it 
 will be found that the right wing, broken and scattered, will be engaged in 
 an irritating guerrilla warfare — no longer a malaria war, just a lot of bandit 
 and freebooter gangs. 
 
 The methods to prevent mosquitoes are several : 
 
 1. Drainage, particularly tile drainage. 
 
 2. The emptying of all buckets, barrels, and cisterns, small accumulations 
 of stagnant water, such as puddles in hoof prints, collections in tin cans, etc. 
 
 3. The emptying of shallow pools, such as reservoir and stock pools in lots 
 and pastures. 
 
 4. Proper sloping of ditches. 
 
 5. Proper tending of brush and grass in and around the ditches within 
 300 yards of the house. 
 
268 CONTAGIOUS DISEASES 
 
 6. The application of oil to all breeding places after the following plan : 
 Mix 100 gallons of stove distillate and 5 gallons of crude oil. Spray with 
 
 a special spray every fifteen days from April to November. In July, August, 
 and September spray every twelve days. Crude oil is 12° to 18° Baume, stove 
 distillate, 28° to 32° Baume. In hot weather the proportion of crude oil may 
 be increased somewhat. The effort should be to cover the water with an un- 
 broken oily film. The method of applying recommended by Herms is with a 
 five-gallon knapsack spray pump. 
 
 7. Treating waters where green scums grow with sulphate of copper, not 
 over one grain to a million of water. 
 
 8. Encouraging mosquito killers. Of such are dragon flies, snake doctors, 
 bats, bullbats, and leather wings, and possibly some birds. 
 
 9. The encouragement of fish which live on wiggletails. Of such are 
 minnows, shiners, and goldfish. In foreign countries several varieties of fish 
 have been found efficient. The probability is that the imported fish will not 
 prove so satisfactory as native fish. The minnows found locally will be more 
 apt to live and multiply, if given a chance, than will species brought in. 
 
 HOW TO KILL THE MOSQUITO BREED 
 
 Dr. Darling of the Board of Health laboratory on the Canal Zone advises 
 the following mixture to kill the young in their breeding places : 
 
 "One hundred and fifty gallons of crude carbolic acid (sp. gr. 97 contain- 
 ing not less than 30 per cent tar acids). 
 
 "Two hundred pounds of finely crushed and sifted resin. 
 
 "Thirty pounds of caustic soda. 
 
 "Six gallons of water. 
 
 "The carbolic acid is heated in an iron tank with steam under fifty pounds 
 pressure. Then the resin is added and finally the soda, dissolved in the water, 
 is poured into the mixture of acid and resin. The mixture fills three and one- 
 half barrels. It costs 14 cents a gallon, including heat and labor. One gallon 
 in 5,000 will kill mosquitoes, larvae, pupae, and eggs. 
 
 "On a smaller scale: Mix one gallon crude carbolic acid, one and one- 
 third pounds of resin, one-fifth pound caustic soda, and one-third pint of 
 water." 
 
 With ordinary mosquitoes the egg period is thirty-six hours, the larvae 
 seven days, the pupae two days or a total from mosquito to mosquito of ten 
 and a half days. 
 
 Darling says this "dope" should be used every seven days. If there is 
 much growth in the water, particularly green scum, this takes up a good part 
 of the larvacide, but enough remains to be effective for about seven days. 
 When the mixture is fresh, the eggs and larvae are killed in a few minutes. 
 If there is much growth of algae (green scum), the larvae are destroyed within 
 forty-eight hours, that is, during the first seven days after the mixture has 
 been used. 
 
 Of course, where it is possible, the proper plan is to get rid of the breed- 
 ing place. In a city this is easier than it seems at first thought. The usual 
 breeding place in a city is some such container as an oyster can, or a slop jar, 
 pr the reservoir for the toilet in the bathroom, or the tank on the house. 
 
MALARIA %m 
 
 Mosquito repellants are not of much service. They work when freshly 
 applied, but they speedily lose their efficacy. One is kept about as busy smear- 
 ing his hands and face with "dope" as he would otherwise be in fanning mos- 
 quitoes away. 
 
 Where mosquitoes are not infected they are still objects of interest.. 
 To prevent mosquitoes from biting, Howard recommends: 
 
 Oil of citronella 1 ounce 
 
 Spirits of camphor 1 ounce 
 
 Oil of cedar J ounce 
 
 A few drops of this on a towel at the head of the bed will answer if the 
 mosquitoes are not especially hungry. To rub some on the face and hands is 
 better. If the mixture has evaporated before morning and the mosquitoes are 
 no longer kept at bay, substitute for it the following : 
 
 Oil of citronella 1 ounce 
 
 Liquid vaselin 4 ounces 
 
 Or 
 
 20 drops of oil of citronella to an ounce of vaselin. 
 
 To ease the hurt of a lite, use soap. Moisten a cake of toilet soap and 
 touch it to the bite. Ammonia is a fairly good substitute. 
 
 Gorgas tells us that, as a rule, mosquito bars and screens do not keep 
 rooms wholly free from mosquitoes. In a malarial country enough will get 
 through ordinary screening to infect. Mosquitoes are persistent and they are 
 certain to find imperfections in the screening. Howard tells us to use bars 
 and screens with twenty mesh to the inch and not to try anything less than 
 fifteen. 
 
 But the great shortcoming is in the cracks around the screen. Gorgas 
 says that an ordinary carpenter will never make things mosquito proof. 
 Howard advises that where bars are used one should not retire until 
 he has gone over his mosquito bar with needle and thread and patched the 
 holes. 
 
 To catch the mosquitoes in the room the following method is used: A 
 cup is nailed through its bottom to the end of a broom handle. A teaspoonful 
 of kerosene is put in the cup. It is easy to catch the mosquitoes resting on 
 the ceiling with this. A glass tumbler fastened to a stick has been used in the 
 same way. 
 
 Mosquitoes are not travelers. Rarely do they go, or are they carried, more 
 than 800 feet. If a wind storm is brewing, the mosquitoes will seemingly 
 sense it early and get into cracks and under leaves. 
 
 The man who keeps his premises free of mosquito breeding places for a 
 distance of 300 feet from his house will have little trouble with mosquitoes. 
 To keep pools free from wigglers, sprinkle with oil about once every two weeks 
 in hot weather. Use a mixture of four parts of heavy crude oil and one part 
 light. The oil on the surface must remain unbroken. A spray is the best 
 method of applying. A sprinkling can will do. If there is a fountain or pool 
 in the yard, keep goldfish or top minnows in it. 
 
Thi 
 
 Pitchers ™ e 
 
 fare Room 
 
 MAY BREED ENOUGH MOSQUITOES TO INFECT THE 
 WHOLE NEIGHBORHOOD. 
 
 Florida Health Notes. 
 Fig. 117. 
 
 270 
 
MALAEIA 
 
 271 
 
 If a neighborhood or village wants to know how to run a mosquito cam- 
 paign, let some one get Herms' "Malaria" and read how some California 
 communities campaigned. 
 
 HOW MALARIA SPREADS 
 
 This is the child who had a chill. 
 
 This is the mosquito that bit the child who had a chill. 
 This is the man who was bitten by the mosquito which bit the child 
 who had a chill. 
 
 To stop the sequence cure the man who infected the mosquito which bit 
 the child who had a chill. 
 
 The malarial parasite gets into a blood cell, where it grows until it is 
 full size, whereupon it divides into a 
 dozen young ones. The chill occurs 
 when the young ones are formed. A 
 single dividing germ in a man's blood 
 will not cause a chill. One and a half 
 millions are needed. When one gets 
 in it multiplies for a while without any 
 chills; when there get to be one and 
 a half millions of them there is a chill. 
 So long as the number keeps over that 
 figure the chills and fever keep com- 
 ing; when it drops below the chills and 
 fever stop. 
 
 The man may be "no account" 
 and weak, or he may even be feeling 
 well. A malarial mosquito biting him 
 during this time is fairly liable to 
 draw in one or more malarial organ- 
 
 isms, even though they are scant. 
 
 Fig. 118. — Anopheles. 
 
 After ten clays this mosquito can trans- 
 mit malaria just as well as one that had bitten a man having chills and fever. 
 
 This tendency of the malarial parasites to remain in an infected man, 
 few in number and not extremely active, makes the greatest obstacle to the 
 eradication of the disease. Such cases are called cases of chronic malaria, 
 relapsing malaria, etc. They are half cured cases ; cases cured enough to stop 
 the attacks but not cured enough to do away with the danger of an attack 
 next month, not cured enough to prevent mosquito infection. 
 
 The remedy is to take quinin enough and to continue to take it long 
 enough to cure the disease wholly, not half cure it. In mild cases thirty' 
 grains a day for a week, then twenty grains a day for a month, then arsenic 
 and iron for three months will do it. 
 
 Most people know how to stop chills. Some of them go to doctors, some 
 of them do not. Whether they treat themselves or go to physicians, they take 
 twenty grains of quinin a day for three days. That method stops the chills 
 for that week, or maybe for three weeks. If they stop at that they are liable to 
 
272 CONTAGIOUS DISEASES 
 
 chill again after a month or so. The malarial mosquitoes biting them will 
 become infected and may spread the disease. 
 
 The only fair policy is to continue the quinin until the cure is completed 
 and then to build up on iron and arsenic. Koch thought this one the most im- 
 portant of the three methods of preventing malaria. 
 
 In Italy efforts at mosquito control cut the malaria rate from 70 to 16. 
 There it hung until they added a quinin policy to their mosquito policy, where- 
 upon it speedily dropped from 16 to 1/.. 
 
 The quinin policy consisted in giving quinin free to everybody who could 
 not buy it and fixing a cheap price by law for those who could buy. 
 
 HOW TO END MALARIA 
 
 When the temperature of the atmosphere remains below 65 degrees for a 
 while mosquitoes become inactive. Those females that are infected with ma- 
 laria become harmless, for the malarial plasmodia within them fail to develop. 
 This being true, nobody will be infected with malaria until next spring. 
 
 The malaria to keep the disease going is now stored away within human 
 bodies. If the malarial people could become nonmalarial it would not matter 
 how many mosquitoes or frog ponds we had next spring. 
 
 When the malarial parasite gets into the blood it begins to develop young. 
 These young are now in the asexual form of the malarial plasmodia. This 
 asexual form causes chills and fever. 
 
 In about two weeks, when left to itself, in addition to the asexual or chills 
 and fever form the plasmodium also begins to develop sexual forms. The 
 sexual forms infect mosquitoes. 
 
 The chill and fever producers, the brothers to the sexual forms, cannot 
 infect mosquitoes. This being true, if a man would start taking quinin 
 quickly, as soon as he got malaria, he could never infect mosquitoes. 
 
 This sexual form, when taken into a mosquito, develops into a form 
 capable of infecting man. If it remains in the body of a man, is not sucked 
 into a mosquito, after a few days it locates in the liver or spleen or bone mar- 
 row, where it lies dormant. Many of them die off from old age when they get 
 to be six weeks old. These old, hardened sexual forms are not easily killed 
 by quinin. 
 
 Now that the temperature is below 65 much of the time, the mosquito is 
 out of it. Can anything be done to clear up the mosquito foci before spring ? 
 
 Bass says: "All that is required for the complete eradication of malaria 
 is for everybody who had malaria during a warm season to take the proper 
 amount of quinin on each of two consecutive days in each of six consecutive 
 weeks during the following cool season/' 
 
 Suppose every person who had an attack of malaria last summer would 
 begin in the middle of November and take twenty grains of quinin a day each 
 Saturday and Sunday until the first of January. 
 
 If Bass is right — and Bass knows malaria as well as anybody in the world 
 — there would be no malaria next spring and summer. There might be a few 
 ague subjects too much malaria-soaked to be freed of the parasites by twelve 
 treatments. Some of these would need iron and arsenic tonics and quinin 
 continued over more than six weeks. 
 
MALARIA 
 
 273 
 
 However, even if a moderate number of ague case people were not cleaned 
 up, the chance that the disease would disappear would be great. The history 
 of malaria teaches that when the foci have become few the disease tends to 
 disappear. 
 
 HOW TO CONTROL MALARIA 
 
 The method of controlling malaria consists of three parts. Each is im- 
 portant. No one can be omitted without increasing inefficiency, increasing the 
 ultimate cost and prolonging the time required for results. 
 
 1. To prevent the breeding of mosquitoes. 
 
 2. To prevent the infection of mosquitoes by people. 
 
 3. To prevent the infection of people by mosquitoes. 
 To prevent the breed- 
 ing of mosquitoes, it is 
 proposed: (a) To drain 
 the land ; (b) cut out the 
 grass and underbrush ; 
 
 (c) catch mosquitoes 
 with bats and birds; 
 
 (d) catch the larvae with 
 fish; (e) catch the mos- 
 quitoes in the houses, 
 particularly the last crop 
 in the fall and the first 
 crop in the spring; (f) 
 to kill the larvae with 
 oil, nicotin, and other 
 compounds. 
 
 As malarial mosqui- 
 toes can only travel short 
 distances, and as they only bite at night, all that is needed for results is to 
 see to it that mosquitoes do not breed within 100 yards of human habitations. 
 A man can protect his own household if he will look well to mosquito pre- 
 vention in the 40,000 square yards around his own house, however careless 
 his neighbors may be. 
 
 To prevent the infection of mosquitoes by malarial people : 
 
 1. Measures should be taken to keep down mosquitoes. 
 
 2. Effective screening of the infected, especially at night. 
 
 3. Complete cure of those who have malaria — the Koch plan of steriliza- 
 tion of the blood by quinin. 
 
 The third part of the plan is to prevent infected mosquitoes from infect- 
 ing people. The measures proposed are : 
 
 1. To prevent the breeding of mosquitoes. 
 
 2. To prevent infected mosquitoes from biting people by (a) keeping 
 mosquitoes uninfected; (b) preventing infected mosquitoes from having access 
 to people; (c) using prophylactic doses of quinin. 
 
 However, individual effort is no more satisfactory than is boiling the 
 water by the individual successful in keeping a community from having 
 typhoid. Not much will be accomplished until mosquito surveys are made, 
 
 Fig. 119. — Deposit of Eggs of the Anopheles (Howard). 
 
274 
 
 CONTAGIOUS DISEASES 
 
 sanitary inspectors are employed, oiling squads are used — the methods proved 
 in Havana, in Panama, and in California. 
 
 Every part of this plan has been demonstrated. Just what to do and 
 ways of doing it have all been tried out. 
 
 Fig. 120. — Position of Anopheles Larva in Obtaining 
 Air (Howard). 
 
 ERADICATING MALARIA 
 
 Treatment of malaria as a community disease is composed of three parts 
 — the prophylactic use of quinin, the thorough cure of the infected, the Koch 
 method, and control of mosquitoes. For a badly infected district all three are 
 necessary. For a mildly and intermittently infected district, in the Mississippi 
 Valley, say, north from an east and west line through Cairo, and in most of the 
 country south of there, only the second and third procedures are advisable. 
 
 Not much of value 
 relating to the control of 
 malaria came out of the 
 Washington meeting of 
 the International Con- 
 gress on Hygiene and 
 Demography. In one 
 warm informal discussion 
 the success of mosquito 
 eradication in Panama 
 was brought into ques- 
 tion. Proof that the 
 mosquito work in Pan- 
 ama was effective was 
 overwhelming, and the English doubter retired from the field rather worse for 
 wear. 
 
 Dr. Le Prince's paper set forth that, mosquitoes not being able to travel 
 against the wind, in a district where the winds blow steadily in one direction 
 an infested community can concentrate its efforts on the marshes which lie to 
 the windward. 
 
 Euge put a good deal of stress on fighting mosquitoes out of season. The 
 race is kept alive by adults that get into warm places and live through the 
 winter. He advocated fumigating all houses at least once during the winter by 
 burning pyrethrum powder in them and sprinkling with Giems 7 solution. He 
 advised that whenever it was necessary to keep water around the house in 
 cisterns or like places minnows should be kept in the water. All unnecessary 
 water catchers, such as bottles, tin cans, fountains, small ponds, should be 
 done away with. Ditches and ponds that cannot be drained must be oiled. 
 
 Sergeant said that in North Africa they required that irrigated districts 
 be allowed to dry out at intervals less than the life cycle of the mosquito, the 
 idea being that the eggs deposited and the larvae developed from them would 
 be destroyed before maturing time. Several towns in Constantine, Sahara, 
 have been moved bodily by the government from an unhealthy site to a new 
 one provided and made healthy by the authorities. 
 
 There seems a fair chance that the Mediterranean country will have elimi- 
 nated its malaria by the time ours is gone. Perhaps by that time South 
 America may be in a fair way to clean out its foci. 
 
MALAEIA 
 
 275 
 
 CURE YOUR MALARIA 
 
 In the United States malaria is one of the fast disappearing diseases. In 
 another generation it should be as rare in the gulf states as it is in Illinois 
 today. Half a century ago the New Englander was afraid to emigrate to 
 Illinois on account of the dreaded malaria. The more active the efforts made 
 to control this disease in a malarial region, the more quickly the disease will 
 disappear. 
 
 Fall is the most important season from the malarial standpoint. The 
 people who have been repeatedly bitten by infected mosquitoes are in greater 
 danger of losing their lives now than earlier in the season. 
 
 After each infection they have taken enough treatment to stop the chills, 
 but not enough to kill all the parasites in the blood. In consequence many of 
 them have a few ma- 
 larial parasites of the 
 tougher kind in their 
 spleens and livers. 
 
 In certain phases 
 of the life of the ma- 
 larial parasite quinin is 
 a deadshot remedy. In 
 other phases the para- 
 site is not so easily 
 killed by quinin. In 
 the fall those who have 
 been chilling from time 
 to time are liable to 
 have outbreaks of ma- 
 lignant malaria. 
 
 King, in writing 
 
 of malaria in central Africa, says: "The cold weather brings out the fever 
 in those natives who have suffered from it in previous months." 
 
 Rosenau tells us that as the troops returned from Cuba after the Spanish 
 war "many cases of malaria broke out among those previously in good health 
 upon reaching the cold winds about Cape Hatteras." 
 
 It is wise to cure one's malaria as completely as possible before going 
 into the winter, to cure it up with plenty of quinin followed by an arsenic-iron 
 tonic. This policy is wise from the standpoint of the individual. It is also 
 wise from the standpoint of the community. 
 
 The mosquitoes that are to carry over into next year are searching out 
 sheltered places in which they will manage to keep alive through the winter. 
 Those that come out next spring will be free from malaria infection. Mos- 
 quitoes have such a hard time in living through the winter that it is certain 
 the sick ones will die. 
 
 // there is to be any malaria next spring the mosquitoes to spread it must 
 get infected. They will get infected through biting the people who now have 
 malaria in their blood and who will go through the winter only half cured* 
 having chills once or twice but feeling fairly well most of the time. 
 
 After the intelligent people have cured themselves completely it would be 
 
 Fig. 121. — Usual Position of Larva in Obtaining Air 
 (Howard) . 
 
276 CONTAGIOTTS DISEASES 
 
 wisdom as well as charity to help the less fortunate people to get a complete 
 cure. 
 
 HALF CURED MALARIA 
 
 Mosquitoes capable of spreading malaria are found all over the United 
 States. They are a great annoyance, and as such they should be prevented, but 
 when uninfected they cannot spread malaria. They must be sinned against 
 before they can sin. As they are uninfected in the upper Mississippi Valley, 
 there is no health reason for paying any attention to them. 
 
 So much for the general run of towns. Any place which is a summer 
 resort for half cured "malarias" had better take care of its mosquito problem 
 to prevent breeding, or, failing in this, to prevent them from becoming in- 
 fected. It has a health as well as a comfort reason. 
 
 The visitor to Havana is impressed by the promptness with which the 
 oiling squad turns out after a rain. Within a few hours the little puddles of 
 water, the tin cans, every little accumulation, are oiled. These efforts are 
 important, but they are no more important than seeing to it that no malarias 
 are left half cured. 
 
 During the days of chills and periodic fever — say, May, June, and July — 
 most people know the need of keeping mosquitoes away from the sick. Some 
 do not know or do not care. But the custom is to give quinin for three days 
 only, and this is not long enough to sterilize the blood completely, particularly 
 after August 1. Dr. Henson, in the Journal of Tropical Medicine for Feb- 
 ruary, 1912, says twenty grains a day for three weeks will completely sterilize 
 the blood when fever is intermittent in type, and thirty grains when the fever 
 is of the type found in the autumn — the irregular type. 
 
 Thirty grains of quinin make one feel far from comfortable. To ask a 
 malarial subject to keep it up for two or three weeks is asking a good deal, but 
 then to ask a "chiller," a big-spleened sufferer from latent malaria, to stay be- 
 hind mosquito bars all of the time is asking a good deal. Asking people to get 
 vaccinated, to keep diphtheria quarantine after they feel well, to burn the 
 sputum in all coughs and colds — all of these things ask a good deal. 
 
 A badly infected malarial section labors under a great handicap. The 
 land sells below its value. There is some hazard to life. Malaria is a bar to 
 prosperity. 
 
 If a man is willing and anxious to be quininized for three days for his own 
 good, he ought to be willing to make it three weeks even if the last two weeks 
 is 75 per cent public good and only 25 personal good. Why not indulge in 
 fewer windy words about dying for one's country and put in the time getting 
 cured for one's country? Foreign enemies are bad, but men with half cured 
 malaria are worse. 
 
 THE COST OF MALARIA ON A PLANTATION 
 
 A Department of Agriculture newsletter to crop correspondents tells of 
 an effort made on a plantation in Louisiana to find out the cost of malaria to 
 the planter and his hands. One thousand eight hundred acres of this planta- 
 tion were farmed, mostly by tenants working on shares, though there were 
 some day hands. One thousand seven hundred and forty acres were uncleared 
 
MALAEIA 
 
 277 
 
 swamp land. The department estimates that the conditions were the same as 
 on 200,000 acres of cultivated land in other parts of this country. 
 
 The plantation physician treated members of forty-six out of sixty-four 
 families during the year for malaria. The loss from loss of time to the owner 
 was $3,835 and to the tenants $1,115. Had malaria been eliminated, the 
 manager figured, the income of each family would have been increased $24. 
 He thought forty families entirely free from malaria could do the work of the 
 sixty-four families, sick as they were. 
 
 The harvest seasons in that section come just as malaria is at its worst. 
 In the sections where boll weevil now is, the people are suffering double loss 
 from malaria. 
 
 In the old days, when the crops had been laid by there was not much 
 to do until the gathering time 
 commenced. If the hands were 
 laid up with chills, not much 
 money was lost. When boll wee- 
 vil is around, the crops must be 
 cultivated after the old "laying 
 by" season in order to keep ahead 
 of the weevil. 
 
 The writer of this letter 
 thinks the most effective method 
 of prevention is complete cure of 
 the sick. He does not think it 
 possible properly to screen negro 
 cabins or to keep mosquitoes 
 away by bars over the beds. The 
 drainage of the lands will require 
 many years. But if the cases of 
 malaria are completely cured, the 
 mosquitoes cannot become infected. 
 
 Concentrating on people sick with malaria, seeing that they get quinin 
 free if not able to pay for it, and at a low price under other circumstances, 
 is the method of control of malaria which is proving so effectual in Italy. The 
 letter says that in the ultimate control drainage would probably play the 
 greater part. 
 
 To distinguish the malaria mosquito from the other varieties, the letter 
 says, it is only necessary to notice its position as it bites. The biting malarial 
 mosquito lifts the hind end of the body and hind legs from the skin. The 
 ordinary mosquito stands on the skin with all its legs. 
 
 Fig. 122. — Culex Pungens, or Common House 
 Mosquito: Female (Howard). 
 
 USE OF QUININ 
 
 To spread malaria the anopheles mosquito must bite a person in whose 
 blood the malarial organisms are ready for the mosquito stage. In the blood 
 sucked up there must be malarial parasites, for not every blood cell, nor even 
 every hundred cells, contains a parasite. The mosquito must live for ten days 
 while the parasite is getting ready for man again, and then the mosquito must 
 discharge the young parasite into the blood of a susceptible man. 
 
278 CONTAGIOUS DISEASES 
 
 To render the blood of men unsusceptible to malaria small daily doses of 
 quinin are used. In the Panama Canal Zone the three-grain chocolates of 
 quinin are kept on the eating tables. Of the 40,000 people in the zone 20,000 
 use this prophylactic quinin daily. The quantity taken is nine grains — three 
 grains three times a day. 
 
 The proper plan is to begin taking quinin this way when the mosquito 
 season opens and to keep it up until the mosquito season closes. The tannate 
 and other tasteless forms of quinin seem to work just as well as the bitter 
 forms. 
 
 Bartholow says that in the Civil War every soldier in the army of northern 
 Virginia took a measure of quinin and a jigger of whisky every day and that it 
 
 was good "neither mor- 
 ally nor physically." 
 The judgment of the 
 men in charge of the 
 malaria campaigns in 
 fa Italy, Algeria, and in 
 
 Fig. 123.— Manner in Which the Eggs of the Culex Pun- Paxiama IS that Bar- 
 gens, or Common House Mosquito, are Deposited tholow was wrong, at 
 (Howard). l eas t so far as the quinin 
 
 was concerned. 
 
 To the International Congress on Hygiene, Celli, speaking of Italy, said : 
 
 "The prophylactic administration of quinin has reduced the malaria rate 
 to the minimum." 
 
 Sergent, from Algiers, said: "In Algeria the government distributes 
 three-grain quinin tablets free of charge." 
 
 Euge, from Kiel, advocated the preventive use of quinin. 
 
 Gorgas, speaking of Panama, says : 
 
 "Prophylactic quinin is furnished in three-grain doses either in a solution 
 in the form of a tonic or in pills. It is placed on the table at all the messes, 
 given to any employee who applies for it. Besides we have from one to three 
 dispensers in each district, who go around to the various villages, offering 
 quinin to all employees who will take it. We look upon prophylactic quinin as 
 a most important measure." 
 
 They use about 500 pounds of quinin a year in the Canal Zone. 
 
 The question arises : By whom should prophylactic quinin be taken ? The 
 answer is: Everybody living in a highly malarial district. If anyone stays 
 behind screens every night during the malaria season he may omit quinin with 
 safety, but others cannot. Negroes and poorer whites living in unscreened 
 cabins should take it from spring until fall. The better-to-do can well afford 
 to see that the poorer people get it without cost. 
 
 Keep clear the distinction between the large doses needed to cure an in- 
 fection and the small doses to prevent one. 
 
 OUTLINE OF MOSQUITO WORK 
 
 1. Find the breeding places. 
 
 2. Destroy all bottles, cans, and buckets capable of catching water. They 
 serve as breeding places. 
 
MALARIA 
 
 279 
 
 3. Fill up the cow tracks and ruts. 
 
 4. Drain the small pools and puddles. 
 
 5. Drain the marshes. 
 
 6. Clean out and straighten *the ditches, 
 
 7. Clean and slope the ditch banks. 
 
 8. Tile ditches, whenever possible. 
 
 9. Screen all tanks and water barrels with No. 18 mesh screening. 
 
 10. Tag the breeding places which cannot be drained, emptied or destroyed. 
 
 11. Oil the breeding 
 places. 
 
 12. Oil once every three 
 weeks in cool weather. 
 
 13. Oil once every two 
 weeks in warm weather. 
 
 14. Oil once every week 
 in very hot weather. 
 
 15. Oil after every hard 
 rain. 
 
 16. Oil after every very 
 hard wind. 
 
 17. Cover the entire 
 surface of the pond with a 
 thin film of oil. 
 
 18. The oil mixture to 
 be used is a combination of 
 kerosene and crude oil. 
 
 19. When a spray pump 
 is not available a sprinkling 
 can may be used. 
 
 20. One ounce of oil properly used is enough to cover fifteen square feet 
 of water with a thin film. 
 
 21. In cooler weather the oil mixture used can consist of three parts 
 kerosene and two parts crude oil. In very hot weather the mixture should 
 contain twelve parts crude oil to ten of kerosene. 
 
 22. Grassy marshes where an inch or more of water stands in the grass 
 are especially in need of oiling. 
 
 23. Special attention should be paid to small accumulations of water. 
 
 24. Water liable to serve as a breeding place and which cannot be emptied 
 should be treated with larvacide. 
 
 25. A good larvacide made from tobacco can be had from tobacco 
 firms. 
 
 26. Bodies of water which can neither be oiled nor treated with larvacide 
 can be kept free of mosquito larvae by stocking with fish. Native minnows are 
 best. 
 
 27. Mosquitoes rarely make their way across open ground for a distance of 
 more than 100 yards. Therefore, if mosquitoes do not breed within 300 feet of 
 a house they rarely cause great discomfort therein. 
 
 28. Female mosquitoes, the biters, live for a month or two. They work 
 their way through the woods and dense grass. They hide in heavy cover. 
 
 Fig. 124. — Culex Solicitans, Salt Water Swamp or 
 Striped-Legged Mosquito: Female (Howard). 
 
280 
 
 CONTAGIOUS DISEASES 
 
 29. Clean the vines and bushes away for a space of 100 feet from the 
 house. Vines on the wall are excellent hiding places for mosquitoes. 
 
 30. Screen porches with No. 18 gauze. 
 
 A MOSQUITO CAMPAIGN 
 
 New Jersey has a reputation for mosquitoes. In 1911 the legislature 
 
 decided that the reputation was doing the state harm, and it therefore passed 
 
 "an act for the establishment of county mosquito extermination commissions/' 
 
 In April, 1912, Union County organized its commission. The budget for 
 
 that year was $28,000. The budget for 1913 was $26,000. In the first annual 
 
 report of the commission there 
 is a statement of the reasons 
 why that county was willing to 
 spend that amount of money 
 in anti-mosquito work. 
 
 It is said that mosquitoes 
 cause some, though not much, 
 disease in New Jersey. They 
 are unpleasant pests, and they 
 cause the people great dis- 
 comfort. But the reasons for 
 the activity are largely eco- 
 nomic. 
 
 "Swamps that are useless 
 now become fertile fields after 
 drainage and a source of gain. 
 Valuable building lots are 
 made by filling in low lands, 
 and once freed from the pests 
 that have given New Jersey a 
 bad name people will come to 
 our county and establish their 
 residence, and this means an increase in property values and prosperity." 
 Union County embraces a good deal of sea marsh land. The 1913 
 report shows that the better drainage of this land had materially increased 
 the value of the hay crop, an economic benefit not included in the first 
 prospectus. 
 
 It is infinitely more difficult to rid a sea marsh of mosquitoes than it is 
 to get rid of them in an upland district. The rise and fall of the tides and 
 the great expanses of grass-covered marsh with its multitude of sluggish ditches 
 create conditions without parallel in upland work. If they can control mos- 
 quitoes the people of Chicago and vicinity would find their work of mosquito 
 extermination child's play. 
 
 The report from Union County is that the mosquito pest is ancient his- 
 tory. More than a year ago all the district was practically free except a section 
 of northeastern Elizabeth. In 1914 the city of Newark undertook to rid that 
 district of mosquitoes since they came from a section of Newark meadow for 
 which Newark, not Elizabeth, was responsible. 
 
 Fig. 125. — Stegomyia, or Yellow Fever Mosquito: 
 Female (Howard). 
 
MALARIA 281 
 
 The Union County commission keeps three men at work cleaning out 
 ditches and draining the salt marsh throughout the winter. Early in March 
 it sets a gang at work cleaning out ditches on the salt marsh and another 
 gang draining small pools in the upland. 
 
 About May 1 the oiling begins. About 2,000 sewer catch basins, stagnant 
 pools and ponds, gutters, open cellars, slow-running streams, open manure 
 pits, drains, and other breeding places were oiled once every ten days from 
 May 1 to October 1. The cleaning of the salt marsh ditches began March 16 
 and was completed on May 20. 
 
 "Now is the time to start anti-mosquito work." 
 
 The statements quoted below are worth listening to because they are 
 based on the experience of men who had a hard job and made good. The 
 men referred to are the mosquito extermination commission of Union 
 County. 
 
 Note this money benefit: "The amount of salt water hay harvested is 
 growing greater every year." And this comfort benefit: "Hardly a single 
 specimen of the salt marsh mosquito was seen in places where in previous 
 years it was a pest." 
 
 The following statements would apply anywhere: 
 
 "The importance of the small breeding place is being realized more 
 and more when the enormous number of barrels, open cesspools, and cis- 
 terns, tubs, pails, broken dishes, cans, etc., found each year is taken into 
 consideration. Even in good neighborhoods dozens of these breeding places 
 are found. In almost every factory yard from one to ten unused vats and 
 barrels holding water can be found, serving no purpose except to breed mos- 
 quitoes. 
 
 "In the patches of gardens scattered throughout the cities, barrels and 
 tubs to hold water are common. Around stables and in vacant lots miscel- 
 laneous collections of old cans, pails, etc., the dumping of many years, are 
 plentiful. Any such breeding places can produce enough mosquitoes to keep 
 the neighborhood for two blocks awake." 
 
 In the opinion of the writer of the report, most of the mosquitoes which 
 infest residences are bred in water in small containers, and not in ponds and 
 marshes. 
 
 The commission has noted sewage-polluted road ditches black with wig- 
 glers. Sewage pollution furnishes plenty of wiggler food. "One hundred 
 times as much breeding will take place in polluted water as in clean." This 
 may be true of ordinary mosquitoes. Yellow fever mosquitoes require clean 
 water. Malaria mosquitoes prefer to breed in greenish water not very badly 
 polluted. 
 
 About 200 premises were inspected each day by each city inspector. 
 The country inspector had forty to fifty inspections as his daily task. An 
 inspector was expected to get around his district, inspect every premise, once 
 in fourteen days. "Although they found a very large amount of breeding, 
 but few mosquitoes got on the wing." 
 
 "The kind of mosquitoes that infest your houses do not come from the 
 salt marshes or large bodies of water, but in nearly every case they were 
 hatched within 1,000 feet of your house, in some small pool or collection of 
 
282 
 
 CONTAGIOUS DISEASES 
 
 water. One rain barrel by actual count has been known to produce 16,800 
 mosquitoes in a week." 
 
 OILING TO PREVENT MALARIA 
 
 The workmen on the Canal Zone suffer very little from malaria. Dr. 
 Watson, who has charge of the malaria work in the Federated Malay States, 
 visited the Zone to study the methods in use there. He reported to the Royal 
 
 Colonial Institute : 
 
 "I concluded the results 
 were mainly from oiling, which 
 was done for practically half 
 a mile on each side of the 
 canal. The great majority of 
 the population do not live in 
 screened houses and very few 
 take quinin." 
 
 Dr. Le Prince, who has 
 had a broad experience in the 
 Canal Zone, has devised a 
 method for oiling running 
 streams. He holds that, wher- 
 ever draining is feasible, it will 
 be found the cheaper as well as 
 the more effective method for 
 controlling mosquitoes. Where 
 a film of oil can be made with 
 a spray pump or a sprinkling 
 can it should be done. 
 
 However, the question of 
 oiling flowing streams arose 
 with them as it does with 
 others. Dr. Le Prince uses a homemade device made with an ordinary five- 
 gallon oil can, a three-inch round nail, and a little cotton. The nail is driven 
 through the bottom of the can from the inside out. A wad of loose cotton 
 is wrapped around the nail just below its head and within the can. 
 
 The can is hung or otherwise held over the water. The drop should fall 
 far enough before striking the water to cause it to break into a thin film on 
 the surface of the water. By varying the pressure of the head of the nail on 
 the cotton the flow of oil is regulated. The number of drops per minute should 
 range between ten and twenty. 
 
 For kerosene and light oils one can use an oil can with a small spigot 
 located on the side of the can an inch above the bottom. The handle of the 
 discharge tap, or spigot, can be manipulated to regulate the rate of dripping. 
 In hot weather, when heavy oils are used, neither of these methods is 
 very satisfactory. The grease clogs the opening after a little time. To obviate 
 this the following plan was devised: 
 
 An opening is made in the side of the can about two inches above the 
 bottom. A flange of thin metal, similar to that used in a lamp burner, is 
 
 126. — Anopheles, or Malarial Mosquito: 
 Female (Howard). 
 
MALARIA 
 
 283 
 
 fastened to the outside of the flat opening in the side of the can. A flat wick 
 is run through the opening. Two or three inches of the inner end of the 
 wick rest on the bottom of the can, and about half an inch of the outer end 
 projects beyond the flange. An inch or two of water is placed in the bottom, 
 and then the can is filled with oil. By pressing the flanges against the wick 
 or by opening them out the rate of dripping is lessened or increased. 
 
 This method is especially adapted to small drainage ditches. It may be 
 adapted to irrigation ditches. Several cans properly spaced may be placed in 
 a row across a larger ditch. 
 
 A marshy place supplied by an oozing spring Le Prince would handle as 
 
 follows : 
 
 A small bundle of oil-soaked cotton waste is placed on the wet ground at 
 the point where the spring oozes out. It will give off a thin film of oil for 
 a week. 
 
 Weeds and Malaria. — Mrs. F. A. T. lives in a southern town within the 
 malarial belt. The town has 2,500 inhabitants and is scattered over a 
 large area. She asks the follow- 
 ing questions: Do rank weeds 
 growing on vacant lots where 
 surface water is liable to stand 
 cause malaria? There are many 
 people ill with malaria, chills and 
 fever both in town and in the 
 surrounding country. How is 
 malaria akin to typhoid fever? 
 If a sewer system is installed it 
 will cost about $18 per inhabitant 
 and the sewage would have to be 
 emptied into a sluggish river. Is 
 there a substitute? Is the odor 
 from stables injurious? How did 
 the belief originate that "horses 
 and hogs are healthy"? 
 
 Eeply. — 1. Tall weeds con- 
 tribute to the breeding' of mos- 
 quitoes. They keep the ground 
 from drying out and are respon- 
 sible for small puddles of water 
 in which mosquitoes can breed. 
 A can of water will sometimes 
 breed enough mosquitoes to spoil 
 a neighborhood. There being 
 cases of malaria in the neighbor- 
 hood, these mosquitoes become 
 infected and then spread the in- 
 fection to other people. 
 
 Malaria reduces the price of 
 
 H 
 
 ^J 
 
 \ 
 
 j$&-^- 
 
 3^_ 
 
 3?C 
 
 ytSL. 
 
 y^ 
 
 
 At 
 
 J^f 
 
 /v 
 
 Fig. 127. — Resting Attitudes or the Cu- 
 lex (left) and Anopheles (right). 
 
 every acre of ground in the district; it lowers the working efficiency of 
 the people from 10 to 25 per cent. ; it causes a good deal of sickness and 
 some deaths; it prevents immigration. Therefore a malarial section is 
 warranted in going to a good deal of trouble to get rid of mosquitoes. 
 
284 CONTAGIONS DISEASES 
 
 The following plan should be followed: First, require that malaria 
 be a reportable disease just like diphtheria ; second, require that all people 
 having malaria shall be screened from mosquitoes; third, insist that all 
 those suffering with malaria shall be forced to continue taking quinin until 
 fully cured, since half cured malaria is largely responsible in spreading the 
 disease; fourth, screen dwellings against mosquitoes; fifth, cut weeds so 
 that puddles of water may dry out; sixth, drain stagnant water; seventh, 
 kerosene bodies of water which cannot be drained and which are mosquito 
 breeders. 
 
 2. Malaria is not akin to typhoid. As malaria disappears from a sec- 
 tion typhoid comes more to the front, but it is our opinion that typhoid was 
 always present but was overshadowed by malaria during the years when 
 malaria was rife. 
 
 3. If sewers are expensive for your town we suggest that ordinances 
 relating to outhouses should be passed. These ordinances should require 
 a permit for every yard closet and should specify the location with relation 
 to dwellings and wells, also the style and type of building. A letter sent 
 to the Public Marine and Hospital Service, Washington, D. C, asking for 
 plans of the Stiles closet will bring a pamphlet telling all about it. It can 
 be built for less than $10. 
 
 4. The odor from a stable is not injurious under ordinary circum- 
 stances, but there are places around stables in which flies breed, and this 
 is a source of bad health. City ordinances should always specify that the 
 manure should be kept in boxes which are fly proof and that the manure 
 boxes should be emptied at weekly intervals. There is no basis for the 
 legend that the odor of horses and hogs is healthy. Another and similar 
 legend is that the odor of goats is healthy. There is no truth in any of 
 these. 
 
 Malaria Easy to Cure. — Mrs. B. P. writes: "We now know, I believe, 
 where malarial fever comes from, but I wish to ask if there is any cure 
 for it. Can the fever ever be entirely eradicated and if so by what means? 
 Will medicine, antitoxin injection, diet or climate affect the disease when 
 it has a hold? Will life out of doors help it?" 
 
 Reply. — Generally speaking, malaria is the most curable of all diseases. 
 Unless the patient is being reinfected by mosquitoes, the disease clears up 
 spontaneously. A few doses of quinin given while the parasite is in the 
 growing stage and repeated for three days are generally all that is neces- 
 sary, if mosquitoes are barred out. 
 
 Occasionally, as Craig of the army has shown, malarial organisms get 
 in the spleen and bone marrow and lie latent for some time. Iron, arsenic, 
 and quinin nearly always suffice for these. 
 
 Ninety-nine per cent of the people who think they have intractable, 
 recurring malaria have no malaria at all; they have something else. 
 
 Daily Allowance of Quinin. — D. B. B. writes: "In taking quinin to 
 cure malaria, how large a dose should be taken at a time and at what 
 intervals? From what part of the body is it best to take a sample of blood 
 for a microscopic examination for malarial germs? When a chill is not 
 evident, what are the symptoms of malaria? Would a severe headache 
 about the same time each week indicate malaria in one who has been in- 
 fected for about three years but had no chill in the last year? Is the tak- 
 ing of large quantities of quinin injurious to any organ of the body? 
 How would it affect a leaky heart?" 
 
MALARIA 285 
 
 Reply. — 1. Thirty grains a day. If the condition is urgent it can be 
 given in one dose. The usual plan is to give it in five-grain doses. Some 
 give the thirty grains in eight hours, some distribute it over the twenty- 
 four hours. 
 
 2. It makes no difference in an ordinary case. The finger is frequently 
 used. The lobe of the ear is preferred by many. 
 
 3. In a marked infection, fever and aching, followed by a sweat. But 
 the variations from this type are many. The microscopic test is practically 
 always available. 
 
 4. It would be ground enough to warrant repeated blood examinations 
 and the therapeutic test — trial of quinin. 
 
 5. No. 
 
 6. Not at all. 
 
 Effect of Quinin. — J. 0. T. writes: "Is quinin a mineral or a vegetable? 
 A party claims that quinin is bad for the health, as it is a mineral. I have 
 always been under the impression that it came from Peruvian bark." 
 
 Reply. — You are right. Quinin is derived from Peruvian bark and it 
 is, therefore, a vegetable substance. Quinin is a poison. If you are in- 
 fested with malarial organisms, take quinin. It will poison you some- 
 what, but it will kill the malarial organisms. If you have not malaria, 
 do not poison yourself with quinin. 
 
 Mosquitoes. — H. J. H. writes: "In your article on malaria you quote 
 Ruge, who says the race of mosquitoes is kept alive by adults that get into 
 warm places and live through the winter. If this is true where do the 
 countless millions of them come from in the arctic regions? They swarm 
 in clouds over every northern swamp, where the temperature is 50 to 75 
 below zero and no warm places for them to live" 
 
 Reply. — There are warm places even in the arctics. Within a short 
 while after the warm weather of the spring comes on the surviving females 
 begin laying. Multiplication is very rapid. The marsh mosquito eggs can 
 live through the winter in mud and hatch in the spring. Whether the eggs 
 of other species can or not is unknown. A few larvae survive. The impor- 
 tant method of winter survival is by hibernation in warm places. 
 
 Mosquitoes from Cisterns. — J. H. F. writes from Joliet: "In your 
 catalog of breeding places for the mosquito you overlooked the cistern. So 
 far as cities and villages go cisterns are the breeding ground of mosquitoes. 
 Where cisterns are in basements it is difficult to shut the mosquito out, 
 unless it is done at the time of construction" 
 
 Reply. — There are anopheles mosquitoes in Joliet, but they are not 
 infected with malaria. 
 
 Malaria in Lexington. — Anxious Mother asks: "Is there much malaria 
 around Lexington? We drink water from a well; is it safe?" 
 
 Reply. — The malaria rate in the district you mention is not high, and 
 it is getting less year by year. Where water is from wells, the question as 
 to safety must be answered for each well. Probably the Kentucky Board 
 of Health can advise you as to the safety of the well to be used. 
 
Where Mojxjuitoej* Breed— 
 
 Jn "Ponds and Riddles 
 
 \n Tloo&fyMezr end Rain- 
 water BorreLr 
 
 »«&" 
 
 JnEmptq Canr eu^d 
 Bottler eic. 
 
 LUi- 
 
 jhe Pitcher in the Sp 
 
 ore 
 
 - Room Maij Breed Enough 
 
 Noscmiiozs to Infect the 
 % Whole Nei/ihhorhood. 
 
 Jn Neglected Street Cuttfe 
 
 4/ C** «*<»/>£* ■ ■flf- 
 
 Florida Health Notes. 
 
 Fig. 128. 
 286 
 
— and How {o Preveni Them. 
 
 ~ ^_JHT o^s. V S^ 
 
 \~ 
 
 Stock Ikmancni Ponds J)rbin or Fill All Low Spotr 
 
 With Firh. mere Stagnant Water May 
 
 S~ ^ ^v Collect. 
 
 h fire- 
 
 "Wtcnl&u CantPrain,Oil 
 
 JJo Noi Allow Stagnant "WS^rl^ 
 Collect -Anywhere onl&ur Ptemirej: 
 
 Florida Health Notes, 
 
 Fig. 129. 
 
 287 
 
288 CONTAGIOUS DISEASES 
 
 To be protected against malaria, be careful of mosquitoes, particularly 
 of mosquitoes that breed and live around the house. Keep away from 
 people who have malaria, or who have had it within a year. 
 
 The disease cannot pass directly from such a person to you, but the 
 mosquitoes around such a person will be a menace to you. 
 
 ANTHRAX 
 
 One of the first bacteria discovered was that of anthrax. The reason 
 is that it is so large that it can be readily seen with low power imperfect 
 microscopes — the only kind the pioneers in bacteriology possessed. 
 
 The disease is frequent in cows and horses. It is infrequent in man. 
 
 Human anthrax is of several varieties. In most cases the bacillus gets 
 into the tissues through some wound in the skin. For some reason, prob- 
 ably because of its large size, it is held near the point where it got in. 
 
 In over half of all the cases the anthrax carbuncle is on the face. In 
 38 per cent, of the cases the infection is on the hands or arms. About 
 two days after the exposure the carbuncle starts as a small red itching 
 point which feels and appears like an insect bite. In less than a day the 
 small pimple is a small blister and within another day it is a fiery carbuncle. 
 
 There is no way to tell this carbuncle from an ordinary carbuncle 
 except to examine for anthrax bacilli under the microscope. This form of 
 anthrax is not a very violent disease. Two-thirds of the cases get well. 
 
 Perhaps some cases of anthrax carbuncle are diagnosed as ordinary car- 
 buncle. Unless the sick man happened to be a dairyman or hostler, 
 shepherd, butcher, tanner, wool sorter, or rag picker it would not occur 
 to the physician in most cases to examine the secretion of the carbuncle 
 under the microscope. 
 
 In Europe the peasants have internal anthrax. Perhaps it comes from 
 eating pickled meat from animals that have died of anthrax. Edwards says 
 that in Saxony in one year there were 206 cases t)f internal anthrax. 
 
 The disease starts with a sharp rise in temperature. The fever is high. 
 There is vomiting of blood. Blood is passed in the stools. Carbuncles of the 
 skin may appear. If the physician gets suspicious and examines the stools for 
 bacilli he discovers the disease, otherwise not. 
 
 ANTHRAX OF THE LUNGS 
 
 Wool sorters and rag pickers sometimes inhale dust containing anthrax 
 bacilli. As the bacillus is large it is caught in the small blood vessels of 
 the lungs. The patient has a high fever and cough. His sputum contains 
 blood. He is liable to die on the second or third day. About the only way 
 to diagnose the disease is to find anthrax bacilli in the sputum. 
 
 ANTHRAX IN THE BLOOD 
 
 Sometimes the bacillus, in spite of its size, gets into the blood stream. 
 When it does it finds itself at home. It multiplies rapidly. Many of them 
 
ANTHRAX 289 
 
 lodge in the tissues but in spite of this they can be found in numbers in the 
 blood stream. The disease is rapidly fatal. 
 
 The patient has a chill, followed by high fever and great exhaustion. 
 The spleen may be large, especially if the patient lives a few days. The 
 urine contains blood, albumin and anthrax bacilli. This is the form in 
 which anthrax usually appears in the lower animals. 
 
 Since the disease is not natural in man it takes on the atypical form — 
 the carbuncle rather than the typical form — of blood infection when it ap- 
 pears in the human subject. 
 
 Anthrax as a disease of human beings has never been, is not, and prob- 
 ably will never be a disease of first importance. The ordinary man engaged 
 in the ordinary work of society is in practically no danger from it. Men 
 who work in hides, hair, and wool need to be protected against it. In some 
 instances that which they work in can be sterilized. To protect against 
 dust the hides, wool, or rags should be sprinkled. Some wool sorters 
 and rag pickers can be persuaded to wear respirators when at work. 
 
 ANTHRAX AND FURS 
 
 A short time ago a girl in New York died from anthrax. The carbuncles 
 in this case were on the neck and the girl had recently worn a new fur 
 collar. Since it was not possible to find any other way in which the girl could 
 have contracted the disease the suggestion was made that the fur collar 
 carried anthrax to the girl. The health authorities investigated the case 
 as well as they could. They came to the conclusion that the fur collar was 
 not responsible. They found that furs are so carefully cleaned that any 
 anthrax bacilli there would be cleaned out. Furthermore, they found that 
 there was no record in medical literature of a case of anthrax in workers 
 in fur. 
 
 Anthrax is due to a very large spore-bearing bacillus. The spore-bear- 
 ing bacilli are hard to kill. When anthrax once infects a pasture or a barn 
 it is exceedingly hard to get rid of it. 
 
 A certain dairy district in northern Illinois had a small amount of 
 anthrax infection which hung on for nearly ten years. About once in two 
 years a few cows would be found infected. The cows would be killed and 
 their bodies burned, whereupon the disease would disappear and no evi- 
 dence of it could be found for a year or two. The bacilli either lay dormant 
 as nonactive spores, probably in the soil of the pastures, or else they lived 
 an active life in some unknown host. 
 
 Anthrax bacilli have been known to keep alive in hides which have 
 been thrown about, beaten, shipped long distances over land and sea and 
 subjected to all sorts of climatic influences. 
 
 The authorities found no account of fur-borne anthrax in medical 
 literature. How much is that point worth? Anthrax in the human sub- 
 ject is a rare disease. The number of cases on record is small. When a 
 case was recorded in the health department recently the newspapers said it 
 was the first case on record in Chicago. While this statement was in- 
 correct it indicates that the disease is very rare. Few physicians know 
 anthrax. If the average physician were to see a case the probability is that 
 he would fail to diagnose it. 
 
290 CONTAGIOUS DISEASES 
 
 Anthrax carbuncle looks like ordinary carbuncle. A suspicions carbuncle 
 in a tanner or wool sorter might cause a bacteriologic examination for an- 
 thrax. A carbuncle in a person who wore furs would not occasion suspicion. 
 All in all, the fact that there are no cases of anthrax in fur workers on 
 record does not prove that there were no cases. 
 
 Considering these several points, the negative finding of the authorities 
 does not convince us that fur might not have been the means of infection. 
 But there is no reason for women to discontinue wearing furs. Even if this 
 case was so infected the fact is that the danger is so slight as to be 
 negligible. 
 
 PLAGUE 
 
 "THE PRESENT PANDEMIC OF PLAGUE" 
 
 Such is the title of a report written by Dr. J. M. Eager in 1908 and 
 issued by the Public Health and Marine Hospital Service at a time when the 
 disease threatened to spread from California to the remainder of the United 
 States. 
 
 There are two perennial foci of plague — places where the plague seed 
 stays and from which, from time to time, epidemics travel out over the world. 
 One of these is in western Asia. This is the more violent strain, but it has 
 less tendency to break out over the world than its kinsman. It is from the 
 other strain — that whose home is Yunan, China — that the present epidemic 
 began to spread in lS9Jf. 
 
 In 1894 plague got out of its home ground and traveled from Canton 
 to Hongkong. By 1896 it had reached Bombay and there it found two 
 conditions making for its growth and spread. The caste and religious preju- 
 dices of the people prevented proper sanitary measures of control and thus 
 the plague got a good foothold. The steamship connections at Bombay then 
 opened up new possibilities for spreading it over the world. 
 
 Eager says that by 1900 plague was present in every quarter of the 
 world — Europe, Asia, Africa, Oceania, North and South America — a pan- 
 demic, or, in other words, a world wide epidemic. Since that time it has 
 been beaten back in this place and that while hither and yonder it has pushed 
 forward. 
 
 The more civilized countries into which it has been imported have driven 
 it out only to find that in some careless land it has been gaining headway, 
 and is ever ready to push back into the forbidden country. 
 
 For instance, it reached California in 1900 and flourished for three 
 years; then it became invisible and so stayed for four years; then it flared 
 up for two years, spread up and down the coast from Los Angeles to Seattle, 
 then vanished and seemed willing to give the San Francisco exposition a fair 
 chance. It quit the attack on the Pacific seaboard and swung around into the 
 Gulf of Mexico and having got a foothold in Cuba and Porto Eico it has 
 again threatened us this time from the East. 
 
 While it seems to yearn for a chance to get at white people it does not 
 make any headway when it gets among them, and is rather easily dislodged. 
 It is most destructive among the yellow people, the Chinese, and brown 
 
PLAGUE 291 
 
 people, the East Indians. In the last sixteen years 7,500,000 East Indians 
 have lost their lives from it. In one province 1 per cent of the total popula- 
 tion died from it in ten years. In Canton between March and August, 1894, 
 it killed 120,000 people. 
 
 Its history on the California coast is most interesting. In January, 
 1900, plague was discovered in San Francisco by Surgeon J. J. Kinyoun of 
 the Public Health and Marine Hospital Service. The existence of the disease 
 was denied by certain business interests. Pressure was brought to bear on 
 the governor who, in turn, proclaimed that there was no plague in San 
 Francisco. 
 
 The national authorities stood their ground. As the plague was wholly 
 among the Chinese and this race habitually herds to itself the bureau's 
 orders governing interstate quarantine and supervision were made to apply 
 only to Chinese. 
 
 There seemed to be no use in supervising the coming and going of white 
 people as none of them had been found sick with the disease. The chance to 
 draw an easy line between the safe and the unsafe appealed to the common 
 sense of the men in the service. 
 
 However, somebody saw a chance to take advantage of a technicality and 
 the Chinese Six Companies were persuaded to ask for an injunction from 
 Judge Morrow. 
 
 The judge heard no testimony as to whether plague was present or not. 
 He granted the injunction on two grounds : First, the regulations discrimi- 
 nated against the Chinese; second, there was no plague in San Francisco. 
 
 Twenty-eight Chinese died of plague in San Francisco in 1900. 
 
 By June the powerful politico-business combination had reached the 
 national government, and the Public Health and Marine Hospital Service 
 was ordered to stop its activities. Officially there was no plague. 
 
 The people of the United States, however, and particularly of Idaho. 
 Washington, Oregon, Nevada, and southern California, would not be fooled. 
 They refused to trade with San Francisco. They did not care to buy carpets 
 there and have plague thrown in for good measure — what they call lag- 
 niappe in New Orleans. 
 
 By 1901 the politico-business combination had begun to yell like a 
 whipped cur. In that year twenty-five Chinese died of plague in San 
 Francisco. In January, 1901, Secretary Gage of the treasury appointed 
 a commission to investigate the plague in San Francisco. The three com- 
 missioners were from the universities of Pennsylvania, Michigan, and 
 Chicago. The railroads and the Chinese Six Companies, forgetting the in- 
 junction granted them by Judge Morrow, cooperated with the commission. 
 
 The commission carefully investigated six dead Chinamen and found 
 plague beyond question. Among other conclusions was one that Wing Chut 
 King had died at 1001 Dupont Street on March 6, 1900, of plague and, 
 inferentially, the learned judge was wrong. Dupont Street at this number 
 is on what is called the Barbary coast. 
 
 Is it any wonder that a political revolution came about in California, 
 that the politico-business combination was thrown in the discard, that the re- 
 call was passed, that women were given the ballot and that the people de- 
 manded the recall of decisions? 
 
292 CONTAGIOUS DISEASES 
 
 The California legislature in 1900 appropriated and the state board of 
 health spent unavailingly $50,000 in trying to control plague. In 1902 
 there were 41 fatal cases in San Francisco's Chinatown. In February, 1903, 
 the national, state, and municipal governments began a joint campaign against 
 plague in Chinatown. For eighteen months they spent monthly sums as 
 follows : United States, $1,600 ; state, $1,500 ; city, $2,500. There is no way 
 of knowing what was spent by property owners. 
 
 By July, 1904, the disease was cleared out of Chinatown. There were 
 17 deaths in 1903 and 8 in 1904. For three years there was no case of human 
 plague but it is quite certain that the disease was kept alive among rats. In 
 June, 1907, a sailor on a harbor tug plying San Francisco bay was found to 
 have plague. 
 
 It has been suggested that the earthquake and fire in 1906 had driven 
 infected rats into closer association with men and thus the disease was 
 brought back to the human family. In 1907 and 1908 there were 159 cases 
 and 77 deaths, all among white people. The Chinaman had learned his 
 lesson. Chinatown had been rebuilt. 
 
 Since 1900 United States supervision and cooperation have been wel- 
 comed. Between 1907 and 1911 the national government spent $900,000 in 
 plague work in California, and the state and municipal governments an aggre- 
 gate of many hundreds of thousands in addition. 
 
 Surgeon General Blue writes me that in the four years, 1907 to 1911, the 
 people spent $2,000,000 in rat-proofing. All these millions to do what a 
 few thousand dollars would have done had the people stood behind Kinyoun 
 in 1900. 
 
 Let me wander enough to emphasize the following: Because he did 
 his duty and tried to protect them, the business-political combination in 
 California drove Kinyoun, a brave, heroic public servant, not only out of 
 California but out of the Public Health and Marine Hospital Service. When 
 Carnegie medals for heroism are being distributed, one should go to Joe 
 Kinyoun. It should go to him on the motion of Lyman J. Gage, because 
 he knows where the pressure came from, and be seconded by ex-Governor Gage 
 of California, who exerted a part of it. 
 
 For several years neither infected people nor infected rats have been 
 found in San Francisco or on its peninsula. But in August, 1903, a black- 
 smith from across the bay spent a day shooting ground squirrels near his 
 home. Two weeks later he had the plague. 
 
 During the next five years case after case developed amongst people who 
 had been shooting ground squirrels; so that although no plague now exists 
 on the Pacific slope among the people or the rats it is more than possible 
 that here and there it is being kept alive by the small animals of the fields. 
 
 It is recognized now that plague is a disease of rats as well as of human 
 beings. Therefore, when a people is threatened with plague it must take 
 thought of its rats. Sick rats are harder to watch than sick people. There- 
 fore, when plague threatens rats are nearly as important as people. 
 
 However, rats are never unimportant. They are enormously destructive. 
 They cost enough to make them burdensome without regard to the danger 
 from them. They spread some disease other than plague. They are nasty 
 as well as destructive. They haul garbage and meat into out of the way 
 
PLAGUE 293 
 
 places there to rot, offend, and become a source of nuisance. There is no 
 redeeming word to be said for a rat. Human affections have been bestowed. 
 and often wasted, on everything from trained fleas to elephants, but who ever 
 loved a rat? 
 
 The common rat of this country is the brown rat, the roof rat not being 
 of much consequence. These, our usual rats, can harbor plague but if the 
 disease comes to us, it will probably be brought into the country by the black 
 rat — the usual ship and harbor rat. 
 
 The black rat, as compared with the brown rat, is smaller, more lithe, and 
 more active, It has longer legs, longer ears, a longer, more pointed nose, 
 and is darker in color. 
 
 A female rat has about ten to a litter and bears four litters a year. 
 No rat census of the United States, or any part thereof, has ever been taken, 
 but we can get some idea of their abundance from a report that on a 2,000 
 acre estate in England they caught 37,000 rats and Lantz says: "Even 
 then the property was by no means free from rats." 
 
 Once, in time of famine in India, when food counted, rewards were 
 offered for rats, and 12,000,000 were brought in. The rat population of 
 any city is probably greater than the human population. 
 
 Lantz, in an interesting bulletin, "The Eat in Its Eelation to the 
 Public Health" (Public Health and Marine Hospital Service, 1910), tells 
 of some interesting rat migrations. 
 
 In 1903 there was a rat migration in Eock Island and Mercer counties, 
 Illinois. The Moline Evening Mail said that F. W. Montgomery of Pre- 
 emption killed 3,435 rats on his farm between March 20 and April 20, 1894. 
 In 1877 there was a similar migration in Saline and Lafayette counties in 
 Missouri and in 1904, another in the Kansas Eiver Valley. 
 
 Eats do not migrate unless there is a reason and not infrequently the 
 reason is the existence among them of an epidemic disease. Therefore, 
 whenever rats are to be seen in the daytime, whenever they get out on the 
 street or on the road, whenever they appear in large numbers or in unwonted 
 places, whenever dead rats are found in unusual abundance, whenever the 
 newspapers or the neighbors note a plague of rats, it is wise to take notice 
 and to inaugurate an investigation. 
 
 California has proved that the ostrich policy does not pay. A rat migra- 
 tion may have health significance. 
 
 Lantz says: "The ferocity of rats has been grossly exaggerated. The 
 stories of their attacks upon human beings, sleeping infants especially, have 
 but slight foundation. Ordinarily, the probability of being bitten by rats is 
 remote, and the bite is not poisonous," which is true. 
 
 I have been in the stockyards and around slaughtering houses after 
 .midnight and have seen hordes of enormous rats, but I have never seen 
 them disposed to fight. I have known children to be bitten by sick rats, not 
 plague-infected rats, but rats otherwise sick. I think when a rat viciously at- 
 tacks a man there is a fairly good chance that the rat is sick, at least it is 
 suggestive enough to demand investigation. Viciousness in rats may have 
 an epidemiological significance. 
 
 In an epidemic of plague in people it is the rule that rats, dead or sick 
 of the plague, are frequently found. Sometimes the finding of a plague- 
 
294 
 
 CONTAGIOUS DISEASES 
 
 stricken rat is the means of establishing a diagnosis of the disease in the 
 human subject since often those who have it cover it up and sometimes the 
 attending physician does not recognize this, to him, strange condition of 
 his patient. 
 
 Sometimes a first case having been found in a human being and a crusade 
 against rats having been started, the disease has been found widely spread 
 among rats. Eats seldom bite people or any article that any person is sub- 
 sequently to eat. The chances of sick people directly infecting rats is slight. 
 All of which suggests that there is needed some agent to bridge over the 
 space between rats and people. 
 
 CLDSED 
 
 □PEN 
 
 Fig. 130. — Rat Guard for a Ship's Cables. 
 
 The flea is the agent that binds them together. Bat fleas carry the bacillus 
 of plague back and forth between rats and men by sucking the bacteria into 
 their stomachs along with the blood. The India Plague Commission found 
 that plague bacilli remained alive in fleas for fifteen days. 
 
 DISEASES OF RATS 
 
 As Rucker says: "Plague is primarily a disease of rodents and, sec- 
 ondarily and accidentally, a disease of man." He puts it in doggerel as 
 follows : 
 
PLAGUE 295 
 
 "First plague in rats, and then in fleas, 
 Then plague in man and quick disease. 
 No rats, no fleas, no plague disease/' 
 
 Our present day interest in rats is because plague is epidemic in Porto 
 Eico and Cuba, and from those footholds is menacing us. 
 
 Through the Panama Canal the pest holes on the north part of the 
 west coast and some of the north coast of South America are within menacing 
 distance of our gulf and Atlantic ports, and plague can jump as far as a 
 freight car or ship can haul a rat in two weeks. 
 
 But we must not lose sight of the fact that rats have other diseases some 
 of which human beings also have. 
 
 Probably the first nation to take an interest in rats was Denmark and 
 the larger part of their interest was due to the rat as a spreader of trichina. 
 Trichinosis is abundant among rats. Stiles says: "Trichinosis will probably 
 never be eradicated from man until rats and mice are practically eradicated, 
 and any public health campaign against trichinosis must take the rat into 
 serious consideration." 
 
 Eats have eleven kinds of internal parasites which also infect men. 
 Among these are tapeworms. The dwarf tapeworm of man is similar to a 
 dwarf tapeworm found in rats. 
 
 They also have fleas, lice, and mites. The flea carries the plague from 
 rats to men and from men to rats. Plague bacilli have also been found 
 in rat lice. 
 
 Eats have pneumonia, Bright's disease, drunkard's liver, stone in the 
 bladder and many other diseases that man arrogates to himself. 
 
 They have many different kinds of tumors, including every sort of 
 cancer. In fact, the most promising experimental work now being done look- 
 ing toward a cure for cancer is that on cancer in rats and mice. Cancer 
 in rats and mice sometimes runs in epidemics. With it they can be inoculated ; 
 they can be cured; the sera from cured cases will cure the disease in other 
 animals. And now experimenters are trying to find a way to apply this 
 information, and possibly even these sera, to the cure of cancer in the 
 human subject. 
 
 Eats have leprosy, and it is hoped studies of rat leprosy may help in 
 working out better cures for human leprosy. 
 
 Eats also have a rather queer disease known as rat-bite disease. Most 
 of the reported cases of this disease have come from Japan. Most of the 
 cases reported from this country have come from the Mississippi Valley. 
 Stiles suggests that rats may be a factor in the spread of sleeping sick- 
 ness — a disease due to a wavy blood parasite known as trypanosoma. These 
 cases were observed before a certain kind of blood parasite had been dis- 
 covered. Probably a parasite of this type is responsible for rat-bite disease. 
 
 PLAGUE AND THE CANAL 
 
 Eecently Dr. Howard King of the Tulane University School of Trop- 
 ical Medicine, taking as his text an old Spanish proverb, "He is in safe 
 quarters who sounds the alarm," told the people of New Orleans and the 
 
296 
 
 CONTAGIOUS DISEASES 
 
 Fig. 131.— The Human Flea. 
 
 Mississippi Valley generally of some of the disadvantages of the Panama 
 Canal. 
 
 Within a few years traffic will be pouring through the canal — many 
 of the ships manned by celestials. Much of the traffic will come into 
 New Orleans. The most efficient health organization in the world — that of 
 the Canal Zone — will have been dissipated. Places now weeks removed 
 from the United States will be close at hand, right on the arteries of com- 
 merce. 
 
 This axiom is everywhere accepted — "Disease follows trade." Certain 
 diseases are best carried by passengers, others by freight; some by railroads, 
 others by steamships. 
 
 Sailors are proverbially indifferent to rats. Some are superstitious 
 
 about sailing on a rat- free ship. 
 Therefore, plague is frequently 
 a ship-borne disease. 
 
 Dr. King's alarm is based 
 upon the fact that the canal is 
 going to put us in close touch 
 with some careless people. In 
 neither Colombia, Ecuador, 
 Peru, nor Chile does there 
 exist a properly constituted 
 board of health. There is no 
 trustworthy recording of deaths. 
 The authorities have neither the power nor the knowledge to prevent the 
 spread of disease among themselves or those who trade with them. The people 
 are both ignorant and indifferent. For example, he says, in Guayaquil the 
 inhabitants are inclined to rejoice in yellow fever because it scares foreigners 
 away. 
 
 President Castro of Venezuela once declared La Guayra a healthy port 
 open to commerce while plague was raging citywide. The order was an- 
 nulled because of the trouble the German minister made about it. La Guayra 
 and Guayaquil are within three days' sail of the canal — and plague is not easily 
 recognized nor easily controlled. Let us not forget that a man died a 
 while ago in the government hospital in Colon from unrecognized plague. If 
 that medical corps fell down anybody will and you and I should base our 
 positions on things as they are. 
 
 Dr. King made two specific recommendations — that the United States 
 Public Health and Marine Hospital Service organize the health forces of the 
 west and northwest coasts of South America and that New Orleans be cleaned 
 up. 
 
 The newspapers recently contained telegrams saying Ecuador had asked 
 Gorgas to clean up Guayaquil. 
 
 From a New Orleans newspaper recently I learn that Dr. Dowling is 
 winning his fight in New Orleans — the French market is to be screened and 
 made more sanitary. 
 
 The leaven is working. 
 
 The changed conditions in California will make San Francisco the 
 safest place, as regards plagues, in the United States. 
 
PLAGUE 
 
 297 
 
 SPREAD OF PLAGUE 
 
 It is rather easy to watch and to isolate plague-afflicted people, but 
 plague in rats is a difficult proposition. Therefore plague is a jumping 
 disease. It jumps from town to town, over others to another. 
 
 A small boy playing near the Southern Pacific freight yards in Los 
 Angeles was bitten by a ground squirrel. He became sick, had buboes, was 
 feverish. His physician called for several days but was still puzzled over a 
 diagnosis, when he asked Dr. Powers to help. Dr. Powers, who had seen 
 plague, inquired if the boy had been around rats. No, but he had caught 
 a sick squirrel. Presto ! the boy had 
 plague. Los Angeles was infected. 
 A freight car had brought an in- 
 fected rodent from San Francisco — 
 a long jump, but one easily under- 
 stood in the light of the yard full 
 of empty grain cars near by. 
 
 The moral is — to prevent plague 
 from getting a foothold in a com- 
 munity two things are necessary: 
 rats must be watched, and the 
 people, especially the doctors, must 
 know the disease when they see it. 
 
 The three kinds of plague are 
 bubonic, septicemic, and pneu- 
 monic. In the bubonic type the 
 lymph glands, and particularly 
 those in the groin, filter the bac- 
 teria out of the lymph, keeping most of them from getting into the blood. 
 
 In the septicemic form the bacteria get right into the blood stream 
 and the groin glands, not being choked with them, do not swell up; in 
 other words, do not make buboes. 
 
 In the pneumonic form the bacteria are carried into the lungs by the 
 air and cause pneumonia. 
 
 In a given epidemic the type of the disease is either pneumonic or 
 bubonic, the septicemic cases being modifications of the bubonic type. 
 
 The bubonic form starts with a chill, followed by a fever, which 
 may go as high as 108°. About this time the glands begin to swell. Generally 
 the swelling is limited to one group of glands. This group is the one which 
 serves as a filter for that part of the body through which the infection entered. 
 There is nausea, vomiting, aching, and profound prostration. Later there is 
 stupor, delirium, and unconsciousness. The glands may break down, may 
 suppurate. There may be hemorrhage from the nose or from any mucous 
 membrane. There may be small hemorrhages under the skin. 
 
 Any physician who reads this description will recall cases of infection — 
 so called blood poisoning — in which there was just this train of symptoms. If 
 the pared corn or the needle prick had been overlooked the case might have 
 easily been called plague. 
 
 Fig. 132.— Dog Flea. 
 
298 CONTAGIOUS DISEASES 
 
 It takes a good deal of mental alertness and usually a bacterial examina- 
 tion to decide whether a bubonic fever is due to pus germs or plague bacillus. 
 There are cases of blood poisoning where the cocci get past the glands and into 
 the blood stream. If in these cases the cut toe or finger is overlooked alert- 
 ness and judgment are required to decide whether the germ in the blood 
 is a streptococcus or a plague bacterium. 
 
 The first requirement of plague prevention is that physicians be able to 
 know the disease when they see it. 
 
 THE COST OF RATS 
 
 Lantz of the national agricultural department wrote one of the articles 
 in the government bulletin on "Rats." His article is on "The Eat as an 
 Economic Factor," and he ends it with the statement, "The keeping of rats 
 is exceedingly expensive." 
 
 Did you ever think of yourself as a ratkeeper ? 
 
 Lantz estimates that it costs $1 a year to keep a rat in a city. A farmer 
 can keep one for about 60 cents. The farmers within 500 miles of Chicago 
 keep about one rat to each acre. These figures give the cost for plain feed- 
 ing. Fancy-fed rats are more expensive. A silk-eating, or a picture-chewing, 
 or a shoe-cutting rat costs more to maintain. 
 
 An Iowa farmer wrote the Missouri Valley Farmer that the rats in his 
 three bins destroyed more than enough corn to pay taxes on 400 acres of land. 
 
 Lantz quotes a newspaper correspondent as writing: "Eats destroyed 
 enough grain and poultry on this place this season to pay our taxes for three 
 years." 
 
 A Washington commission merchant stored one hundred dozen eggs in 
 a tub. When he went for them he found the rats had gnawed through 
 the bottom and made a clean getaway with over seventy-one dozen. 
 
 Lantz thinks rats are worse chicken catchers than skunks or minks. 
 
 To the cost of feeding the rats are added fire loss, damage to property 
 from gnawing and breaking and the indirect loss due to the expense of rat 
 catchers and rat-proofing. 
 
 The total cost per inhabitant for city people is $1.27 per year per rat. 
 In other ivords, Chicago's rat bill is something over $3,000,000 a year; that 
 of the United States, $35,000,000. 
 
 In rat killing the author places traps first, poisons second, dogs third, 
 skunks fourth and cats a bad fifth. An alley cat in a city is worth while, 
 but a kitchen fed cat is useless. While rat-catching dogs, rat traps, rat poisons, 
 covered garbage cans, and other anti-rat procedures help a little, no plan of 
 rat eradication makes much headway except rat-proofing or a part of it. Eat- 
 proofing means cement construction. A man who will rat-proof his buildings 
 and then keep a few rat dogs around will not be greatly annoyed by rats. Any 
 man in a city can keep the rat population off his premises in this way. 
 
 But eradicating rats from a city is a different matter. In San Francisco 
 the United States has spent several hundred thousand dollars for rat 
 catching since 1907 and the citizens have spent more than $2,000,000 in rat- 
 proofing. A good day's rat catch is not a fifth of the 1907 figures; still 
 San Francisco is not rat-proof nor rat-free. 
 
LEPROSY 299 
 
 Dr. Heiser says Manila, in 1900 to 1905, paid $15,000 in rat bounties and 
 $325,000 in other rat-catching expense without decreasing the number of rats. 
 
 The way they succeeded in getting rid of bubonic plague was to catch 
 a few rats in each part of town, examine them for bubonic plague — a rat- 
 sampling process, if you please — and then draw circles around the places 
 where plague-infected rats were found. They then began rat extermination 
 and rat-proofing at the periphery and worked toward the middle. 
 
 Symptoms of Bubonic Plague. — G. V. H. writes: "Kindly tell me the 
 symptoms of bubonic plague." 
 
 Reply. — The symptoms of bubonic plague usually follow one or two 
 types, the bubonic or the septicemic. In the first, the attack starts with 
 a chill and the fever rapidly rises to somewhere between 104° and 108°. 
 Prostration is extreme — the lymph glands swell, usually beginning with a 
 swelling of the groin glands. Sometimes the buboes form abscesses ; usually 
 they do not. In the septicemic form there are chills, fever, prostration, 
 unconsciousness, but no glandular enlargement. The most violent of all 
 the forms is the pneumonic, where the disease manifests itself as a rapidly 
 fatal pneumonia. This was the variety they had in Manchuria two years 
 ago. It is, however, not often found in the strain that is threatening us 
 now through Cuba and Porto Rico. That strain usually furnishes the 
 bubonic type and often the septicemic, but not the pneumonic. 
 
 LEPROSY 
 
 DANGER OF LEPROSY 
 
 Dr. E. L. McEwen analyzed the references to leprosy in the Bible and 
 profane literature on the subject of leprosy in biblical times. The con- 
 clusion to which he came was that the term leprosy in biblical times stood for 
 many different skin diseases. Some of them were highly contagious. It may 
 have been that leprosy proper in that day was extremely catching and also 
 deadfy, but Dr. McEwen could not find evidence of it. 
 
 However, if leprosy was highly contagious two thousand years ago it is not 
 so now. Dr. McCoy, director of the leprosy investigation station in Hawaii, 
 got the history of everybody connected with the leper colony or who had been 
 connected with it for many years back. 
 
 The Hawaiian law permits well people to accompany lepers when they go 
 to the colony and to remain with them as long as they wish and then return 
 to society, provided a careful examination shows no leprosy. 
 
 Several hundred people whose histories were carefully investigated lived 
 in the colony for months and some of them for years and then went back to 
 society. Some are living with lepers as husband or wife; others live in the 
 same rooms with lepers; others eat at the table with them. The contact is 
 of the closest character and this intimate contact is kept up for years. 
 
 The results? One person in twenty-five developed the disease. Then 
 the chance that a person living in a leper colony will escape infection is about 
 twenty-four to one. 
 
300 CONTAGIOUS DISEASES 
 
 There are a moderate number of lepers in the United States. I pre- 
 sume there are one or two in Chicago always. 
 
 There is practically no danger that the people who incidentally meet 
 lepers on the street, in the stores, in restaurants, or on the cars will contract 
 the disease. 
 
 There is about one chance in twenty-five for the people living in the same 
 house with a leper to contract the disease. 
 
 This degree of danger is great enough to make it advisable to care for 
 lepers in leper colonies, but it is not great enough to warrant the average man 
 on the street to have any fear of lepers or leprosy confined or at large. 
 
 Leprosy is a disappearing disease. That which has made it a disappearing 
 disease is the policy of caring for lepers in colonies. 
 
 Causes of Leprosy. — J. F. B. R. asks: "1. Can you tell me if there is 
 any way to prevent leprosy? 
 
 "2. Has the germ that causes leprosy been discovered? 
 
 "3. Is there any way, as, for instance, by the injection of a serum into 
 the human body, to make it immune from leprosy? I have been thinking 
 that as there is an antitoxin for diphtheria there might possibly be some 
 preventive for leprosy. 
 
 '%. Can you tell me, is there now being made, or has there ever been a 
 systematic study made, of leprosy? 
 
 "5. What has been done, and what is now being done to fight it?" 
 
 Reply. — 1. Yes, by keeping away from those having the disease. The 
 disease is very mild. It is not easily transmitted. It is not contagious. 
 There is very little danger of contracting it except by prolonged contact 
 with a leper. 
 
 2. Yes. 
 
 3. No. 
 
 4. The disease is being thoroughly studied in Europe, in the Philip- 
 pines, in Havana, and in a few places in this country. The investigators 
 are about convinced that they have worked out a solution. It is too early 
 to talk much about it. 
 
 5. Several states have isolated their cases of leprosy. A few cities 
 have done likewise. The national government is in control of several 
 colonies. It is the general belief that the disease is losing ground. 
 
 HYDROPHOBIA 
 
 DOG DAYS 
 
 Summer is the season of the year when the mosquitoes are trying, 
 the flies are annoying, the snakes are most menacing, and our fear of dogs is 
 the greatest. The season is known as "dog days," and the reason for the 
 name is that for some strange reason dogs are supposed to be in especial 
 danger of going mad. If mad dogs were found to be especially abundant in 
 July and August it would be a good reason to call March and April the dog 
 days, since about that much time is needed for hydrophobia to develop. 
 
 But there are no dog days. The sun, the summer solstice, the July 
 moon, the torrid heat, the high humidity — none of these has anything 
 to do with hydrophobia. January is just as much dog days as July, 
 
HYDROPHOBIA 301 
 
 Hydrophobia is a disease of dogs. It can be spread to men, cats, skunks, 
 cows, mules — in fact, almost all animals. But it is not of importance except 
 in two of them — men and dogs. A campaign against hydrophobia need not 
 take in anything except man and dogs; men because their protection is our 
 problem and dogs because they create the hydrophobia problem. 
 
 The disease is due to an infection. The infection locates in the brain. 
 The infecting virus is excreted by the saliva. The virus travels slowly from 
 the bite up the nerves to the brain. The journey takes time, more than is 
 required for any other germ. It may take three weeks, it may take three 
 months, and it may take several times three months. 
 
 We have no laboratory test for hydrophobia that can be applied in a 
 living animal, be it man or dog. The veterinarian or the doctor can watch the 
 symptom and conclude usually whether the disease is hydrophobia or not 
 but he cannot get any help from the laboratory until after the sick one has 
 died. The laboratory worker can then take the brain and if he finds negri 
 bodies in it can say positively that hydrophobia was present. 
 
 This is not so important as it seems on first blush. It is nearly always 
 possible to tell from the symptoms. It is easy so to keep a dog and very easy 
 so to keep a man that he is not dangerous to the attendants and if the head 
 is sent to the laboratory in every case they will clear up the few doubtful cases 
 in ample time to protect all of those who were bitten. From the standpoint 
 of treatment it makes no difference. There is no treatment for hydrophobia 
 after the disease has developed. After the symptoms have started and the 
 disease is clearly developed, there is nothing to do with an affected man 
 except to take him to a hospital and then have him cared for — have his symp- 
 toms treated as they arise. In that event the disease is not being treated. 
 The treatment is of the symptoms. 
 
 HYDROPHOBIA PREVENTION 
 
 The Conference of State Health Officers has adopted the following as a 
 standard plan to prevent hydrophobia : 
 
 1. Destruction of ownerless dogs. Dr. Stimson of the Public Health 
 Service thinks this the most effectual single measure. By an ownerless dog is 
 meant a dog without a collar and license tag for the current year. This 
 necessitates a dog-catching department and a pound. Dogs should not be sold 
 from the pound. 
 
 2. A license fee for dogs. In cities the tag should be attached by the 
 license officer who files a report describing the dog and its appearance as 
 to health. The license system (a) makes it easy to locate ownerless and 
 straying dogs, (b) reduces the number of dogs kept, and restricts the owner- 
 ship of dogs to those who will give them care. Unspayed females should be 
 licensed at a higher rate than other dogs. 
 
 3. Legal responsibility. Owners should be made legally responsible for 
 damage done by their dogs. 
 
 4. Public education. The care of dogs as well as the harm done people 
 by infected dogs should be taught. 
 
 5. Muzzling. All dogs should be muzzled for six months after each 
 case of hydrophobia in a dog in the district under control. This means that 
 
302 CONTAGIOUS DISEASES 
 
 in country townships in the Mississippi Valley the dogs need not be muzzled 
 all the time. In cities, as six months practically never lapses between cases, 
 the dogs must be muzzled all the time. In either case the season has nothing 
 to do with the case. It is not the history of the weather but the history of 
 the mad dogs around about that determines whether dogs are to be muzzled 
 or not. 
 
 6. Restraint of dogs. If there is much of the disease around the 
 country dogs must be kept at home for at least three months after the time 
 of great danger. 
 
 7. Leading in leash. Not advised unless the dogs are also muzzled. 
 
 8. Compulsory notification. Rabies in lower animals as well as in man 
 should be reported. In the lower animals, in case the diagnosis is certain, the 
 animal should be killed, the head sent to the proper laboratory and the case 
 reported. If the case is suspicious the animal should be safely confined and 
 developments awaited. Animals bitten by rabid animals should be reported. 
 Those of little value should be destroyed. Those of greater value should be 
 held under supervised quarantine for six months. No part of the carcass or 
 hide of a "mad" animal should be used. Kennels and stalls should be disin- 
 fected by the authorities. 
 
 9. Imported dogs should be held in quarantine until the danger is past. 
 A person bitten by a mad dog should have the wound cleaned, made to ooze 
 and bleed and then cauterized. As soon as possible thereafter the Pasteur 
 vaccine should be given. Mad stones are worse than useless. 
 
 Hydrophobia and Milk. — H. E. V. writes: "Is there any danger in 
 using the milk from a cow that has been bitten by a horse that had hydro- 
 phobia? Today is the tenth day. How long before it would be safe to use 
 her milk?" 
 
 Reply. — No. If the cow should get sick, stop using the milk — not be- 
 cause the milk will convey hydrophobia but because it is the milk of a 
 sick cow. 
 
 Dog Bites. — G. H. writes: "If a person is bitten by a family dog, 
 treated by a physician who says the dog is not mad, ought the person to be 
 treated by the Pasteur method? Ought the dog to be hilled? What are 
 the kinds of treatment, where given, and by whom, and how long after a 
 bite does rabies show in the person? Does the law require the person to be 
 treated if all the evidence goes to show the dog is not mad? What shall 
 be done with the dog?" 
 
 Reply. — The dog should not be killed. He should be taken to a vet- 
 erinarian for observation. If it turns out that the dog is not mad, nothing 
 need be done. If the dog is dead the body should be taken to a laboratory 
 for microscopic examination and biologic testing — that is, inoculation of a 
 guinea pig. If these show the dog was not mad and the history of the 
 sickness in the dog bears this out, nothing should be done. If the dog was 
 mad, Pasteur treatment should be taken at once — the quicker the better. 
 The disease usually develops within six weeks after the bite. Occa- 
 sionally it is delayed. 
 
LOCKJAW 303 
 
 LOCKJAW 
 
 The physicians' name for lockjaw (tetanus) has the advantage of not 
 putting too much emphasis on one symptom. As a matter of fact, tetanus 
 runs a day or two before the jaws lock, and in time spasm of other muscles 
 becomes much more prominent than spasm of the muscles of the jaw. 
 
 A case of lockjaw starts in with difficulty in swallowing, profuse sweat- 
 ing, and starting at noises, at bright lights, or when struck by the air from a 
 fan. Perhaps before these symptoms came there was a period of head- 
 ache and general sick feeling, not in any way different from an ordinary head- 
 ache or the beginning of any one of a score of diseases. 
 
 When the disease is fully developed all of the muscles of the body are 
 rigid all of the time. The rigidity gets worse and better, alternatingly, but 
 relaxation is never complete. Convulsions come on, last a few minutes, 
 and pass away, but even when the period of quiet has come the pressure 
 with the hand will show that certain muscles are hard and firm. 
 
 The set contraction of the muscles around the mouth give to the face a 
 grin that is characteristic. The muscles of the trunk bow the back. There 
 is some fever. 
 
 The tetanus bacillus lives in the intestines of animals, causing them 
 
 Fig. 133. — Clinical Thermometer. 
 
 no harm. It has been proved that certain horses are tetanus carriers, just 
 as certain men are typhoid carriers. These horses pollute the soil with 
 tetanus bacilli. The bacilli cannot increase in the presence of oxygen, 
 which means that they cannot increase and secrete in any place which 
 the air can reach. 
 
 The wounds most liable to infection with lockjaw are the deep narrow 
 wounds into which manure, or dirt, or powder has been carried. The ideal 
 wound combination for lockjaw is a nail puncture which is made in a horse 
 barn. 
 
 The bacillus secretes a poison. Probably there are two drugs in this 
 poison. The poison is absorbed by the nerves, not by the blood or lymph, 
 as is the case with ordinary poisons. It is carried by the nerves to the brain 
 and spinal cord. The symptoms are due to the action of the poison on the 
 cells of the brain and, perhaps, the spinal cord. 
 
 If tetanus starts within less than ten days of the wounding the outlook 
 is bad. If it takes more than ten days for the poison to reach the nerve 
 cells and affect them the outlook is good. 
 
 The reports that come from the armies of Europe show that about 
 one-half the cases of lockjaw are being cured. One authority reports that in a 
 certain hospital six out of ten cases are being cured. . Anders tells us that 
 eleven out of twelve of the slowly developing, mild cases get well. 
 
 It is well to bear this in mind, because in lockjaw, cancer, consumption, 
 and other dreaded diseases well meaning people jump to the conclusion that 
 
304 CONTAGIOUS DISEASES 
 
 some remedy used in one case which recovered is therefore a newly discovered 
 panacea capable of curing all cases. 
 
 The treatment used in these hospitals is antitoxin into the tissues 
 around the wound; oxygen, peroxid of hydrogen, and air into the wound; 
 antitoxin into the vein; iodized serum and a solution of Epsom salts into 
 the tissues; good nursing and the control of symptoms according to the 
 judgment of the attending physician. 
 
 The experiences of this war have taught us several things about wounds. 
 They are : 
 
 1. Dirty wounds must be so dressed that they can get air. 
 
 2. Every man who has received a dirty wound should have a small 
 dose of antitoxin ; twenty to fifty units are enough. 
 
 3. Certain horses are tetanus carriers. Attention should be concen- 
 trated on these carriers. 
 
 4. Tetanus is fairly curable. But before this information will be 
 very helpful it is necessary that the people know the warnings of the 
 disease. 
 
 TYPHOID FEVER 
 
 Typhoid fever is a preventable disease. This means it can be prevented, 
 not that it is being prevented. The armies have prevented it. The United 
 States Army has had no typhoid for four years. The soldiers are vaccinated 
 against it. 
 
 Typhoid fever is due to the typhoid bacillus. The typhoid bacillus is 
 closely allied to the colon bacillus, but there is this important difference be- 
 tween them — the colon bacillus lives in the intestines of many species of ani- 
 mals; the typhoid bacillus lives in the intestines of man only. Nor can it 
 live in the human intestine indefinitely. It abounds there during an attack 
 of typhoid fever. In some cases, during the attack of fever it gets into the 
 gall-bladder and, having secured a hold, remains there almost indefinitely. 
 Such an individual is known as a typhoid carrier. 
 
 No animal except man is subject to typhoid fever. The excretions of no 
 animal except man contain typhoid bacilli. Therefore no animal except man 
 pollutes the water and soil with typhoid bacilli. 
 
 Furthermore, typhoid bacilli do not live long outside the human body. 
 Polluted water, polluted soil, or polluted milk will be free of typhoid bacilli 
 after about one month. One of the great laws of nature is that forms of 
 life which are capable of rapid multiplication are easily destroyed. 
 
 Not all men are subject to typhoid fever. Some have the power to 
 throw off the bacteria without contracting the disease. A small dose of 
 typhoid bacilli will not cause typhoid fever. The laboratory men have 
 worked out just the number of bacilli to an ounce of water required to cause 
 infection with typhoid bacilli. It is easy to see that in man's combat with 
 typhoid fever the bacillus is at a disadvantage. It should be easy for man 
 to win. Then, is there wonder that typhoid is disappearing? 
 
 Any man can avoid the disease. He can be vaccinated. That is certain 
 to make him safe. He can take no raw water or raw food. He can refuse to 
 eat with unwashed hands. If he does not care for water that has been heated 
 
TYPHOID FEVER 305 
 
 he can refuse to drink any polluted water. If he does not care to boil his 
 milk he can drink pasteurized milk. Properly inspected milk is fairly safe. 
 
 A community can avoid the disease. It must have its typhoid citizens, 
 carriers as well as sick, properly nursed and cared for. It must have- its 
 water supply, milk supply, and food supply protected. It must abolish its fly 
 nuisance. It must vaccinate. 
 
 After the bacilli get into the intestines there follows a period of ten days, 
 called the incubation period. What is happening during that time nobody 
 knows. It is something of importance in the course of the disease. The 
 sickness starts gradually and slowly at the end of the incubation period. There 
 is a tired feeling and some aching. The bowels are usually constipated. After 
 about a day of this the patient feels feverish, and if he takes his temperature 
 he finds that he has an elevation of a degree or two — say 100.5. By the next 
 day he is feeling generally more achy, with a higher fever. He sends for the 
 doctor. The doctor takes a half-teaspoonful of blood from the patient's elbow. 
 This is examined in the laboratory. Two days later it is found that typhoid 
 bacilli are growing in the laboratory test tubes. If a blood culture was not 
 made toward the end of the first week, the doctor will take a drop of blood 
 from the finger or ear and send it to the laboratory for a Widal test. A blood 
 culture will usually show the presence of typhoid fever within the first few 
 days of the start. The Widal test will not show it before the end of the first 
 week or ten days. 
 
 A positive blood culture means that the patient has typhoid bacilli float- 
 ing around in his blood. A positive Widal means that the patient has bacilli 
 in him and that he is beginning to make substances and pass them into his 
 blood, substances which knock out typhoid bacilli in several ways. In the 
 meanwhile, the fever is getting higher and the symptoms more characteristic. 
 
 It generally takes a week from the time that the fever starts for the diag- 
 nosis to be fairly certain. Therefore, in figuring out the source of contagion 
 you must figure back seventeen days — ten days for the incubation period and 
 seven days for the diagnosis period. If the milk is being investigated two 
 more days should be added — the time from the cow to the consumption by 
 the consumer. 
 
 During the second week the .fever is getting higher day by day. The 
 patient is getting thinner and weaker. He is, however, more comfortable 
 than during the first week. During the third week the fever remains at 
 about the height reached during the second week. The patient is getting 
 progressively weaker and thinner. 
 
 If the patient was freely purged during several days at the beginning of 
 his fever and his bowels have been well attended to since, there will be no 
 diarrhea in the average case. If these things have not been properly attended 
 to diarrhea usually gets troublesome in the third week. Early in the disease 
 the lower end of the small intestine becomes swollen in patches. In the 
 second week these patches break down and form ulcers. These ulcers vary in 
 size from that of a pea to more than an inch in diameter. Sometimes these 
 ulcers cause troublesome diarrhea in spite of everything which can be done. 
 But when proper care is used the danger of this is slight. The ulcers some- 
 times spread from the large intestines and thus increase greatly the chance of 
 diarrhea developing. 
 
306 
 
 CONTAGIOUS DISEASES 
 
 During the fourth week the fever gets less day by day. By the end of 
 the fourth week the temperature will be normal for several hours during the 
 day. It is during this week that complications are most liable to occur. 
 Complications hill more people than typhoid of itself. 
 
 The complications usually met with are : 
 
 Secondary infections, particularly pneumonia. 
 
 Inflammation of veins, inflammation of glands. 
 
 Perforations and secondary peritonitis. 
 
 Hemorrhages. 
 
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 Zowa Bulletin. 
 Fig. 134. — Typhoid Fever Death-Rates in German Cities, Showing Decrease in the Last 
 Three Decades, Due Largely to Improved Water Supplies. 
 
 The old-fashioned typhoid with low muttering delirium, great exhaustion, 
 dirty mouth, and flies crawling over the eyes we seldom see at the present 
 time. When the case has been properly cared for by nursing and properly con- 
 trolled by medical supervision this old-style typhoid state does not develop. 
 This is a partial statement of the nature of a more typical run of typhoid at 
 the present day. It is not so long drawn out nor so exhausting as the typhoid 
 of twenty years ago. The number of cases which cleaning out of the bowels 
 and other good care cut under four or five weeks is getting larger all of the 
 time. 
 
TYPHOID FEVER 
 
 307 
 
 It is a disease in which the patient is influenced by good medical care 
 and good nursing to an unusual degree. The patient sails a sea in which there 
 are many covered rocks and good piloting is essential. During the first week 
 it is easy to get the bacteria from the blood. After that it is increasingly 
 
 
 
 
 
 
 
 
 
 
 
 
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 Kansas State Board of Health. 
 
 Fig. 135. The Fly as Carrier or Typhoid. Numbers indicate order of cases by date of 
 onset. Cases •. Deaths ©. Wells °. 
 
 difficult. During the first week a Widal reaction is not given. After that 
 and for weeks after recovery the blood will give the Widal test. 
 
 What is the meaning of these two facts? The bacteria run unhindered 
 during the first week. By the end of that time the body has developed a 
 pretty good power of hindering the bacilli. This power increases in strength 
 until the body can destroy typhoid germs whenever they get into the blood. 
 This is called immunity. The man is immune to typhoid. Soon after the 
 disease began the sick man started throwing off typhoid bacilli. This is done 
 principally by the kidneys and liver. The excretions from the bowels and 
 
308 CONTAGIOUS DISEASES 
 
 kidneys contain live, active, virulent typhoid germs. It is in this way that the 
 disease is spread. 
 
 When the man has got well from the disease he still excretes typhoid 
 bacilli from his kidneys and bowels. Sometimes this keeps up for months. 
 Occasionally it persists for years, and semi-occasionally for a lifetime. People 
 who continue to excrete typhoid are called typhoid carriers. The reason is 
 this: 
 
 A mother colony of bacilli will locate in the gall-bladder or in the urinary 
 passages. The young are thrown out each day just as a hive of bees sends 
 out swarms periodically. 
 
 The bacilli in the gall-bladder do not infect the man, because he is im- 
 mune. But should they pass out and eventually get on the raw food eaten 
 by a susceptible man they are fully capable of infecting him. 
 
 Then what is a man to do if he has the disease? 
 
 Get the best medical and nursing service possible and obey orders abso- 
 lutely. Equanimity is necessary when one has typhoid fever — no worrying, 
 no fretting — just quietly accepting and trusting. Therefore, take aboard 
 pilots at once and let them walk the deck. 
 
 // proper freedom from worry, proper security for the family, and 
 proper 7iursing cannot be had at home, then go to the hospital by all means. 
 
 What is the man to do who has not had the disease? 
 
 In ordinary times be careful of the water. Drink no suspicious water 
 which you do not know to be right. 
 
 Of the milk — drink no raw milk unless you are positive that its source 
 is safe. 
 
 Of raw fruits and vegetables — if they can be peeled, peel them yourself. 
 If you are not certain of the raw vegetables eat cooked vegetables. 
 
 Of raw oysters and clams — unless you are certain of them, have them 
 cooked. 
 
 Of flies — do not eat food in places where flies abound. 
 
 Of hands — see that your own hands are washed before eating. Insist 
 that all who handle your food shall have clean hands. 
 
 Of cooks — at least in your own house see that no cook is employed who 
 has recently (within six months) had typhoid or who has been in places where 
 there was typhoid. 
 
 Following these directions, no man under ordinary circumstances should 
 have typhoid fever.' 
 
 The United States soldiers sent to the Mexican frontier in the spring of 
 1911 were vaccinated against typhoid. Those soldiers have been returned to 
 their posts and Colonel J. E. Kean has reported to the surgeon general the 
 lessons taught by that campaign. He compares the 12,000 troops stationed at 
 San Antonio with 10,000 stationed at Jacksonville, Florida, during the Cuban 
 War in 1898. In the Jacksonville troops there were 2,693 cases of typhoid 
 fever, with 248 deaths. In the San Antonio troops there was one case of 
 typhoid and no deaths. That some of this improvement was due to better 
 general sanitation and better medical attendance is shown by the decrease in 
 the number of deaths due to other causes from thirty-three at Jacksonville to 
 eleven at San Antonio. 
 
 The decrease in typhoid was out of all proportion to the decrease in other 
 
t10WTOGO"fTPflOID 
 
 OPEN PRIVIES SPREAD TYPHOB) 
 
 PLIES CAREY TYPHOID 
 
 OPETf WELLS ARE: CAmEROUS 
 
 DIRTY MILK CARRIES DISEASE 
 
 Eft 
 
 ABOUT one: person out op three 
 
 C0MTRACT3 TYPHOID 
 
 TYPHOID FEVER 
 
 HOW TO GET IT AND HOW TO PREVENT IT 
 
 More than one person out of three in North Carolina has 
 had typhoid. If you haven't had it yet you are fortunate. 
 
 ABOLISH OPEN -BACK PRIVIES 
 
 Old open-back privies spread much typhoid. AD privies 
 should be fly-tight. In general, they should be placed over 
 pits or holes in the ground about three feet square by four 
 or five feet deep. In two or three years, if the pit becomes 
 filled, dig a new one nearby and cover up the old one.' 
 
 FLIES SPREAD TYPHOID 
 
 Flies carry typhoid and other diseases on their feet and 
 bodies, and, worst of all, in their own excreta. Screen them 
 out and aboVfh their breeding places. 
 
 USE PUMPS INSTEAD OF OPEN WELLS 
 
 Open wells are much more likely to be polluted than 
 closed wells. Cover your well tight and use a pump. 
 
 BEWARE OF DIRTY MILK 
 
 Dirty milk is i 
 germs. Never di 
 
 breeding place for typhoid and other 
 nk milk unless you know it is dean. 
 
 DIRTY HANDS SPREAD DISEASE 
 
 Much typhoid is caused by handling food with unwashed 
 hands after attending the sick, especially in the case oj 
 typhoid. Be clean. 
 
 FREE ANTI-TYPHOID TREATMENT 
 
 Why take further chances with typhoid? The anti- 
 typhoid treatment win protect you absolutely. It is safe, 
 practically painless and furnished free by the State. It is 
 administered by a health officer or physician in three doses 
 as shown below. Health officers administer it free. If 
 your county has no health officer ask your family physician 
 to secure it for you and have 1 
 
 STATE BOARD OF HEALTH 
 
 RALEIGH. N. C 
 
 null PUT THM PIACAKD I 
 
 OW TO PRtVtMT TYPTIOID 
 
 CLOSED PRIVIES PPEVE/YT TYPHOID 
 
 SCREEN THE rUES OUT 
 
 CLQ5ED WELLS 4RESAEEE 
 
 CLEAM MILK 15 HEALTHFUL 
 
 DKIT HANDS SPREAD TYPHOID 
 
 FREE ANTI-TYPHOID TREATMENT 
 
 CLfA!iUME55 PPEVEAi75 TYPHOID 
 
 Fig. 136. 
 309 
 
 Chicago Health Department, 
 
310 CONTAGIOUS DISEASES 
 
 causes. As the result of this experience the surgeon general has ordered that 
 all soldiers shall be periodically vaccinated against typhoid fever. 
 
 In certain localities in this country it is becoming the custom for men 
 going off for vacations to have themselves vaccinated. 
 
 People who live in other localities had better pursue the same 
 policy if their community has a high typhoid rate or if they are going to 
 travel in a country having a high rate or be in hotels or other stopping places 
 where they are not certain of the care of the food. 
 
 Travelers in central Europe, including England, are safer than when at 
 home. Travelers in Asia and Africa, Central and South America, and the 
 islands generally had better be vaccinated before leaving. 
 
 WALKING TYPHOID 
 
 There are people who take life seriously. There are others to whom 
 everything is a joke. There are people who take disease seriously. There are 
 others who have their diseases in milder form. One man may have one 
 disease seriously and another one mildly, while his neighbor may reverse the 
 degree of response to the invading cause. People differ in their way of doing 
 things and disease is no exception to the above general rule. 
 
 While the typhoid bacillus in two people may be the same in virulence, 
 just as poisonous, just as active in growth, just as prompt in getting into 
 the blood stream, the disease in the two individuals may be widely different. 
 It is the man who makes his disease. 
 
 The virulence of the bacilli of typhoid is not to be judged by the virulence 
 of the disease. It is just as dangerous to have a case of walking typhoid 
 around the milkhouse as it would be if he were violently ill, even more so, 
 for in that event he would be in bed away from the milkhouse, and there is 
 a pretty good chance that the nurse would wash her hands before leaving the 
 presence of the sick man. 
 
 Perhaps the reader wonders how anyone is to tell when typhoid is typhoid 
 if every man makes his own typhoid. Just there is where diagnostic skill 
 comes in. Ability in guessing the typical and early cases rightly makes the 
 difference between good and poor medical service. 
 
 But fortunately, in recent years, some tests have been discovered that 
 help out. Such are the blood tests for typhoid fever, and especially the 
 Widal tests and the bacteriologic blood examination. Every state and most 
 cities now have laboratories where these tests are made free of charge. A 
 drop of dried blood on a clean piece of glass is all that is required. 
 
 In the winter time the typhoid fever in a city is something the govern- 
 ment can properly be blamed for. In the fall a good part of the blame falls 
 on the shoulders of the people themselves. The fall rise in typhoid fever 
 means infection by careless people, walking typhoid carriers, typhoid milk, 
 and by flies. 
 
 I notice that Dr. Hurty of the Indiana State Board of Health chided 
 the rural citizens of his state with being less clean than they ought to be, 
 whereupon a local granger rose up and called him names. 
 
 Typhoid is more nearly a filth disease than is smallpox or most any other 
 disease. 
 
TYPHOID FEVER 311 
 
 Chicago's typhoid rate for 1912 should be under 8. Indiana's is over 34. 
 Chicago is far from clean. Under this test, how about Indiana? Would it 
 not be well for the granger to make a survey of local conditions similar to 
 the one made by Professor Condra of Nebraska, and then decide on the facts 
 as the survey shows them? 
 
 FOODS THAT CAUSE TYPHOID 
 
 Milk and water are foods, but they are so important as spreaders of 
 typhoid that I have treated them separately. The other foods are not of much 
 importance as compared with milk and water. 
 
 In considering foods three questions should be in mind: 
 
 1. Is the food to be eaten raw ? 
 
 2. If it is cooked, is it handled after cooking by anyone who has recently 
 had typhoid or been around typhoid? 
 
 3. Have flies got on it after cooking? 
 
 Articles to be watched are fruits, cabbage, lettuce, tomatoes, celery, 
 radishes, onions, watercress, cucumbers, raw oysters and clams. 
 
 To begin with, no one should buy vegetables or fruit from a store, stand, 
 or wagon where things are not clean. Articles of food exposed where dust, 
 flies, dogs, and cats can get at them should cause customers to buy elsewhere. 
 
 However clean fruits and vegetables may look, before they are eaten raw 
 they should always be ivashed in clean water. Celery should be split up so 
 that each leaf can be washed. 
 
 It is inadvisable to eat raw oysters. Methods of oyster shipping have 
 improved greatly in the last two years. More than half the oysters are now 
 shipped in excellent fashion. There is still some sloppy, open icing and dip- 
 ping in stores, but the customers can control that end of it by refusing to buy 
 oysters out of an open bucket in which there is a chunk of ice and a dipper 
 not so clean as it ought to be. 
 
 The principal reason for warning against raw oysters and clams is that 
 so many of the beds are not properly supervised and so many of the oysters 
 are being floated or fattened in foul water. Until oyster beds are better 
 supervised and more information is available as to which are right and which 
 are not, oysters and clams should be cooked before being eaten. 
 
 No person should handle food who has recently had typhoid fever or who 
 is a typhoid carrier. Washing the hands before handling food and before 
 eating is not a fad. It is the best of common sense and prudence. No- 
 body should ever eat without washing the hands. 
 
 Flies can carry typhoid bacilli to the sugar, the bread, the butter, or any 
 other article of food. The flies in a house may not have typhoid on them, but 
 the person eating has no way of knowing, therefore the only safe policy is 
 to keep flies away from the food. 
 
 CONTACT OR FINGER TYPHOID FEVER 
 
 Two years ago in a household on the west side of Chicago every member 
 of the family had typhoid fever within three months. Two members of the 
 family died of it. First one got sick and later another, and so on until it 
 
^snxmmMm, 
 
 Illinois State Board of Health. Cartoon No. J+. 
 
 Fig. 137. — Deadly Parallels. Perhaps this explains the "fine mineral flavor" you notice 
 
 in well water. 
 
 312 
 
TYPHOID FEVER 315 
 
 went through the family. Had all of them got sick at the same time we 
 would have thought of milk or water as the cause. They lived in an insanitary 
 basement, but a study of the epidemic led us to think the cause was in the 
 household. That was the cause of all of the cases after the first. 
 
 A few years ago there was a milk epidemic in West Pullman. Ten days 
 after the use of the typhoid-infected milk was stopped the cases of typhoid 
 fever quit developing. In one household there were cases during the period 
 of milk contamination and one developed some weeks after the use of the 
 infected milk was stopped. This was a case of contact typhoid. 
 
 Typhoid is "catching." It is not so catching as smallpox or measles. If 
 100 persons who have never had smallpox diseases or have never been vacci- 
 nated are brought into close contact in a room with a case of smallpox more 
 than 90 of them will contract the disease. Measles is about as "catching" 
 as smallpox. 
 
 If 100 people who never had typhoid or who had not been vaccinated 
 against it were brought in close contact with a case in a room, all of them 
 might escape having the disease. Everything would depend on whether they 
 swallowed any typhoid bacilli or not. Typhoid bacilli are liable to get on the 
 hands, the bedclothes, and on articles around the room. The excretions of the 
 patient are certain to contain them. Bits or droplets of excretion too small to 
 see with the naked eye can get on the hands or on articles around the room. 
 The nurse's hands are certain to get infected. The patient cannot be cared 
 for without infecting the hands of those who care for him. "Whenever the 
 hands remain infected for any length of time the infection is pretty certain 
 to reach the mouth. The hands are traveling to the mouth frequently. In- 
 fected hands are liable to infect food. 
 
 Flies carry infection from the excretions of the patient to the food. 
 
 It is in these ways that contact infection occurs. There is no air infec- 
 tion. To visit in the room, if nothing is eaten and the hands are washed 
 after the visit, is absolutely safe. Then in order that a patient may not cause 
 contact infection it is necessary: (1) to have everybody's hands washed fre- 
 quently — especially those of the patient and nurse; (2) to have the excretions 
 and all vessels used therefor sterilized with carbolic acid,- bleaching powder, 
 or some other strong antiseptic; (3) to have the bedclothes kept clean; (4) to 
 have the patient and his excretions protected against flies; (5) to have the 
 food kept clean and especially to have it protected against flies and against 
 handling. 
 
 If these things cannot be successfully accomplished in the house the 
 patient should be taken to a hospital. No other course is fair to the other 
 members of the family. 
 
 Good nursing and good medical care are about as necessary for the pro- 
 tection of the other members of the family as for the welfare of the patient. 
 If such nursing and medical care cannot be had in the home the hospital is 
 at hand. 
 
 If the family, or any member thereof, is engaged in handling food for 
 sale, then the patient should go to the hospital, or a high grade nurse should 
 take entire charge of the patient and the family should do nothing more than 
 visit. I have known of several local epidemics of typhoid fever due to some 
 wife or mother trying to nurse the patient and at the same time attend to 
 
314 
 
 CONTAGIOUS DISEASES 
 
 MICHIGAN STATE BOARD OF Jjf ALTH 
 
 Fig. 138. 
 
 the milk or wait on customers in the store. No one should patronize a milk 
 producer or milk dealer or buy goods in a grocery store, delicatessen, or bakery 
 where a case of typhoid fever is being cared for on the premises. 
 Typhoid will not spread in a family where cleanliness prevails, 
 
TYPHOID FEVER 31i 
 
 ACTIVITY OF TYPHOID 
 
 Drs. Sedgwick, Taylor, and McNutt of the Massachusetts Institute of 
 Technology have attempted to find the answer to the question : Is there more 
 typhoid fever in the city or in the country? It ought to be a disease of the 
 city, because it is a disease of crowding, one party says. It ought to be a 
 disease of the country because it is the result of pollution of food and water 
 supply, and, whereas the cities try to protect their food and water, the village, 
 township, and county authorities make no effort, says the other. 
 
 Statistics show that where a city is grossly careless about its water and 
 food it has a typhoid rate much higher than that in the country. They also 
 show that when a city is exceedingly caref ul it has a typhoid rate that is lower 
 than that of the country. 
 
 This study was made in New England, and the conditions there do not 
 exactly parallel those in the other parts of the country. The investigators 
 conclude that in New England there is less typhoid in the country than in the 
 cities and towns. 
 
 Benjamin Franklin said that war was always paid for, but the plan was 
 deferred payments. According to these scientists the soldiers returning from 
 the Civil War infected rural New England. For twenty-five years some of the 
 deferred payments for the war took the form of rural typhoid. Hence, for 
 a quarter of a century there was more typhoid in the country than in the 
 city. Since that time the pendulum has swung, and the cities are feeding 
 typhoid into the country. Typhoid feeds into its surroundings, whether it 
 be city or country typhoid. 
 
 The city health authorities run down epidemics of typhoid to their origin 
 in some milk farm in the country and then roundly abuse their country cousins. 
 Or some cases of typhoid start in a hotel at some springs in the country and 
 find their way into city homes. When the city authorities get the facts they 
 publish them. 
 
 The Institute of Technology scientists say the shoe is often on the other 
 foot. The country people have not the same agents of publicity. Therefore, 
 nobody hears of the case of typhoid carried from the city to the country. 
 
 They quote Professor Bass' investigation of the Mankato, Minnesota, 
 epidemic, wherein seventy-two cases of and five deaths from typhoid occurring 
 in the country around Mankato were traceable to the epidemics in Mankato. 
 Some of these radiated cases went to the country around Seattle, Washing- 
 ton ; Cedilla, Michigan ; ToWner, North Dakota ; and White, South Dakota. 
 
 HOW WINTER TYPHOID IS SPREAD 
 
 The typhoid rate should be divided in two parts — the winter rate, com- 
 prising the rates for December to May, inclusive, and the summer rate, that 
 of the remainder of the twelve months. The winter rate indicates how much 
 filth gets into the water supply. The summer rate indicates how much filth 
 gets into the entire food supply, including the water. 
 
 Freeman says: "We have learned by sad experience the measure of 
 typhoid fever in any community is the measure of the distribution of human 
 
316 
 
 CONTAGIOUS DISEASES 
 
 i r if %$$^f-==. 
 
 filth in that community, and that the dissemination of human excrement will 
 inevitably result in the spread of typhoid fever." 
 
 In the winter the conditions for the spread of filth to other foods than 
 water are not good. The few typhoid bacilli that get into milk are killed 
 off before they come to the consumer. The few flies stay so close to the 
 warm places that they do not carry infection, at least in cold climates. 
 
 But the sewers empty their contents into the water supplies during the 
 winter as well as during the summer. 
 
 The consensus of opinion is that water is about as dangerous in cold 
 weather as in warm. There may be local conditions that modify this rule in 
 
 certain cities, but it is true as a rule. 
 Therefore the amount of winter typhoid 
 is pretty nearly a measure of the 
 habitual and customary water pollution 
 of a given community. 
 
 The existence of a typical winter 
 typhoid is better known than the same 
 condition as a summer complaint. 
 Winter cholera and winter diarrhea are 
 names by which it is known. When 
 Yaughan was investigating typhoid at 
 Chickamauga he found proof that much 
 of the typhoid had been called diar- 
 rhea, summer complaint, and similar 
 names by the physicians in attendance. 
 It is rather natural to ascribe diarrhea 
 in summer to fruit, vegetables, and 
 other foods. In winter it is more apt 
 to be recognized as a typical typhoid. 
 Winter typhoid is spread through 
 infection of the water. The method of 
 prevention is either to prevent infection 
 of the water or to stop the use of in- 
 fected water. Municipal filtration will do this; so will treatment with hypo- 
 chlorite. A proper household filtration will do it. However, individual house- 
 hold filtration has generally been of little service in lowering the typhoid rates. 
 Boiling the water will do it. Here, also, individual action has never been of 
 much service. Winter typhoid is a community disease which must be met by 
 community measures. 
 
 If we could manage to stamp out winter typhoid the control of summer ty- 
 phoid would come within reach. It should get on the same plane as smallpox. 
 The only agencies left to carry it over from season to season would be carriers, 
 and the number of effective typhoid distributers is not large. The problem 
 would then be about as difficult as the smallpox problem and no more so. 
 Suppose a man lives in a town with an infected water supply, as shown 
 by a high winter typhoid rate. What can he do? Get vaccinated and then 
 agitate all the harder for better water. As Freeman says, "The problem 
 remaining for solution is how to convince the American people that protection 
 from typhoid is something worth spending money for." 
 
 '""• ■ '••'■ •••••■ "•*■ •■ - ■ • ■' ■■'■ •■•■■' ■ • • ••••- ■•■ ' ■•■■■ ■'■•■ 
 
 Virginia Health Department. 
 
 Fig. 139.— Safe Well. 
 
TYPHOID FEVER 317 
 
 Preventing Typhoid. — J. II. writes: 
 
 "1. Would you advise vaccination as a preventive of typhoid fever? 
 "2. Is such vaccination safe? 
 
 "3. If cows drink water in which typhoid germs are present do these 
 germs appear in the milk? 
 
 "If. Should such milk be boiled? 
 
 "5. How long should water be boiled?" 
 
 Reply. — When an epidemic of typhoid fever is on: 
 
 1. Nothing should be eaten raw. 
 No raw water. 
 
 No raw milk. 
 No raw vegetables. 
 No raw fruit. 
 No raw oysters. 
 Nothing raw. 
 
 2. All typhoid should be promptly reported to the health department. 
 
 3. A modified quarantine (typhoid quarantine) should be established. 
 
 4. All nurses, or all doing nursing duty, should be instructed in detail 
 how to take care of their patients. 
 
 5. All the people should be vaccinated against typhoid. 
 
 Such a policy will stop the outbreak of new cases in two weeks. It 
 takes ten days for typhoid to develop after infection. 
 Now, answering your questions in detail: 
 1 and 2. Yes. 
 
 3. No. 
 
 4. Yes, for one minute after it starts to boil. Then keep it warm for 
 fifteen minutes. Cool quickly. 
 
 5. Same length of time as milk. 
 
 Milk and Typhoid. — X. Y. Z. writes: "I have been taking milk and 
 cream daily from a milkman who has a case of typhoid fever in his home. 
 He tells me the doctor says there is no danger at all of the disease being 
 carried to the customers. Please advise me." 
 
 Reply. — You should not use milk from a milk dealer who has typhoid 
 fever in his home, unless you know "for sure" that the man who handles 
 the milk does not see the sick person or touch anything which goes into 
 the sick room. It is possible to handle raw milk with safety on premises 
 where there is typhoid fever, if the dealer is very intelligent and very 
 careful, but ninety times out of a hundred it is too risky. 
 
 Typhoid Vaccination. — G. W. M. writes: "Why is it that typhobac- 
 terin is not recommended for use in persons over 40 years of age?" 
 
 Reply. — There is no reason why a person over 40 who has not had 
 typhoid and who is to be exposed to it should not be vaccinated against 
 typhoid. At the last meeting of the American Medical Association such 
 vaccination in old people was reported. Generally speaking, old people 
 do not need it so much as the young ones. 
 
 Cesspools and Typhoid. — J. W. D. writes : "In your paper you have a 
 department for typhoid fever? We have had considerable typhoid in 
 our vicinity. I claim part of the sickness is from not having sewers, but, 
 instead, having cesspools, and that our drinking water is bad by having 
 
318 
 
 CONTAGIOUS DISEASES 
 
 JACK- JILL. 
 
 Jack and Jill I Jack pell sick 
 
 Went down the Mill Of Typhoid, quick, 
 
 To get a Drink or Water. And Jill came following after 
 
 - And This Is The Reason Why - 
 
 Typhoid fever in the bouse -J" 
 
 i Ljpbotd Germs 119 the Drain -pipe 
 
 oid Germs in the Creek _ 
 
 Typhoid Germs seepiorf into the Wei I - 
 
 Typhoid Germs 11? the Well Water 
 
 TYPHOID GERM5 IN JACK AND JILL ! 
 
 BEWARE OF 
 LOW-LYING 
 5MALL0W- 
 DU& WELL5 
 
 Chicago Health Department -educational Poster MS 134 
 
 iKATHEfllNE FIELD WHITE -191*1 
 
 Fig. 140. 
 
 cesspools dug down to running water. I would like to have your opinion 
 on the matter/' 
 
 Reply. — The conditions you describe are usually responsible for typhoid 
 fever. Cesspools reaching to or nearly to the strata which carry the water 
 
TYPHOID FEA 7 ER 319 
 
 which supplies your wells are reasonably certain to give you polluted water. 
 This water from time to time will become infected. When cesspools and 
 wells are located near each other there are usually found other causes of 
 typhoid not closely related to these. A community which has a good deal 
 of water typhoid usually has more than the average amount of milk, fly, and 
 finger typhoid. The better care of sewage and the better protection of the 
 drinking water also helps to decrease these other forms of typhoid infec- 
 tion. And also when typhoid rates fall other disease rates fall. 
 
 Developing Typhoid Fever. — J. 0. 8. writes: "Kindly tell me if any- 
 thing can he done to prevent typhoid fever. The patient threatened with 
 it a week ago has taken nothing hut liquid foods since. Shall she con- 
 tinue with the liquid diet?" 
 
 Reply. — Vaccination, boiling the water, boiling the milk, screening 
 against flies are the most important methods of preventing typhoid. How- 
 ever, with your friend it was too late to talk about preventing the disease 
 at the time you wrote your letter. The typhoid bacillus gets in the body 
 and stays there ten days before any symptom develops, and two weeks 
 before the symptoms look much like typhoid. After the patient begins 
 to have fever or to get weak it is too late to prevent the disease. 
 
 Avoiding Typhoid Germs. — Drummer writes: "What am I, a travel- 
 ing man, to do to he sure of avoiding typhoid? I'm afraid of that disease, 
 hut traveling constantly I cannot boil the water I drink or guard against 
 the carelessness of cooks and waitresses in the hotels." 
 
 Reply. — Get vaccinated against it. If you are from Wisconsin, the 
 state board of health will furnish the serum. In any event your physician 
 can get it for you. 
 
 Protection of Typhoid Vaccination. — H. C. asks how long the typhoid 
 inoculation lasts and if it protects against malaria. Vaccination lasts for 
 seven years, he is told. 
 
 Reply. — Typhoid vaccination requires twenty to thirty days. Beyond a 
 temporary redness at the points of injection there is no inconvenience or 
 other ill effect. It will not protect you against malaria. The way to pre- 
 vent malaria in the tropics is to protect yourself against mosquitoes. This 
 properly done is effective after you strike a district where the mosquitoes 
 are infected. Your danger of malaria will be proportioned to the number 
 of mosquitoes which bite you. The inoculation against typhoid will pro- 
 tect you for five months. It will make you reasonably safe for an addi- 
 tional seven months. 
 
 Filters. — A. W. W. asks the following questions: "Is there a filter 
 made which can he attached to the faucet, which will destroy typhoid 
 germs?" 
 
 Reply. — Any of the artificial rock filters which attach to the faucet will 
 filter out typhoid bacilli. All parts of the filter must be kept clean. At 
 short intervals the candle must be baked out. Otherwise the typhoid 
 bacteria grow through it and the filter does more harm than good. 
 
 Winter Cholera.' — 0. C. sends the following clipping from the Tribune 
 and suggests the advisability of furnishing more information on the 
 subject: 
 
320 
 
 CONTAGIOUS DISEASES 
 
 "Waukegan, III. — Jan. 2. — [Special.] — Winter dysentery among 
 infants has been discovered in Chicago by scientists and is said to be 
 prevalent in northern Illinois. When a Waukegan physician who 
 
 n/"«- ' ->»;/' / T .',,'/ "•/•/'■' .it 1 '' *'!'" ' '•'■>>'/'' ''"'. M r 
 
 
 SCREEN THE EUES OUT CLOSED WELLS ARt SAffR 
 
 CLOSED PRIVIES PREVENT TYPHOID 
 
 North Carolina Health Bulletin. 
 
 Fig. 141. — To Prevent Typhoid. 
 
 had charge of a six-months-old son of Mr. and Mrs. Walter Ellis 
 called a Chicago laboratory by telephone he was informed they had 
 had many inquiries about similar cases. 
 
 "It is said to be an entirely new disease. 
 
 "The child died this morning." 
 
 Eeply. — Winter diarrhea, also called winter dysentery, is typhoid 
 fever. In 1908, Dr. Breitenbaeh reported to the section on preventive 
 
TYPHOID FEYER 321 
 
 medicine of the American Medical Association a so-called epidemic of 
 winter diarrhea in a Wisconsin city. The people were trying to fool 
 themselves and everybody else by calling their epidemic winter diarrhea. 
 The proof was conclusive that the disease was typhoid and due to polluted 
 water. Many such reports are on record. 
 
 Cause of Typhoid. — D. A. Carson writes: "In your article in the 
 Tribune of today you do not come out and squarely say that bacteria causes 
 typhoid fever, but you say: 'It is a bacterial disease. The bacteria are 
 taken in with food and water/ and hence I am forced to believe that you 
 mean to assert that bacteria are the cause of the disease. I have heard 
 other doctors make this assertion and I have asked many of them how 
 they know that bacteria cause typhoid fever or any other disease. I have 
 not been able to get a satisfactory answer to my question from any of 
 them. The best they can do is to say bacteria are found in the discharges, 
 etc., of typhoid patients. That proves really nothing more than the fact 
 of its presence. Several doctors have told and the books tell me that the 
 same bacteria that are found in the discharges of typhoid patients are also 
 found in other diseases. As this has never been denied as far as I can 
 learn it is strong testimony against your theory that typhoid is caused 
 by the so-called typhoid bacteria. 
 
 "I think you should in your Tribune articles prove your assertion as 
 to the cause of typhoid. It will not do to merely prove its presence in the 
 typhoid patient nor to say the theory must be true because 'it was made in 
 Germany/ Unless you prove your assertion all your talk will go for noth- 
 ing and no thinking person will believe one word of it." 
 
 Reply. — Typhoid fever is due to the typhoid bacillus. The proof is : 
 
 1. The bacillus is found in the blood and organs of people having 
 typhoid fever. It is also found in certain of the excretions of those having 
 typhoid fever or who have had typhoid fever. 
 
 2. It is not found in the blood or organs of anyone who is not suffering 
 from typhoid fever. It is not found in the excretions of anyone except 
 those who are suffering from typhoid or who have been infected with 
 typhoid at some time. 
 
 3. It is not found in the blood or in the excretions of animals which 
 do not have typhoid. 
 
 4. The blood of a person having typhoid fever will first clump and later 
 destroy typhoid bacilli. It will not cause this effect with other bacteria 
 under like conditions. 
 
 5. Typhoid bacilli cultured from the blood of a person in an early stage 
 of typhoid will be first clumped and later destroyed by blood taken from 
 another person who is in the midst of a developed typhoid. 
 
 6. These bacilli will not be clumped by other blood when applied under 
 like conditions. 
 
 7. It has been proved that people with typhoid infect other people with 
 the disease. 
 
 8. It has been proved that under certain circumstances people with 
 typhoid infect water, milk and other food substances. It has been proved 
 that people with typhoid had consumed food in which there were typhoid 
 bacilli. 
 
 Koch laid down certain laws which must be conformed to and the fact 
 of conforming proved before it could be proved that a certain bacterium 
 caused a certain disease. 
 
 Typhoid fever meets every one of these requirements. 
 
322 CONTAGIOUS DISEASES 
 
 FOOT AND MOUTH DISEASE 
 
 Foot and mouth disease is a malady of cloven footed animals. It be- 
 longs in Europe. Eosenau tells us that it has invaded this country on several 
 occasions prior to the last. 
 
 When the disease was discovered the Bureau of Animal Industry took 
 active charge of the invaded districts and within a few weeks the disease was 
 under control. Its complete suppression necessitated the killing of a large num- 
 ber of cows and was done at great expense. 
 
 In this epidemic the same bureau assumed charge as soon as the diag- 
 nosis was made and the situation is being handled in its usual masterly 
 way. The disease will shortly be under control and before long it will be 
 eradicated but the expense to farmers and to governments will be great. 
 
 The cause of the disease is a microbe too small to be seen with any 
 microscope. It passes through the pores of a porcelain filter and therefore it is 
 classed as a filterable virus. This was the first ultra-microscopic filterable 
 virus to be discovered. 
 
 The virus can be transmitted to human beings by the milk. Although 
 the disease in animals is violent and often fatal, in the human subject it is mild. 
 It occasionally produces death. 
 
 Children sick with foot and mouth disease have fever and vomiting; 
 small blisters appear in the mouth; swallowing is difficult; sometimes slight 
 blisters appear on the fingers. 
 
 Eosenau says : "Man is infected through the ingestion of raw milk, but- 
 termilk, butter, cheese, and whey from animals suffering with foot and mouth 
 disease. It may also, though more rarely, be transmitted directly from the 
 salivary secretions." 
 
 Eosenau also says that foot and mouth disease cannot be transmitted by 
 vaccination or any other variety of skin wound. 
 
 The virus is easily killed by heat. Experiments made in Denmark and 
 Germany have proved this. Milk pasteurized at 140° for twenty minutes 
 is safe. 
 
 There is no reason for alarm. So long as the disease continues all milk and 
 milk products from the infected districts should be pasteurized. Any consumer 
 of milk who is not certain of his supply should pasteurize at home. Physicians 
 in the district or near it should inquire carefully into their cases of stomatitis. 
 
 FIGHTING FOOT AND MOUTH DISEASE 
 
 From three to ten days after exposure the infected person is attacked by 
 chill followed by general aching. The fever goes to about 102°. There is 
 vomiting and diarrhea. About three days after the beginning of the fever 
 the mouth becomes inflamed. 
 
 The most frequent affection in the mouth is a crop of small, clear 
 blisters. These appear on the inside of the lips and cheeks, on the gums and 
 tongue. They seldom appear on the hard or soft palate. 
 
 In most cases the crop of blisters is preceded by a fall in the fever. If 
 the fever keeps up it is a sign that a second or even a third crop of blisters 
 will follow, coming at intervals of three to four days. 
 
FOOT AND MOUTH DISEASE 323 
 
 The worst epidemic of foot and mouth disease on record was one occurring 
 in Berlin and reported by Sergei. In that epidemic there was much swelling 
 of the gums and the tongue swelled so as to protrude from the mouth. Many 
 of the cases of that epidemic died as the result of pneumonia, Bright's disease 
 and extreme wasting. 
 
 The disease is usually spread by the drinking of raw milk from in- 
 fected cows. To settle the point Hertwig drank some infected milk and gave 
 some to his assistants. The disease resulted. 
 
 To prevent the disease from spreading Nicolaier says that the follow- 
 ing procedures should be followed : 
 
 All infected and exposed cows should be quarantined. 
 
 All infected people should be quarantined. 
 
 All milk from sick cows should be destroyed. 
 
 The general milk supply should be thoroughly pasteurized. 
 
 These are provisions of the German law. That law does not require 
 that butter from infected animals should be made from pasteurized milk. In 
 this Mcolaier thought the law was faulty. 
 
 It is generally agreed that the disease may be dangerous, especially to 
 children. An infected person may infect a susceptible person- by contact, 
 such as hissing. 
 
 • 
 
 FOOT AND MOUTH DISEASE EASILY AVOIDED BY PEOPLE 
 
 When Mediaerr wrote about foot and mouth disease in the human 
 subject he was able to gather together histories of one hundred and forty 
 cases. In the medical history of the entire world there had been recorded 
 less than two hundred cases of human foot and mouth disease. 
 
 Nicolaier said he was sure there had been more cases and with this 
 Sergei agreed. In fact everyone who has written on the subject has agreed 
 that the physicians have failed to recognize many of the cases of foot and 
 mouth disease. How could it be otherwise with a disease so rare and so little 
 understood ? How can you expect an American physician to make a 
 diagnosis ? 
 
 But after due allowance has been made the fact remains that foot and 
 mouth disease is not now and never has been much of a menace to human 
 beings. It is not at all to be compared with consumption, typhoid fever, 
 pneumonia, scarlet fever or any other of a dozen diseases which are always 
 with us. Aside from the fact that it has rarely affected persons there is the 
 ease with which human beings can protect themselves against it. 
 
 Meat is not a menace. Meat from government controlled slaughter 
 houses is not a menace in the raw state. Cooked meat is absolutely safe. 
 Pasteurized milk is safe and any citizen can get pasteurized milk. The 
 man who purchases raw milk is needlessly endangering the life of his 
 family. 
 
 Butter from pasteurized milk — usually called pasteurized butter — is also 
 safe. There is plenty of that on the market. Anybody who wants pasteurized 
 butter can get it. 
 
 The foot and mouth disease is a stockman's peril. The consumer of 
 milk and meat has no reason to be panicky. 
 
324 CONTAGIOUS DISEASES 
 
 Human Foot and Mouth Disease. — K. J. M. writes: "Being interested 
 in science and my brother man, I send you this report that, should you 
 think it advisable, you can warn your readers to 'boil the milk.' 
 
 "I am satisfied since reading your article giving symptoms of hoof and 
 mouth disease that I am recovering from an attack of that plague. I give 
 you my case. 
 
 "Twelve days ago I felt badly and noticed a slight sore throat. Fear- 
 ing I had 'caught' some one's tonsillitis or 'grip,' I gargled several times 
 with listerin. Toward evening I had a slight chill and some fever; only 
 took temperature once, 100 1-5; do not think it went higher. 
 
 "For several days my throat got worse and I wondered what made 
 blisters on back of my throat, tonsils, inside of lips and cheek, and on soft 
 palate, none on roof of mouth or on gums, though latter were swollen. 
 I don't think there were more than a dozen or so of these blisters, but all 
 the time other red places came out inside my lips and cheeks, which 
 seemed to bleed slightly, as I noticed in expectorating (there was constant 
 flow of saliva) there were streaks of blood and I found these bled easily. 
 
 "As my throat got worse my tongue did, too, not on surface, but at 
 'root' or back it was swollen and hurt to move it. This more than sore 
 throat made swallowing very painful for a week. 
 
 "The front edge of my tongue and under it, back of mouth and throat 
 are still much inflamed and inflammation has reached my chest, making 
 me feel like I had a severe cold there, though I have had no signs of a 
 cold. I had no vomiting, no diarrhea. 
 
 "Now my husband is on his fourth day of infection, with exactly the 
 same symptoms. I have not consulted a physician, as it seemed more 
 (painful than alarming, and I am one of those that 'take three days to 
 decide to go to a doctor and then back out.' As a precaution we have 
 avoided everyone for several days. Do you think we have this disease? 
 Should we fumigate, and with what?" 
 
 Eeply. — If you have the disease, boil or burn all handkerchiefs, towels, 
 and clothes that come in contact with your mouth secretions. Use no 
 cups, spoons, or plates used by others. Use chlorinated lime solution 
 freely around the room. 
 
 When you have recovered wash all woodwork with 5 per cent, solution 
 of carbolic acid. Air and sun your rooms well. 
 
 That you have recovered does not prove that you did not have the 
 disease. The fine stock at the yards recovered, all of them, and they cer- 
 tainly had it. 
 
 Prevalence of Human Foot and Mouth Disease. — Veterinarian writes: 
 "In your article on foot and mouth disease I believe you have not only 
 underestimated the human susceptibility for the disease but also the num- 
 ber of cases on record, both mild and fatal. 
 
 "Hutyra and Marek, a late work on veterinary science (Vol. I), quote 
 Bussenius and Siegel, 'Sixteen epizootics occurred in man in the years of 
 1878-1896, in the course of which entire families, sometimes all inhabitants 
 of certain houses, and even townships, became affected. During different 
 outbreaks the cases terminated fatally in thirty-six, twenty-six, and six- 
 teen instances respectively.' " 
 
 Eeply. — Nicolaier, whom I quoted in my article, quoted Bussenius and 
 Siegel at length. In fact, most of the 140 cases collected were from that 
 source. I have just read Hutyra and Marek's article. They say that the 
 
EOCKY MOUNTAIN FEVER 325 
 
 disease is not of great importance from the human standpoint. "This 
 disease develops in man usually in a mild form, except in children, in 
 which an associated gastro-intestinal catarrh may lead to death. During 
 some of the outbreaks, however, adult persons also became severely 
 affected." 
 
 ROCKY MOUNTAIN FEVER 
 
 In the Rocky Mountain states there exists a disease known as the Rocky 
 Mountain spotted fever. Within recent years cases have been reported in 
 Montana, Idaho, Wyoming, Washington, Oregon, California, Nevada, Utah, 
 and Colorado. The disease is not especially severe. The death rate is less 
 than that of typhoid fever. Wlien a man gets sick with typhoid fever he 
 expects to get well and the chances are about fifteen to one that he will. 
 
 From the epidemic standpoint the disease is not very important. The 
 Public Health Service was able to get track of only 440 cases of it during 1914. 
 Of these twenty-nine died. 
 
 There are a few counties in Montana, Wyoming and Idaho that do not 
 settle up because the people are afraid of tick fever. This last fact is one 
 of the reasons why the government is actively working to eradicate Rocky 
 Mountain spotted fever. 
 
 What seems to be a more important reason is that it wants to make two 
 demonstrations. First it wants to show the people how a centralized national 
 agency for the conservation of human beings could — shall we say can? — 
 operate to eradicate an endemic disease. What could be done with this 
 disease could be done with any other endemic disease which had been repressed 
 to the proper point for work for suppression. ■ 
 
 Second, it wants to demonstrate the method of suppression applicable to 
 this particular disease. This fever is spread by wood ticks. The ticks live on 
 gophers, squirrels, coyotes and every other species of wild animal. To sup- 
 press this fever it is necessary to get rid of the ticks. 
 
 To rid a region of ticks the government advises killing the wild hosts, 
 dipping all domestic stock, cleaning out the undergrowth and sheep grazing. 
 
 Of these measures, the most effective is sheep grazing. When sheep graze 
 over a piece of ground they gather up all the ticks. 
 
 Ticks will leave any animal for a sheep. When they get into a sheep's 
 wool between 80 and 90 per cent, of them die. 
 
 To get the other 10 to 20 per cent., the government recommends that the 
 sheep be grazed high up the mountain side. A flock of sheep start grazing 
 in the valley. The sheep graze up the mountain side. By the time the sur- 
 viving female ticks are fully grown and gorged with blood the sheep are above 
 the range of gophers, chipmunks, squirrels and wild animals generally. The 
 females drop off, lay their eggs and die. The larvae hatch out and finding 
 no small animals to live on, die. 
 
 It is common information that there is no tick fever on the east side of 
 Bitter Root Yalley. Many years ago 40,000 sheep were put on this slope. 
 The method of grazing was just that described. The "snoozers" cleaned that 
 side of the valley of ticks without trying or having any idea of the good 
 they were doing. 
 
 Apparently it is within the power of the sheepmen to redeem the coun- 
 
326 CONTAGIOUS DISEASES 
 
 try. This should improve the standing of the "snoozer." It might make 
 O'Henry sit up in his coffin. 
 
 Rocky Mountain spotted fever is an American disease. It is not found 
 outside of the United States. If we annihilate it here the world will be 
 permanently rid of it. Our responsibility toward it is the same as that of the 
 few countries in which yellow fever is left. 
 
 TYPHUS 
 
 Typhus is, or was, the war disease. Hirsch begins his chapter on typhus 
 as follows : "The history of typhus is written in those dark pages of the world's 
 story which tell of the grievous visitations of mankind by war, famine, and 
 misery of every kind. . . . The history of typhus in war affords further 
 classical proof of the influence of overcrowding, filthy and unventilated spaces, 
 upon the development of the fever." 
 
 The history of this disease shows that war has been the chief agency 
 of its spread. In fact, Mexico was free of it until the Spaniards, bent on 
 conquest, brought it with their armies in 1570. 
 
 While most of the records of typhus relate to wars of a hundred years or 
 more ago it has come down to our day. It was responsible for a heavy death 
 rate in the Crimean War and also in the Eusso-Turkish War of the late ; 70's. 
 It was troublesome among the French troops in the war of 1871. There is 
 information that in the Madero revolution of five years ago the disease was 
 quite prevalent. It has raged in Serbia. 
 
 In Mexico typhus fever is* always present in the tierras f rias, the colder 
 plateau lands south of Torreon. This tableland is the normal habitat of 
 typhus in Mexico; but it is reasonably certain that the disease can be carried 
 by the Mexican troops wherever they go in Mexico. They carried it to 
 Juarez; they can and will carry it to whatever tropical district they go. 
 
 A physician who had practiced medicine in Mexico for many years was 
 asked what were the worst diseases that we might expect in case of war 
 with the southern republic. His reply was that the greatest menace to life 
 would be typhus. Venereal disease would be the greatest disabler. 
 
 The typhus that we shall encounter there will not be of the mild type 
 found here. There the disease is violent. It has a case mortality of 80 
 per cent. We in this section have no personal knowledge of so violent a form. 
 
 Where's the hope? There is good evidence that typhus is spread by 
 lice. We may prove that this is the only method of its spreading. At any 
 rate we shall work cleanliness and louse killers to the limit to protect our 
 men. Those sick with typhus will be protected against lice. The well will 
 be examined for lice frequently. Louse killers will be distributed freely. 
 
 Typhus is a disease of bad sanitary conditions. It has never thrived 
 where there was any sort of sanitary standard. It may not be a filth disease, 
 but it comes nearer being one than typhoid, and is infinitely more a filth 
 disease than smallpox. 
 
 Nobody has it except people housed in filthy places. It develops in filthy 
 jails, filthy construction camps and filthy army camps. 
 
CHAPTER XX 
 
 Habit-Forming Drugs 
 
 Farmers' Bulletin No. 393, Department of Agriculture, is on the sub- 
 ject .of habit-forming drugs. I do not know why this was issued as a farm- 
 ers' bulletin, except that there is no place in our scheme of government for 
 people's bulletins. Farmers have no more drug habits than the general 
 run of people. On the other hand, it has been said there are more drug 
 habitues among physicians than any other class. 
 
 This bulletin says it is estimated that there are more than 1,000,000 
 drug addicts in the United States. 
 Another statement is: "The amount 
 of opium imported into the United 
 States so far during the present decade 
 indicates that the amount per capita is 
 about the same as for the preceding 
 ten years." 
 
 Crothers says that two-thirds of 
 the morphin used is consumed by ad- 
 dicts. 
 
 There are three reasons for this 
 article. The first one is that the mor- 
 phin disease is no trifling matter. 
 
 The morphin habit is always ac- 
 quired under an alias. A man seeks 
 to escape a pain and justifies himself 
 in talcing morphin by saying a dose, or 
 a few doses, will do him less harm than 
 the pain. His mistake is in not seeing 
 that he is really deciding between the 
 pain and the habit. 
 
 A man seeks to get a needed 
 night's sleep with morphin. He weighs 
 one night against one dose. He should be able to see the end of the string 
 and know that he is weighing a habit against a temporary discomfort. A 
 man is temporarily in straits and feels that he has not the grit to carry 
 himself over. He takes a dose of morphin, forgetting he is only "laying the 
 question on the table," and that when he takes it up tomorrow the morphin 
 will have left him with even less grit; the difficulty to be met has grown 
 as it lay unmet. 
 
 The second reason for writing this article is to call attention to the 
 score or more of paths that seem innocent enough, but that lead to fiend- 
 dom: cough medicines, sleep medicines, refilled prescriptions, opium cures, 
 
 327 
 
 Fig. 142. 
 
 North Carolina Health Bulletin. 
 Taking Patent Medicine by the 
 Clock. 
 
328 HABIT-FORMING DRUGS 
 
 which contain opium, morphin, or codein, medicine for pain, and the like. 
 The man who begins with these does not fight out the question, "Will I be 
 an opium fiend ?" While he is strong he cannot conceive of any answer but 
 no. But let him consider what his answer will be when the question is put — 
 that is, when the time has come that his will is weak and his grit has gone. 
 
 A large part of the opium addicts are neurasthenics by inheritance. A 
 large part are neurasthenics from lack of training in self-control. Another 
 part become mentally disturbed by the drug. Certain types of criminality 
 are frequently found in drug fiends. 
 
 The third reason for writing this article is to set forth the justice of 
 taking morphin into consideration in judging the motives of addicts, and to 
 suggest that opium fiends cannot be cured or helped by punishment. They 
 must be patiently and persistently helped and then retrained. Cure is not 
 effected when morphin is no longer used. They are not cured until they 
 have got a grip on themselves and a new hold on affairs. 
 
 It is the duty of the physician to examine closely and find out not only 
 what is the organic basis, but also its relative value. For him to become 
 impatient is to miss the point. He must catch the patient's point of view 
 and then, through suggestion, analysis, reason, bring him to a better view- 
 point, and patiently hold him there until he can stand alone. 
 
 Even in organic diseases, while the basic organic changes cannot be 
 altered, the physician who is wise, sympathetic, and patient can steady 
 his patient and assist the weak organ to do its work. He cannot cure 
 the leaking heart, but he can stay the mental trepidation, which means 
 more frequent and more painful periods of palpitation. And this is what 
 the patient wants — he judges by symptoms. 
 
 DOPE FIENDS OF ONE CITY 
 
 Jacksonville, Florida, has an ordinance requiring that drug users shall 
 register with the department of health. Druggists, physicians, and other 
 dealers and dispensers are allowed by law to sell the needed drug to a person 
 registered as a dope user. 
 
 The purpose of the Jacksonville authorities was to concentrate their 
 efforts on the prevention of the habit. In order to get a record of drug 
 users, their number, the drug used, the amount, the reason for the habit, 
 and other items concerning them for careful study, they passed and are 
 enforcing this ordinance. 
 
 The Tennessee legislature made a similar measure into a state law. The 
 Tennessee law is enforced by the state food department. 
 
 Dr. Terry, the efficient Health Commissioner of Jacksonville, reports 
 that of the total population of that city drug users compose about 1.5 
 per cent. The percentage of drug users among grown people is much higher 
 than that. These are distributed by color and sex as follows : 
 
 White males 32.69 Total males 43.74 
 
 White females 36.98 Total females 56.26 
 
 Colored males 11.04 Total white ' 69.67 
 
 Colored females 19.28 Total colored 30.33 
 
DOPE LAW WEAKNESSES 329 
 
 The population of Jacksonville is about equally divided into white and 
 colored. It will surprise some people to know that white people, as compared 
 with colored, are more than twice as liable to become dope fiends. This 
 does not hold true of cocain. Negroes are especially prone to use cocain. 
 
 There are a few more women than men in Jacksonville, but this dis- 
 proportion is not as fifty-six to forty-three. The conclusion is that women 
 are somewhat more disposed to use dope than are men. 
 
 Please Do Not Ask Us 
 
 f ANY OLD ] 
 What is J PATENT [ Worth? 
 
 ImedicineJ 
 
 For you embarrass us, as our honest answer must be that 
 
 It Is Worthless 
 
 If you mean to ask us at what price we sell it, that is an 
 entirely different proposition. When sick consult a good physi- 
 cian. It is the only proper course; and you will find it cheaper 
 in the end than self -medicine with worthless "patent" nostrums. 
 
 The report from State Food Commissioner Brown of Tennessee is 
 that the proportions between female and male addicts and white and 
 colored are about the same in that state as in the figures given by Dr. Terry 
 for Jacksonville. 
 
 An analysis of the replies given by 250 users as to how they started 
 is as follows: 
 
 Prescriptions of physicians 48.8 
 
 Through dissipation 30.4 
 
 Through advice of users 18.8 
 
 Chronic and incurable diseases 2. 
 
 Investigation on this point did not go back of the reply returned 
 on the blank. For instance, how many of the 48.8 per cent, who put the 
 blame on prescriptions of physicians made a misstatement to cover their 
 own shortcoming is not known. Nor is it known how many cases were due 
 to indefinite refilling of prescriptions or counter-prescribing, and how many 
 were due to physicians' prescriptions, so considered. Indirect . causes given 
 were in the order named, rheumatism, pelvic inflammation, accidents, head- 
 aches, surgical operation, stomach trouble. About 15 per cent, of the dope 
 fiends were prostitutes. 
 
 Dr. Terry thinks that every community should provide a free sanitarium 
 for the cure of the drug habit as well as enforce laws to prevent it. 
 
 DOPE LAW WEAKNESSES 
 
 The Treasury Department began the enforcement of the Harrison law on 
 March 1, 1915. While this bill relates to the purchase and sale of opium and 
 
330 HABIT-FORMING DRUGS 
 
 coca leaves and preparations made from them, it is capable of being made a 
 national measure for the control of drug habits, being limited, however, to the 
 opium and cocain habits. 
 
 Under rulings made by the commissioner of internal revenue the law, 
 properly enforced, will make it impossible for any drug habit victim to get 
 an adequate and continuous supply of his drug. It therefore will force 
 the drug habit victims to be cured. 
 
 The law, properly enforced, will be highly effective in preventing 
 people from being drug addicts. Prescriptions containing opium and coca 
 preparations cannot be refilled and records of the purchases of drugs 
 must be kept. These provisions are calculated to prevent the formation of 
 habits. 
 
 However, there are two weak points in the law. Physicians, den- 
 tists, and veterinarians who register as such are allowed some leeway. 
 Up to date, applicants have been permitted to register as physicians, den- 
 tists, and veterinarians without being required to make proof that 
 they were such. Nothing is easier than for the collector to require 
 each applicant to show the license granted him by the authorities of his 
 state. 
 
 The Commissioner of Internal Revenue writes: "It devolves upon the 
 collector of internal revenue to see that no other persons [than legal prac- 
 titioners of medicine, dentistry, and veterinary medicine] register under this 
 law." 
 
 This weakness in the law, as it has been administered up to date, is 
 purely one of administration. It lies within the power of the department 
 to purge the lists of any improperly registered, to supervise those who are 
 properly registered, and to require legal proof of right to practice as a requi- 
 site to registration. 
 
 The second weakness is far more important. Section 6 of the law 
 prescribes that patent medicines containing opium and cocain do not come 
 under the law. If an ounce of the patent medicine contains less than two 
 grains and a fraction of opium, or one-fourth of a grain of morphin, or one- 
 eighth of heroin, or one grain of codein it may be sold freely without any 
 of the limitations imposed by this law. 
 
 These are not inconsiderable strengths. For instance, this law would 
 not prevent a man from buying a ten-gallon jug of paregoric without having 
 any record made of the purchase. Section 6 makes easy the formation 
 of habit. 
 
 The law as a whole is an excellent measure against self -drugging. At 
 the point where the need is for great strength we find this fatally weak section. 
 It is a crawfish hole in the levee. 
 
 Section 6 did not get into the law by accident. The patent medicine 
 people put it there. While it was not their purpose to make drug fiends of 
 people, they were quite willing to be the beneficiaries of the provision which 
 makes drug fiends. 
 
 It is possible that the Pure Food and Drug Act of 1906 or the Sherley 
 Law of 1912 or state and local laws may be so administered as to cover 
 this point of weakness. So far as this law is concerned the only remedy 
 \s to amend it by striking out Section 6. 
 
WHAT IS THE DRUG FIEND TO DO? 
 
 331 
 
 WHAT IS THE DRUG FIEND TO DO? 
 
 On March 1, 1915, the Harrison bill went into effect. It is a federal 
 law and, therefore, applies in every part of the United States. The federal 
 government has a way of enforcing its law. Furthermore, drugs are in the 
 hands of druggists — a law-abiding class. All in all, the chance that the 
 law will be enforced is excellent. 
 
 Section 1 gives the Commissioner of Internal Revenue, with the ap- 
 proval of the Secretary of the Treasury, the right to make rules and regula- 
 tions for carrying the provisions of this act into effect. 
 
 Section 2 requires that no drug of the kinds specified in the law shall 
 be sold to anyone except upon a written order, said order to be on a blank 
 provided by the collector. The collector has ruled that blanks shall not 
 be issued to addicts. 
 
 The person who has a drug habit 
 nowadays can get his supply through 
 physicians only. As a means of getting 
 a supply this will prove unsatisfactory. 
 Some physicians will be careless. 
 Some will be worse than careless. 
 The great majority will refuse to 
 act as mediums for the evasion of 
 the law. 
 
 There are more than a million 
 opium and cocain users in the United 
 States. What can they do? 
 
 Some have made more or less 
 permanent connections with improper 
 sources of supply. Physicians, den- 
 tists, and veterinarians tempted to 
 supply drugs to addicts, whether im- 
 pelled by cupidity or weakness, should 
 bear in mind that the federal govern- 
 ment is strong and compelling. 
 
 Some addicts have found temporary supplies to tide them over a brief 
 period. 
 
 Some have undertaken cures. They will find it easier to break off than 
 they thought. Cures are fairly satisfactory. They will be doubly satisfactory 
 now that relapsing is to be a difficult matter. 
 
 It is common knowledge that some criminals are broken of their 
 habits by short jail sentences. Deprived of their drug, they suffer severely 
 for a few days and moderately for a few weeks, but at the expiration of their 
 sentences they go out freed of the habit. As they are, generally speaking, 
 neurotic or feeble-minded, they relapse. But the jail experience has proved 
 that breaking off is not so unpleasant as was expected. 
 
 Perhaps now that a strong government proposes to act in lieu of a strong 
 will the cures may be without relapse. 
 
 North Carolina State Health Department- 
 
 Fig. 143. — Penny Wise and Pound Fool- 
 ish. Headache Medicine. 
 
332 
 
 HABIT-FOKMING DRUGS 
 
 MORPHIN CURE 
 
 A ruling by the Commissioner of Internal Bevenue shuts off drug users 
 from their supply. Evasion of a federal law is a risky procedure. Taking 
 the cure is painful and troublesome, but settling with the federal authorities 
 is worse and more of it. 
 
 There are hundreds of thousands of drug users. In the entire coun- 
 try there are not 5,000 beds available for cures for drug users. Those 
 who can do so should go to institutions. Taking the cure outside an in- 
 stitution is far more risky and far less satisfactory than inside one. But where 
 the number of institution beds is so small and the number of those in need is 
 
 so large many must be cared 
 for in private homes under 
 the close care of physicians 
 and nurses. 
 
 In view of this situation 
 an article by Dr. W. K. Mc- 
 Laughlin in the Chicago Med- 
 ical Recorder for February, 
 1915, is useful. We give his 
 statement of the Towns mor- 
 phin cure method: 
 
 "Start Sunday morning 
 at 8 a. M. Give five com- 
 pound cathartic pills and five 
 grains of blue mass. At 2 
 p. M., unless the bowels have 
 moved freely, a dose of salts 
 is given. Some time during 
 the middle of the afternoon, 
 the bowels having moved 
 three times, the patient is 
 given two-thirds his total 
 daily dose of morphin. It 
 is given by mouth or by hypo- 
 dermic as the patient wishes. 
 "The amount of the drug is divided into three parts. One-third is 
 given at, say, 3 p. m., one-third at 3 :30. Unless the patient is fully under 
 the influence of his drug he is given the last third at 4 p. m. At 4 p. m. he is 
 given six drops (not minims) of the following belladonna mixture : Tincture 
 of belladonna (15 per cent strength), 2 ounces; fluid extract of xanthoxyli, 
 1 ounce; fluid extract hyoscyamus, 1 ounce. 
 
 "Give six drops of the belladonna mixture at 4, 5, 6, 7, 8, and 9 p. M. 
 Then increase the dose to 8 drops and give one dose every hour until 3 a. m. 
 Then increase to ten drops and give every hour until 9 o'clock Monday 
 morning; then twelve drops every hour until 3 p. m., then fourteen drops 
 every hour until 9 o'clock Monday night; then sixteen drops every hour 
 until the throat becomes very dry from the belladonna. 
 
 \ ~ ^jr,*^ 
 
 AMEBIC** MEDICAL AI60CIATI0N PRIZE CARTOON SERIES. I8I3-N0- 8. 
 
 YOU CAN'T FLOAT A SALOON WITHOUT GAS. 
 
 North Carolina Health Bulletin. 
 Fig. 144. 
 
MORPHIN CURE 33o 
 
 "This is dangerously powerful drugging and it should not be under, 
 taken except under close observation. 
 
 "Ten hours after the first dose of morphin ( about 1 o'clock Monday morn= 
 ing) give five compound cathartic pills and five grains of blue mass. At 9 
 o'clock Monday morning give a dose of salts unless the last cathartic has acted 
 freely. When the bowels have acted freely — say about 5 o'clock Monday 
 morning — give the second round of opium. Half the amount given on 
 Sunday afternoon is the amount to be given. It is divided into three 
 doses. These are taken at 5, 5 :30, and 6 o'clock Monday morning. 
 
 "Ten hours later, say at 4 in the afternoon, five compound cathartic 
 pills and five grains of blue mass are given. After these have acted thor- 
 oughly, say about 10 at night, a third dose of opium is given. The amount 
 given should be one-sixth the twenty-four-hour quantity used by the drug 
 user. The next morning (Tuesday) at 6 o'clock five compound cathartic 
 pills and five grains of # blue mass are given. At noon a dose of salts is 
 given. About 4 o'clock in the afternoon two ounces of castor oil is given. 
 
 "In most cases the belladonna can be stopped on Tuesday night. During 
 Tuesday it is necessary in some cases to give a simple sedative. Care in 
 diet and good nursing for several days after Tuesday are necessary." 
 
 We repeat the advice given at the beginning of this article. 
 
 SCELETH DRUG TREATMENT 
 
 During 'the last fifteen years the hospital connected with the Chicago 
 House of Correction has treated 3,000 cases of drug addiction, in the main, 
 morphin. Since the need for a cure is so great and so immediate just now, 
 we give the treatment employed by Dr. Sceleth. 
 
 The patient upon arrival at the hospital is given a full saline purge. 
 The medicine used as a bracer during the period of drug hunger is com- 
 posed as follows : 
 
 Scopolamin hydrobromid gr. 1-100 
 
 Pilocarpin hydrobromid gr. 1-12 
 
 Ethyl morphin hydrochlorid (dionin) gr. V2 
 
 Fluid extract cascara sagrada M, 15 
 
 Alcohol M. 35 
 
 Water q. s Ad 1 fl. drachm 
 
 If the patient was accustomed to taking more than ten grains of 
 morphin a day he is given of this mixture sixty minims every three hours, 
 night and day, for six days. On the seventh day the dose is reduced to 
 thirty minims; on the eighth, fifteen minims; on the ninth, fifteen minims 
 three times a day instead of every three hours. On the tenth day the mixture 
 is discontinued and one-thirtieth of a grain of strychnin nitrate is given three 
 times a day. On the eleventh day and for six days thereafter one-sixtieth 
 of a grain of strychnin nitrate is given three times a day. 
 
 If the patient used less than ten grains of morphin a day the doses 
 of the mixture should be one-half those given above. If he used less than 
 five grains he can start with fifteen minims of the mixture. 
 
 The use of the remedies must be varied somewhat, according to the 
 
334 HABIT-FORMING DRUGS 
 
 patient. The best policy by odds for a man who must continue the use of a 
 drug is to go to a sanitarium for a cure. If for any reason this is not 
 feasible he can succeed in a fair proportion of cases under the care of physi- 
 cians in his own home. 
 
 When the drug is withdrawn from a cocain addict he goes crazy. His in- 
 sanity lasts a few days and then his mind clears. Cocain users need re- 
 straint above every other element of cure. 
 
 Heroin addicts generally suffer from something of the same quality 
 of mental degeneration. Watching and restraint are very necessary with 
 them. 
 
 In handling morphin and codein users drugs are more important and re- 
 straint is somewhat less so. Dr. Sceleth says that when the morphin dose 
 is more than ten grains a day close medical supervision is required and 
 that at the best some will die. 
 
 Commissioner Brown of Tennessee says thaj; the average daily dose 
 of morphin of the morphin addict in that state is 8.8 grains. 
 
 These drug cures are for drug hunger. After the cure comes the need 
 for mental and moral training. 
 
 Do Not Take Morphin. — H. H. writes: "The writer is troubled with 
 wakefulness for two or three hours every night just after going to bed. 
 Usually I drop into a deep, unbroken sleep after that until about 6:30 a. m. 
 I retire usually at 10 P. M. or thereabouts. It often seems, no matter how 
 late I retire or how dead tired I may be, I must lie wide awake till sleep 
 finally comes on. I do not wish to take too extreme measures, but would 
 you recommend morphin or opium cigarettes, as I would be rid of insom- 
 nia at any price?" 
 
 Reply. — You do not go to sleep until you relax mentally. You must 
 stop working- after supper, or whatever else keeps you keyed up. After 
 supper take a walk with some agreeable companion, talk about incidental 
 things, then play cards for a while, or read something which interests you 
 but entirely apart from your day's work. Sometimes a hot bath before 
 retiring helps. Don't worry. Worry means mental tension and that means 
 insomnia. But as you value your future, take no morphin or any other 
 sedative. 
 
 Drug Habit Danger. — F. A. C. writes: "If a strong young man insists 
 on taking quarter-grain codein tablets at the constant rate of two or three 
 daily, is there any danger of this excessive use of them proving fatal? How 
 long could an ordinary heart stand six or seven grains of codein a week? 
 What, if any, bad effect would antikamnia- codein tablets have, to replace 
 the plain codein? He takes the tablets for headaches, caused, I think, by 
 too much eye work, and insists they are not harmful." 
 
 Reply. — Probably they would not prove fatal, and certainly not by 
 paralyzing the heart. But the man will soon become a drug fiend and drug 
 fiends shortly become so inefficient, incapable, and usually so immoral that 
 life is not worth living. Antikamnia and codein tablets are liable to pro- 
 duce the drug habit. However, they are more certain to produce constant 
 headaches. They poison the nerve cells and the blood cells so that they 
 bring about the condition they are supposed to cure and that they do 
 sometimes relieve. 
 
MORPHIN CURE 
 
 335 
 
 Morphin Habit. — C. C. writes: "Do you think it possible for a person 
 taking from two and a half to four grains of morphin sulphate daily to 
 overcome this habit?" 
 
 Reply. — I do not think it possible. The morphin habit is a worse dis- 
 ease than the whisky habit. The person should go into a good institution 
 prepared to stay long enough to get built up. Drug users are usually 
 neurasthenics and they need mental and nerve upbuilding. 
 
 Must Give Up Morphin. — Mrs. M. C. C. writes : "During an illness and 
 afterward for insomnia, a doctor prescribed morphin. Since then I have 
 been unable to sleep without it. One-eighth of a grain will insure sleep 
 
 North Carolina Health Bulletin. 
 
 Fig. 145. — Sunlight. 
 
 for two nights. Kindly inform me if this dose will harm me and what will 
 be the effect on my system? Can I effect a cure at home? 1 am a woman 
 past middle life." 
 
 Reply. — You are taking a small dose. Nevertheless you must stop it. 
 You will have no difficulty in curing yourself. Eat sensibly; take a purge; 
 repeat in a day or two. Take a warm bath at night; stay in the bath long 
 enough to get quiet. Remember that it makes no great difference whether 
 you sleep or not as long as you worry and fret. Go to bed and sleep if you 
 can, or stay awake if you must, but do not worry. 
 
 Bars Morphin Users. — R. W. writes: "I have three friends who are 
 more or less addicted to the use of morphin, and they fear the humiliation 
 of exposure when the new law goes into effect on March 1. What should 
 they do?" 
 
 Reply. — The Commissioner of Internal Revenue has ruled that drug 
 users shall not be allowed to buy the blanks necessary for the purchase of 
 drugs. 
 
336 HABIT-FORMING DRUGS 
 
 Your friends should take a cure. They should have all the moral sup- 
 port their friends can give them during the period of readjustment after 
 the cure. 
 
 Sleep Caused by Drugs. — F. B. N. writes: "What is the effect on a 
 person who for years takes from seven to ten grains of veronal every 
 night to produce sleep? Is it harmful to the system in any way?" 
 
 Reply. — It is. It is better to lie awake than to get sleep from drugs. 
 Have your physician discover why you do not sleep and then teach you 
 mental control so that you can sleep. 
 
 See Doctor First. — H. K. writes: "I was once upon a time troubled 
 with insomnia. A doctor prescribed sleeping powders for me to take at 
 bedtime about every third day. Would it be advisable for me to take 
 them again, perhaps twice a week? Could they do any harm to the heart 
 or any other organ of the body?" 
 
 Reply. — Do not take sleeping powders on your own account under any 
 circumstances. 
 
 Don't Take Soporific. — M. E. S. writes: "When I work hard I cannot 
 go to sleep for from two to five hours after I go to bed. I have been taking 
 veronal. Is it dope? Shall I form a habit? I am a woman of 67." 
 
 Reply. — 1. Veronal is not dope in the sense that the word is generally 
 used. Its use is not regulated by the Harrison Drug Act. At the same time 
 my advice is that you do not use veronal to produce sleep. It will not help 
 you, but will harm you. This statement holds true of every medicine used 
 to produce sleep. 
 
 Be quiet after sundown, and you will sleep as much as you need to. 
 Eat a light supper. 
 
 A woman of 67 does not require much sleep. If she will retire quietly 
 after a quiet evening, determined to be content with whatever comes in the 
 way of sleep, she will find that sleep will arrive. 
 
 Don't Take Bracers. — G. T. writes: "I understand nux vomica is a 
 good stomach and nerve bracer. Will strychnin tablets give the same 
 results? Same thing, isn't it? What's the dose? Are caffein tablets as 
 good a stimulant as coffee?" 
 
 Reply. — 1. The effect is about the same. One-sixtieth grain. 
 2. Yes. 
 
 Let me advise you as emphatically as I can not to use nux vomica, 
 strychnin, or caffein, or any other drug as a stomach and nerve bracer. 
 
 Heroin Derived from Opium. — A correspondent sends us a clipping 
 from a Pittsburgh paper in which it was stated that the school children 
 of that city were becoming addicted to the use of heroin. The correspond- 
 ent wants to know what heroin is. 
 
 Reply. — Heroin is derived from opium. It is as dangerous and as 
 prone to cause a habit as is morphin. 
 
 An Opium Fiend. — H. L. M. writes: "Will you kindly write of the 
 effects of codein upon the system and character of a person who uses codein 
 tablets at frequent intervals to quiet pain." 
 
 Reply. — Codein is derived from opium. Its effects are not very dif- 
 ferent from those of morphin. To make matters worse a good part of the 
 
COCAIN FIENDS 337 
 
 codein on the market contains a considerable percentage of morphin. 
 A codein addict can figure that he is an opium fiend. 
 
 When to Use Codein. — Anxiously Waiting: "A nurse wants to know 
 why codein is frequently combined with morphin in prescriptions." 
 
 Reply. — There is no reason. It would be wiser, when morphin is 
 needed, to give it in its proper dose. Codein is derived from opium, as is 
 morphin, and has about the same effect. 
 
 Starts Drug Habit. — M. G. writes: "Will you please tell me whether 
 common baking soda, taken frequently for distress in the stomach, is 
 harmful?" 
 
 Reply. — It is. It begets a drug habit. It makes the original condition 
 worse. It substitutes an improper curative method. 
 Relief — a proper one — removal of the cause. 
 
 Drug Habit Effect. — A. F. G. recites the story of a painter arrested for 
 stealing. The defense of the man was that for eight years he had been a 
 drug fiend, using morphin, cocain, heroin, and aspirin. A. F. G. wants to 
 know if the use of aspirin would cause the effects claimed above. 
 
 Reply. — Any drug habit will cause moral degeneration. Cocain is 
 especially effective in this way ; so is morphin. Aspirin also causes a habit. 
 However, the probability in this case is that cocain and morphin are 
 responsible. 
 
 COCAIN FIENDS 
 
 There is no excuse for the cocain habit. Cocain has no place in medicine 
 and but a limited place in surgery. Any discomfort relieved by cocain will 
 be worse in three hours than it was before cocain was used. When a team 
 is laboriously dragging a wagon uphill, from time to time the driver will 
 "scotch the wheel" to give his team a chance to catch their wind. Some 
 medicines "scotch the wheel" to give nature a little resting spell. Not so 
 cocain. 
 
 Any man who uses cocain to relieve any discomfort or allows it in 
 any proprietary or patent remedy used by him or allows any doctor to use 
 it on him is just an everyday fool. A surgeon may use it to remove a 
 cinder or to operate on an eye or nose, but that is no reason why a patient 
 should use it or allow it to be medically used. The only excuse for the 
 cocain habit that has any standing is that the subject is a neurotic and if 
 he does not do one half crazy thing he will do another. Developed "coke" 
 fiends are willing enough to admit this as the reason for their habit, but 
 no potential "coke" fiend would care to offer it as a reason for taking the 
 drug. 
 
 There is more deliberation, even what we might call malicious intent, or 
 weak, wabbly, neurasthenic indecision about cocain addiction than there is 
 about opium or alcohol use. 
 
 Many take opium because they have not the grit to stand pain, and 
 they fail to recognize where they are going. Most cocain fiends know 
 well enough where they are headed for, or think they do, but their miserable, 
 
338 HABIT-FORMING DEUGS 
 
 poor-working minds tell them it is better to fly the ills they have and take 
 what comes. 
 
 The cocain fiend, when in his drug, is able to forget, and that is about 
 all that can be said in its favor. There is none of the grandeur of alcoholism 
 or the dreams of morphinism or the fantasies of hasheeshism. No literature 
 or anything else has ever been produced by the "coke" in his drug. He is 
 negative, that's all. Deprived of his drug he is as free from any conception of 
 rights of property and morality as is the opium fiend and nearly as free 
 from any conception of the right of life as is the man suffering from acute 
 alcoholism. 
 
 Therefore, whether you look on the one side or the other, the "coke" 
 addict does not present an attractive picture. 
 
 We quoted Dr. Crothers as saying that one-third of the opium is used 
 for legitimate purposes. Not one-thirtieth of one-third of the cocain is 
 so used. 
 
 What can be gained by warning against the careless use of cocain is 
 small, as compared with the use of morphin. Nevertheless, some people 
 get the habit through carelessness. Asthmatics and hay fever sufferers 
 are in some danger. Snuffs, sprays, and cures sometimes contain cocain. 
 Occasionally a physician will prescribe it. 
 
 Again — no circumstances warrant the medical use of cocain. Its surgical 
 use is never warranted, except for a definite operative procedure. 
 
 Can a cocain fiend be cured? Yes, it is one of the easiest of all habits 
 to cure while under treatment. The method is as follows : 
 
 Confinement is necessary. The man deprived of his cocain will probably 
 become delirious. He may become maniacal and definitely insane. He may 
 develop a tendency to run amuck and kill and destroy. He must be under 
 close, compelling control. He should have very free, in fact excessive, 
 purgation. For his nervousness he may have morphin or other sedatives at 
 the discretion of his physician. After two or three days the drugs will 
 be out of his system. He will be freer from craving for drug than the 
 man just cured of the alcohol habit or the morphin habit. 
 
 The cocain fiend is the craziest of all fiends when his drug is first 
 withdrawn. He loses his craving quicker than does any other fiend. But, alas, 
 he is most apt of all fiends to resume his habit. 
 
 He was a neurotic before he began the use of the drug. Having been 
 cured of his drug habit, he is still a neurotic. He is very apt to dig up an 
 excuse for again becoming a fiend. 
 
 Cocain Habit. — W. O'D. writes: "1. Is there any cure for the cocain 
 habit? 2. Is a person so addicted and having a violent temper liable to do 
 anyone injury? 8. Kindly give me the name and address of a journal 
 on nervous diseases" 
 
 Reply. — 1. Yes; sanitaria for the cure of drug habits cure the cocain 
 habit sometimes. Of all habits it is about the most difficult to cure perma- 
 nently. 
 
 2. Yes. 
 
 3. Journal of Nervous and Mental Diseases, published in New York 
 City. 
 
 Do Not Use Cocain. — Miss C. writes: "In your article on insanity last 
 
THE ALCOHOL HABIT 339 
 
 Sunday you referred several times to cocain. I am troubled with hay 
 fever, and for a number of years I have been talcing treatments each season 
 from a physician who uses each day a spray in my nostrils containing 
 cocain. He also gave me some to take home, to use when my 'nose is 
 stuffed' He did not tell me it was cocain until I asked him as I had heard 
 it was harmful, and I found I had to use it more often each year, and on 
 dusty days as well as during the hay fever season. The doctor assured me 
 there was no harm or danger so long as I used the 'pure drug.' He said 
 there is no such thing as the 'cocain habit/ It is the 'morphin habit' that 
 is bad. He says anyone can easily stop using cocain if he wishes to. Are 
 his statements correct? The spray is so soothing that I do not wish to stop 
 unless it is harmful." 
 
 Reply. — The most dangerous of all habits is the cocain habit. Do not 
 use cocain regularly, regardless of who tells you to. Stop the spray. 
 
 THE ALCOHOL HABIT 
 
 The alcohol habit is much more appealing than the other habits. It 
 narcotizes certain adverse impulses, puts "bogies" to sleep, and infuses "Dutch 
 courage." There are certain mental attitudes and certain types of mind 
 that are harmonized into greater effectiveness by it. 
 
 While I cannot see why cocain should tempt anyone, I can under- 
 stand why even a fairly smart man could be lured "into the marsh" by 
 alcohol. It is much easier to escape its clutches than it is to get loose 
 after opium has you. This point is no mean factor, as a large part of the 
 "addicts" genuinely feel that they can break away when they get ready. 
 Some of them do. Most of them could, but they never get ready. Some of 
 them suffer from an egomania due to alcoholism. Their drink makes them 
 weak minded, and, at the same time, gives them an exaggerated idea of their 
 power over themselves. 
 
 A man with the alcohol habit is a sick man, however much he may 
 think to the contrary. He is mentally sick. He may have inherited a 
 mental make-up which makes it strongly probable that he will be a drunkard, 
 or it may be the fault of bad social training. Usually, however, the disease 
 develops as the result of what it feeds on. The man's mentality becomes 
 perverted through chronic alcohol poisoning. 
 
 Alcohol has fuel value, but no food value. Its poisonous qualities over- 
 shadow its fuel value. It has no toxin neutralizing power. It is no longer 
 used by well informed people for snake bite, or consumption, or blood poison- 
 ing. Where it is a question of keeping a person alive for, say, four hours 
 in some crisis disease, its use may be justified, but to keep a patient upon it 
 for days or perhaps weeks in typhoid or pneumonia is unwise. Even as a 
 stimulant, aromatic spirits of ammonia is better. 
 
 There is mighty little, if there is any, place for alcohol in medicine. 
 But alcohol as a medicine is not an important source of drunkenness. 
 Drunkards are made by the drink which is taken because it makes one feel 
 good. 
 
 The harm of addiction to headache powders is pretty nearly limited to 
 the habitue. Alcohol is different. A pebble dropped into the water causes 
 a ripple that affects the entire mass. The alcohol habit ripples out, affects 
 
340 HABIT-FORMING DRUGS 
 
 the family, and then society. The crimes of alcoholics are crimes against 
 society. 
 
 The drug end of cures does not amount to a row of pins. Just as whisky 
 affects the mind of the drunkard and the lives of those around, the cure of the 
 habit is mental and social. The drug end of "jag" cures is a minor detail. 
 The items which count are suggestion and mental training followed by proper, 
 continuous, and sustained social help. 
 
 WHISKY AND HEAT 
 
 The scene was a sleeper on a Frisco train between Memphis and Birming- 
 ham. It was 11 o'clock on a hot morning in June. The thermometer 
 had registered over 90 for several days. A fairly fat passenger sat in the 
 smoking compartment. He was in his shirt sleeves. By taking things easy 
 he managed to keep fairly cool. When the train stopped at Tupelo he 
 bought a lunch from a basket. 
 
 "Do your sandwiches contain a whole chicken apiece?" he asked. 
 
 "Some of them have a half chicken," was the reply. 
 
 "Then give me one with half a chicken in it." 
 
 He bought his lunch and returned with it to the smoking compart- 
 ment. , 
 
 The "butch" came along and sold our fairly fat friend a bottle of 
 a non-alcoholic beverage. He opened his grip; took out a full quart 
 of whisky; poured three fingers into a cup; filled the cup with the pur- 
 chased beverage, and drank it down. He offered me a pull at his bottle. I 
 declined. 
 
 He ate his lunch, including the half a chicken. Then he began to sweat, 
 and the sweat fairly rolled. In half an hour he was as hot as a broiled 
 lobster, and as wet as a dishrag. 
 
 Now, why did he do it? He was not on a jag. He did not have a 
 "still on." His mind was as clear as a hell. He knew what he was doing. 
 It was not sociability, or to he a good fellow, or to he swagger. He did it 
 because it was coming lunch time and he was of the opinion that a nice little 
 drink and a lunch would make him happy, comfortable, and contented. His 
 judgment was poor, and he paid the price. 
 
 To drink whisky on a hot day is like throwing kerosene on a fire. 
 Within a few minutes the whisky was circulating in his blood and burning 
 to form heat. Furthermore, it was sending the blood into the skin, and 
 an excess of hot blood in the skin makes one feel hotter than he is. Whisky 
 cannot make anything but heat and energy, and, when a man sits quietly 
 in a sleeping car, all of the whisky goes to heat. Then he added the meat 
 lunch. 
 
 There are those who claim that the act of digesting makes heat. The 
 best opinion seems to be that, while the act of digestion does not of itself 
 produce heat, in the process of digestion foods, especially meats, immediately 
 liberate some heat. At any rate, after eating the amount of heat made 
 by the body increases. 
 
 This man had to spend some hours in that hot car. He should have 
 figured on how to keep cool. He could not get any exercise except the exercise 
 
THE ALCOHOL HABIT 341 
 
 of breathing, sitting up, and a few similar acts. He needed little food to 
 repair waste. He 'certainly needed no whisky. 
 
 Had he been a man of good judgment he would have gone without his 
 noonday meal or eaten an apple or orange and drunk a lemonade. He would 
 have drunk about six glasses of water between breakfast and supper. By 
 following that plan he would have had a comfortable ride. 
 
 RULES FOR GETTING DRUNK 
 
 Mike, my Italian fruit peddler, told me some time ago that when the 
 former mayor of Chicago was defeated at the primaries he, Mike, celebrated 
 by getting drunk. He said, furthermore, that if a certain candidate were 
 elected in April he proposed to celebrate that victory by getting drunk. He 
 had already put aside ten dollars for the purpose. 
 
 If a fellow feels that he must get drunk he might as well go about 
 it in the right way. The early spring is a bad time to go at it in the wrong 
 way. Pneumonia is liable to follow a March-April drunk, and the natural 
 sequence of drunk pneumonia is death. 
 
 Now, the Mikes I know are good people. Their families need them, 
 and I need a fruit peddler. Therefore I am going to lay down some rules for 
 planned drunks. 
 
 He should prepare for a drunk by taking a purge. 
 
 He should not get drunk when he has a cold. It is not safe to go on 
 a drunk even if the aching stage of the cold has passed and nothing is left 
 but a hard cough. 
 
 He should rest up for a day before starting in, or, to put it another 
 way, not get drunk when tired. Great fatigue lowers resistance against the 
 pneumonia germ, and one resistance lowerer is as much as a man should 
 stack up against. 
 
 He should eat from time to time while he is drinking. 
 
 He should drink only in clean, well-ventilated places. To hang around 
 a hot stove in a close room with a sawdust sprinkled floor, drinking booze, 
 is to hang out the "Welcome" sign to pneumonia germs. 
 
 Before his brain quits working he should arrange a place in which to 
 spend his unconscious period. It should be a cool, well-ventilated room. It 
 is necessary that he should not be chilled through, and therefore he must 
 provide bedclothes enough. It is just as necessary that he should not be 
 overwarm; therefore he must raise a window. 
 
 He will save inconvenience and trouble and lessen his danger if he will 
 vomit before he falls off. The disposition will be present. All he needs 
 to do is to let it come up. 
 
 When he wakes up he will have a headache, a dark brown taste, and a dry 
 cough. His first act should be to take a purge; a second dose within that 
 first twelve hours is advised. One should be a dose of calomel or some com- 
 pound cathartic pills; the other can be a saline. He should drink freely of 
 water, carbonated and plain. He should take one dose of headache medicine. 
 This should not be repeated. 
 
 It is time now to take some nourishment — a glass of milk, a cup of clam 
 broth, and a cup of coffee; then a package of chewing gum. 
 
342 HABIT-FORMING DRUGS 
 
 He should wrap up well and get some exercise in the open air. 
 
 He should take no medicine for his cough. When the purge acts 
 well his cough will go. 
 
 He will feel "all shot to pieces" and his natural impulse will be for 
 a bracer. The bracer he craves may be ale or sour beer or whisky. He 
 should cut out his bracer. A cup of coffee or a pint of milk will serve him 
 better. 
 
 Periodic Drinkers. — S. B. writes : "I have a friend 30 years old who is a 
 periodic alcoholic. He has taken two liquor cure treatments, hut was re- 
 lieved for only a short time. The attacks, which at first were several 
 months apart, are becoming more frequent. What is the best treatment 
 for this trouble?" 
 
 Reply. — There is nothing left to try but religion. A strong dose of 
 that may save him. Periodic drinkers are mentally wrong. These cures 
 nauseate and disgust and then clean out the alcohol, which steps simply 
 clear the decks, clean off the ledger, or any other way you want to put it. 
 Then comes the real treatment in such cures. It is applied psychology or 
 the use of fear, shame, disgust, hope, family love, pride, and finally deter- 
 mination and grit. What is being worked out is training of will. Often 
 the combination succeeds; often it fails. If a man is capable of being 
 powerfully gripped by religion, he can shortcut quickly from condition to 
 cure. If a man is so made up mentally that he cannot be reached in any • 
 of these ways, he cannot be cured. Some day the community will perma- 
 nently detain the incurable periodic alcoholics. 
 
 Whisky and Alcohol. — M. H. F. writes: "A few weeks ago I was called 
 to the country to see a patient whom I found in a state of collapse. I felt 
 the necessity of using an alcoholic stimulant in the case, but had neither 
 whisky nor brandy with me. I had, however, a small bottle of grain alcohol 
 and used that properly diluted. A few days ago the question arose as to 
 whether the use of diluted alcohol by an habitual drinker would be more 
 harmful than the same amount of whisky, the percentage of alcohol being 
 the same. I find that the impression, even among the medical men, is that 
 alcohol, no matter how pure it may be, is much more harmful than good or 
 even common grades of whisky. What is your opinion?" 
 
 Reply. — Alcohol diluted to the percentage of the alcohol contained 
 in whisky is no more harmful than whisky. The alcohol contained 
 being the same, the effect for the various purposes is only a matter of 
 quantity. 
 
 Aromatic spirits of ammonia is generally used now for a diffusible 
 stimulant rather than whisky or other forms of alcohol. Emergency kits 
 and ambulance and hospital equipments have nearly all been changed in 
 this particular. 
 
 Drink Habit. — Mrs. J. G. S. writes : "Is the drink habit a disease, and 
 can it be cured by some treatment which can be taken in the home? If not, 
 what treatment would you advise?" 
 
 Reply. — It is a disease. Sometimes it can be cured at home. Fre- 
 quently, it is necessary for the patient to stay in an institution until he has 
 got his nerve back. Most drinkers are neurasthenics and need some mental 
 upbuilding to be cured so as ito stay cured. 
 
SMOKING 343 
 
 Cures for Liquor Habit. — E. R. writes: "I am S2 years old and a 
 heavier drinker than I care to be. Do you advise the Keeley cure, the Neal 
 Institute, or the Gatlin cure? What is the difference in treatment of the 
 three? Are there undesirable physical effects, or any physical effect other 
 than the quenching of a thirst for alcohol?" 
 
 Eeply. — As these treatments are secret, it is impossible to answer sev- 
 eral of your questions authoritatively. My opinion is that the basis of 
 practically all treatments is to stimulate elimination and to provoke nausea 
 or disgust with alcoholic beverages. To do this drugs are employed. After 
 these ends have been accomplished the next step is to build up the determi- 
 nation to quit. I am sure this important part of the treatment is psychic. 
 Therefore residence in an institution where one is thrown with people who 
 are determined to get well and who are getting well is of great advantage. 
 The longer this psychic treatment is continued the surer are the results. 
 I do not believe there are any harmful or undesirable physical effects. 
 
 SMOKING 
 
 The use of tobacco does no good. Therefore, there is no reason why 
 any person should plan to use it. Used in small amounts by grown persons, 
 it does no harm, and, accordingly, there is no reason why any adult should 
 not use it in moderation if he so desires. It is just as useless and just as 
 harmless to women as to men, and, therefore, there is no physical reason 
 why women should or should not use it. There is no more logic in 
 different tobacco standards for the sexes than there is in different morality 
 standards. 
 
 Heavy lasers of tobacco excrete it from all parts of their bodies. This 
 means that every cell in their bodies is bathed in the products of tobacco. 
 The cells of matured tissues will stand a great deal of this, and for a 
 long time, before plainly diagnosed harm is apparent. The tissues in which 
 harm is most apparent are certain nervous elements. 
 
 Tobacco blindness is due to degeneration and final destruction of the 
 optic nerve. Tobacco heart is a term applied to a heart which is irritable. 
 It is the result of degeneration of the heart nerves. 
 
 Tobacco juice in the mouth is not an antiseptic. It does not hill germs 
 nor keep the tonsils or teeth clean. The same is true of tobacco smoke. 
 
 Tobacco users are usually spitters, and thus, indirectly, harm is done. 
 
 There are those who believe that they can sit down and think more 
 deliberately and with better judgment when smoking than when they are 
 not. There is nothing in the effect of tobacco which is responsible for this 
 difference. It is suggestion, a psychological phenomenon. Nevertheless, 
 to them it is a fact which cannot be questioned. 
 
 There is no more harm in cigarettes than cigars or pipe tobacco. In the 
 main, the tobacco in cigarettes is not of a high grade. No chemicals are 
 mixed with it except a small percentage of glycerin. As it is a light smoke, 
 there is a greater disposition to inhale than when cigar or pipe smoking 
 is indulged in. 
 
 The main objection to cigarettes is that they especially appeal to boys 
 with immature, impressionable tissues and with habits in the forming. There 
 
344 HABIT-FORMING DRUGS 
 
 are very grave objections to the use of tobacco by children and youths. This 
 forms the strongest argument against cigarettes. 
 
 This is about as judicial a weighing of the tobacco question as we can 
 write. Young people should not smoke. Cigarettes should be discouraged, 
 because of the moral effect on young people. 
 
 Women have as much right to smoke as men. There is no reason 
 why anybody should smoke. There is no reason why the average adult 
 should not smoke if he wants to. 
 
 When a smoker is becoming nervous or has an irritable heart or is 
 going blind he must stop or pay the penalty. 
 
 Tobacco and Capacity. — Dr. D. S. Hager writes that Dr. Evans has not 
 studied the tobacco question, else he cannot understand why he, as a physi- 
 cian, is not absolutely opposed to it. The immediate effect is nausea, 
 vomiting, depression, and sometimes unconsciousness. The chronic effects 
 are high blood pressure, arteriosclerosis, and sometimes apoplexy. Dr. 
 Carjaval has written a book telling of the harm which tobacco does to 
 Mexican youths. This book, issued by the Interior Department of the 
 Mexican government, was recently reviewed in the Journal of the Ameri- 
 can Medical Association. He says that the habit is acquired through ex- 
 ample, and no man should lightly do that which his neighbors will ape him 
 in to their detriment. 
 
 Reply. — There is truth in Dr. Hager's criticism. Any man who steeps 
 himself in tobacco will be harmed materially. The man who takes a mod- 
 erate amount will be harmed a little. 
 
 Athletes* in training are never allowed to use tobacco. No man who 
 expects to be called on to use 100 per cent of his capacity is justified in 
 using tobacco. The athlete making a jump which requires all his muscle 
 power should not use it. The runner who is going to use up every ounce 
 of stamina in a mile race should not touch it. 
 
 Ordinarily, however, heart work, kidney work, muscle work is done 
 on about 10 per cent of capacity, and 90 per cent is held in reserve — the 
 principle which has been economical in the use of boilers. 
 
 For the purposes of the man who is running under low pressure the 
 moderate use of tobacco does no harm. To work under high pressure is 
 worse than using tobacco. 
 
 Whenever disease has knocked down capacity until the margin of re- 
 serve is about used up tobacco in moderation is harmful. The point about 
 example is well taken. 
 
 Not Justified in Smoking. — N. S. C. writes: "Will you kindly write 
 about the ill effects of cigarette smoking, especially upon a man of 25, 
 broken down in health after an attack of pleurisy two years ago and then 
 sent to Colorado, where the lungs improved? When better he resumed 
 smoking cigarettes against his physician's advice, and has great throat 
 trouble now. Is very thin, only weighing 120 pounds, though six feet tall. 
 His father died of tuberculosis. He has a wife. Does not drink and has 
 ability to work; only needs health. Cigarette smoking is undermining 
 this." 
 
 Reply. — A moderate amount of cigarette smoking does not materially 
 harm a full-grown man in good health and living well within his physical 
 
SMOKING 345 
 
 powers. If it gives him pleasure the harm done will not be enough of a 
 disadvantage to offset it. But cigarette smoking does harm to: 
 
 Boys and young men who have not attained their physical stature. 
 Particularly does it harm adolescents. 
 
 Athletes or anyone who must at times use his heart muscles or other 
 muscles to their full capacity. 
 
 Nervous people, particularly those with nervous hearts. 
 
 A man who has broken down from pleurisy, weighs 120 pounds, and 
 is six feet tall, has had to go to Colorado for his lungs, who has a tubercu- 
 lous family history, is not justified in smoking. 
 
 Giving Up Tobacco. — Repentant writes: "I am 66 years old and in 
 fairly good health. I was married at 20. I have chewed tobacco ever 
 since I was 21. I smoke a pipe a great deal. My wife, a refined woman, 
 has always seriously objected and felt I wronged her and the babies by 
 polluting the air they were compelled to breathe, and she has felt disgust 
 for kisses from tobacco lips. In fact, tobacco has seriously marred our 
 otherwise happy life. My daughters feel humiliated and ashamed of their 
 old dad, and I am ashamed of myself, and would like to do one decent thing 
 before I die and quit. Can I quit with safety? Will it impair my health 
 or shorten my life? I want to quit, but am afraid my will power will not 
 carry me safely through. Is there anything that will help me? Do I need 
 a tonic? How long will it take to get the nicotin out of my system? 
 Will my brain ever be as clear and quick as though I had not used the 
 weed'?" 
 
 Keply. — 1. Yes. 
 
 2. No. Assuming that you are a tobacco fiend, continuing your habit 
 may impair your health and shorten your life. Stopping will not. Those 
 habit cases which show impairment after stopping were impaired by the 
 drugs and not by the absence of them. 
 
 3. All habit cures operate through the mind. You will succeed, if you 
 have confidence in your success and determination enough to put up with 
 the inconvenience while you are ridding yourself of the habit. 
 
 4. Your physician must decide that. 
 
 5. Practically speaking, you will have the "nicotin" out of your system 
 in, say, three days. It will take some weeks, say two, for your poisoned 
 nerves to get back their normal chemistry. You will be months getting 
 your habits readjusted on a non-tobacco basis. 
 
 6. The good effects of tobacco on the mind are the results of suggestion. 
 As an illustration : The man who takes a pipe composes himself and thinks 
 calmly; does it, not by reason of any medicine, but because of autosug- 
 gestion. He has trained himself to the routine pipe — calm thinking. 
 If, when he stops smoking, he retrains himself to the same degree of 
 efficiency by using some other method of suggestion, his brain will work 
 satisfactorily. Quitting and getting on a new basis are both up to the 
 man. 
 
 Woman and Tobacco. — M. L. writes : "Is cigarette smoking harmful to 
 a woman s health? If so, how? Do you consider smoking among women a 
 sign of degeneracy? Could one or two cigarettes a week bring injurious 
 consequences in the future, either for oneself or one's children?" 
 
 Reply. — 1 and 2. The degree depends on the woman's age and the num- 
 ber smoked. If she is mature and the number smoked is not excessive, the 
 
346 HABIT-FORMING DRUGS 
 
 • 
 habit will decrease her capacity for extreme sustained exertion, but as the 
 smoking woman is usually a loafer, she will not be troubled. If she is im- 
 mature it will harm her more. If she is a fiend it may give her tobacco 
 heart or tobacco blindness. 
 
 3. No. 
 
 4. The only injurious consequence in the future will be an increase of 
 the habit, almost to a certainty. It will have no effect on the progeny. 
 
 Should Stop Smoking. — W. J. writes: "I am a hoy 17 years old. I 
 weigh 145 pounds and my height is 5 feet 10 inches. I had acute inflam- 
 matory rheumatism last winter, and I was unable to use my right arm for 
 eight weeks. I find when the weather is damp it troubles me now. I smoke 
 cigarettes, sometimes two packages a day. I also smoke cigars. I am in- 
 clined to be round-shouldered. I do office work. Will smoking weaken my 
 lungs and heart, or what effect does it have on rheumatism, if any? I am 
 also troubled with nose bleed. What exercise would increase my chest 
 measurement?" 
 
 Reply. — There is not much use in talking about exercises to increase 
 the chest measure to a boy of 17 who smokes two packages of cigarettes 
 and some cigars a day. The do-as-I-please-regardless frame of mind is 
 pretty well established. But here goes. 
 
 Your rheumatism comes from, your tonsils, teeth, gums, or nose in all 
 probability. Go to your physician and have that attended to. It is certain 
 that he will tell you to stop smoking. Then go to a gymnasium and have 
 them put you to work at climbing, chinning, and bar exercises to develop 
 your back muscles. They will also tell you to stop smoking. 
 
 Quit Smoking. — Reader writes: "A friend who has neurasthenia has 
 quit smoking, but, of course, still has the desire to smoke again. He has 
 tried several times, but it seems to make him nervous; he can smoke out' 
 side with apparently no ill effects, but when he smokes in the house or 
 office it makes him nervous, although he believes that he brings it upon 
 himself more than the cigar does. 
 
 "The trouble seems to be all in his throat, chest, and back of his neck; 
 he feels 0. K. but for the occasional worries and moods that make one who 
 has neurasthenia so miserable. 
 
 "Do you think that three cigars a day would harm him and do you 
 think they would tend to make him worry more?" 
 
 Reply. — As I understand your description, your friend is a neuras- 
 thenic who is nervous over trying to make a decision whether to smoke or 
 not, and he is nervous whether he smokes or does not. It seems to me that 
 he is suffering from the typical indecision of the neurasthenic. When 
 he definitely decides and .quits thinking about it his nervousness will 
 end and that without much regard to whether he decides to smoke or 
 not to smoke. 
 
 The wise policy for your friend is to decide not to smoke — to decide 
 it once for all and quit thinking about it, whereupon his worries will 
 end. . 
 
 Neurasthenics have no business tampering with drugs. Tobacco is a 
 drug. 
 
 Tobacco Stunts Growth. — Mrs. H. M. C. writes: "Please inform me 
 whether smoking a pipe or cigar, when about 16 years old, will stunt one's 
 growth. What other effect is possible?" 
 
SMOKING 347 
 
 Keply. — 1. Yes. 
 
 2. May cause nervousness, nervous heart, cough, indigestion, and to- 
 bacco habit. 
 
 Cigarettes of No Benefit. — B. C writes: "Please advise a cigarette 
 smok&r of years the reason and remedy for quitting it. Can it he done 
 without much physical discomfort? 
 
 Reply. — Cigarette smoking does nobody any good. Many who smoke 
 cigarettes never feel the harm done; others do. To quit requires grit. 
 
 Inhaling Smoke. — R. W. H. writes: "I. Kindly explain the harmful 
 effect on the lungs of inhaling tobacco smohe. 2. Also please state the 
 amount of nourishment in bananas." 
 
 Reply. — 1. The harmful effect is not exerted on the lungs. The warm 
 smoke unduly dries the upper breathing apparatus, but not the lungs 
 proper. The harmful effects of tobacco are exerted especially on the nerves. 
 The nerves most frequently affected are those of the heart. 
 
 2. We eat about two-thirds of the banana. About one-quarter of what 
 we eat is sugar and starch. As a food it compares fairly well with potatoes. 
 
 Smoking Harms Sight. — T. L. J. smokes pipes and cigars and inhales 
 the smoke. He wishes to know if it harms the sight. 
 
 Reply. — Excessive smoking may harm the sight. It is an occasional 
 cause of blindness. Careful eye specialists can detect the effects on the 
 eyes of tobacco excess. Generally cases of partial tobacco blindness begin 
 to improve within two weeks after the drug is stopped. 
 
 Will Alone Suffices. — J. W. J. writes: "When about 12 years of age I 
 began smoking cigarettes and continued to do so until I was 22 or 23, 
 at which time I substituted a pipe and strong tobacco. Since then, ten 
 years ago, I have begun chewing also. I now chew and smoke strong 
 tobacco. I have both the will power and inclination to quit the use of 
 tobacco, but fear to do so without first taking something to rid my system 
 of nicotin. Would it be harmful to quit abruptly without taking anything 
 to rid my system of nicotin?" 
 
 Reply. — If you have the will power to quit, quit. Your system will 
 take up the job of ridding you of nicotin. It has been doing it, and it is 
 well trained by now. It will not be harmful to quit abruptly. The will 
 power's the thing. If you have that, you need use nobody's remedy. 
 
 Chewing Tobacco. — J. H. K. writes : "I know a man who chews tobacco 
 without spitting. He has poor eyesight. Otherwise he appears to be in 
 normal condition. Is it likely that there is any connection between his 
 habit and the condition of his eyes? If so, in what way does the effect 
 reach the eyes; and what is likely to be the effect on the general 
 health?" 
 
 Reply. — The man probably chews slowly, and some of the juice is swal- 
 lowed and some absorbed. I do not know whether or not his poor eyesight 
 is due to his habit, but the use of tobacco frequently impairs the sight, 
 and sometimes causes blindness. The tobacco solution gets into the blood 
 and is carried to the different tissues in the body. The tissues are able 
 to stand a pretty good dose of it. It acts especially on the nerves. The 
 
348 HABIT-FORMING DRUGS 
 
 optic nerve carries sight impulses from the eye to the brain. Sometimes 
 tobacco causes this nerve to degenerate, and, rarely, it causes blindness 
 through atrophy of this nerve. 
 
 Tobacco and Weak Heart. — E. W. S. writes: "1. Would 5 cents' worth 
 of chewing tobacco a week be injurious to a person with heart leakage? 
 2. Is a person with a weak heart liable to be troubled with insomnia? 3. Is 
 a person with a weak heart apt to be troubled with nervousness? Jf. Should 
 a person with heart leakage take much exercise, and what kind is best? 
 5. Which is more injurious, smoking or chewing tobacco? 6. Would one 
 or two glasses of beer daily be injurious to a person with a weak or 'leaking' 
 heart r 
 
 Reply. — 1. No. 
 
 2. No; not until heart asthma comes on. 
 
 3. No; not particularly. 
 
 4. A person with a leaking heart valve must take enough exercise to 
 keep his muscles strong. He needs individual medical counsel. . 
 
 5. Generally smoking, though it depends on the quantities consumed 
 and the habit as to inhaling. 
 
 6. No. 
 
 Tobacco Heart. — A. M. S. writes: "I am 32 years old and have the 
 appearance of being in the best of health. I have a good appetite but have 
 suffered with rheumatism nearly fifteen years. During the day my heart 
 beats at least 100 times a minute. I smoke a lot, but when I was not 
 smoking I was in the same condition. I also have pains at my heart. I 
 drink a lot of water and this seems to make me feel better. I seldom use 
 strong drink." 
 
 Reply. — Any man whose heart beats 100 should have an examination 
 by a physician capable of discovering the reason why. My guess is tobacco 
 heart, but this is only a guess. If you will quit smoking, quit drinking 
 strong drink, and eat less, you should lose some flesh. Slow up your pulse 
 and have less of what you call rheumatism. 
 
 Tobacco and Hearing. — D. 8. H. writes: "As a specialist on the ear, 
 nose, and throat, I am thoroughly convinced that an enormous amount of 
 damage is done by constant irritation to the pharynx, and therefore to the 
 eustachian tube. In fact, I am convinced that if the irritation from ton- 
 sillar inflammation, bad teeth, and the irritating effects of tobacco were 
 eliminated, men and women would retain their hearing much longer and 
 have a better quality of sound perception. I helped to examine 7,000 train- 
 men on the Sante Fe railway two years ago for sight, color sense, and 
 hearing. I was told beforehand that trainmen, from the noises they 
 were subjected to, had bad hearing, but after this examination I 
 was compelled to think that the aforementioned causes had more to 
 do with the loss of hearing in these men than had ever been thought of. 
 Illustrating: Nearly every man whom I examined, no matter how long 
 in the service, if he had good, clean teeth and was a non-user of tobacco, 
 had good hearing, while the reverse was true of the chronic conditions 
 from either bad teeth, bad tonsils, or tobacco irritation. It is not an infre- 
 quent occurrence to have patients in the specialist's office with sore throat 
 that can immediately be attributed to excessive tobacco irritation." 
 
 Graving That Persists. — J. W. R. writes: "Will you please tell me 
 about how long one must abstain from the use of tobacco in order to cease 
 
SMOKING 349 
 
 craving for it? I began smoking at 17. At 27 I left off entirely for four 
 years. At 31, still craving the drug, I resumed smoking and have smoked 
 ever since. I am now 51." 
 
 Reply. — The kind of craving you had would not stop in 100 years, 
 assuming that you kept going that long. When one stops the use of a drug 
 the cells affected by that drug cry out. It is a species of hunger. In a 
 few days, say two weeks at most, that craving has passed. 
 
 The craving that persists is a form of mental unrest. It is not a crav- 
 ing for tobacco especially. It is a form of mental perversion which calls 
 for something, some drug maybe, and, if so, any other drug will answer, 
 or any habit. You are 51. Be a man. 
 
 Danger from Cigars. — W. T. N. writes: "Will you kindly state whether 
 there is much, if any, danger of disease being transmitted through the 
 putting of cigars in one's mouth?" 
 
 Reply. — Some cigarmakers still practice the nasty habit of shaping 
 the cigar end by moistening and rolling it between their lips. Again some 
 smokers put their cigars in their mouths and then clip the end with the 
 cutting machine. The next man does the same thing. In this way the 
 cigar cutter may become a source for the spread of disease. 
 
 Cigarette Habit Cure. — R. T. B. writes: "Will you kindly advise where 
 Dr. Kress's cigarette cure can be purchased? If it is not on the market, 
 please publish the prescription. I am sure it would do much more good in 
 this manner than that in which it is being tried out now in the anti- 
 cigarette crusade." 
 
 Reply. — The treatment is as follows : 
 
 "The mouth wash calls for six ounces of silver nitrate solution, one- 
 eighth to one- fourth of 1 per cent. Use as a mouth wash after each meal, 
 not to exceed three days ; then after breakfast only for not more than four 
 days. Do not swallow any of the solution. 
 
 "Chew gentian root (not the powder) whenever the desire for smoking 
 appears. Gentian root is slightly tonic and an aid to the digestion. It 
 may be used for several weeks without injury. 
 
 "The diet for the first two weeks consists exclusively of fruits, well- 
 baked cereal foods, and milk. The moderate use of nuts, well masticated, 
 is of value. At the close of each meal use fresh, slightly acid fruits, such 
 as peaches, pears, apples, pineapples, etc. Drink sweet milk, buttermilk, 
 malted milk in place of coffee, tea, or cocoa. 
 
 "In some special cases an entire milk diet for a few days may be bene- 
 ficial, especially if there exists an irritable stomach, bordering on ulcera- 
 tion, with excess of hydrochloric acid. Where the digestion is slow and 
 there is a deficiency or absence of free hydrochloric acid, a diet composed 
 entirely of fresh fruits for a day or two preceding the grain, fruit, and 
 milk diet, may be of benefit. 
 
 "Baths, preferably the Turkish bath, will assist in rapidly getting rid 
 of stored-up nicotin. As a rule, it takes from three to six weeks to elimi- 
 nate entirely the desire for tobacco. The time depends upon how closely 
 the directions are followed." 
 
 Use of Snuff. — 31. B. writes: "Has the use of snuff any effect on one' 
 health or nervous system? 
 
 ,-)!> 
 
350 HABIT-FORMING DRUGS 
 
 Reply. — The use of snuff is one of the mild vices of mankind. The 
 habit is not a commendable one. Moderately used, it is not positively in- 
 jurious. The catarrh snuffs frequently contain cocain and are therefore 
 highly injurious. 
 
 COFFEE 
 
 Coffee is a drug. Those who are addicted to its use are drug addicts. 
 The people of the United States are among the largest users of coffee of all 
 the people of the world. Its use is on the increase. 
 
 From the standpoint of public hygiene the coffee question is worth while. 
 It is much the most widespread form of drug addiction. Some people are 
 certain that coffee is of service to them. Some are equally certain that it 
 harms them. Many are much interested, though they are in doubt as to 
 whether it benefits or harms them. The largest number enjoy their cup of 
 coffee, and they care not at all whether ii^ harms them. From the standpoint 
 of individual hygiene the coffee question is worth while going into very care- 
 fully. 
 
 Two-thirds of the coffee entering the markets of the world comes from 
 Brazil. That country exports twenty times as much coffee as the Dutch 
 East Indies, the coffee from which is commonly called Java. Little coffee 
 is exported from Arabia, and practically none from the small Mocha district. 
 Of the small amount of Arabian coffee exported the best goes to Turkey and 
 Egypt, near-by markets. 
 
 The world's use of coffee per year amounts to about 16,000,000 bags. In 
 fact, the disposition to overproduce in Brazil is so strong that the govern- 
 men exerts itself to maintain the price of the berry. 
 
 The only approximately accurate figures on the use of coffee we have 
 are those for the United States, the countries of western Europe, and Australia. 
 The people of Holland in normal times use about fifteen pounds of coffee 
 per capita a year. Norway and Sweden follow, each using about fourteen 
 pounds. The per capita use by the people of the United States is twelve 
 pounds. The German people use about seven pounds, and the British, 
 Canadians, and Australians about one pound. 
 
 Some of the peoples use tea instead of coffee. Probably the Chinese and 
 Indians are the most inveterate tea drinkers, but there is no way of know- 
 ing the per capita use of the drink by these peoples. The New Zealanders, 
 Australians, and nations composing the United Kingdom are the heaviest 
 users of tea. They consume more than 6.5 pounds per person. The Canadians 
 use 4.3 pounds; Hollanders, 1.45 pounds; Russians, .94 pound; Americans, 
 .89; Germans, .11; and French, .06. 
 
 Tea contains about twice as much caffein as does coffee. By multiplying 
 the per capita amount of tea by two and adding it to the pounds of coffee, we 
 get a fair idea of the relative use of caffein-containing beverages by the 
 races for whom we have statistics. 
 
 We find that the Hollanders lead with seventeen pounds. They are 
 followed by the Swedes and Norwegians. Next comes a group composed 
 of the people of the United States, the British, including English, Scotch, 
 and Irish, and the Australians. Their rate of consumption is around fourteen 
 
COFFEE 351 
 
 pounds. The Canadians use nine and six-tenths pounds. The Germans use 
 about seven, and the Russians about four. 
 
 Legends tell us that the Chinese used tea 8,000 years before the birth of 
 Christ. Europeans began to use it in the sixteenth century. In the seven- 
 teenth century its use in England was fairly well established. By the eight- 
 eenth century the English people were using it at one-third the per capita 
 rate now prevailing. 
 
 For centuries governments have always exerted themselves to promote 
 the traffic in tea. During the 5,000 years prior to the time when trading 
 and plantation companies, backed by government grants, strove to develop the 
 planting and merchandising of tea, its use as a beverage seems to have been 
 limited to rather a small part of the Chinese people. 
 
 On the other hand, coffee has had its troubles. The legend is that the 
 use of coffee was discovered in Abyssinia. A flock of sheep which fed on 
 coffee berries was wakeful and restless at night. After a while these coffee 
 jags attracted the attention of one shepherd after another, and presently 
 some of them investigated the cause and tried the berry. 
 
 The Arabians began the use of coffee before the fifth century. Its 
 use was becoming so general in the time of Mahomet that the Koran pro- 
 hibited its use. 
 
 Hollingworth, who in 1912 published the best study of the effects of 
 caffein which has come to my attention, says that the average cupful of hot tea 
 (five fluid ounces) contains one and five-tenths grains of caffein. An after- 
 dinner cup of black coffee (two fluid ounces) contains one and five-tenths 
 grains of caffein. An average glass of iced tea contains two grains of 
 caffein. An average cup of good coffee and milk (three ounces of coffee and 
 two ounces of milk) contains two and five-tenths grains of caffein. 
 
 Professor Hollingworth's study was made on a "poison" squad of sixteen 
 people. The test lasted forty days. Its purpose was to find whether moderate 
 doses of caffein had a good or bad effect on persons who took it. 
 
 Generally speaking, he gave doses of less than six grains a day. Let 
 us say that most of his subjects took less than three cups of coffee a day. 
 His conclusions, therefore, apply to people who take two cups of coffee a day. 
 
 When more than six grains a day was the dose the subjects were harmed. 
 He did not study the subject of the prolonged use of coffee nor its effects 
 on digestion. 
 
 It has been well established that coffee is a good muscle and nerve stimu- 
 lant; "that it lightens the sensation of fatigue and sustains the strength 
 under prolonged and severe muscular exertion/' "that coffee squads come 
 in first in endurance tests, water squads second, and alcohol squads last;" 
 that coffee produces "a feeling of buoyancy and exhilaration comparable to 
 a certain stage of alcoholic intoxication, but which does not end in depression 
 or collapse." 
 
 Elvers' study establishes the point that the stimulation from caffein is 
 not followed by the letting down which follows the use of alcohol and other 
 stimulants. 
 
 Hollingworth found that there was no secondary reaction following 
 the use of caffein in the tests made by him. Even when the dose given 
 was large enough to produce bad direct effects, there was no "katzen jammer." 
 
352 HABIT-FORMING DRUGS 
 
 The Hollingworth tests were to determine the effect of caffein on the con- 
 trol of the muscles, the motor nerves, the nerves of coordination, and on certain 
 kinds of mental activity. 
 
 A type of result was that shown by a test known as the tapping tests. 
 The effect began ninety minutes after taking a small dose and forty-five 
 minutes after a large one. It lasted for one to two hours for a three-grain 
 dose (a large cup of coffee) and for four hours and a half after six grains 
 (two very large cups). No secondary effects followed within seventy-two 
 hours. 
 
 Another test was to determine whether coffee made the hands tremble. 
 One to four grains of caffein caused a slight tremor. Six grains (two 
 very large cups) caused an appreciable unsteadiness of the hands, coming 
 on about an hour after taking and increasing for three hours. 
 
 Muscle movements requiring several muscles to work together with 
 proper relation to one another were better and more thoroughly carried 
 out when a smail dose of caffein was given than without it. On the 
 other hand, a larger dose, six grains of the drug, produced a retarding 
 effect. 
 
 It was found that typewriting was speedier after one- to three-grain doses 
 of caffein (half a cup to a full cup of coffee), but that it was slowed up by 
 two full cups. Typewriting was freer from errors when the operators took 
 coffee. This was true even after two large cups. 
 
 A series of tests to determine whether the mind .worked better with or 
 without coffee showed in a general way that mental processes were improved 
 by coffee. The effect came on from two to four hours after the drug was 
 taken, and it lasted into the next day. The stimulation was not followed 
 by mental depression. 
 
 These studies prove that a man can increase the volume and the quality 
 of the work, both mental and physical, by taking one-half to one cup of 
 coffee a day. When he takes two large or three ordinary size cups of it, he 
 improves some of his capacities but lessens others. 
 
 The groups of people experimented on were not specially fatigued or 
 tired. In this connection it is well to recall the experiments by Rivers, 
 which prove that, when a man is fatigued, coffee will increase his capacity 
 for work either mental or physical. 
 
 However, this is only one side of the question. Various other phases are 
 of some importance. A great many people are interested in knowing the 
 effect of coffee on sleep. Hollingworth came to the conclusion that the 
 sleep of the average person was not disturbed by taking one to four grains 
 of caffein (one-half to one large cup and one-half of coffee) a day. Some of 
 the people experimented on slept poorly from even that quantity. When 
 one cup of coffee a day was taken for several days sleep was disturbed 
 on the second or third day in certain instances in which there had been no 
 disturbance on the first day. 
 
 Most of the people who took six grains a day (a little more than two 
 large cups) slept poorly; in consequence, when the coffee was taken with the 
 food, the harmful effect was much less than when it was taken alone. Fat 
 people stood coffee better than thin ones. The morning cup of coffee did 
 not disturb sleep so much as coffee taken later in the day. 
 
COFFEE 353 
 
 The age of the individual did not affect the effects of caffein on the 
 people experimented on; nor did previous coffee habits. 
 
 One subject investigated by Hollingworth was the influence of caffein 
 on the general health. At the end of forty days of this test "the subjects 
 quite uniformly report improvement in health, spirits, and general efficiency. 
 This is, perhaps, due to the regular regime of life followed during the forty 
 days." 
 
 When we examine the reports of the individuals we find that some of 
 them were definitely nervous at times, had headaches, palpitation, and in- 
 digestion. This rarely happened with a small daily dose. Some form of 
 disturbance was frequently noticed when the dose equaled six grains a 
 day. 
 
 When we apply these results to the habitual use of coffee, we must 
 bear several facts in mind : 
 
 First, the work was done with pure caffein. A cup of coffee contains 
 several other ingredients, some of which have physiological effects. 
 
 Second, when the caffein is translated into terms of cups of coffee the 
 dosage used is not large. 
 
 Third, the tests extended over forty days. Most of the people who 
 want to know about coffee have in mind the use of coffee for forty months 
 or forty years. 
 
 Fourth, the tests were, in the main, to determine whether coffee im- 
 mediately increased mental and physical power and whether there was 
 sag within a few days. 
 
 A little information was gained as to cumulative effects, headache, 
 sleeplessness, and one or two other incidental questions of prolonged effects. 
 The broad question of ultimate effects of prolonged use was not inquired into. 
 
 Bearing these limitations in mind, the following conclusions seem 
 justified by the work of Hollingworth and that of Eivers so frequently 
 quoted : 
 
 1. Caffein in small doses (one to four grains) increases the quantity and 
 quality of mental and physical work. 
 
 2. Caffein in larger doses (six grains and over) decreases the above 
 capacities as often as it increases them. 
 
 3. Caffein increases the capacity for work of a tired brain or tired 
 muscles. 
 
 4. Caffein produces a sense of buoyancy and well-being. 
 
 5. The stimulating effects of caffein are not followed by the depression 
 which follows the use of other drugs. 
 
 6. The amount of caffein in one full cup of coffee does not produce 
 sleeplessness or nervousness. Many took the amount in two cups without 
 discomfort. Many were disturbed by two cups. When the amount taken 
 went beyond the amount of caffein in two full cups the majority were 
 harmed by it. 
 
 7. The effects of caffein are less in fat people than in thin ones. 
 
 8. The effects are much less when the drug is taken with food. 
 
 9. The drug is somewhat slow in exerting its effect. Generally more 
 than an hour was required. Often two or three hours passed before the effect 
 was felt, and some of the effect commonly held over until the next day. 
 
354 HABIT-FORMING DRUGS 
 
 INGREDIENTS OF COFFEE 
 
 The London Lancet in 1913 published the report of a commission that 
 had investigated the effects of coffee. For their chemical analyses the mem- 
 bers made use of the brew in the cup rather than the berry. To their minds 
 it mattered little what the berry contained, as long as some of the ingredients 
 remained in the grounds. For instance, coffee berries contain 12 per cent oil, 
 but there is only a very small percentage of oil in a cup of coffee. 
 
 The analysis of coffee made from a high roasted average grade Costa 
 Rica coffee showed: 
 
 Total extract 24.30 i Caffetannic acid 3.9 
 
 Ash of extract 4.66 | Caffein 1.23 
 
 A cup of coffee is practically without food value. Analyses show a 
 trifling quantity of dextrin, sugar, and traces of alcohol. There is no starch. 
 It contains 1.25 per cent of protein. There is .6 per cent [six parts in 
 10,000] of a nitrogen-containing oil — caffeol. 
 
 However, if coffee without sugar and cream is without nourishing 
 qualities, it does not follow that it is without effect on the system. In the first 
 place there is a considerable percentage of caffein, 1.23 per cent, a powerful 
 medicine, the effects of which have been described already. Caffein is closely 
 akin to xanthin, and xanthin is a chemical substance produced in the human 
 body supposed to be related in some way to the cause of gout. 
 
 Most analysts are of the opinion that coffee contains a small amount 
 of pyridin. Pyridin is formed when paper is burned. It is held to be the 
 substance responsible for the benefit which asthmatics get from smoking 
 asthma cigarettes. When roasted coffee is treated with chloroform a chemical, 
 noncrystalline and nonsoluble in ether, is extracted. It has the strong but 
 pleasant aroma and bitter taste of coffee. 
 
 Caffein, pyridin, caffeol, and this flavoring substance are responsible for 
 the effects of a cup of coffee. 
 
 Coffee taken into the stomach is rather quickly absorbed therefrom. 
 It differs in this particular from tea, since tea is not absorbed until it gets 
 into the small intestines. Therefore, the effects of coffee begin to show 
 themselves after a brief period. The person who has partaken feels the 
 influence within a half hour. Hollingsworth's tests showed effects plain 
 enough to register his subjects in an hour, sometimes less, sometimes more. 
 
 On the mind the first effect is drowsiness, quickly followed by wakeful- 
 ness. The wheels of the mind work easily and truly. 
 
 In so far as there is any effect on digestion, coffee is of some slight aid. 
 Especially is this true of the after-dinner cup of coffee, taken at the end of 
 a full meal. The stimulating effect of some of the ingredients is somewhat 
 more than an offset to the restraining effect of the caffetannic acid. The great 
 outstanding effect of a cup of coffee, though, is the stimulation to brain, nerves, 
 and muscles — a stimulation without a closely following sagging. 
 
COFFEE 355 
 
 COFFEE EFFECTS 
 
 Coffee has been accused of harming the digestion. Is it guilty of the 
 charge ? I do not think so. The charge rests upon the fact that people with 
 indigestion are able to taste the coffee taken at the previous meal. This merely 
 means that coffee has an aroma and a taste, which facts needed no proof. 
 For the same reason every aromatic and every positively tasting food in the 
 list of foods has been accused of causing indigestion. 
 
 The blame has been laid on the oil. The amount of oil in a cup of coffee 
 is small. It is not to be compared with the amount of grease in a piece of 
 meat or a piece of buttered bread. 
 
 The blame has been laid to the caffetannic acid, but coffee is not an 
 astringent. It does not pucker the mouth. The small astringent effect of 
 the tannic acid present is more than offset by the dilating effect on the blood 
 vessels of the heart. 
 
 7s the use of coffee of service? Yes. When? When one is tired, fatigued, 
 unable to concentrate, and yet must keep going or must keep up for some 
 supreme effort. 
 
 Does the daily use of coffee as a beverage, continued for a series of years, 
 do harm? Yes. A horse cannot be whipped daily for years without being 
 harmed. A man cannot be nagged continuously for years without being 
 harmed. The very fact that, when fatigue is slowing muscles and brain cells 
 down, coffee will whip them on, the very fact that under the stimulus of 
 coffee capacity is unduly excited, is proof that harm will come if the process 
 is kept up for a series of years. 
 
 That no immediate secondary sagging is noted proves nothing. It is the 
 old question of the cost of something for nothing. 
 
 When, through the influence of coffee, you become able to do and do 
 more than you would otherwise, you must settle some time or other. That is 
 just ordinary sense. 
 
 Can the scientist tell you how you are to settle ? I think not. The state- 
 ment that you settle in terms of high blood pressure may be true, but proof is 
 lacking. The same can be said of kidney disease, caused by coffee. But then, 
 there's mighty little we know of the cause of high blood pressure, worn out 
 arteries, frazzled kidneys, or frayed hearts. 
 
 Health departments are just beginning to study the wear diseases. A 
 hundred years after the writing of the "One Hoss Shay" we shall begin to 
 know what it was all about. 
 
 Shall one take his morning cup of coffee ? Perhaps. To sleep in a well 
 ventilated room were better. To take a cold plunge, or a shower, or a ride, 
 or a walk were better ; but, failing these, a man may use coffee to get himself 
 together for the day. 
 
 Should a man take coffee at other hours ? Yes, when he needs a bracer in 
 order to meet a need ; then not regularly, or by the clock. 
 
 Should he take an after-dinner cup? Yes, if he has eaten like a glutton 
 and needs help. 
 
356 HABIT-FORMING DRUGS 
 
 COFFEE MAKING 
 
 The National Coffee Roasters' Association a year or so ago appointed a 
 committee on better coffee making. This committee has issued its report, 
 from which the following is taken: 
 
 First of all, the ease of extraction of the virtues of the coffee bean is 
 directly proportioned to the fineness of the grinding. The first essential, and 
 the most important, is that the coffee should be finely ground. To grind 
 finely is also economy, as less coffee is needed. Finely ground coffee does 
 not keep its strength. Therefore grind your own coffee, but in a high grade 
 mill. 
 
 Water at 212° (boiling) is twice as efficient in extracting color and 
 more than twice as efficient in extracting aroma as water at 150°. Cold water 
 is very efficient in extracting the caffein and the tannic acid. 
 
 The committee tried seven methods of preparing coffee : 
 
 1. Coffee placed in cold water, brought to a boil, boiled five minutes, coffee 
 ground medium. 
 
 2. Same method, but coffee used was ground fine. 
 
 3. Coffee placed in cold water, brought to a boil, taken off the fire and 
 allowed to steep. Medium ground coffee used. 
 
 4. Same method, but finely ground coffee used. 
 
 5. Percolation three minutes. 
 
 6. Percolation five minutes. 
 
 7. Filtration; pulverized coffee used. 
 
 To get the flavor and only a moderate amount of caffein, use method No. 
 7. Method No. 6 yields ten times as much tannin as No. 7. 
 
 If one wants some flavor, but must avoid the stimulating effects of caf- 
 fein, method No. 3 is best. It gives less than one-sixth the caffein given by No. 
 2, and a little more than a fourth as much as method No. 7. 
 
 Boiled coffee has the least to commend it. It is high in caffein, tannic 
 acid, and bitter matter. Long continued boiling makes the coffee weaker, not 
 stronger. After about five minutes of boiling the aroma is driven off, without 
 extracting from the coffee any desirable matter. 
 
 The report says that most of the deleterious effects of coffee are due to 
 excessive boiling, or to the use of grounds a second time mixed with some 
 fresh coffee. 
 
 In the steeping method the extraction comes mainly just as the water 
 boils. In using a percolator the water does not heat above 150°. The ap- 
 parent boiling is not really boiling. The condensed vapors percolating through 
 the coffee are not hot enough to extract the best of the flavor of the coffee. It 
 does extract the tannin. Percolated coffee is about 25 per cent higher in 
 caffein than filtration coffee. It requires more coffee than does the filtration 
 method. 
 
 In the filtration method the finely pulverized coffee is placed in a close 
 mesh muslin bag. Boiling water is poured through it slowly. Nothing is 
 gained and something is lost by pouring the water a second time. This 
 method uses least coffee. 
 
 In the comparative tests the experimenters used 1,200 grains of coffee in 
 a pint and a half of water. 
 
COFFEE 357 
 
 The experimenters favor the filtration method, except for those overstimu- 
 lated by coffee. They should used the steeping method. 
 
 THE COFFEE OR TEA HABIT 
 
 A victim of habit is willing enough to admit that there are habit victims, 
 but unwilling to admit that he is one of them. This is fortunate. Just this 
 mental attitude saves many. It is like trying to stay in bed with a cocklebur. 
 This constant self -asking, Is mine a drug habit? — this constant assertion, I 
 can quit — made to convince oneself and not others — this mental unrest some- 
 times makes a man grit his teeth and pull out of the mire. All in all, it does 
 no harm for the woman who always carries a headache tablet in her pocket- 
 book or for the man who takes his morning brandy to say that she or he has 
 no habit. 
 
 The most difficult of all places to draw the habit line is among tea and 
 coffee drinkers. The use of these drugs has much to commend it. When a 
 man's mental energies are at "sixes and sevens," when the different faculties 
 of his brain are not doing good teamwork, a cup of coffee or tea may har- 
 monize things. 
 
 Or, better yet, let us say that the little harm it does is more than com- 
 pensated for by good in other directions. It indicates that he or she still has 
 pride. The denial of a habit by the addict indicates that he still has pride. 
 For a man to pull out of the mire of opium requires teamwork by his mental 
 impulses. Unless he has pride as one of the wheel team he will not get out. 
 
 Eecently there has been some research work decidedly favorable to tea. 
 The writer says a man does better work with it than without. Such benefit 
 is not because of any food value, because neither tea nor coffee has enough 
 food or fuel value to take into account. It is because of better teamwork. 
 
 Another advantage of tea is that it is a pleasant way to drink sterile 
 water. No wise man drinks water from unknown sources. Our country is 
 getting too thickly populated for that. Boiled water, unfavored, is not gen- 
 erally liked. Boiled water, slightly flavored with tea, is the one drink that 
 tastes well, hot, cold, or in between. The test is the in between. 
 
 Tea and coffee may serve a purpose, and I think right there is the place 
 to draw the line. 
 
 For what purpose do you drink it? Do you drink it to make you feel 
 warm? The hot drink throws the blood to the surface and warms the skin, 
 but a warm skin loses heat rapidly and presently the loss more than offsets the 
 gain. If you are of this group — quit it. 
 
 Do you drink it at supper to hold you together for work after supper ? 
 
 If a habit, it does harm and not good. The wise course is to train oneself 
 to brain teamwork and to leave enough in one's energy bank to draw on for 
 the evening's work. Do not drink it at night. 
 
 There is no excuse for the noon or mid-afternoon cup except it be as an 
 excuse for a break in the day's concentration. On that basis, it is the height 
 of wisdom from the efficiency standpoint, but let the draft be very weak — 
 scarcely more than flavored water. 
 
 For the morning cup there is much excuse. The body has been storing up 
 energy all night. In the morning it has some tendency to leak — to waste. 
 
358 
 
 HABIT-FORMING DRUGS 
 
 The first work of the morning is to hitch up the team. A cold bath, water or 
 air, can do it. Some open-air work can do it. A cup of coffee or tea can do it. 
 A well-trained man can do it without any help. 
 
 But there are people who have headaches or "grumps" or are generally 
 no account if they do not get their coffee. For them it must be strong. They 
 are fiends. They are in the same boat as opium, cocain, or whisky fiends. 
 
 A good rule is to quit anything that has become to you a crutch or that, 
 you can figure out, usually becomes a crutch. 
 
 To summarize: 
 
 Morning cup. A cold bath or a round of exercise is better, but for most 
 adults it is permissible — or even more. 
 
 An afternoon cup — Yes, if you will make it very weak. 
 
 The night cup — No. 
 
 The noon cup — No. 
 
 When traveling or camping, yes — if taken weak as a cup of sterilized 
 water. 
 
 To brace for a supreme effort, yes; as a habit, no. 
 
 TEA AND WAR 
 
 In the Russo-Japanese War, some part of the great result in preventing 
 typhoid fever in both armies was due to the habit of drinking tea instead of 
 water. The soldier, starting out on a day's march, would fill his canteen with 
 
 weak tea. Tea is boiled, flavored 
 water. From the sanitary standpoint 
 it came back to this: the soldiers were 
 drinking sterilized water. 
 
 In the next war, however, the 
 typhoid problem will not exist. The 
 troops will be vaccinated against 
 typhoid, and the experiences of the 
 last three summers along the Rio 
 Grande teach us that typhoid as an 
 army menace is among the disappear- 
 ing diseases. 
 
 However, the soldiers of 1861 
 remember the dysenteries with dread. 
 Some of these ran an acute course 
 and got well in a few weeks. Dr. 
 Vaughan of the University of Michi- 
 gan proved that most of these diar- 
 rheas at Chickamauga were atypical 
 forms of typhoid and probably the same is true of those of the Chicka- 
 hominy. 
 
 Major Whitmore of the United States army has been studying the dysen- 
 teries with a view of finding a way to protect the army against them. Inci- 
 dentally, whatever is discovered is available for the people at large. 
 
 The chronic dysenteries of which the soldiers complained so much after 
 1865, Major Whitmore says, were due to amebae. An ameba is a small animal 
 
 Fig. 146. — Tropical Amebae cause Abscess 
 op the Liver, Dysentery and Possibly 
 Diarrhea. 
 
COFFEE 359 
 
 belonging in the same class as the malaria parasite, but larger and different in 
 many other ways. 
 
 This form of dysentery sometimes kills by reason of the ameba getting in 
 the liver and causing liver abscess. But, in the main, the harm it does is by 
 producing a chronic disabling disorder — a producer of inefficiency. 
 
 Many thousand people in civil life suffer from chronic amebic dysentery. 
 The acute dysenteries or fluxes are due to infection with bacteria. 
 
 Shiga, a Japanese bacteriologist, studied the bacteria of dysentery a num- 
 ber of years ago. He found the group of germs responsible and then de- 
 veloped a serum for the condition. The serum has not proved satisfactory 
 for summer complaint in babies, but Major Whitmore says it is more service- 
 able in dysentery of grown people. 
 
 This form of complaint was not highly prevalent in the Japanese army 
 because the soldiers cooked all their food, and boiled their water to make tea. 
 But our people have never had the habit of drinking weak tea instead of water. 
 
 So long as they are at home drinking water known to be good they should 
 not drink tea, but they should not drink tea when hunting, camping, or 
 going to war. They get dysentery from spring water, creek water, lake water, 
 or from eating raw foods. The Japanese serum may prove of service to our 
 people. 
 
 Coffee and Sleep. — A. B. writes: "I teach, and the strain invariably 
 tells on me. I find myself quite frequently in a state of nervous exhaus- 
 tion. I use tea and coffee, drinking usually two cups of each a day. My 
 friend, who also teaches, uses neither and does not suffer fatigue as I do. 
 1. Do you think one less likely to suffer thus if tea and coffee are aban- 
 doned? 2. If one is tired and therefore sleepless, would a little strong 
 coffee be conducive to sleep? On the whole, is it advantageous or disad- 
 vantageous to use tea or coffee?" 
 
 Eeply. — 1 and 2. Yes. 
 
 The above answers are apparently contradictory and explanation is 
 needed. Tea and coffee are general stimulants. They are drugs. They 
 stimulate judgment and control, among other effects. 
 
 People differ radically in their susceptibility to fatigue. That your 
 friend is less fatigued at the end of the day may be due to her better 
 mental habits and therefore lessened susceptibility to fatigue. However, 
 one who whips himself through the day by using four cups of a drug can 
 blame some part of his fatigue on the drug taken. 
 
 Sometimes insomnia is due to a racing mind, a mind that jumps around, 
 here, there, and everywhere. A small dose of coffee for some persons will 
 steady the mind and bring about sleep. A full dose of coffee will prevent 
 sleep. 
 
 Avoid Tea and Coffee. — K. L. D. writes: "What foods act as stimu- 
 lants without being injurious? For years I have been a coffee drinker and 
 feel the need of such a stimulant, but wish to discontinue tea and coffee 
 and want something else to take their place. I am intensely nervous. I 
 have been engaged in office work for a number of years. I do not seem to 
 have the strength or vitality that I used to have and would be glad to know 
 how to build up through proper eating and a light exercise. Long walks 
 do not agree with me — that is, over six miles at a time. I think I recently 
 
360 HABIT-FORMING DRUGS 
 
 overdid myself by walking more than this each day. I am a woman over 
 28 years of age." 
 
 Reply. — None of the foods except tea and coffee is stimulating. 
 If you are being harmed by the stimulation of coffee, stop it. Substitute 
 any warm drink which suits your palate. One is as good as another. If 
 you are not in good condition, a six-mile walk certainly is too much for 
 you. Get Galbraith's 'Tersonal Hygiene and Physical Training for 
 Women," read it, and follow it. 
 
 Harm from Coffee. — C. T. E. writes: "1. Can coffee be made harmless 
 except by the removal of caffeinf 2. Should a person who has had an op- 
 eration for gall-bladder infection, has neuritis and slight rheumatism, 
 abstain from coffee?" 
 
 Reply. — 1. In addition to the harm from the excessive dosage of caf- 
 fein, the oils of coffee sometimes impair the digestion. However, the state- 
 ment that to remove the caffein is the only way to make coffee harmless is 
 reasonably accurate. Overcoming the effect of drug habits by the use of 
 other drugs does not help. 
 
 2. No more and no less than any other person. 
 
 Coffee and Tobacco. — N. H. C. writes : "This statement is made : 'It is 
 every bit as bad for one to drink a cup of coffee every morning for break- 
 fast as it is for one to take a glass of wine every day for dinner — as a 
 habit/ Also: 'The coffee habit is as bad as the tobacco habit/ Are these 
 statements true? My son says he will quit using tobacco if I will stop 
 drinking coffee/* 
 
 Reply. — No one of the habits is a good one. I think I should rank 
 them in the order of their badness — wine, tobacco, coffee. Moderately 
 indulged in, none of them is a very bad habit. I think you had better agree 
 with your son that they are almost on a par, concede him a little more 
 than you ought to, and then contract with him to stop coffee if he will stop 
 tobacco. 
 
 Coffee and Caffein. — Mrs. A. C. H. writes: "I was very much inter- 
 ested in your recent article on 'Coffee Making/ but there is one point I do 
 not understand. Will you kindly explain? You say: 'Cold water is very 
 efficient in extracting the caffein and tannic acid. ... 7/ one wants some 
 flavor, but must avoid the stimulating effects of caffein, No. 3 is best. . . . 
 Coffee placed in cold water, brought to a boil, taken from the fire, and 
 allowed to steep. Medium ground coffee used/ It would seem to me that 
 the cold water used in No. 3 ought, according to the first statement, to 
 result in more caffein. How can I get the complete report referred to in 
 your article?" 
 
 Reply. — The condensed account affords more ground for your con- 
 clusion than did the fuller account. Our article was based on a report in 
 the American Food Journal, published at 15 South Market Street, Chicago. 
 The Food Journal editor can tell you where to get a copy of the original 
 report. 
 
 Coffee Story False. — W. J. N. writes: "I have heard from many dif- 
 ferent sources that by putting cream and sugar into tea and coffee the 
 beverage is rendered more harmful than if it was drunk plain. Is this a 
 
COFFEE 361 
 
 fact? Some say that they bring out the tannic acid in tea and the caffein 
 in coffee/' 
 
 Reply. — It is not a fact. 
 
 No Food Value in Coffee. — C. H. C. writes: "Is %t liarmful to drink 
 much coffee, either strong or weak? What is your medical opinion regard- 
 ing substitutes for coffee?" 
 
 Reply. — Yes. Coffee is a "habit-forming drug" with practically no food 
 value. Coffee substitutes are hot flavored "waters." For those accustomed 
 to drinking something warm with their meals they are all right. 
 
 No "Weed"; No Tea; No Coffee.— A. B. C. writes: "Do you think a 
 person of nervous temperament who is making an effort to overcome 
 nervousness by exercise of the will should smoke cigars, cigarettes, or a 
 pipe, and drink tea and coffee?" 
 
 Reply. — No. 
 
 To Make Tea. — J. writes: "A friend and I had an argument as to the 
 hot water supplied in flats. I contend that the boiler and pipes cannot be 
 cleaned, and hence corrode. Therefore, that tea and coffee, for instance, 
 should be made with cold water brought to the boiling point in a tea- 
 kettle which can be cleaned out. She says that the hot water supplied in 
 the pipes is all right for drinking purposes. Who is right?" 
 
 Reply. — I think you are both right. Hot water from hot water pipes 
 is good for drinking purposes. However, making tea is an art. To make 
 tea properly, heat water in a vessel until there is a vigorous boiling; then 
 pour water on the tea, and permit the mixture to stand. 
 
 Too Much Tea. — R. H. writes: "I am a woman, aged 35. I have head- 
 aches at times, am troubled with insomnia, and am not physically strong. 
 I drink three cups of tea at each meal, using plenty of cream and sugar. 
 Do you think my tea drinking excessive and likely to do me harm?" 
 
 Reply. — I do; very much so. 
 
 The Coca Cola Habit. — Young Man writes: "Please explain fully the 
 injurious effects of the coca cola habit." 
 
 Reply. — Coca cola contains no alkaloid except caffein. Its effects are 
 the same as those of coffee. People get the coca cola habit just as they get 
 the coffee habit. 
 
 A few days ago I stood at a soda fountain and heard two boys order 
 coca cola, adding, "Make 'em strong, boy, you know. Make 'em strong." 
 A little while ago I saw a sign, "Double strength coca cola, 10 cents." 
 
 A certain portion of the coca cola drinkers now call for ammonia in 
 their drink. These illustrations cover your point. 
 
 The habit of taking stimulants is a bad one. A man gets up in the 
 morning somewhat let down. Instead of cranking his machine by a cold 
 water bath or a cold air bath or a few minutes of exercise in his bathroom, 
 he takes a cup of coffee. 
 
 At 11 o'clock and once or twice at other hours during the day he feels 
 as badly as he did before breakfast. He steps to the nearest stand and 
 throws down a coca cola. Almost instantly thereafter his machine speeds 
 up. After a little while his glass has no kick. He then wants the boy to 
 "make 'em strong." Next he buys double strength. Next he gets the kick 
 by adding ammonia. 
 
CHAPTEE XXI 
 
 The Mind 
 
 The family physician of half a century ago was a very poor scientist, 
 and, from a purely medical standpoint, scarcely worthy of his hire. Yet he 
 was "mighty good for sickness." He looked at the patient's tongue, felt his 
 pulse, asked some questions, and fixed up some medicine. 
 
 The laboratory trained physician of the present day would say that he 
 had done very little for his patient. Certainly he had made no chemical 
 or bacteriological tests, no blood pressure determinations, he had not taken 
 off his coat and worked over his patient. Yet there must have been some way 
 in which he had done good, for certainly so great an institution as the medical 
 profession could not have been built up on any basis other than utility. 
 
 The explanation is that he had a fair knowledge of personal hygiene and 
 right living, — and he was a rattling good mental healer. He begot faith and 
 courage, and radiated sympathy and cheer. 
 
 It is a far cry from the science of symptoms, which found its flower in the 
 writings of Trousseau, to the science of causes, using symptoms but inci- 
 dentally as it flowers, in the writings of Osier. As the practice of medicine 
 has gone beyond the expressions of disease into its causes, it has left the 
 field of symptoms poorly attended. 
 
 Let it be understood that it is the physicians who have moved. People 
 have stayed where they were. Meanwhile symptoms, like branches, have 
 grown up more luxuriantly in this nerve-racking, self-centering, neurasthenia- 
 engendering age than in any other time. 
 
 In order to fill the field which was left when medical men moved out, 
 several agencies have flourished. One of these is social service associated with 
 or separate from medicine; another is Christian Science. 
 
 In saying that these agencies have come into an unoccupied field I do not 
 wish to say that their motives are the same, or that there is any kinship 
 between them. Each developed because society abhors a vacuum. 
 
 This field, vacated by medicine, has had its borders extended. There 
 may be fewer diseases than in olden times but there are more symptoms. 
 
 It was inevitable that, when the doctors developed the plan of concen- 
 trating on disease and neglecting the patient, there should grow up a number 
 of specialists dealing with symptoms primarily and disease secondarily or 
 not at all. 
 
 The mind of the prospective parent cannot cause birthmarks or physical 
 deformities. 
 
 There is a field for hypnotism, suggestion, autosuggestion, the mixed 
 suggestion and mental training of Du Bois, the analysis and mind training of 
 Freud, the methods of the mental healer, spiritual healer, faith healer — re- 
 lated methods all — as well as for the pills taken with faith. 
 
THE MIND 363 
 
 This being so, is it not wise for those who have not given the matter 
 thought to read what mind can and cannot do to the human body? 
 
 What are some of the errors and some of the facts? 
 
 A common error relates to heredity. The mind of the mother has no 
 power to mark her unborn babe. The mother's cell, the breeding cell from 
 the mother, is given its type and its power to fix the character of the offspring 
 by the mother; the cell from the father gets its type and its power to determine 
 type from the father. These two cells come together and start the new cell 
 called the child. 
 
 When they come together the last entry is made in the book of inheritance, 
 and the developing child clicks off his changes in regular routine, regardless 
 of what is going on in the outside world, just as a piece of machinery running 
 its routine is uninfluenced by the wind which blows outside the building. 
 No shock, no unusual sights, no dreams, nothing which enters the mind of 
 the pregnant mother can mark or deform the baby. 
 
 Another error, though not of much consequence, relates to the influence 
 of mind over life and death. Is it possible for the mind to prevent death? 
 Or, to put it differently, can any mind or body ever be developed into any 
 state where life will be perpetual ? No, Dowie, Mrs. Eddy, the story is always 
 the same. Your theory for perpetual life did not work in your case. It 
 never has worked. It never will work. Mind can neither cause death nor 
 prevent it. 
 
 Human life and death are just as real as the lives and deaths of trees 
 or cows, or as the wear on steel rails, and no philosophy will ever make it dif- 
 ferent. The human body is real, just as all matter is real, and it obeys 
 divine law, and wordy words, whether termed human or divine, cannot change 
 this obedience. 
 
 When it comes to diseases, the lines are not so sharply drawn. Disease 
 is a hodge podge. In it are some elements with which the mind has nothing 
 to do and other elements over which the mind has control. "It is the sick man 
 who makes the disease/' This, interpreted, means that, while the real diffi- 
 culty is due to morbid processes, the symptoms which express the disease are 
 in many instances the interpretation given the condition by the mind of the 
 patient. 
 
 I have received many letters saying that when I write about disease I 
 promote disease by engendering fear. This is true in some measure; untrue 
 in greater measure. Sometimes the writers have made the mistake of detail- 
 ing instances of diseases which were the result of fear, and at once they 
 have gotten into water which was over their poor, foolish heads. 
 
 They have usually specified infectious diseases. Therefore, what is the 
 truth about fear in relation to such diseases as consumption, pneumonia, diph- 
 theria, and scarlet fever, and many others of similar kinds ? • 
 
 Occasionally it has been found that an animal, profoundly shocked by 
 violent fear, has had its susceptibility to infection increased. As these infec- 
 tions have been more closely analyzed and studied, the importance of this 
 factor in infection has decreased until the opinion now is that violent mental 
 shock only has a slight influence in changing susceptibility and minor emo- 
 tions, and lesser mental states have none at all. 
 • Most cults recognize these limitations after some sort of a fashion. That 
 
364 THE MIND 
 
 susceptible children exposed to scarlet fever contract the disease in 60 per 
 cent of cases is capable of a demonstration too mathematical to be denied. 
 In consequence, they usually except contagion. 
 
 Christian Scientists are told by their leaders to report contagious diseases. 
 
 Surgery is a very limited field, but, within its limitations, it is much more 
 exact than medicine. Demonstrations in the course of surgical procedure are 
 much more convincing than those of medicine. In consequence, many of the 
 cults, and those the wisest, also except surgical conditions. 
 
 But there must be some basis for the growth of Christian Science and 
 other kinds of mental healing. Among their adherents are bankers, whose 
 minds work very accurately when it comes to business. It cannot be that, 
 when it comes to the business of the human body, they go off mentally. 
 Among them are judges capable of weighing evidence. If some part of these 
 teachings cannot stand the acid, other parts must, or these judges would not 
 go on accepting. 
 
 Where is the explanation? 
 
 The train dominates its sister organs in the commonwealth called the 
 human body. It can furnish symptoms where there are none. It can exag- 
 gerate existing symptoms. It can pervert and change symptoms, so that 
 they bear slight relation to their beginnings. 
 
 It is the mind that interprets. 
 
 "It is in the mind that the poppy is red, the apple odorous, the music of 
 the lark is felt." 
 
 The statement that it is in the mind that the poppy is red does not 
 mean that the flower has not certain pigments. It means that two differ- 
 ent minds, seeing the same poppy, might interpret its color in different 
 ways. 
 
 Symptoms are conditions talking in the language they know, as the 
 poppy speaks in mind-interpreted pigment. 
 
 Let us illustrate with the symptom pain. One mind would interpret it 
 as something scarcely worth noticing; another would writhe and cry out 
 under it. 
 
 The human machine cannot run without friction. With a car wheel, 
 every turn means some heat, some noise, some wear. Every act of living means 
 some heat, some noise, some wear. 
 
 And so on with other phenomena. A function goes wrong, and, dwelt on, 
 grows more wrong, and still more wrong. Studying human ailments might be 
 compared to picking a duck. One strips feathers, and still more feathers, until 
 he begins to wonder if the duck is not all feathers. If he persists, he will 
 finally get down to duck. 
 
 // one is stripping feathers from a mans symptoms, after a while he 
 will get down to duck. Sometimes, when the feathers are all removed, he 
 finds there is and has been no duck. 
 
 Such cases are easily proper for faith cure. 
 
 On the other hand, some birds have but few feathers, and in them there 
 is but little field for faith. Between, there lies a mixed field — some part 
 best cured by one method ; other parts by the other. 
 
 After applying the law of probabilities, weighing the tendency of diseases 
 to get well spontaneously even without care, the tendency greater with good 
 
"THE HUMAN MACHINE" 365 
 
 personal hygiene, the conclusion is justified that the mind can modify the 
 course of disease in some measure and its symptoms in great measure. 
 
 In a summarized fashion : The mind cannot prevent life, influence the sex 
 or the structure of the child, prevent infection, annul contagion, influence 
 changes in organs, or make life everlasting. 
 
 Fear and worry as causes of pneumonia are so insignificant that they 
 deserve no thought. The same statement is true of other infections. 
 
 That the mind can cure cancers, or limber up stiffened knees, or make 
 blind eyes see, or change any of those conditions which are organic, is based 
 on no evidence worth anything to the mind of a man accustomed to weigh 
 evidence. 
 
 "THE HUMAN MACHINE" 
 
 Plato excluded from his Republic the men who were always busy dream- 
 ing of imaginary ills. This group includes others as well as the developed 
 neurasthenics. If you will remember, Plato proposed a safe and sane repub- 
 lic, in which every citizen would be born and raised to a life of efficiency. 
 There would be no drones, no incompetents, no defectives. 
 
 Plato's republic would be devoid of genius, because, as Galton has 
 shown, genius and feeble mindedness are closely allied. There would be 
 no dreamers, no poets, no artists. 
 
 On the other hand, laws and customs would be most logical and sane — 
 the men would be level-headed; labor of every kind would be so productive, 
 life would be so free from waste that two or three hours would be the work- 
 ing day and the balance of the time could be devoted to the pursuits of 
 leisure. 
 
 Genius and dreaming are highly necessary, but the individual who de- 
 parts from level-headedness misses genius and falls into the neurasthenia 
 group pays more than his share for the community's opportunity. Of the 
 hundreds who get off the plane of level headedness, one is a genius and the 
 balance are neurasthenics or other kinds of mental misfits. 
 
 The sensible policy for any man to pursue is to work to keep in the 
 level-headed group. Averaging things — that's where the best pay is; that's 
 where the most happiness is; that's where the community most needs to have 
 men. 
 
 Arnold Bennett has written a small book telling all about this matter 
 of level-headedness. He has named this story "The Human Machine." It 
 tells about the waste that comes from untrained brains, not brains that cannot 
 read or write or figure, but brains that cannot take up a job, proportion the 
 mental effort just right, do the job without worry or undue tension or over- 
 effort, and then arrive at a sane, logical conclusion. That is what he means 
 by untrained brains. 
 
 A part of the same subject is the uncontrolled brain that must run off in 
 anger or in prejudice or in some other sluiceway. It takes a good many pages 
 to tell of the waste to the individual and to the public from untrained brains. 
 
 "The Human Machine" goes even farther than that. It proposes that 
 a man give thirty minutes a day to systematic efforts to get the brain under 
 control. Efforts to hold the brain centered are like efforts to hold a pig tied 
 
366 THE MIND 
 
 by the leg — first in this direction, then in that, but a constantly recurring effort 
 to run away. 
 
 The thirty minutes a day set aside for the single task of getting mental 
 concentration will result also in a more level-headed doing of the day's work. 
 
 If any reader gets this booh, let him remember this. Reading it is not 
 what is needed. Studying it, thumbing it, applying it — that's the thing. 
 
 There are those who assert that there are toxins of anger; that when a 
 man is angry or violently excited new chemical compounds are formed within 
 him and that these are powerfully poisonous. Observers have noted that men 
 who have been violently agitated turned gray, had headaches and other pains 
 and, many different disorders. Experimenters have found that after anger 
 certain secretions had a heightened toxicity. From this and a few similar 
 bits of evidence they have patched together a theory of the "toxins of 
 anger." 
 
 Under the influence of anger the brain may "run red." Stirred by strong 
 emotion, there may be a temporary binding together of mental faculties, but, 
 taking it all in all, all strong emotion makes for disharmony — a lack of co- 
 ordination of mental faculties and a lessening sum total of mental activities — 
 certainly of mental efficiency. As the result of the greater waste, more fatigue 
 toxins are made, but they are fatigue toxins and not a special brand called 
 anger toxins or emotion toxins. Mental tension burns tissue to ash, smoke, 
 and waste, and emotional mental tension does all this without a proper return 
 in effective work. 
 
 But, if there is no established scientific basis for the theory of anger toxins, 
 there are some ways in which emotions disturb the body equilibrium. For 
 instance, near the kidney there is located a gland called the adrenal. An 
 increase in the secretion of this gland causes the small blood vessels to get 
 smaller. A decrease in its secretion causes the muscles of these small blood 
 vessels to lose their tone. Emotions influence the secretion of this gland. This 
 much has been proven definitely. 
 
 Now, the blood is in the vessels and there it must stay. The blood is 
 no more compressible than is the water in a hydraulic ram. Therefore, for 
 instance, the vessels of the face dilate and a blush mantles the cheek ; the 
 extra blood supply there is compensated for by a diminished supply in some 
 other organ. Emotion then substitutes for a physiological distribution of 
 blood — the distribution best for the work in hand — one determined by the 
 emotions — one not best for the work in hand. Call it harmony; call it 
 sparing the body from toxins; call it by whatever name you please, the fact 
 remains that the body does its work best when equanimity prevails. 
 
 HUMAN BETTERMENT ADVICE 
 
 The Massachusetts Society for Mental Hygiene issues a circular which 
 I quote as it is, although with some items I do not wholly agree. For 
 instance, if closely related people are of good stock, free from inheritable 
 vices, they can marry with safety. Or, for instance, there are circumstances 
 under which one feeble minded parent does not greatly hazard the offspring. 
 Or, again, feeble mindedness is of as many degrees as drunkenness. 
 
HUMAN BETTEKMENT ADVICE 
 
 367 
 
 Cervical region 
 
 Dorsal region 
 
 "Only the mentally and physically fit should beget and hear children. 
 
 "The marriage of closely related persons should be avoided. 
 
 "Children of grossly intemperate parents are liable to be imbecile or 
 epileptic, and may inherit a nervous system unable to cope successfully with 
 the conditions of our complex civilization. 
 
 "Children of feeble minded, imbecile, or epileptic parents are liable to 
 inherit a constitution that tends to insanity; and may, though apparently 
 normal, transmit to their children this predisposition; the liability is greater 
 if both parents are or have been thus affected. 
 
 "Train your child to thorough cleanliness both of mind and body. Bad 
 companions as well as common towels, 
 common drinking cups and the like 
 should be avoided, because there is 
 danger of contagion both physical and 
 mental. 
 
 "Give your child a variety of well 
 cooked, wholesome food in ample quan- 
 tity at regular intervals. 
 
 "Train your child to healthful habits 
 of sleep in fresh air, giving opportunity 
 for at least nine hours, and for more than 
 that before the age of 12. 
 
 "Avoid conditions that tend to pro- 
 duce overstrain or precocity. The special 
 business of a young child is to grow, and 
 to play with other children. 
 
 "Give your child opportunity for a 
 variety of wholesome activities and in- 
 terests. 
 
 "Train your child to work hard in 
 some regular occupation suited to his 
 ability and talents, but to avoid extreme 
 fatigue by alternation of work and rest. 
 
 "Train your child to give attention 
 to the present situation and not to worry 
 about the past or the future. 
 
 "Train your child to strict obedi- 
 ence in a few important matters, and let 
 him alone in regard to other things. 
 
 "Train your child to avoid drugs and stimulants of all kinds. 
 
 "Protect your child from shocks. Do not frighten him yourself or 
 let other people do so. 
 
 "If your child becomes worried and sleepless, or has muscular twitchings, 
 or the like, consult a competent physician at once." 
 
 The recommendations of the Massachusetts Mental Hygiene Society 
 continue as follows: 
 
 "The best method of training is example; and what is good for your 
 child is usually good for you. 
 
 "Take advice of a competent person concerning the peculiar, sensitive, 
 
 Lumbar region 
 
 — , Coccyx 
 
 Fig. 147. — The Spine. Lateral aspect. 
 
368 
 
 THE MIND 
 
 or nervous child in order to correct a possibly bad inheritance by proper 
 education and environment. 
 
 "The intemperate use of alcohol is a contributing or causative factor of 
 several forms of insanity in the individual predisposed thereto. 
 
 "The habitual use of the habit-forming drugs, especially those of sedative 
 and hypnotic type, may cause delirium or insanity. 
 
 "Kemembering that syphilis, typhoid fever, scarlet fever, measles, tuber- 
 
 SECRETORY, 
 VISCERAL .TROPHIC 
 
 PAIN AND TEM- 
 PERATURE SENSE 
 
 TACTILE 
 SENSE 
 
 f^l J DEEP SENSIBILITY(JOINT- MUSCLE) 
 
 = — X J^ ^— -=^-^A-FR0M LEG ANDLOWCRTRUI 
 
 DIRECT AND 
 CROSSED REFLE 
 
 AND LOWER TRUNK. 
 B-FROM ARM AND UPPER 
 TRUNK. 
 
 DIRECT 
 PYRAMID. 
 
 COMMISSURE 
 CELL 
 
 Anterior horns below; posterior abov* 
 
 Anterior horns below; posterior above. 
 Fig. 148. — Tracts in the Spinal Cord. Location of certain diseases. 
 
HUMAN BETTERMENT ADVICE 369 
 
 culosis, influenza, heart, kidney, and other diseases are not infrequently con- 
 tributing factors in insanity or mental and nervous breakdowns, it behooves 
 you to see that the health regulations of your community are kept abreast of 
 modern standards of efficiency and to seek early a physician's advice when 
 illness invades your home. 
 
 "A contagious and infectious germ disease, known as syphilis, is the 
 direct cause of three kinds of brain disease, which represent at least one-tenth 
 of the admissions to insane hospitals. 
 
 "Most of them are characterized by a progressive failure of mind and 
 body, which ends in death in a few years. 
 
 "Syphilis has other ill effects on the individual, and may be transmitted to 
 the next generation. Most cases of insanity caused by syphilis are incurable 
 by any means now known to medical science. 
 
 "Do not allow diffidence or similar feelings to prevent you from promptly 
 seeking competent medical advice concerning sexual, ethical, emotional, or 
 mental problems which perplex you. 
 
 "Remember that the mental equilibrium of many persons is endangered 
 by the high pressure of our twentieth- century civilization — be thoughtful of 
 them. 
 
 "Try to get a little recreation every day, and a vacation oftener than once 
 a year. 
 
 "Try to keep your weight up to that regarded as 'standard* for your 
 height. 
 
 "Cultivate a cheerful, generous, and charitable disposition. 
 
 "There are many forms of insanity; a large percentage is preventable 
 and a considerable proportion curable. 
 
 "Observe the few well established and simple rules of health concerning 
 food, sleep, exercise, bathing, and recreation. Avoid alcohol, drugs, immoral 
 living, venereal diseases, great mental or physical stress and excesses of all 
 kinds/' 
 
CHAPTEE XXII 
 
 Sympathetic Nervous System 
 
 Every structure in the body has nerves. Every nerve in the body con- 
 nects into central. The nerves of such organs as the liver, kidney, lungs, 
 and heart are known as the visceral nerves. They, too, connect into central. 
 Whatever happens to them is telegraphed in over certain of these nerves, 
 passes through two relay stations and finally rings a bell at central ; impulses 
 start out from central, pass through at least two relays and finally deliver the 
 message to the organ. 
 
 As these nerves pass in and out they come in close contact with other 
 nerves. In consequence we can sometimes learn something about some obscure 
 organ by some sign that is more frequently displayed. Sometimes we can 
 treat some less easily reached organ by applying this same principle. That 
 is one door that is opening in what appeared to be a blank wall. 
 
 This sympathetic system is divided into at least two systems. Some of 
 the component parts of these systems have been pretty well studied. The 
 effects of action by these parts have been investigated, and medicines influenc- 
 ing them have been experimented with. That is the second door that is open- 
 ing in this a-while-ago blank stone wall. 
 
 Probably you have noticed that in cleaning your ears with a hairpin you 
 caused a slight fit of coughing. When one introduces a match into the ear 
 canal and presses on a certain point on the floor of the canal, he feels an 
 irritation in his bronchial tubes, and a cough results. 
 
 One of the causes of chronic, dry coughs is trouble in the external 
 ear. The visceral nerves of the bronchial tubes have a nerve connection with 
 the external ear. 
 
 The nose men discovered that in certain cases of asthma there were 
 polypi in the nose. When these polypi were removed, the asthma got better. 
 Then it was discovered that many cases of asthma got better if the nose was 
 burned, though there seemed to be nothing wrong with the nose. 
 
 At first they said the burning should be done at certain spots. Then it 
 was found that burning at most any point would give results. The explanation 
 is that there is a nervous connection between the visceral nerves of the lungs 
 and the nose. 
 
 When there is disturbance with the nutrition, ulcers appear in or around 
 the mouth. A frequent kind is the small aphthous ulcer. The pain of this 
 ulcer shows that it is not an ordinary sore, that it is a neuralgic affair. 
 (Shingles is the best known neuralgic sore.) There is a connection between 
 the visceral nerves of nutrition and the mouth. 
 
 370 
 
TO PREVENT NERVOUSNESS 371 
 
 DISTURBANCE AREAS 
 
 The nerves supplying the internal organs, after passing through one 
 or more relay stations, reach the spinal cord. The centers for the different 
 organs in the cord are sometimes close to and sometimes connected with cen- 
 ters for sensation or for motion in areas on the skin or superficial muscles. 
 When an impulse comes in from some organ, that impulse overflows into some 
 near-by center, and a painful sensation is felt at some point in the skin. 
 
 We have all heard of one-armed men suffering pain in the lost fingers. 
 The pain is in some nerve high up or in the cord itself, but it is "referred" 
 to the fingers. If there are no fingers there, it is easy to guess that the pain 
 is higher up. When there are fingers and pain is felt in them, it is not so easy 
 to prove that the seat of pain is elsewhere than where it is felt. 
 
 As the result of much study, Head and other investigators have found 
 some areas to which internal organs are prone to refer their disturbances. 
 Sometimes the disturbance expresses itself as a pain, sometimes as a muscular 
 spasm, and sometimes as a local edema or swelling. Some of the more im- 
 portant of these relations are as follows: 
 
 Liver — In the back near the point of the right shoulder or under the 
 shoulder blade ; in the pit of the stomach at the end of the breast bone. 
 
 Kidneys — On the edge of the ribs a little above the level of the navel; 
 in the small of the back; in the male genital organs. 
 
 Lungs — Anywhere over the chest; in a circle four inches in diameter 
 around the navel. 
 
 Diaphragmatic pleura — Over the pleura; under the collar bone toward 
 the shoulder in front; in the backbone just below the juncture of the neck 
 and trunk. 
 
 Heart — In the left shoulder ; down the left arm ; over the heart and along 
 the breast bone above the heart; occasionally in the pit of the stomach. 
 
 Uterus and tubes — In the nipple and breast; in the abdomen below the 
 navel; on the top of the head; in the base of the brain; "in the spine/' low 
 down ; in the thighs both front and back. 
 
 Pain in the legs due to disease of the uterus and tubes may be the result 
 of pelvic pressure on the nerves as well as to impulses transmitted in the cord. 
 
 Ovary — The transmitted pains, the result of changes in the ovary, may 
 run to the same areas as those from the uterus and tubes. Pain in the heel 
 is one of the odd indirect results of ovarian disease. 
 
 Hip joint pain is frequently referred to the knee joint. The pain of dis- 
 ease in the lower vertebra is felt in the legs. 
 
 TO PREVENT NERVOUSNESS 
 
 It is important that a child should not come of neurasthenic stock, yet 
 Oppenheim thinks that association with neurasthenic parents produces more 
 neurasthenia than does inheritance. To save children from the "dangers of 
 psychic infection in the parental environment," he thinks they should be re- 
 moved from their own homes to better environments. "All these neurasthenic, 
 
372 SYMPATHETIC NERVOUS SYSTEM 
 
 hysteric, worried, and fear controlled adults came up through childhood. In 
 many of them their troubles could have been prevented had they had proper 
 training in childhood." 
 
 The most important point is that the child be stimulated to play with 
 other children. Nothing so helps a child to find himself as ordinary everyday, 
 rough-and-tumble play. 
 
 On the subject of food, Barker of Johns Hopkins says: "The child that 
 learns to eat and digest all wholesome foods and who is not permitted to 
 cultivate little food antipathies makes a good start and avoids one of the worst 
 pitfalls of life, namely, a finical anxiety concerning the effects of various foods 
 all too likely to develop into a hypochondriacal state." 
 
 Barker thinks it important that the child should undergo a process of 
 mental hardening. "Nothing can be more harmful than the gratification of 
 caprice. Especially when a child shows a tendency to be nauseated by certain 
 smells and tastes and to complain of noises or of sensitiveness to bright light, 
 the family physician should be consulted and, provided no actual disease of 
 the sense organs or brain is found, the process of psychic hardening should at 
 once be begun." 
 
 The child must be trained to disregard these abnormalities by counsel and 
 precept and also by discipline. If he is convinced that he is just like other 
 boys, he will forget his caprice, for caprices are manifestations of an exag- 
 gerated ego. Pain and suffering have their place in the training. Unless a 
 boy gets hurt occasionally in boxing, wrestling, aye, in fighting, he goes 
 through life with an exaggerated fear of pain and suffering. The best way 
 to rid him of this exaggerated fear, even of fear itself, is to have him get 
 hurt occasionally. 
 
 Fear is powerful in its capacity for producing ill health, as well as for 
 making men incapable. Barker thinks that the foundation for abnormal 
 fears and timidity is laid by the practice of frightening children. 
 
 In Greece and Eome the children were frightened with stories of female 
 demons. At the present time use is made of goblins, witches, ghosts, and 
 "hants." 
 
 Children must be protected from such stories, and when through them 
 morbid fears exist they must be trained into better mental states. 
 
 What is to be done with the child that flies into tantrums ; with the child 
 that, when it wants anything, cries and cries until he gets it? In the first 
 place, if training is begun early and is properly carried out, the child will 
 never develop into this type. If, through neglect, such habits have been 
 developed, the habit of self-mastery must be substituted for emotional out- 
 breaks, even though it be difficult. 
 
 The mother must ignore the temper, and, after calm has come, she 
 must wait a while and then gratify the wish or request, if it is proper to 
 gratify it. Not much Montessori in the plan, but it is proper just the 
 same. 
 
 A striking symptom present in most neurasthenics is indecision. Some- 
 times obstinacy or explosive decision is the form that the vacillation takes. 
 Some children of the "hair trigger" type need to learn deliberation. Some are 
 given to fear, doubt, and indecision. 
 
 The parent can do much to help this latter group to a habit of decision. 
 
INFLUENCE OF THE MIND ON DIGESTION 373 
 
 This recommendation is much more in line with the Montessori method, since 
 overcontrol is largely responsible for the fault. 
 
 Barker quotes a page from Arnold Bennett's "Human Machine/' in which 
 there is set forth the folly of blaming people and the wisdom of running one's 
 own life and allowing others to run theirs. The pernicious habit of blaming 
 the child learns from its parent. 
 
 The sensitive, nervous system of the child must not be overprotected. 
 The policy of over protection begets a capacity for keen suffering. Pouting, 
 sulkiness, harboring a grudge and bearing malice must not be transformed 
 into more persistent moods. Left to grow as weeds these lead to envy, suspi- 
 cion, a morbid sense of neglect, and perhaps in time, to delusions of persecution 
 and paranoiac states. 
 
 The habit of flying into violent tempers in older children can sometimes be 
 broken by showing the child that he is making himself ridiculous. Even 
 children have a horror of making donkeys of themselves. 
 
 Finally the article deals with the joy of work and its ability to bring 
 health to the nervous. The education to idleness is education to nervousness. 
 
 INFLUENCE OF THE MIND ON DIGESTION 
 
 When the animal body was planned it was arranged that certain proc- 
 esses necessary for the growth and maintenance of the body and for the 
 perpetuation of the race should go on without process of mind. There was 
 economy in this in that it left the higher nerve centers to do certain other 
 things. The functions over which the mind has little control are digestion, 
 nutrition, circulation, respiration, and the growth and development of the 
 unborn babe. Yet all of them are in some measure capable of being affected 
 by the mind. 
 
 This is true of digestion. The understanding of the digestion may be 
 said to have begun with the observations of Dr. Beaumont of Mackinac 
 Island on Alexis St. Martin, a French Canadian, who had been wounded in 
 such a way that the stomach secretions could be studied. Following Beaumont, 
 investigations have piled discovery on discovery. 
 
 Eecently a Eussian, Pawlaw, has taught us a lot about digestion. One 
 of the things which he has taught us is that, when the eye sees and the nose 
 smells food, the mind goes to work and stimulates the stomach to secrete. I 
 give just enough of this to make the point that what the mind can start it 
 can stop. 
 
 Certainly 60 per cent of dyspepsia, indigestion, and stomach troubles is 
 in the mind. Of the remaining 40 per cent, about one-half, 20 per cent, is 
 the expression by the stomach of organic trouble located elsewhere in the 
 abdomen, for while in telephone language the brain is "central," the stomach 
 is an important "branch." Therefore, as Dr. Will Mayo puts it, "When the 
 stomach telephone bell rings, one should always inquire, 'Who's talking V " 
 It may be brain, it may be appendix, it may be liver. When you get the 
 feathers off the stomach diseases there is mighty little duck left, not over 
 20 per cent. In plainer speech, not over one-fifth of the cases of indigestion, 
 "stomach trouble," "dyspepsia," are due to stomach disease. 
 
374 SYMPATHETIC NEEVOUS SYSTEM 
 
 A good stomach specialist is a good nerve specialist, a good mental 
 therapist, a good "suggester" — for most stomach troubles can be cured by 
 sensible eating (as to articles, quantity, and method), combined with mental 
 therapy. It is said men dig their graves with their teeth. Dyspepsia grows 
 by what it feeds on. Most cases would get well if the subjects would eat 
 simply — and forget. 
 
 THE INFLUENCE OF MIND ON NUTRITION 
 
 Of course, the fat man is jolly and the thin man is a "born worrier. " 
 Can it be concluded from these truths that the mind influences nutrition and, 
 carrying it a step further, that the mind can influence the nutrition of any 
 particular organ, say the lung or a structure more under the will — a muscle 
 of the arm? 
 
 Being fat or thin depends upon how much or how little fat or grease 
 is slipped into spaces here and there. The deposition of fat in an organ is 
 quite different from nourishing its cells. The food which the body takes up 
 is used first to nourish the healthy cells, to repair wear and tear, and then 
 the surplus is deposited as fat. The fat man has all of his organs nourished 
 and some to spare. Therefore, he ought to be happy and he frequently is. 
 
 Many things work together to make a man thin. If he worries he burns 
 up a lot of food energy and just the amount used in that way may mean 
 that, in his ledger, his "fat" account shows more liabilities than assets. There 
 is no doubt but that some men worry themselves thin. The way it is done 
 is by the useless burning of food, not through any direct influence of the 
 mind on the tissues. Fat is always a foreign body among the cells proper 
 to the organ. 
 
 To influence the nourishing of the cells proper to any important degree 
 is beyond the power of the mind. The mind can round out the arm. If a 
 man eats and digests well and does not worry, he can increase, let us say, his 
 biceps measurement. It increases because the surplus nourishment fat is de- 
 posited under the skin as fat. But no amount of thinking can make the 
 biceps muscle have more fibers or grow larger ones. 
 
 Nourishment comes through use rather than through mind. This 
 illustration applies to all the cells of the body. Mind influences the features 
 greatly; it has not much influence on the essential tissues. The fact is that 
 the frame of mind has little influence on the nutrition of those tissues that 
 have work to do. Nor can concentration of the mind on any particular organ 
 or its work in any material way modify its nutrition or its working. 
 
 A man can worry himself thin or, by being even-tempered, he can promote 
 rotundity. But he cannot by any direct mind action increase the size of his 
 muscles, or the state of his health or nutrition of his lungs, heart, liver, kidney 
 or any other organ. 
 
 THE MIND AND THE HEART AND CIRCULATION 
 
 The rhythmical movement of the heart is automatically regulated. The 
 size and carrying capacity of the blood vessels is also automatic, regulated 
 
INFLUENCE OF THE BODY ON THE MIND 
 
 375 
 
 by the needs of the area for which each particular vessel carries. God did not 
 propose that a process as necessary as the circulation of Mood should be con- 
 trolled by so weak, vacillating, and incompetent an agency as the human 
 mind. And yet the fairly independent state called the circulatory apparatus 
 belongs to the federation of states called the human body, and it must have 
 its capital. 
 
 The brain, through the mind, can influence the heart and blood vessels 
 in some degree. Blushing is frequently a mental process. That fact has 
 always been recognized. And yet Darwin taught us that the capacity of the 
 brain to dilate the blood vessels of the cheeks is highly developed as the result 
 of special training, and the same change cannot be 
 made in the blood vessels of other parts of the 
 body, at least not to any considerable extent. 
 
 That emotion can make the heart beat fast 
 or slow or irregularly everybody knows, but not 
 even the most violent emotion can mate a healthy 
 heart stop beating. Sometimes the brain tries 
 hard only to fail. Men go into cataleptic states, 
 hypnotic conditions, major hysterical manifesta- 
 tions, with many functions suspended in whole or 
 in part, but the heart beats away regular in its 
 rhythm, neither faster nor slower. 
 
 If a man has a heart disease the mind can 
 make his heart asthma worse. If he has lime in 
 his valves and palpitation is a result, dread, fright, 
 and worry can make his attacks more frequent and 
 more agitating. In other words, the mind can 
 
 help in perpetuating a vicious circle, but when that is said there remains 
 nothing else of consequence to say. 
 
 It is a long way from these manifestations to the curing or preventing of 
 leaking heart valves or poorly nourished heart muscles. It is a long way 
 from blushing or blanching of the cheeks to increasing or decreasing to any 
 material degree the blood in, say, the kidneys or lungs. 
 
 £IJ§ 
 
 Fig. 149. — F. Site of Fron- 
 tal Sinuses. A. Site of An- 
 trum of Highmore. Pres- 
 sure on the skin over these 
 points may show tenderness 
 in inflammation (sinusitis) 
 in these cavities. 
 
 INFLUENCE OF THE BODY ON THE MIND 
 
 How does the body influence the mind? 
 
 Man is not an individual. He is a community, consisting of millions of 
 individuals called cells. 
 
 Some of these are doing nerve work — we call them brain cells; some are 
 doing muscle work — we call them muscle cells. Nothing can affect Illinois 
 without affecting Texas ; nothing can affect one organ without affecting the 
 other organs. The more one organ comes to being "central" for all the other 
 organs the more it is affected by them. 
 
 On this principle the body affects the mind more than the mind affects 
 the body. For one thing, it is "central"; for another, it is sensitive, it is 
 delicately poised, it puts out a thousand "feelers," while the other organs are 
 as oysters in their shells. 
 
376 
 
 SYMPATHETIC NEKVOUS SYSTEM 
 
 Let this statement stand out: The body affects the mind more than 
 the mind affects the body. 
 
 When impulses travel from sick organs to "central" they stimulate more 
 than the centers which immediately control them. New impulses spread 
 from the new focus. The state of mind incited by a diseased organ may react 
 to disease that organ further. A vicious circle is established. 
 
 Constipation 
 Fatigue. 
 
 {Defective Vision, 
 Indigestion, In-) mtmi 
 sufficient Blood ( 
 
 ( Poor Blood Supply, 
 \ Excitement, Worry 
 
 ._- — E y e 
 
 ^.-.-j/-- Decayed Teeth 
 .-- "~?5Ear Disease 
 
 Fig. 150. — Showing Location of Headaches, According to Their Causes. 
 
 It is the fashion to call all sorts of things neurasthenia, to ascribe symp- 
 toms to a state of mind. That is good as far as it goes, but much harm will 
 come unless the so-called neurasthenics are closely analyzed to eliminate those 
 wrongly in the class, and also to find the organic basis, sometimes large and 
 sometimes small, of many of the cases. 
 
 Pretty nearly everybody recognizes the dependence of mental and emo- 
 tional states on conditions of health and disease. When a man's tissues are 
 
 SOLE OP FOOT 
 
 Neuralgia of the Sole; 
 Neuralgia of the Met- 
 atarsus (lower ankle) ; 
 Flat-foot; Disease of 
 the Prostate. 
 
 
 Gout, Neuras- 
 thenia, Ova- 
 rian Diseases, 
 Pain in the 
 Tendo Achillis 
 
 Fig. 151. — The Possible Causes of Pain in the Foot and Heel. 
 
 nourished he takes a kindlier view of things, while, on the other hand, the 
 irritability of the dyspeptic is the offspring of his physical condition. 
 
 Here we see a man able to conceive and carry out large enterprises, radi- 
 ating vitality and dominating situations, because of his capacity to eat thick 
 steaks and burn them into mental energy. There we see another — narrow, 
 pessimistic, unjust, jaundice-eyed, incapable of inspiring others to action, as 
 he is incapable of action himself, because of physical deficiencies. There is 
 
THE MIND m MENTAL DISORDEKS 
 
 377 
 
 a third man, he who is able to shield his mind from the influence of his 
 body. 
 
 The greatest service which mental therapy, called Christian Science, or 
 
 
 
 PAIN OK TENDEBNESS AT VARIOUS POINTS 
 
 
 ALONG THE SPINE 
 
 
 wkwm 
 
 Hysteria and Neu- 
 
 
 n jfj^=M 
 
 rasthenia. Very 
 
 
 r~ V^ 
 
 much the most fre- 
 quent causes of 
 
 
 1 ,„ \^mm\ 
 
 "backache," espe- 
 
 
 y//////, \ ^m 
 
 cially at the base of 
 
 
 W \ B 
 
 the skull; between 
 
 
 • the shoulders and 
 
 
 #^ 1 f§ 
 
 at the base are fa- 
 
 
 W£ I m% 
 
 tigue and neuras- 
 
 
 m£ 1 am 
 
 thenia. 
 
 
 W y l m 
 
 Other causes some- 
 what frequent are 
 
 
 - / iH 
 
 Pott's disease, spinal 
 
 
 l ■ 
 
 curvature, ulcer of 
 
 ■ BiicSr 
 
 f 
 
 the stomach, small- 
 
 mmWf/7/r 
 
 ■ 
 
 pox and other 
 
 mm/ Iff/// 
 
 t M 
 
 fevers. 
 
 
 
 
 
 Fig. 152. 
 
 some other name, has rendered society is in increasing the members of this 
 third group. In teaching how to shield the mind against the body they are 
 more successful than in curing the body through the mind. 
 
 THE MIND IN MENTAL DISORDERS 
 
 There is a group of people whose disorders are out of proportion to their 
 physical bases. At one end of the line are the insane, at the other the self- 
 centered; and in between there come the cataleptics, the hysterics, the neu- 
 rasthenics, the neurotics, the alcoholics, and the drug fiends. 
 
 The insane have gross changes in their brain structure; others have very 
 little. Generally speaking, the symptoms are out of proportion to the changes 
 which are present. In all forms of insanity, except those advanced cases 
 where the nerve structures are badly degenerated, music and pleasant sur- 
 roundings as means of suggestion, supplemented by patient talks and counsel 
 from those in attendance, are the best agencies for helping the patient to 
 sane and calm moments. 
 
 In nearly all functional nervous disorders the symptoms are out of pro- 
 portion to the organic changes. In hysteria, while authorities vary from the 
 
SUSIES 
 
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THE MIND IN MENTAL DISORDEES 
 
 379 
 
 group who think the generative organs have little to do with it, to Freud 
 and his school, who think they have much, they all unite on the ground that 
 the symptoms, as expressed, are out of proportion to the organic changes. 
 
 In neurasthenia, as a base there is usually some overtire, or, maybe, some 
 
 Renal Colic, Perirenal Ab- 
 
 Lumbago, Pelvic Disease 
 
 POSTERIOR AND LATERAL 
 ASPECT OF THIGH 
 
 Sciatica (unilateral tract 
 of nerve), Both Sciatica; 
 Locomotor Ataxia, Lum- 
 bar Abscess, Growth in- 
 volving Cord or Both 
 Sciatics in Pelvis, Impact- 
 ed Feces, Cancer or Ulcer 
 of Rectum 
 
 Cramp due to Chronio 
 Nephritis, Overexertion, 
 Diabetes, Gout, Alcohol- 
 ism, Hysteria, Deep-seat- 
 ed Varicose Veins 
 
 JOINTS IN GENERAL 
 
 Acute and Chronic Rheu- 
 matism, Arthritis Deform- 
 ans, Gonorrheal Arthritis, 
 Synovitis, Postfebrile 
 Arthritis, Rachitis, Syph- 
 ilis, Tuberculosis, Scurvy, 
 Hysteria, Gout, Tumor, 
 or Compression of Neu- 
 ralgia Cord, Locomotor 
 Ataxia 
 
 DIFFUSE PAIN IN EXTREM- 
 ITIES 
 
 Multiple Neuritis, Mus- 
 cular Rheumatism, My- 
 ositis, Locomotor Ataxia, 
 Spinal Meningitis, Myel- 
 itis or Apoplexy, Scurvy 
 or Hemophilia, Lead- 
 Poisoning, Rachitis, Trich- 
 inosis, Influenza 
 
 Below Knee, Unilateral,- 
 Non-Inflammatory, Pre- 
 monitory of Cerebral 
 Hemorrhage 
 
 Fig. 155. — The Possible Causes of Pain in Various Pabts of the Body. 
 
 organic diseases, but what constitutes a neurasthenic is an exaggeration of his 
 disorder — for instance, making over a capacity for being easily fatigued into 
 a virtue instead of a vice, believing in it, bowing down to it, and trying to 
 persuade others to do the same. 
 
 Neurasthenics and hysterics being largely mind caused, the main line of 
 cure must be mind cure. To relieve them the underbrush of malnutrition, 
 constipation, anemia, poor physical development, underoxidation must be 
 cleared away so that hypnotism, suggestion, auto-suggestion, faith cure, and 
 mental training may have a chance to chop the trees. 
 
 The function of hypnotism is to give relief, but, wisely done, it can be 
 used to train to self-dependence. The greater advantage of the analytical 
 
380 
 
 SYMPATHETIC NEEVOUS SYSTEM 
 
 method employed by the Freud school, the mixed suggestion and mental train- 
 ing of Du Bois, the psychology of Christian Science, and that of mental 
 therapy is that they have power to beget self-dependence, independence of 
 others. 
 
 They help a man to see himself as he is, not as he thought himself to be. 
 But seeing is not enough. To see and stop there leads to still greater helpless- 
 
 T7PPEB JAW 
 
 Periostitis, Disease of 
 Antrum, Dental Af- 
 fections, Neuralgia of 
 Superior Maxillary 
 Nerve 
 
 LOWER JAW 
 
 Mumps, Salivary Cal- 
 culus, Dental Affec- 
 tions (caries, pulpitis, 
 alveolar abscess, or 
 periodontitis), Neur- 
 algia of Inferior 
 Maxillary Nerve 
 
 AURAL AND PARIETAL 
 
 Otitis Media or Internal Furuncle of Meatus, For- 
 eign Body in Meatus, Mastoid Abscess, Polypus, 
 Caries of Teeth, Pulpitis, Alveolar Abscess, 
 Dentition, Eye-strain, Neuralgia, Temporomax- 
 illary Rheumatism, 
 Syphilitic or Other 
 Disease of Maxillary 
 or Temporal Bones, 
 Cancer or Irritable 
 Ulcer of Tongue, In- 
 juries 
 
 Tonsilitis, Follicular or 
 Phlegmonous Pharyn- 
 gitis, Postpharyngeal 
 Abscess, _ Scarlatina, 
 Diphtheria, Laryngitis, 
 Carcinoma, Foreign 
 Body, Irritant-Poison- 
 ing 
 
 Myalgia, Sprains, Cer- 
 vical Caries, Cervical 
 Abscess, Inflamed 
 Lymph Glands, Aneu- 
 rism of Irmominate 
 
 Fig. 156. — The General Diagnostic Indications to be Derived from the Seat of Pain 
 
 in the Face and Neck. 
 
 ness. Where relief is permanent it is through mental training. The hysteric 
 may be temporarily relieved by hypnotism, but, if she stop there, she has re- 
 newed attacks. The drunkard (all drug fiends are neurotics) may be cured 
 by suggestion (called cured), but if he stop there he will "fall from grace." 
 
 All neurasthenics who would be cured must patiently, persistently, cour- 
 ageously work out their own salvation, helped by competent trainers, build up 
 a resistance to fatigue, cure self-centering by broadening their interests, gain 
 calm and an abiding optimism. 
 
PEBSISTING NEUEALGIAS 
 
 381 
 
 PERSISTING NEURALGIAS 
 
 Had the inventor of the submarine cable been an anatomist, he -would 
 have saved himself a lot of trouble. He could have studied a nerve and had a 
 working plan for his cable. As it was, he probably puzzled his brain for years 
 over the plan, using for his planning brain cells and nerves built exactly as a 
 cable is built — nerves built on the proper plan. 
 
 PRECORDIAL 
 REGION 
 
 Angina Pectoris (ra- 
 diates down left 
 arm), Pseudo-an- 
 gina (aneuric, gas- 
 tric, neurasthenic, 
 grippal, toxic), Func- 
 tional Disorders of 
 the Heart, Valvu- 
 lar Defects (aortic 
 in particular), Gas- 
 tralgia (cardialgia), 
 Gastritis, Poisoning 
 by Arsenic, Flatus 
 in Splenic Colon, 
 Anemia, Hysteria, 
 Epilepsy, Locomo- 
 tor Ataxia (more 
 common in axilla) 
 
 Colon, Diaphragm 
 
 LEFT HYPOCHON» 
 DRUM 
 
 Impacted Splenic 
 Colon, Colitis, Gas- 
 tritis, Gastric Car- 
 cinoma, Gastric Ul- 
 cer, Dilated or Pro- 
 lapsed Stomach, 
 Enlarged Spleen 
 (Malarial Leuke- 
 mic), Renal Colic, 
 Exercise, Anemia, 
 Acute Rheumatism 
 (especially in chil- 
 dren) 
 
 LEFT ILIAC 
 
 Colitis, Impacted 
 Sigmoid, Hernia 
 (Patulous Internal 
 Ring) , Varicocele, 
 Ovaritis, Muoous 
 Colic 
 
 Fig. 157. — The Possible Causes of Pain in Various Parts of the Body. 
 
 I presume that, occasionally, a telegraph operator will transmit an inquiry 
 about something that he, the operator, could inform both the sender and the 
 recipient of. But his duty is to transmit, and he holds his peace. I can 
 imagine the nerves in the inventor feeling about it about like the operator does. 
 
 In the center of the nerve is the wire that runs from the sending office as 
 a continuous unbroken cord. Around this is a lot of insulating, and around 
 the insulation is the wrapping for strength and protection. The impulse 
 travels from the center to the muscle to be moved. 
 
 In the spasmodic disorders so frequently noted, the seat of the trouble is 
 not in the jerking muscle nor in the nerve which makes it jerk. The impulse 
 is transmitted, unchanged, from some nerve cell, and the muscle jerks because 
 it is powerless to disobey orders — which makes plain the absurdity of treat- 
 ments directed to the muscle or even to the nerve in its course. 
 
382 
 
 SYMPATHETIC NERVOUS SYSTEM 
 
 An old book directed that, when a baby's head was jerking in convulsions, 
 it should be held still. The absurdity of such a plan anyone can see. As nobody 
 would be so foolish as to believe it, nobody is so foolish as to advocate it. 
 
 However, though the curtain is lifted and the imagination makes us see 
 beyond the jerking head, it is not wholly lifted. We are still prone to stop 
 short of the center where the trouble is starting and prone to forget that back 
 of the disturbing cell lies that which has disturbed the cell. 
 
 Eye and Teeth Anemia and Neurasthenia 
 
 Neurasthenia 
 
 Ocular Neurasthenia 
 and Melancholia 
 
 
 Fig. 158. — The Causes of Localized Headache, According to the Exact Site of the Pain. 
 
 Failing in other and better measures for control, the surgeon steps in and 
 cuts the nerve. 
 
 At once the jerk stops, or the pain stops, if pain were the trouble. Or he 
 kills the nerve by injecting alcohol into it. 
 
 No external expression of the nerve cell change can be given, but back of 
 the cut the nerve cell change goes on. 
 
 The methods of cutting the wires with the knife and with alcohol injec- 
 tion replaces an older, less efficient, and much more harmful method. It was 
 the drug method— the use of alcohol, or morphin, or cocain. 
 
 These acted like nippers in cutting the nerve. The cut was not a perma- 
 nent cut. In a few hours, the line had been repaired, and down it telegraph 
 messages were going again. 
 
 Again, unlike the act of the nippers, the cut was not a clean one. Mor- 
 phin, cocain, and alcohol, in their efforts to cut the line, smash things gener- 
 ally. They lay out all the cells reached by the blood and amenable to them. 
 It is from this action drug habits are born. 
 
NEURALGIA 
 
 383 
 
 The use of sedative drugs ts horn of a partial view, not so foolish as hold- 
 ing a hdby's head for fits, out nearly so. 
 
 i\ sufferer from a persistent neuralgic pain should try to locate the 
 cause of his trouble and remove it. The cause may be connected with the 
 nerve itself — a pressure, for instance. It may be on some other nerve. The 
 pain is reflex. It may be due to absorption of infection from some 
 distant area — the teeth, tonsils, nose, gall bladder, appendix, prostate, fallopian 
 tubes. 
 
 Chicago Medical Recorder. 
 Fig. 159. — Trifacial Nerve. Nerve of sensation, with branches to teeth, nose, orbit and 
 sinuses in the upper jaw showing. 
 
 If relief cannot be secured in this way the question of relief by cutting 
 the wires comes up. Is it better to suffer the pain than to suffer the remedy ? 
 If it has been decided that the pain is the worse evil the question comes up : 
 Shall the cable be put out of commission by the knife or by injection of alcohol 
 or a similar drug into the nerve, or shall it be done by the use of morphin 
 or other drugs ? The answer is : Do not use habit-forming drugs to relieve 
 persisting neuralgias. 
 
 NEURALGIA 
 
 The men who analyze the origin of words tell us that neuralgia 
 means nerve pain. Following out this general idea we call those cases 
 
384 SYMPATHETIC NERVOUS SYSTEM 
 
 neuralgia in which there is pain but no other evidence of disease in a nerve. 
 
 Perhaps about as good a way to divide neuralgia from neuritis is by 
 calling neuralgia all those cases in which the pain conies and goes. If 
 the ache is steady day and night for weeks, months, or years, the probability 
 is that if we looked at the nerve we would find it inflamed — neuritis. If the 
 pain comes and goes the probability is that if we got the nerve out and 
 examined it with the unaided eye we would find nothing abnormal. Such 
 cases we call neuralgia. 
 
 The pain in neuralgia is paroxysmal. It gets much better and much 
 worse, or disappears and reappears. Sometimes it occurs with clocklike 
 regularity. Such periodicity in neuralgia may be due to malaria. More 
 frequently it is not. The pain is apt to shift from place to place. It comes 
 on suddenly and is apt to leave just as suddenly. While the pain is deep, the 
 skin over the painful areas may become tender. In some cases of neuralgia 
 the skin swells as in nettle rash. In others blisters and sores appear; for 
 example, shingles. 
 
 It is in this disease that painful points or tender points are found. In 
 neuritis the nerve is tender along its entire course. In neuralgia there may be 
 one or more tender points along the nerve, or where it comes out of the 
 spine or where it crosses some bone. The one outstanding symptom in 
 neuralgia is pain. A nerve of sensation is disturbed and it is crying out 
 in the only terms in which it is able to talk. 
 
 What is to be done about it? Naturally, the first call is for relief 
 from pain. This is where the chiropractor, osteopath, and masseur come 
 into their own. They find these tender points, and in many instances, by 
 manipulating them, relieve the pain. It is natural for neuralgic pain 
 to stop suddenly, and there is every reason to think that skillful massage 
 and manipulation of the muscles, bones, joints and ligaments can bring 
 relief in some of these cases, though no one can tell in advance which 
 cases can be relieved. 
 
 The physicians who give medicine have many drugs in their quivers. 
 Preparations of opium, morphin, and codein should never be given. The 
 danger of habit is too great. Some people take whisky for neuralgia. 
 Though physicians cannot be blamed for that practice, possibly some would 
 say that alcohol as a neuralgia remedy belongs, in the physician's quiver. 
 Alcohol should not be given in neuralgia for the same reason that morphin 
 is forbidden. 
 
 Among the effective drugs which do not produce habit are acetanilid 
 and other coal tar preparations, salicylates, gelsemium, cannabis indica, and 
 aconite. None of these should be given except for short periods, and 
 then only under physicians' control. A drug powerful enough to do good 
 is powerful enough to do harm. 
 
 The matter of relief having been attended to, the question arises : What 
 is behind the pain? The answer is more important than the answer to 
 the cry for relief. Malaria may be the underlying cause. Or it may be 
 alcoholism, diabetes, lead poisoning, syphilis, gout, rheumatism, or Bright's 
 disease. It may be that the neuralgia is really an expression of central 
 disease — for instance, locomotor ataxia. It may be some local cause, such as 
 a diseased tooth or a diseased ovary. In every case treatment must include 
 
SCIATICA 385 
 
 treatment of the underlying cause. Neuralgia is never anything more 
 than a symptom. 
 
 SCIATICA 
 
 Stedman defines sciatica as sciatic neuritis, neuralgia of the sciatic 
 nerve, felt at the back of the thighs and sometimes running down the 
 calf of the leg. The sciatic nerve is the great nerve trunk of the leg. In 
 the public mind any pain in the leg not located in a joint is known as 
 sciatica. In many cases thought to be sciatica the pain is not even in 
 the nerve trunk. In many others the pain is in the nerve, but the seat of the 
 trouble is elsewhere. 
 
 In the Medical Record Dr. Hunt classifies cases of sciatica into four 
 groups : There are the cases of sciatica in which the pain felt in the nerve 
 is the result of pressure on the nerve at the point where it comes away 
 from the spinal column. Injury to or disease in the bones of the lower 
 end of the spinal column, or damage to the joint which joins the spine to 
 the hip bones, affects the sciatic nerve and causes pain to be felt in the leg. 
 
 Second, pressure on the nerve in the pelvis by a tumor, a pregnant uterus, 
 or a distended bowel causes a neuralgia in which the pain is felt in the leg 
 rather than in the pelvis. To the causes belonging in these two groups 
 may be added the cases of sciatica in which the real trouble is disease 
 of the hip joint. In these cases the injury to the nerves of the hip makes 
 itself felt in the leg. 
 
 Third, constitutional states such as syphilis, alcoholism, diabetes, and 
 malaria. 
 
 Fourth, damage to the nerve trunk from injury or exposure to cold. 
 
 Plainly, the man who thinks he has sciatica and who wants to be 
 rid of it should first find out what his trouble is. He should make certain 
 the pain is in the nerve and not just somewhere in his leg. Next, he 
 should investigate the possible conditions elsewhere in the body capable of 
 causing pain in the sciatic nerve. What he is to do depends on what he 
 finds. If the trouble is a broken arch he must treat his feet. If the hip 
 joint is responsible treatment must be directed there and not to the nerve. 
 If the pain is due to spinal cord disease, for instance locomotor ataxia, little 
 is gained by treating the nerve. If the pain is the result of conditions in 
 the pelvis attention must be directed to the organs in that locality. If 
 syphilis, malaria, or diabetes is the cause the underlying disease is to be 
 treated. Some men are called upon to choose between alcohol and sciatica. 
 
 Neuritis — Neuralgia. — M. B. M. writes: "Can you tell me of some 
 permanent relief for neuritis? I have doctored for it for fifteen months, 
 taking medicines, hot water applications, and rubbings. Nothing seems 
 to effect a cure. My right arm and across my neck seem the most affected 
 and at times the pain is almost unbearable." 
 
 Reply. — Your disease may be neuralgia. The fact is, I think it is 
 neuralgia. A pain which just scatters around generally across the neck 
 and down the arm is very apt to be neuralgia rather than neuritis. 
 
 Neuralgia means pain in a nerve. Neuritis means inflammation of the 
 
386 SYMPATHETIC NERVOUS SYSTEM 
 
 nerve. In neuritis the pain is located in the affected nerve. It sticks 
 there rather closely. It hangs on steadily day and night for some time. 
 In neuralgia the pain comes and goes. In neuritis the inflamed nerve is 
 tender. 
 
 You are suffering from pain in your neck and arm. You have had 
 this for fifteen months and hot water bottles and rubbings have not relieved 
 you. Why ? For one thing, you may be absorbing bacteria constantly from 
 bad tonsils or bad teeth. If so, you will not get well until your teeth or 
 tonsils are cleaned up. 
 
 Another possibility is pressure from a bursa somewhere in your neck 
 or shoulder. Again, there may be pressure on the nerve from an extra 
 rib, one located about where the neck joins the body. Both neuralgia and 
 neuritis are caused by the above causes, and so long as the cause persists 
 there is no need in splitting hairs over names. Then again, your trouble 
 may be due to lead poisoning or alcoholism. 
 
 How are you to know whether you have neuritis or neuralgia? In 
 neuritis the pain is rather steady day and night. In neuralgia the pain 
 comes and goes. In neuritis the course of the inflamed nerve can be made 
 out by the tenderness on deep pressure. Sometimes the tender nerve can 
 be felt with the fingers. In a neuritis which has lasted sixteen months it 
 will be found that the muscles supplied by the inflamed nerve have 
 shrunken. Ah examination with electricity will show that the muscles are 
 degenerating. 
 
 Let us suppose that you have neuritis. What can be done about it? 
 First, you must look for and try to remove the cause. Unless you can 
 remove the cause you will not make much headway with the cure. In 
 giving relief care should be exercised that drug habits do not result. A 
 drug habit is worse than neuritis. 
 
 There is not much chance of relief from osteopaths, chiropractors, and 
 masseurs. If the case is obstinate by all means try them, but do not be 
 disappointed if you fail to get relief. Salicylates, iodids, acetanilid, gelse- 
 mium, and other neuralgia medicines may give relief, but they probably 
 will not. Rest and electricity and light therapy offer more hope of relief 
 of pain than do any other agents. 
 
 While this was being written a man told me of his experience. He had 
 had neuritis for four months when he broke a tooth and went to see his 
 dentist. The dentist X-rayed his mouth and found that two crowned teeth 
 which seemed healthy were decaying in their deeper parts. The teeth were 
 drawn. His neuritis got well at once. He also had a slight albuminuria. 
 This disappeared after the teeth were pulled. 
 
 Adjust Your Mind. — A. J. W. writes: "I have had considerable trouble 
 in sleeping. I can sleep, but I dream all night, hence I am not fully 
 rested in the morning. Would a tablet of sodium bromid, ten grains, have 
 any bad effect on the heart if taken nightly f" 
 
 Reply. — Ten grains of bromid at night will not affect your heart, but it 
 will not help you to sleep, except it help you by suggestion. You are not 
 justified in taking bromid or any other medicine to make you sleep. No 
 one is ever justified in taking sleeping potions on his own responsibility. 
 When one gets in the proper frame of mind to sleep he sleeps. 
 
 Everybody dreams all night. There is nothing wrong about that. 
 Maybe you are not rested in the morning because you sleep too long or in 
 a badly ventilated room. Maybe you worry about your sleeping- 
 
SCIATICA 387 
 
 To sleep, fix your room right, and then go quietly to bed to sleep, if you 
 can; to rest, if you cannot sleep. When you go to bed in that frame of 
 mind you will sleep. 
 
 Thinking Disease. — A woman writes: "I have come to believe there are 
 a lot of people who think so much of sickness, especially tuberculosis, that 
 they think themselves into disease, whereas if they had more to keep their 
 minds busy and not think and listen to others trying to tell them they 
 have such and such disease they would sleep better and live longer." 
 The writer quotes this statement from a magazine: 
 "Many have contracted, consumption and died of it simply because they 
 thought they would die of this disease because their parents did." 
 
 Eeply. — Your advice to think of other things than disease is excellent, 
 but you are mistaken in saying that to think consumption will cause it. 
 Thinking collision never made trains collide. It's getting on the wrong 
 track or the wrong schedule that does that. Thinking consumption never 
 made consumption. It is living wrong that does that. Your position on 
 that point is as wrong as is the position of those you criticize. Live right 
 and then let consequences come. The consequences will be right. 
 
 Has Poor Memory. — L. A. W. writes: "I am married, SO years of age, 
 and a traveling salesman. My health is good. In my work it is necessary 
 to do a great deal of memorizing and it seems impossible for me to -remem- 
 ber. Is there anything I can do to remedy this trouble? Can you suggest 
 any treatment or anyone to whom I may turn for help?" 
 
 Memory can be greatly benefited by training. To train one there are 
 memory schools and correspondence courses. See the advertisements in 
 papers and magazines. 
 
 Nervous Indigestion. — H. B. writes: "Can you suggest a cure for 
 nervous indigestion? As sleeplessness is a feature of the case, what is the 
 best food to be eaten at the evening meal? The case has been in the hands 
 of a physician, but he frankly says he does not know what else to do." 
 
 Reply. — You will not make much headway trying to cure sleeplessness 
 or nervous indigestion by a diet. Simple, light meals eaten slowly and 
 calmly will help, but to try to divide foods into this you shall eat and this 
 you shall not eat will not help you much. Above all, eat a simple, light 
 supper. This is about as far as you can go in the diet cure of either 
 nervous indigestion or sleeplessness. Both are conditions of mind. Find 
 someone who can teach you mental control — how not to be stomach-cen- 
 tered or sleep-centered, or tense, and who will then teach you to live on 
 light, simple meals, and you will find a cure. 
 
 May Imagine Illness. — B. R. S. writes: "Last January I was taken by 
 nervous prostration and it is so I can't sleep without a vegetable to make 
 me. I have been to seven doctors. What do you recommend? I am getting 
 desperate." 
 
 Eeply. — As you have been to seven doctors, and none has found any 
 organic trouble, you probably have none of great consequence. Nervous 
 prostration under these circumstances is the result of bad mental habits. 
 When these are corrected the nervous prostration gets well. To start with, 
 taking something to make you sleep is a habit that must be corrected. 
 Some men can get themselves in hand by reading books on nerves, of which 
 
388 
 
 SYMPATHETIC NEKVOUS SYSTEM 
 
 there are many. Some need mental healers, of whom some varieties are 
 in the medical profession and some outside. Baths, massage, electricity, 
 exercise, and tonics are aids. The essential treatment is to be directed 
 to the mental habits. 
 
 Nervous and Run Down. — A. M. writes: "I am run down from over- 
 work and am thin and weak and nervous. I have teen advised to take 
 
 Chicago Medical Recorder. 
 
 Fig. 160. — Nerve of Sensation to the Soft Palate, the Teeth, the Nose, the 
 Eye, Orbit and the Sinuses of the Upper Face. 
 
 three-grain hyponuclane tablets to enrich the blood and make me strong 
 and healthy. Is there any harm in taking these tabletsV' 
 
 Eeply. — I have not been able to find out what this tablet contains. It is 
 not likely to hurt you. It may not help you much without feeding, plenty 
 of sleep, and plenty of open air. Don't you think these will fatten you up 
 and rest you? 
 
 Should Go to Sanitarium. — Interested Reader writes: "I have a friend 
 who is, I think, affected with neurasthenia. He is a man of about JfO 
 years of age, of unusually fine mind, and temperate in every way. He 
 has an idea that he is going to die and always says he is afraid of death. 
 He complains of a dreadful pain in his head and says he thinks it will 
 burst and that will be the end of him. He lies down a good deal in a dark 
 room. Sometimes, when you tell him to get up, he says he is suffering so 
 that he cant move and that he is afraid his back will break. I think, of 
 
SCIATICA 
 
 389 
 
 Trigem. I 
 
 course, this is all imaginary, but it seems to be real to him. He is de- 
 spondent. Doctors do not do him any good. How should he be treated — 
 that is, should he be talked to severely or should we sympathize with himf 
 He has had to give up his 
 business, of course, and it 
 is too cold for any outdoor 
 exercise. He complains a 
 great deal of not sleeping. 
 Please advise something 
 that can be done for him 
 
 at home. I know he seems ^M &:-vlWIS»3:'.v!3 
 
 better as long as he is oc- \m wi Trigem. ni 
 
 cupied, but he is not 
 capable of doing a great 
 deal — at least he thinks he 
 
 isn't; and he seems nerv- S ±fl 
 
 ous and clenches his fists * 
 
 and has a most distressed 
 expression." 
 
 Eeply. — The above de- 
 scription is that of an in- 
 dividual with an excessive 
 neurasthenia — almost be- 
 yond the limits of that 
 condition. Ordinary 
 medicine and ordinary 
 medical service will not 
 help him materially. He 
 needs mental training and 
 psychotherapy. He may 
 be able to accomplish 
 what he needs at home, 
 but prolonged sanitarium 
 treatment will be much 
 more promising. 
 
 Have Him Examined. 
 — R. D. writes: "I have 
 a son who is 20 years old, 
 5 feet 6 inches tall, 
 weighs 115 pounds, and is 
 strong for his weight. 
 He eats well and sleeps 
 well, but doesn't like to 
 get up in the morning. 
 He doesn't feel tired, but 
 listless and drowsy — more 
 at the age of llf years. 
 
 Trigem. I 
 
 Trigem. II 
 Trigem. m 
 
 Fig. 
 
 161. — Distribution of Nerves of Sensation 
 of the Head. 
 
 so in hot weather. He lost interest in school 
 Nothing seems to interest him and he doesn't care 
 for company, especially where there are women and girls. He has a poor 
 memory and cannot keep his mind on anything. He has no confidence 
 in himself. He won't look for work, but will work if someone gets it for 
 him. He sits around with his head hung down in his hands and at times 
 he thinks someone is going to hurt him. As I am anxious for his welfare, 
 any advice you give me will be greatly appreciated." 
 
390 SYMPATHETIC NERVOUS SYSTEM 
 
 Reply. — The boy is in need of help. Have him examined as to his 
 nerves and mind condition right away. If he is off mentally he should have 
 care in an institution. If he is temperamentally off, as frequently happens 
 with boys at his age, he needs somebody to get him out of himself and 
 interested in something. He needs both mental and physical training and 
 interests. 
 
 Boy Needs Control. — Mrs. -8. L. P. writes: "I have a son who first 
 showed symptoms of hysteria in his thirteenth year. He would lie for 
 hours in a seizure. When this condition ivas recognized the seizures were 
 stopped in a short time. It is seven months since one appeared. He is 
 now 16 years old. His disposition is not good. His will power is not 
 strong, only in his own way. His family affection seems to be lost. What 
 is the cause? Is the condition apt to come on again? Do habits that are 
 not good — for instance, deception, or picking up others' money, or will- 
 fulness — develop? Will one recover entirely from* this?" 
 
 Reply. — Habits of deception, willfulness, and lax ideas of honesty are 
 apt to develop in the wake of the condition noted. Fortunately, most of 
 the mental and nervous disorders that develop during adolescence tend to 
 remedy themselves. After the individual has readjusted himself the kinks 
 disappear. Wise guidance and help in which sympathy and judgment are 
 properly blended are of the greatest service. 
 
 Study your boy and try to get for him the schooling and control he 
 needs. Perhaps you can get helpful suggestions from Hall's "Adolescence." 
 
 Has Sudden Fears. — 0. J. 8. writes: "Please explain what causes me to 
 be extremely nervous at times, making my heart beat abnormally. Occa- 
 sionally a sudden fear comes over me when I am alone. I feel scared, as 
 if something were going to happen to me. I have been in this condition 
 for four weeks, and have lost four pounds during this period. I am weak, 
 yet my appetite is good and I sleep well. I am unable to work at my 
 trade as a carpenter. I am 29 years of age, weigh lkh pounds, and am 
 about 5 feet 10 inches tall. I have worked steadily and hard all summer."' 
 
 Reply. — It is possible you have an organic disease. Go to a capable 
 physician and have an examination made. If he tells you that you have 
 no organic disease, and he probably will, then proceed to get control of 
 yourself. You have worked and worried too hard and are tired. It is 
 easy to worry off four pounds in four weeks. 
 
 Go back to your trade. Carpenter work is good for neurasthenia. If 
 you cannot govern your mind and banish these fears by yourself, some 
 one of the books on nerves may help you. If you try a book, you must 
 study it. Casual reading is not enough. You may need the services of a 
 psychotherapist. 
 
 Needs Mental Treatment.— A. 0. writes: "A young lady of my ac- 
 quaintance has been, or appears to me to have been, mentally unbalanced 
 for several years. These are some of her actions: She is highly nervous 
 and will get extremely angry at times when others are not thinking of 
 such a thing. She will throw knives or anything she gets hold of into the 
 wall, or shove the dishes on the table, or slam the doors. She will jump 
 up of a sudden and slam things on the floor and threaten to knock people 
 over or to gouge their eyes out. She is of an exceedingly jealous nature, 
 
SCIATICA 391 
 
 and has an evil look when in these spells. She is also forgetful. She has 
 a brother in an insane asylum and her father s family seems to have insan- 
 ity among the members. Does she inherit it from him, and can she be 
 cured? She also takes spells of laughing and seems unable to control her- 
 self. Is there danger of her doing any harm to those about her when in 
 these spells? What in your opinion is the matter with her?" 
 
 Reply. — In spite of the insanity in this girl's family I should not judge 
 from your letter that she is insane. I do not think she will harm anyone. 
 That does not mean that she does not need mental treatment. 
 
 A few weeks in an institution should enable the girl to get herself 
 under control. 
 
 Relaxing Body and Mind. — Mrs. A. V. F. writes: "What is the best way 
 to relax the body while lying down to rest? How relax the mind?" 
 
 Reply. — 1. Just relax. 
 
 2. A more difficult question to answer. Some employ monotonous for- 
 mulae which fatigue the mind to rest. Much the better plan is to lie down 
 in an indifferent frame of mind, resolved to sleep, if possible, but not to 
 worry, if sleep will not come. When one accepts what comes resignedly, 
 calmly, and cheerfully, sleep comes. To try to relax generally defeats the 
 end sought. 
 
 But Little Danger. — R. P. F. writes: "I am a subject to rapid heart 
 beats. Rave I valvular heart disease, and are long walks injurious? Is 
 there any danger of sudden death?" 
 
 Reply. — You are evidently in a "funk," probably worrying about 
 nothing. Have a physician examine your heart ; find out if you have heart 
 disease and advise you what to do. As to danger of sudden death, there is 
 but little danger whether or not you have heart disease. 
 
 Stop Worrying. — J. A. II. writes that he has been nervous for three 
 years. He says: "I worry and am greatly troubled with insomnia. I am 
 an office worker and do not get much exercise, and I know that that has 
 something to do with my nervousness. I should like to drink a large 
 quantity of milk, but it gripes me. Will a bath in the morning help 
 nervousness? Is bathing in the morning or at night best? Hot or cold 
 water? What is the best way to avoid worry? What is the best way to 
 regain lost weight? Will malt tonics, such as are sold in drug stores, help? 
 Should I drink milk?" 
 
 Reply. — All your troubles come from your worry — your insomnia, your 
 indigestion, your loss of weight. You must stop worrying. That is the 
 important thing; the other things are secondary. This is a mental process 
 which you must work out for yourself. 
 
 Worry is illogical. Nothing is more cause for worry than worry. Begin 
 by cutting out all worry and all other forms of concentration after supper. 
 The harm of worry comes from our concentration. Lackadaisical worry 
 causes no more insomnia than lackadaisical inventing, merchandising, 
 clerking, or keeping house. # 
 
 A recent correspondent told of his method. It was to let his mind 
 travel over the neighborhood where he spent his childhood. We recom- 
 mend the adoption of some similar plan. The thing thought about 
 must catch enough hold on the mind to drag it away from the worry 
 
392 SYMPATHETIC NERVOUS SYSTEM 
 
 theme, and at the same time it must not be itself a worry theme. As you 
 gain mental calm, contentment, and poise you will gain in weight. 
 
 In the meantime nothing helps as much as milk and cream. Drink 
 three to four pints a day. If you will heat it well you will not get "gripes" 
 from it. Milk itself does not cause gripes. Bacteria in milk may. So 
 cook your milk. Malt tonics sold in drug stores will help. 
 
 Finally, get some exercise. Walk to and from work. If this is not 
 feasible, walk up and down the stairs to your office. If you will walk up 
 ten flights to your office each day it will help. 
 
 Don't Worry About It. — A. K. writes: "I talk to myself in a whisper 
 unconsciously. I do so more frequently while riding on a street car than 
 anywhere else. I think this is done often without any muscular movement. 
 Sometimes I am on guard against it, and I feel certain I am not talking, 
 yet the action of the other passengers seems to indicate that I am. This is 
 dreadfully annoying. What causes this, and what is the remedy? I am 
 70 years old. I have arteriosclerosis, hut otherwise my health is fair for 
 my age." 
 
 Reply. — Why worry about it ? Even if you continue it will not disturb 
 the passengers and should not worry you. Keep your bowels open and your 
 digestion good, eat moderately and be in the open air as much as possible. 
 Do not worry or fret about your arteriosclerosis or your little lapses. In 
 this way you will decrease your annoyance and you will find it will prevent 
 you from annoying others. 
 
 Quit Worrying. — M. K. writes: "I am 46 years old and am told by 
 some of the best doctors that I have slow Bright's and intestinal indi- 
 gestion. My hands and feet are always cold except when I am in bed. 
 I have pain in the back between shoulders all the time, and sometimes up 
 in back of the head. I am terribly nervous; everything worries me. What 
 would you recommend?" 
 
 Reply. — Quit worrying. Keep your skin going by wearing warm 
 clothes, especially warm socks and gloves. Did you read that Amundsen 
 put his thought on how to wrap his feet for warmth? Keep your bowels 
 open, eat lightly and sensibly. When you have regulated your life sensibly 
 you have done all that you can; therefore, quit worrying. 
 
CHAPTEE XXIII 
 
 Neurasthenia 
 
 THE PHYSICIAN AND NEURASTHENICS 
 
 Taking it all in all, people employ and reward physicians on the basis of 
 symptoms and emotions. They, therefore, think more of that physician who 
 relieves them or gives them positive optimistic suggestion than of the one who 
 discovers causes. 
 
 The sick man wants to lean — just plain lean — and lie does not want to go 
 hack up the stream to the fountain of things. If he is wise, and he usually is, 
 he wants somebody to work out causes for him, but meanwhile he is tired and 
 he wants to lean. It follows that the physicians who, along with their min- 
 istrations, brighten and cheer as they go, are those who have succeeded best 
 in gaining clients. 
 
 But aside from this the pill that has been given to a patient who had 
 faith, who took his medicine believing it would do him good, has always 
 had its natural efficiency increased. Who of us has not seen people who 
 scoffed at hypnotism, rejected suggestion, but who unconsciously paid tribute 
 to it when it came as a potion taken in faith? For there are cer- 
 tain types of minds which are incapable of accepting a purely mental 
 presentation, but who readily yield when this is supplemented by some 
 physical act, such as taking medicine, laying on of hands or crystal 
 gazing. 
 
 Even the strongest man needs spiritual help in his strongest moods. 
 He needs it more when he is sick. 
 
 What then shall we say of the neurasthenic, the neurotic, the hysteric? 
 They must have mental help and the physician must give it — admitted that 
 the aches and pains are out of proportion to their organic or even 
 their functional basis; admitted that the fifteen-story structure — the pa- 
 tient's complaint — is one story fact and fourteen stories mental per- 
 version. 
 
 Let the medical counselor explore well the organic basis of the disorder 
 and give to it every weight and care which it deserves — admitted that the 
 physician sees clearly just how much of the disorder is real and that the 
 patient exaggerates all out of proportion. But, is it not worth his while, 
 from the purely medical standpoint, that the patient's concept is distorted? 
 Should he not see in the wrong working of the patient's mind a demand 
 for study, care, and help? If he observes clearly that the patient sees 
 cloudily, is that a reason why he should dismiss the matter with a care- 
 less word? Eather does it not oblige him the more carefully to clear the 
 cloud ? 
 
 393 
 
394 NEURASTHENIA 
 
 SYMPTOMS OF NEURASTHENIA 
 
 Neurasthenia is sometimes known as the American disease. It was first 
 described by an American, Beard, and for a long time foreigners pretended 
 that we had it copyrighted. It is cosmopolitan. Wherever men wear out 
 their brain cells with work or worry or fear, there neurasthenia is present. 
 
 The word means nerve exhaustion. When the di( i onary starts in to de- 
 fine neurasthenia it refers to nerve exhaustion, and then, recognizing that 
 that means nothing tangible, it proceeds to add a lot of symptoms, each 
 of which may or may not be present. For instance, the Encyclopedia 
 Britannica names eight groups of unnatural sensations and then five or six 
 kinds of fear. Stedman, after saying it is nervous exhaustion, names eleven 
 groups of symptoms. They could just as well have named eighty. 
 
 The symptoms are the speakings of the exhausted nerve cells and they 
 are liable to tell any sort of a story. The eleven given in one definition and 
 the twenty given in another are just the eleven or the twenty stories most 
 frequently heard. 
 
 These most frequent ones are headaches, pain in the back, toothache- 
 like pain in the end of the spine, exhaustion after a little work, easy fatigue, 
 poor memory, mental confusion, insomnia, worry, fear, and susceptibility to 
 drug habits. 
 
 Some neurasthenics have one group and some another. I think the 
 most important group are the drug crowd — the men who must get drunk 
 when things do not go just right, those who have a little pain and must 
 take morphin for it, repeating it until they are slaves; those who have 
 a headache if they do not get their coffee or their soda fountain stimulant. 
 
 It has never seemed to me that anybody could read a dictionary definition 
 and decide whether or not he was a neurasthenic. On the other hand, almost 
 anyone who will read fifty or a hundred pages in some book on nerves can 
 get a line on himself. 
 
 It has seemed to me much more important that a man should be able to 
 decide whether he is of a mental makeup that develops neurasthenia under a 
 little stress. Such an inquiry is the more profitable of the two. 
 
 If a man's brain is not under control, the foundation is there for 
 neurasthenia. If he has not trained his mind to do its work without fear or 
 worry or fretting, using therefor just the units of energy to do the job, the 
 foundation is there. If he cannot rest, or relax, or play, or laugh, or sympa- 
 thize, the foundation is there. 
 
 If he is erratic mentally, flies off the handle in anger or in prejudice, 
 gets worked up or hysterical, he is of the neurasthenic type. 
 
 If he is fearful or worried, or gets headache after a little exertion, or 
 is always undecided, he has got fairly well out of the group of neurasthenia 
 potentials and into potential neurasthenics. 
 
 The less one is in the easier he can work himself out; but, whether 
 in deep or shallow, the only way to get out is to work out. 
 
TREATMENT OF NEURASTHENIA 395 
 
 TREATMENT OF NEURASTHENIA 
 
 "A Constant Reader: 
 the replyes that poor Nervous Sufferers get from your Health Corner is 
 Simply heart rendering I clout the one that publishes them have ever had any 
 Nervous trouble if they had they Never would publish Such Cruel things. I 
 never would wish a dog Such Suffering, but I hope you people will have your 
 shair some day. Speaking about a Neurasthenic Exaggerating thair suffering 
 they never could make thair suffering known. I sourely know what I am talk- 
 ing about, how easey it is to advise a poor sufferer about something that you 
 never have had any experience your Self. I don't cair how well learned 
 you are, you don't know what anuther surfers unless you have suffered like 
 
 The above letter is published for several reasons. An idea prevails that 
 neurasthenia is a disease of the rich and idle. The composition and spelling, 
 reproduced as written, suggest that the writer has not had much opportunity 
 for education, and therefore probably is not rich. 
 
 The object of printing the letter with its errors is not in any way to 
 expose the writer's limitations. It emphasizes the fact that neurasthenia is 
 not a disease of the rich and idle. Being a result of nerve fag, it would be 
 expected that those whose lives are hard would furnish many of its subjects, 
 and they do. A great deal of neurasthenia is found among the poor. 
 
 The second reason for publishing the letter is that it is a typical 
 neurasthenic output; a disposition to be unfair to others, a tendency to 
 criticize and ofttimes abuse others is a part of the infirmity. 
 
 The third reason is that it sets forth the tendency of the person to 
 exaggerate his sufferings, an inability to judge accurately of just how his 
 suffering compares with the sufferings of others. 
 
 The fourth reason is that it is proof of the fruitlessness of trying to 
 generalize with neurasthenics. 
 
 In order to understand these points better, let us see what neurasthenia 
 is. In neurasthenia there is nerve tire. It may be that, through inheritance 
 or poor food or a poor physique, the nerve cells are so constituted as to be 
 easily tired. 
 
 Some people are so constituted that exertion which leaves others fresh 
 will fatigue them to the point of exhaustion. In others the volume of work 
 is so great or the character of the work is so wearing that exhaustion comes 
 regardless of a good inheritance or a good physique or a good poise. 
 
 In still others the work kills, not because it is especially hard or 
 fatiguing but because the individual has an untrained or an imperfectly 
 trained mind. This lack of mental levelness, of control, causes the brain 
 to exhaust itself in doing tasks which a better trained brain could do without 
 fatigue. 
 
 Of these groups I think the lack of brain training group is the largest 
 and most important. Next in importance I place the bad inheritance group. 
 Last of all is the straight work group. 
 
 The individual who is neurasthenic has a physical basis for every ill he 
 
396 NEURASTHENIA 
 
 has. His difficulty is in perspective. He cannot form good judgment as 
 to the importance of his sufferings or the violence of his pains as compared 
 with other people's sufferings and pains. He knows that he suffers like a 
 dog, and he does. But what he cannot appreciate or understand is that 
 somebody else is suffering like two dogs. 
 
 Back of it all lie the exhausted nerve cells. The nerve cells interpret 
 things. If the digestion is wrong, the nerve cells tell us about it. If 
 the gall bladder is wrong, the story is told by the nerve cells. If the day is 
 hot, the nerve cells speak for us. 
 
 When the speaking is done by good, sound cells the story they tell 
 compares about right with the stories told by the nerve cells of other people. 
 When the speaking is done by exhausted nerve cells, the story is modified 
 by the cells which tell it, and in consequence it cannot be taken literally, 
 as can the story told by the better rested, better fed, and better equipped 
 cells. 
 
 To ignore the physical disorder of the neurasthenic is not wise. To 
 take the position that his recital of his sufferings is a gross exaggeration 
 and that all forms of deception must be frowned upon is not wise. To dismiss 
 the neurasthenic with a generalization, be it in the form of advice or of 
 medicine in a bottle, is unwise. 
 
 The individual must be carefully studied, a diagnosis made, and then a 
 prolonged treatment undertaken. The first object of the study is to find 
 out what physical disorder is present — a much more difficult proposition 
 than where the statement of the symptoms indicate accurately the condition 
 of the organs. 
 
 Ofttimes the nervous exhaustion is the result of serious disease. In 
 such a case, to make a diagnosis of neurasthenia and to conclude that there 
 is no organic disease may be to overlook some such condition as a chronic 
 infection of the gall bladder which has produced nervous exhaustion as the 
 result of years of slight suffering; or the disease may be cancer or something 
 else. 
 
 Assuming that the careful examination has ruled out important diseases, 
 there still are the minor disorders present serving to nag and tire and also 
 furnishing the nub of the symptom which the exhausted nerve cells are 
 presently to touch up, change, exaggerate, and hand out as the symptom. 
 
 The next inquiry should be to determine the type to which this nerve 
 exhaustion belongs. Is inheritance at fault, or bad physique, or bad mental 
 habits, or overwork? As the result of these inquiries, diagnosis is to be 
 made. And now on this diagnosis the treatment is to be outlined. 
 
 The dominating feature of the group is the exhausted nerves. To 
 remedy this condition patient, plodding effort is required. 
 
 The most important of all the groups are those who are neurasthenic be- 
 cause of untrained brains. In this group belong most of the poor-sleeping 
 neurasthenics, the worriers, the fretters, those who cannot pull because the 
 harness frets them. 
 
 I remember driving a pair of horses seven miles in the country a few 
 years ago. One, quiet, steady, calm, pulled most of the load and kept cool. 
 The other, nervous and fretful, pulled almost not at all; nevertheless he was 
 lathered with sweat. 
 
TBEATMENT OF NEURASTHENIA 397 
 
 It is easy for a person criticizing a neurasthenic to prove that he pulls 
 but little, that he gets nothing accomplished. On the other hand, it is 
 easy for the neurasthenic to show that he is always lathered with sweat 
 and to argue therefrom that he is working. 
 
 More units of nerve force are used up in an hour of work, more nerve 
 exhaustion results from ill devised, neurasthenic, fruitless labor than from 
 exertion rendering the full amount of returns. 
 
 Therefore, the critic says, "You accomplish nothing." The neurasthenic 
 replies, "I work harder than anybody and I suffer worse than a dog." 
 
 Of course, there is no contradiction in their statements. If these two 
 people, critic and neurasthenic, are to get on together they must learn to 
 see the other's point of view. 
 
 It is desirable that neurasthenics should get on with each other and the 
 world at large. The inefficiency produced by neurasthenia will be greatly 
 lessened by a greater capacity to make a superficial diagnosis of neurasthenia 
 and to treat the individual thereafter as a neurasthenic, blaming him less 
 than we do. 
 
 Some of the revolutions, many of the queer freaks of men, many of 
 the opinions for which men are rejected, maligned, abused, defeated, banished, 
 imprisoned, or beheaded are the result of neurasthenia. 
 
 It is important to be able to pick out neurasthenic men and neurasthenic 
 opinions. It is also important to improve the condition of the neurasthenic. 
 Some of them can be cured so as to gain much in efficiency. 
 
 To help a neurasthenic several procedures are necessary. The first 
 is to be certain of the diagnosis. The next is to recognize such physical dis- 
 orders as are present and give to them just their proper values. 
 
 The next step is to prove to the neurasthenic that you are able to see his 
 point of view, to understand that tire is in proportion to work done, and 
 not in proportion to results accomplished. 
 
 To do this just right requires intelligence. To convince the neurasthenic 
 that you understand him and at the same time to save him from inferring 
 that you agree with his opinion of the gravity of his disease is not an easy 
 task. 
 
 The next step is to make the neurasthenic see himself as a neurasthenic. 
 To do this he must be able to stand himself up by the side of others and 
 then walk off a few feet and compare. Not an easy task ! 
 
 Once a neurasthenic begins to analyze his own acts and his own opin- 
 ions to find the neurasthenia in them a good part of the cure has been 
 effected. So long as he keeps that up he will be a much more efficient 
 neurasthenic, a neurasthenic much easier to live with. Next to being a cured 
 neurasthenic it is desirable to be a neurasthenic who has found him- 
 self. 
 
 The next step comes in daily exercise in control of the brain. This is 
 the most difficult of all the steps. It is time consuming; it is the step 
 which leads to cure. 
 
 Some brains are strong enough to work out a cure alone. A neurasthenic 
 may be strong brained, his disorder having arisen because his strong brain 
 was untrained and uncontrolled. 
 
 Some brains are strong enough to work out a cure with a little help. 
 
398 NEURASTHENIA 
 
 Some can get this help from daily study of some such works as those by 
 Du Bois, Freud, Sadler, or even Vittoz. 
 
 Vittoz, while not on a plane with Du Bois or Freud, has the advantage of 
 setting the subject a daily stunt. Such a stunt is a necessity, whether it be 
 Bennett's, Vittoz's, or some devised for the particular case. 
 
 Some must have personal contact and teaching by a physician, psycholo- 
 gist, or a teacher of classes of neurasthenics. Some must lean upon faith 
 in the supernatural while they are training their brains. 
 
 Some diagnostic skill is required to tell to which group each neurasthenic 
 belongs. Another point in which the diagnostic skill is called for is the 
 decision as to whether the neurasthenic is to be given rest or work. 
 
 If the nerve exhaustion has resulted from work and worry has been 
 but a small factor in it, if the subject has gone about his task level headed, 
 well poised, sleeping well, and has broken down because the load was 
 too great, beyond question rest is indicated. Prolonged rest, free from every 
 sort of work, including the strains of daily friction, is to be followed 
 out. 
 
 It is in the nerve exhaustion where the work has been largely worry 
 and insomnia that nice diagnosis is required. This group, given more 
 release from work, will fill their minds with worry. There is no rule for them. 
 The advice must be changed for the individual from time to time. 
 
 The fact is that the question is of secondary importance. The main thing 
 is the mental training, the brain control. This having been acquired, rest 
 will result from eliminating worry and fear. 
 
 The questions of feeding and giving of medicine belong somewhere 
 in the same class as rest. The worry-fear group of neurasthenics will 
 be steadied by a bromid-arsenic mixture as they will be by a period of 
 rest. 
 
 If they use their drug-caused steadiness as a piece of firm ground on 
 which to stand while starting mental training they will be permanent 
 gainers. If they use it as an end in itself, they will gain but little. 
 
 There remain the two groups — the inheritance neurasthenics and the 
 neurasthenics whose brains are part of poor body machines, the groups whose 
 brain cells are exhausted from small loads of work or worry. 
 
 They are in this position: They did not enter the game of wear upon 
 the same terms. It will be necessary for them to do all the things the others 
 must do and a few things besides. 
 
 The man with poor physique must exercise systematically and persistently 
 to develop a better machine. In exercising his muscles and in doing tasks 
 requiring large numbers of muscles to work together he will be training all 
 parts of his machine. 
 
 The neurasthenic with an inheritance basis must work still harder. 
 He can find himself, one kind of a cure, or cure himself, a better kind of a 
 cure; but he will have to work harder for it than the man with a good 
 inheritance. 
 
 Neurasthenia cannot be cured by coldness or by sympathy. To begin 
 with, its cure requires keen analysis of the individual case. Then follows 
 patient, persistent, plodding training of the untrained brain. There is no 
 royal road. 
 
TREATMENT OF NEURASTHENIA 399 
 
 Neurasthenia. — S. D. A. writes: "1. For about a year I have felt 
 despondent, undecided, changeable, discontented, self-conscious, sensitive, 
 and irritable. I crave friendship and feel depressed when left alone. My 
 health seems to be good otherwise. I am constantly trying to analyze and 
 cure myself as best I know how, but feel discouraged. However, I am 
 not hopeless and am willing to try anything that will restore me to my 
 former cheerfulness. 2. What is a psychotherapist? 3. Where could I find 
 one? Jf. Can you name any boohs on nerves that would help me?" 
 
 Reply. — 1. You are neurasthenic. 2. A psychotherapist is one who 
 studies the mental processes and prescribes not medicine but mental exer- 
 cises. 3. Every community has many such. 4. ''Physiology of Faith and 
 Fear," by Sadler; "Conquest of Nerves," by Courtney; "Psychic Treat- 
 ment of Nervous Diseases," by Du Bois. 
 
 First, find out if you have any physical ills. If none is found that 
 is in proportion to your symptoms, put yourself in proper hands for a 
 course in mental training. Expect, in the main, to work out your own 
 salvation. Your psychotherapist can guide, direct, and control you, but 
 it is your mind that is to be trained and it cannot be accomplished save as 
 you work at it, patiently, optimistically, altruistically, sanely, and per- 
 sistently. 
 
 Medicine in Neurasthenia. — Reader writes: "I have been troubled with 
 nervousness for almost a year and a half; I believe the doctor calls it 
 neurasthenia. I have been examined by several physicians, and all say my 
 blood pressure is all right and that I have no physical ailment. It is worry 
 and fears that make me so miserable; the fears are things that seem ridicu- 
 lous, yet, no matter how hard I try, it seems almost impossible for me to 
 overcome them. The medicine I have taken seems to do me no good. Can 
 you suggest anything?" 
 
 Reply. — You do not need medicine and you are right that it does you 
 no good. Neurasthenia is, in part, inherited. In part, it results from bad 
 training. The inheritance part you camt help. The training part you 
 can help, although it will require more patience and persistence than if 
 you had started right. First, get "Physiology of Faith and Fear" and 
 study it carefully and persistently. Second, put yourself in the hands of 
 a nerve specialist who will give some time to unraveling your mental state 
 and finding you out. Third, go to work on your own mentality, for your 
 mental regeneration will, in great part, result from your efforts at self- 
 control and training. 
 
 Marriage and Neurasthenia. — H. W. T. writes: "I send you herewith 
 a newspaper clipping regarding a proposed change in the English marriage 
 law. It seems to me the conditions referred to have been present with me 
 for more than twenty years and have become more pronounced within the 
 last few years. I find it difficult to center my attention upon any one 
 thing. I have no initiative. There is a strange indecision as to the most 
 trivial of my affairs. Everything is postponed to the last minute of the 
 last day. My memory is poor and mental lapses are frequent. Periods of 
 depression come with fears of the future or with regrets over the past. 
 My anger is sometimes aroused on the slightest provocation and there is a 
 proneness to weep. Please tell me what is the oest thing for me to do." 
 
 Reply. — I have read the clipping referring to the proposed English law 
 making marriage with a mental defective a misdemeanor. It is one of 
 
400 NEURASTHENIA 
 
 those negative eugenic measures that various countries are wrestling with. 
 Such laws, though probably different from their present forms, will event- 
 ually prevail everywhere. Of course, correspondence diagnoses are guesses, 
 but there is an axiom that no man is insane who thinks he is. On the other 
 hand, your letter describes a typical neurasthenia. You are in no danger 
 of going crazy. You do need medical help. Put yourself in the hands of a 
 psychotherapist. Read some of the popular books on nerves. Go to work 
 on your mental methods and keep at it. 
 
 Neurasthenic. — W. F. writes: "Can you suggest mode of living and 
 treatment for great nervousness, irritability, physical and mental exhaus- 
 tion, aches and pain in eyes, head, and all over body, which are perma- 
 nent and increase in dull and heavy weather? The condition has repeatedly 
 been diagnosed as neurasthenia. Is chlorid of iron beneficial, and for how 
 long a period can that be taken?" 
 
 Reply. — If you are in need of iron, chlorid of iron is a good form to 
 take. You can take it for a year without detriment. Exercise in the open 
 air, training of your muscles, plenty of sleep in fresh air, properly adjusted 
 eating, and regular bowel habits are all helpful in neurasthenia. But, 
 assuming that you have been correctly diagnosed and are a neurasthenic, 
 you must not forget the fact that neurasthenia is a quality of mind. The 
 essential is that you train your untrained or wrongly trained mind. It is 
 necessary that you forget your ills. You are self-centered. You worry. 
 You are afraid. 
 
 First, you must learn sociability. You must learn to play, and with 
 others. You must learn courage. You have an idea that the bogey man 
 will get you if you don't watch out. That you must overcome. You worry. 
 That you must stop. You cannot decide. You wabble between opinions, 
 between hopes and fears. That wears you to a frazzle in the day and 
 dreams you into waking at night. 
 
 Have I said enough to show you where your salvation lies? 
 
 Mild Neurasthenia. — M . J. K. writes : "I find trouble often in concen- 
 trating my mind on any one subject. I often have to read such matter as 
 newspaper writeups three and four times before I know what I'm reading. 
 In other words, I read the words mechanically, while I am thinking of 
 something else. And in my work I find myself dreaming at times. Is 
 there anything I can do to train my mind to stay where it is put until I 
 get ready to use it for something else?" 
 
 Reply. — This is a mild neurasthenia. Maybe all that you need will be 
 to read and apply Freud or Du Bois, or perhaps even Yittoz. 
 
 In the last named are some things which are misleading. Freud is the 
 more critical in his analysis of mental states. Du Bois holds the mirror up 
 so that a neurasthenic sees himself in a saner light. 
 
 The crux of the neurasthenia situation is, first to find oneself and then 
 patiently, ploddingly, and sanely to make good. 
 
 Try Reading These Books. — H. P. P. writes: "I frequently have sensa- 
 tions of fear that any breath may be my last, or something sensational. 
 My heart is in excellent condition. Please give me your opinion." 
 
 Reply. — You probably have a simple neurasthenia and are in no danger. 
 Go to the library and read "Physiology of Faith and Fear" by Sadler, or 
 "Mind and Work" by Gulick, or "Making Life Worth While" by Fisher. 
 
TREATMENT OF NEURASTHENIA 401 
 
 You must be trained or train yourself so that you can control foolish 
 fears. 
 
 Better Read Du Bois. — B. L. B. writes: "For a couple of years I have 
 been addicted to worry, mental indecision, melancholia, and have often 
 wondered if I was not on the verge of insanity, so extreme has been the 
 trouble. I doctored for a time, but without permanent benefit, and now am 
 inclined to think that there is no medicine that will avail in such a case. 
 The only antidote for this anxiety, etc., that I have found is a sense of 
 intelligence that comes and goes, but whose coming temporarily allays 
 mental stress. What is this mental relief agent, and how may one learn 
 to meet every worry with intelligent thought instead of being driven by 
 constantly arising perplexities into a state of worry that so reduces one's 
 living efficiency f I have found that to associate with healthy minded, 
 unselfish people and a habit of reading anything of general interest are of 
 great benefit. True humor is a veritable godsend. Work is often a great 
 help, but sometimes an added worry. I doubt not that I am but one of 
 thousands who are similarly troubled, at least to some extent." 
 
 Reply. — B. L. B. paints a good picture of neurasthenia. Neurasthenics 
 seldom become insane, though they usually think they are on the verge 
 of it. This disposition to magnify their troubles, to think that their pecu- 
 liarities differ from those of thousands of others, constitutes one of the 
 manifestations of their self-centered condition. 
 
 B. L. B. has a vein of humor and a sub-stratum of good sense that 
 make it plain that he is on good ground. Were he to read Du Bois, he 
 would laugh at himself for a week. 
 
 Probably he requires nothing except to read this book. 
 
 Cures Self of Neurasthenia. — C. M. M. writes: "The article which ap- 
 peared March 6 on neurasthenia was especially interesting to me, as I 
 have been troubled with the same disease or ailment, but have been re- 
 stored back to health. I had a severe attack of nervous trouble about 
 eighteen months ago. My pulse would beat rapidly and then irregularly. 
 Then at times I would have spells of fear, and think I was dying. The 
 palm of my hands would be wet with cold perspiration. I had shortness 
 of breath sometimes. The blood in my limbs would feel hot and clogged. 
 My mind would be almost a blank at times. I slept but little, but when 
 I did I would awaken with a sensation of fear. I would lie for hours with 
 my hand on my pulse, thinking every beat was the last. I would get weak 
 at times. This trouble would generally come after eating. I had some of 
 the best physicians. Medicine did me more harm than good. I finally 
 took my own case. I got out in the open air. I associated with people of 
 strong personality. I kept my mind off what I termed a fatal disease, and 
 threw off that fear. I got hold of new life, and said to myself, Til live it 
 down.' I succeeded. That was my medicine." 
 
 Reply. — This is published for the help of neurasthenics. However, you 
 got off easily. With most people working oneself out of even a mild 
 neurasthenia, as was yours, is more difficult and tedious. 
 
 Should Learn Control. — C. writes: "About two years ago I was struck 
 at the base of the brain on the left side of my head in an accident and 
 practically recovered in about three weeks. I find that I am now suffering 
 from fear to such an extent that I am miserable. I am employed as secre- 
 
402 NEURASTHENIA 
 
 tary and carry heavy responsibilities. Is it the natural spring decline or is 
 it due to my nerves? I feel like screaming when at the theater and lay 
 wide awake at night, while my body seems exhausted, and finally doze off in 
 the morning. Would you advise my taking treatment physically or men- 
 tally? I am worried over this affair, as I had wonderful nerve control and 
 a happy-go-lucky spirit previously. I sleep restlessly and dream of ugly 
 things. While busy I am all right, but when I get home at night, tired and 
 hungry and long for rest, I become unhappy, and this state has made me 
 worse every evening until now I don't enjoy anything. I tried to fill my 
 evenings with entertainment and plesaure, but have a desire to scream and 
 picture horrible calamities and vivid suffering. Am I just overworked? 
 What mental food do I need? I am 25 years old. I have severe pains in 
 my head {where I was struck) almost continually. I gave up all kinds of 
 headache powders a long time ago." 
 
 Reply. — So far as your use of headache powders is concerned you are 
 wise. Headache powders give temporary relief. If their use is persisted 
 in they come, in time, to cause headaches. You are neurasthenic, almost 
 hysterical. 
 
 Neurasthenia usually has a physical basis. The characteristic of the 
 disease is exaggeration of symptoms, not imaginary, but actually existent 
 symptoms. Self-pity, nerves, desire to scream, restlessness, dreams, worry 
 are the results of such exaggeration. It is not often as easy +o prove the 
 physical base as in your case. But, so far as the injury to your head is 
 concerned, you can do nothing. 
 
 The plan is to build up your general health and to learn control. A 
 course in a sanitarium where control is taught would benefit you. Psycho- 
 therapy given outside an institution would benefit you. 
 
 Case for Psychotherapy. — M. H. writes: "Would you think the follow- 
 ing symptoms serious: A skipping pulse, never counting fifty without 
 three and sometimes more skips; each time the pulsation is felt in the 
 throat; a palpitation in the stomach with the same sensation in the throat; 
 a pulsation at times all through the body till the ears pop and the head 
 seems full; great exhaustion at times; occasionally acute pain in the chest, 
 this, however, not frequent. Some days these symptoms are trying. The 
 subject is in good condition every other way. The age is 51." 
 
 Reply. — A lot of subjective symptoms. If a physician finds no organic 
 basis for them, and he probably will not, the case is one for psychotherapy. 
 Watching the pulse can make it skip one beat in sixteen. 
 
 Temper in the Morning. — T. A. writes: "Why should I, a middle-aged 
 man, be so ill tempered in the morning and be quite good natured after 
 starting to work? Has the body been manufacturing poisons while I 
 slept? Please suggest some simple remedy to overcome this condition." 
 
 Reply. — I should say you have sized the situation up right. Maybe you 
 do not sleep enough; maybe you sleep too much. First, regulate your 
 sleeping hours; second, improve the ventilation in your sleeping room; 
 third, take a cold bath — water or air — and a good rub before breakfast. 
 Do not take any medicine for the condition. 
 
 Victim of Neurasthenia. — Mrs. W. N. E. writes: "I am five feet four 
 inches tall and weigh 162 pounds. What should I weigh? The doctor says 
 my heart is weak. The top of my head hurts and the back of my neck. 
 
NEURASTHENIA AND HYSTERIA 403 
 
 It is worse at night and often keeps me awake. At times 1 feel so de- 
 pressed everything looks dark. I am very nervous. At times I cant keep 
 quiet. At other times I am completely exhausted and could lie down for 
 hours and never move or wish for anything. When some of my most wel- 
 come and loved friends come in to call I get so cold I shake after they are 
 gone. I feel warm soon. I have always been among people a great deal. 
 What causes such troubles? I am 3Jf years of age." 
 
 Reply. — You are twenty-five to thirty pounds overweight. You are 
 neurasthenic. Your physician can show you how ill founded are your 
 aches and fears. Read Sadler's "Physiology of Faith and Fear," pub- 
 lished by A. C. McClurg & Co., or "Conquest of Nerves," by Courtney, 
 published by Macmillan Company. 
 
 Neurotic and Nervous. — R. M. C. writes: "Will you please give the 
 definite meaning of neurotic, and how it differs from nervous? Is there 
 value for a poorly nourished person in rubbing the flesh with olive oil or 
 milk, either fresh or evaporated?" 
 
 Reply. — 1. A neurotic is a person suffering from a nervous disorder. 
 As the term is generally used, a neurotic is a person suffering from neuras- 
 thenia, or with a tendency toward melancholia, or exaggerating his ills, or 
 disposed to be hysterical. A nervous person is one whose nerves are on 
 edge, but where there is less disturbance than with a neurotic. A nervous 
 person is one easily excited or agitated. 
 
 2. No; neither will be absorbed. 
 
 NEURASTHENIA AND HYSTERIA 
 
 As compared with general paresis, dementia precox and paranoia, 
 neurasthenia, hysteria, and melancholia are minor maladies. They produce no 
 deaths and no sickness that find their way into morbidity tables. Yet as pro- 
 ducers of inefficiency they approach, though they do not equal, hookworm 
 and malaria. 
 
 That so large a part of the people are neurasthenics and hysterics is 
 the result of several causes. One of them is a faulty educational system. 
 Payot in his "Education of the Will" says : 
 
 "It is from this point of view that we should readjust from its very 
 foundation our method of undergraduate and higher instruction. It is 
 very important to abolish the foolish principle of cultivating the memory 
 exclusively, for this is weakening the vital forces of the nation. 
 
 "We shall have to plunge into the inextricable thickets of the curriculums 
 of all the schools with a hatchet so that we may cut out the tangle on 
 every side to let in the daylight and the air, and we must be willing some- 
 times even to sacrifice some beautiful plants which are too crowded and 
 which will never grow. 
 
 "Instead of encouraging: feats of memory, we must substitute active 
 exercise and work which will develop the power of judgment and intellectual 
 initiative and vigorous deductions." 
 
 The schools are for the purpose of training the mental machine. It is a 
 part of their duty to prevent the development of the inefficient machines known 
 as the neurasthenic and hysteric minds. 
 
404 NEITKASTHENIA 
 
 Another cause is bad inheritance. In Bridger's "Mind in Distress/' the 
 great canse of neurasthenia and hysteria is given as mental isolation. 
 This suggests as an increasing cause the isolated life of the only child and this 
 leads easily into the next heading. 
 
 Neurasthenia and hysteria are caused by a lack of training in the home. 
 Bad heredity, poor home training, poor school training, lack of opportunity 
 for play, absence of proper training in one's work — these causes operating 
 result in a great mass of neurasthenics and hysterics. 
 
 Why they are here is not the subject of this article. This article is 
 written in answer to the question : Can anything be done for those already 
 among us? The answer is: Yes. 
 
 At that, there is no royal road. Those who are willing and able to 
 work out their salvation can do so. Those who are looking for cure from a 
 bottle of medicine or some other form of magic will not be cured. 
 
 The machinery of society for curing neurasthenics is of no consequence. 
 If a neurasthenic has it in him to work out his cure he will attain it, but 
 not otherwise. If a man has smallpox society will catch him and cure him; 
 not so if he has neurasthenia. 
 
 Bridger defines neurasthenia as loss of balance in the masculine type 
 of mind; hysteria as the loss of balance in the feminine type of mind. 
 Note the statements are "masculine type," not male type; and "feminine 
 type," not female type. 
 
 The masculine type is highly practical, demands proof before accepting 
 conclusions, and relies only on facts. These are the plodding, steady people 
 who achieve financial success or at least stability. Without having studied 
 formal logic, they are logical and rely upon the relation of cause and 
 effect, considering that to be the one and only criterion of sane judg- 
 ment. 
 
 The feminine type is devoted to ideals. It sees the end to be attained, 
 but is little concerned with process of attainment. The feminine type 
 has the reasoning faculty, but it does not rely on it exclusively. It depends 
 largely upon intuition and instinct. 
 
 The feminine type of mind occupies a much greater area of the brain 
 than does the masculine and presumably that is the explanation of its 
 wider range, its greater capacity, and its relative incomprehensibility. Being 
 more complex, it is more unstable. 
 
 Bridger says of the feminine type that, given a good heredity and a 
 wise education, it presents the highest type- of mental development, range 
 of vision, clearness of faith, conception and love of ideals, rapidity of percep- 
 tion, breadth of judgment, love of the beautiful, all under the control of 
 a reasoning power not tied to material possessions, never accepting the 
 narrow and practical as the only view. 
 
 He divides feminine mind types into three groups, 
 
 1. The pure feminine mind type, occasionally found in men, found 
 in a high percentage of women. 
 
 2. The weak feminine mind type. Many men as well as many women 
 are in this class. 
 
 3. The mixed type, in which many traits of the masculine type are 
 intermingled with feminine traits. 
 
NEURASTHENIA AND HYSTEEIA 405 
 
 Bridger attempts to reduce these types to mathematical mental formulae 
 as follows: 
 
 NORMAL AVERAGE MASCULINE TYPE OF MIND 
 
 Total Distribution Ex- 
 Conscious portion— Amount. Inhibited. hibited. 
 
 A — Ideas relating to self 30 15 15 
 
 B — Ideas relating to others 15 10 5 
 
 C — Sensation (impressions) 15 5 10 
 
 Subconscious portion — 
 
 D— Instincts 10 8 2 
 
 E — Impulses 10 8 2 
 
 Unconscious portion — 
 
 G — Reflex muscular and secretory impulses ... 20 8 12 
 
 100 54 46 
 
 NORMAL AVERAGE FEMININE TYPE OF MIND 
 
 Conscious portion — 
 
 A— Ideas relating to self 20 10 10 
 
 B — Ideas relating to others 5 2 3 
 
 C — Sensation (impulses) 10 5 5 
 
 Subconscious portion — 
 
 D— Instincts 30 25 5 
 
 E— Impulses 15 10 5 
 
 Unconscious portion — 
 
 G — Reflex muscular and secretory impulses ... 20 8 12 
 
 100 55 45 
 
 . A frequent division of the mental impulse is into three groups. The 
 reflex acts are usually designated as the lowest mind functions. Most 
 authorities refer to instincts and intuitions as mental processes of the 
 second order. Bergson, however, disagrees with this idea. Bridger says 
 that it is not proper to say that the conscious ideas are either superior to 
 or inferior to the instincts. 
 
 Environment furnishes stimulation to the mind. Some of this stimula- 
 tion is distributed to be stored as inhibited impulses (memory), and some 
 is distributed to more active mental acts. It is the will which determines 
 the distribution. 
 
 Bridger thinks that whatever tends to produce isolation of mind is the 
 one great antecedent condition to neurasthenia. As long as even the most 
 unstable of minds keeps itself among the crowd and is in and of the world, 
 it is on safe ground. 
 
 In proportion as one fails to keep in contact with humanity the 
 tendency to isolate oneself grows, until the mind has become a hermit 
 mind. Out of this grows neurasthenia or hysteria, according to whether 
 one is of a masculine or feminine type. The men "grand, gloomy, and 
 peculiar," are peculiar because they are grand and gloomy. 
 
406 NEURASTHENIA 
 
 The neurasthenic, having lost his sense of proportion and having 
 exaggerated his ego, exaggerates qualities relating to his ego. 
 
 Our general store of knowledge, a register of our conclusions to date, 
 constitutes our common sense, and this is one arm of the mental balance. 
 This common sense is kept in a state of general average with other minds 
 by contact with current opinion. Lose this contact and the balance is dis- 
 ordered. Much depends on the soundness and stability of the common 
 sense. 
 
 The other arm of the balance is made up of the new impressions coming 
 from the internal organs and from the outside as well. A normal individual 
 maintains a mental balance between these with ease. 
 
 When this balance is disturbed in the masculine mind, the reason tries to 
 reestablish it; the egotism trained in isolation and introspection leads 
 wrongly. The person becomes a victim of self-suggestion. This is Bridger's 
 idea of neurasthenia. 
 
 The influences predisposing to hysteria fall into two groups — the exalted 
 ego or overcultivation of self, and the starved instinct, which includes all 
 checks to the proper gratification of normal instincts. These act on the 
 feminine type of mind. 
 
 When they act on the pure feminine mind type the result is the or- 
 dinary hysteria of the textbooks with the excessive emotional explosions so well 
 understood. 
 
 When they act on the weak feminine mind type, the person is always 
 ailing and sick, exaggerating and coloring her statements, unreliable and un- 
 truthful, excitable, weakly emotional, and selfish. 
 
 Hysterical persons can develop any symptom. They may have any 
 form of mental disturbance or nervous symptom. They may develop fever 
 or jaundice or slow, fast, or irregular pulse. 
 
 As a means of curing, the first essential is to give time enough to 
 find out everything in heredity and environment, even to the smallest detail ; 
 then to encourage the mind to show how it works. Bridger closes his 
 eyes and allows the patient to talk himself out. Barker lays stress upon allow- 
 ing the patient to tell his whole story. 
 
 The next step should be a painstaking physical examination to ex- 
 clude organic disease giving symptoms sometimes simulated by neurasthenia 
 and hysteria. 
 
 This information being in hand, the next step is to analyze it and 
 map out a plan of procedure. The best authorities are of the opinion that 
 work is the thing. 
 
 Cabot says: "The sufferer must learn to stand upon his own feet. He 
 must get back into life. 'Real life,' as we now begin to see, after all is the 
 best teacher and the best doctor. Seclusion in sanitaria or rescue homes is 
 being replaced by efforts to get the sufferers back into industrial life, back 
 into family life, back to the surroundings which keep ordinary people going, 
 back to the best that civilization has to offer to normal people." 
 
 Bridger says: "Work must be insisted on. A man's occupation, if it 
 be at all congenial to him, and if it provide means of meeting and con- 
 versing with his fellow man, is the best. It should be of a kind that, once 
 started, means compulsory regularity and attention. All other measures 
 
NEURASTHENIA AND HYSTERIA 407 
 
 will fail until you have secured this essential to success. In nine cases 
 out of ten it is the only treatment necessary. 
 
 "Seek out the ambition latent in the patient — some ambition is latent 
 or active in every man — and stimulate it. All who treat neurasthenics make 
 use of some form of suggestion. The variety to be used is to be determined 
 by the person and by the psychotherapist/' 
 
 The method of treating hysteria given by Bridger is (1) understand 
 and control the patient, (2) alter her surroundings to her benefit, (3) find 
 systematic employment for the mind, (4) make a dramatic mental appeal 
 and suggestion. 
 
 As a resume, Bridger says the cure of hysteria depends in general 
 on the personality of the doctor, on his knowledge, firmness, judicious sym- 
 pathy, and above all on the confidence he inspires. 
 
 In neither hysteria nor neurasthenia does he advocate the use of drugs. 
 In his opinion they keep the person self -centered ; they further stimulate 
 introspection; they appeal to his ego and the little good they do is better 
 done by exercise in the open air, while they do harm by twanging the 
 string that is most out of tune. 
 
 An essential part of the Bridger system of treating minor mental dis- 
 orders, especially neurasthenia, is to discover the bogey and to get around 
 it. By the bogey he means the phobia. 
 
 The bogey of a neurasthenic is that person's supreme dread. It may 
 be insanity, suicide, injury to self-esteem, loss of good repute. When one 
 has had some experience he can guess the patient's bogey long before he tells 
 it, as he relates his story. 
 
 Bridger advises that bogey never be charged in the open. Sometimes 
 he builds a rival bogey; sometimes he patiently and slowly tears it to pieces; 
 sometimes he undermines it. As I understand it, he thinks it advisable 
 to deceive the neurasthenic and thus in time show him how he has been 
 deceiving himself. 
 
 To do this requires a very great skill. Neurasthenics and hysterics 
 especially are exceedingly suspicious. They suspect everybody, and to outwit 
 them is not easy. 
 
 On the other hand, Cabot is a strong believer in telling the truth. 
 Barker advocates telling the truth discreetly and tactfully. "Reprehensible, 
 most will agree, is the practice of permitting the patient to believe that 
 his absurd fears are well grounded." 
 
 Most important of all, finally, is the tedious work of reeducation, the 
 doing of work that should have been done in childhood; the doing of it 
 under circumstances in which the person starts from much worse than an 
 even break. The different steps in reeducation are as follows: training of 
 the voluntary attention; following this comes the rational reeducation of 
 the emotions and the will; then comes training of voluntary activity or 
 conduct. To begin with, this may have to be done under outside direction. 
 At the end it must be largely self-direction. 
 
 Treatment of Neurasthenia. — R. R. R. writes: "How should neuras- 
 thenia he treated when it has been growing worse since childhood? What 
 causes neurasthenia in children? A neurasthenic knows no mental disci- 
 
408 NEURASTHENIA 
 
 pline, so please do not suggest it. I would do almost anything to rid 
 myself of that terrible fear which overshadows me, but I cant do it with 
 my mind. If you do not care to answer my questions will you kindly sug- 
 gest any books on the subject?" 
 
 Reply. — A supposed neurasthenic should be carefully examined to ex- 
 clude organic disease. If it be found that there is no organic disease, then 
 treatment for neurasthenia should be begun. The neurasthenic should not 
 be ridiculed. Such a course is folly. Neither should he be sympathized 
 with. That, too, is folly. The only treatment worth while is mental train- 
 ing. 
 
 You are right, a neurasthenic knows no mental discipline. But that 
 fact is a reason for mentioning mental discipline, not for ignoring. The 
 neurasthenic who can train his mind can be cured ; the others cannot. The 
 process is necessarily a slow one, but no one can say in advance that it can- 
 not be done. Some neurasthenics read such a book as Du Bois or Sadler, rec- 
 ognize themselves in the cases stated, and get control of themselves without 
 outside help. Some follow the exercises in Walton's "Calm Yourself" or 
 Bennett's "Human Machine" or Sadler's "Worry and Nervousness," and 
 cure themselves. Some require the services of neurasthenic specialists. 
 Some gain control by constant study of Mrs. Eddy's "Science and Health." 
 Some prove incapable of mental discipline. Neurasthenia in children may 
 be the result of inheritance or lack of training, or both. 
 
 INSOMNIA 
 
 Insomnia is sleeplessness. It does not occur in youth or in those 
 who work with their muscle, especially if they work and live in the open 
 air. It does not occur much before middle life and then more frequently in 
 men than in women. 
 
 Excluding actual disease, pain or delirium it is substantially always 
 accompanied by overeating or injudicious eating in those of sedentary in- 
 door lives. Granted that worry is the cause it is wise, in offering relief, 
 to consider well the digestive apparatus of the sufferer. 
 
 As health editor I receive letters about insomnia every day. Certainly 
 many people are not sleeping well. To these letters I sometimes reply 
 telling of this or that thing which can be done. Then there follows a 
 series of letters from people recommending procedures. Therefore let us 
 make our views plain and emphatic. 
 
 Insomnia is a condition of mind. When the brain works too hard, the 
 man wakes. He cannot go to sleep again until he has got his trolley off 
 the wire. The thinking may be cool, judgmatical weighing of probabilities; 
 it may be imagination producing poems, ideas, or inventions. (The best 
 thinking can be done in the night hours.) Or it may be worry with its 5 
 per cent, of efficiency and 95 per cent, of waste, worse than railroad waste or 
 most any other kind, for the most foolish thinking can be done during night 
 hours. 
 
 The point is, it is thinking that does it. Whether the thinking is 
 good or bad is a detail. 
 
 There is no remedy except mental training. A man must either 
 
INSOMNIA 409 
 
 train himself to loosen his mental tension before and while he sleeps or pay 
 the consequences. 
 
 How he is to train himself is another matter. But it must be done. 
 Physical work, hot baths, and things of that character are better than 
 sulphonal and bromids. Nevertheless, they are in the same category. 
 They do not take care of the root of the difficulty, which is wrong mental 
 methods — taking your work or your worry to bed with you. 
 
 A man who has. done hard, muscular labor and who worries will have 
 his brain paralyzed by the chemicals of muscular fatigue for, say, six hours, 
 but following that brain concentration gets the upper hand, and he wakes 
 up. 
 
 In insomnia there is no permanent short cut. You must make your 
 brain join the union and keep the working hours of the brain workers' 
 union, otherwise you will go on the scrap heap before your time. And 
 finally your death certificate may read any one of a dozen ways. 
 
 Insomnia. — L. W. C. writes: "I have for several years teen a great 
 sufferer from insomnia, not getting on the average three hours' sleep out 
 of twenty-four. For six months I have not averaged more than that, and 
 alternate eevry night with bromidia, somnos, and veronal, so that no one 
 wears out entirely. But I fear I am endangering myself by this constant 
 use of these medicines. I am so heavy every morning it is hard to get up. 
 What evil effects can come of constant uses of these medicines? I am a 
 traveling man and constantly on the go." 
 
 E. W. S. writes: "I felt that you had found the root of the matter 
 when you referred to the primal cause of sleeplessness as being a matter 
 of mental control. If you can go just one step further and tell the great 
 army of insomniacs just how they can barricade their minds against the 
 'imps of thought' that come thronging in the hours that should be given to 
 slumber you will be demonstrating a priceless boon to sufferers from wake- 
 fulness that 'terror by night/" 
 
 J. 8. T. writes: "To divert the mind from worrying subjects read one 
 or more chapters of history before retiring and select a number of topics to 
 be remembered, say ten or twenty, or as many as you please. When wake- 
 ful recall these topics, counting each topic recalled by holding up a finger 
 till the full number is recalled. You generally go to sleep in the effort." 
 
 C. S. S. writes: "I see much written about insomnia. I would be glad 
 to relate my experience to those that are troubled that way. I come to 
 look upon my experience as a great blessing. I learned to repeat the 
 fourteenth and fifteenth chapters of St. John. Then, when awake, I would 
 repeat and study these words, words teaching us how to live and how to be 
 saved through all eternity." 
 
 Reply. — So many people write me about insomnia that I am sure it is 
 a matter of great public interest. I have written about it more than 
 once, but I think it advisable to publish the above series of letters and 
 to comment on them. 
 
 To L. W. C. we wish to say that no circumstances justify the nightly 
 use of bromidia, somnos, and veronal alternating or after any other plan. 
 He must take such steps as are necessary to remedy his condition. Pallia- 
 tion will get him in trouble. 
 
 E. W. S. recognizes that thought cannot be stopped by willing it. If 
 the mind is occupied by thoughts which keep one tense, the remedy is 
 
410 NEURASTHENIA 
 
 to start a train of thought which is attractive enough to replace the 
 harming line and not stimulating enough to develop tenseness. 
 
 To some people J. S. T.'s suggestion is a good one, to others the sug- 
 gestion of C. S. S. will be more helpful. Some line of diverting thought 
 must be indulged in. 
 
 Let us keep this clearly in mind — insomnia is a state of mind. The 
 remedy for it is mental. Physical conditions contribute somewhat. Phys- 
 ical treatments of different kinds help somewhat. Drugs for it are not 
 to be thought of. If the condition is bad enough to need drugs, or is 
 thought bad enough to need them, it needs remedial treatment worse. 
 
 Cause of Sleeplessness. — 8. J. C. writes: "I wish to know what is the 
 cause of my restlessness when retiring for the night. It takes hours hefore 
 I fall asleep. I am in perfect health, have nothing to worry about or any- 
 thing to cause me to keep awake. Kindly tell me what causes it and advise 
 me as to the cure for it" 
 
 Reply. — You do not go to bed with a mind at rest. Spend at least two 
 hours before retiring in getting rid of all mental tension, and then go to 
 bed and sleep. Don't try to sleep or think about not sleeping. Just take 
 sleep as it comes, and come it will. 
 
 Sleep Mental Condition. — M. B. writes: "1 am an office man of 65 
 years and weigh 11^5 pounds. My health is pretty good, but I am nervous 
 and my sleep is not good. I go early to bed. I don't drink nor smoke in 
 the evening, and my sleep is disturbed by dreams all night. In the morning 
 I feel weak. What could you suggest to obtain a more healthy sleep?" 
 
 Reply. — Sleep is a condition of mind. It is similar to worry, anxiety, 
 concentration, equanimity, in that it is a mental state. Therefore the 
 treatment for it is mental. Briefly, certain principles are: 
 
 1. Do not try to sleep. Simply turn loose and sleep. 
 
 2. Drop the concentrations of the day a few hours before bedtime. 
 Some can accomplish this by physical or mental play after supper. Some 
 can only force their minds to turn loose by reading something with grip in 
 it for them — novels for some, philosophy for others. 
 
 3. Physical aids, such as baths, proper eating, and proper bedroom 
 arrangements, are of service. 
 
 Needs More Sleep. — Anxious Mother writes: "I am not a strong 
 woman and not sickly, but I am nervous. If I get eight hours' sleep I feel 
 well for the day, but I seldom get it, as I wake up and cannot go to sleep 
 again. Is there anything I can do for this, so I can sleep more? I have 
 a daughter two years old who is nervous. If the mother is nervous does 
 it affect the child, or does she outgrow it?" 
 
 Reply. — 1. You are right; you need more sleep. Eight hours is not 
 enough for a nervous woman ; less than eight hours is certainly not enough. 
 When you awake, do not get nervous about being awake or over your 
 thoughts. Convince yourself that you do not care to sleep. Do not let 
 your desire to sleep make you tense — turn loose and sleep or stay awake, 
 as it comes. As soon as you get in this frame of mind you will sleep. 
 Perhaps intestinal indigestion awakens you a certain number of hours after 
 your evening meal. If so, eat a light, simple supper. 
 
 2. Children do not grow out of nervousness, but they may be trained 
 out of it. A nervous mother is liable to have a nervous child for two 
 
 
iisrsoMNiA 411 
 
 reasons — inheritance and association. Train your child to be quiet and 
 calm. 
 
 Cause of Dreams. — H. G. B. writes: "Can you tell me what causes a 
 person to dream after retiring at night ?" 
 
 Reply. — Lock the doors to your brain when going to bed. The nerves 
 are the doors through which impressions reach the brain and disturb 
 sleep. These disturbing impressions may come from outside, such as 
 noises, cold, and uncomfortable bed. They may come from within in the 
 nature of pains of various kinds, disturbing thoughts, worry, or mental 
 excitement. 
 
 If the sleep disturbing impressions are strong enough to unlock the 
 doors to your brain against your will, they may be due to some under- 
 lying organic disease. 
 
 Often the stomach gets in between the door and will not allow it to 
 lock. In such instances it is well to let the stomach go to bed empty, in 
 order that the brain may not be rocked and disturbed by dream thoughts. 
 
 Wants More Sleep. — B. M, writes: "I work at night and go to bed 
 about 9 a. m. dead tired. But every day I wake up about 2 to 2:30 p. m., 
 and, although I lie in bed sometimes until 6 or 7 it is impossible to go back 
 to sleep. I wake up without any cause. Can you suggest any way of get- 
 ting over this?" 
 
 Reply. — By that hour your fatigue poisons are pretty well used up. In 
 consequence, slight influences are sufficient to awaken you. A gripping 
 dream will do it, or a noise, or a full bladder, et cetera. 
 
 Make things right as best you can; then lie quietly in bed, free from 
 worry and fret, until 5. If you do not sleep you will rest, and that will do 
 you nearly as much good. If you sleep, so much the better. When you 
 have developed the above frame of mind you will sleep that extra time. 
 
 Insomnia not Disease. — W. B. writes : "In your recent article on insom- 
 nia you lay the cause for same to a mental condition. Is it not a fact that 
 some cases are due to physical causes, for instance, an overloaded stomach? 
 I am given to nervousness and worry, I admit, but I find that after eating 
 heavily in the evening, I invariably awake about 3 a. m. and find it hard to 
 fall asleep again. Would not a person of good, healthy nerves become a 
 victim of insomnia in time through this cause alone? In case both the 
 physical and mental conditions have run down and both were good at birth, 
 which would you lay the blame to for the state of both, ordinarily — that is, 
 is it not usually the bad mental state that brings on the physical ailments?" 
 
 Reply. — A man going to bed with his mind tense would wake up from 
 any one of a dozen things, ordinarily of minor consequence. A full stom- 
 ach would be one of these ; a little noise, the light turned on, the flapping 
 of a curtain, are illustrations of other things, ordinarily of minor impor- 
 tance, which would serve to wake up a tense mind about ready to become 
 conscious. Do not confuse the issue. Mental tension is the main thing. 
 A bad mental state would affect the physical state. A bad physical state 
 would affect the mental state. The latter is more of a factor than the 
 former, but the relations between these two must be determined for each 
 case. Do not forget that insomnia is a state of mind and not a disease. 
 
 Mental Training for Dreams. — Mrs. J. K. P. writes: "What, in your 
 opinion, causes dreams? I dream every night, sometimes having as many 
 
412 NEURASTHENIA 
 
 os five different dreams, waking up dull and untested. Also, what causes 
 talking in one's sleep, which consists usually of muttered phrases?" 
 
 Reply. — Dreams are the thoughts of a sleeping mind. There is no rad- 
 ical difference between dreams and ordinary thoughts. If yon want to 
 study the subject deeper, go to the library and ask to see Brill's 
 work on Freudian analysis. You may be able to understand most of it 
 and you may not. There is no way to stop dreams short of mental training. 
 If you care for your digestion and sleep in a comfortable bed in a cool room 
 you will help some, but the real cure is to go to bed always with a mind 
 well poised, happy, contented, and free from hate, envy, worry, or fear. If 
 you can train yourself to that as a constant frame of mind, your dreams 
 will be sweet, peaceful, and restful. 
 
 Afflicted, with Nightmare. — J. E. M. of Canon City, Colo., writes: "I 
 am now over 65 years old. I have what is called nightmare and although I 
 seem to know enough to make a noise so that my wife comes from another 
 room, she often has difficulty in getting me out of them, as I cannot move 
 hand or foot. When I do get awake my heart is fluttering as if I had 
 exhausted myself by running. I have not found a doctor who can give me 
 anything to prevent them. Can you advise a remedy?" 
 
 Reply. — 1. Train yourself to go to bed with your mind at rest. A man 
 who suffers from nightmare also surfers from daymare. A man whose mind 
 is agitated during his waking hours is certain to have more or less agitation 
 during his sleeping hours. 
 
 2. See to it that your sleeping arrangements make for comfort. 
 
 3. Eat very simple evening meals — milk, bread, cheese. 
 
 4. Correct all constipation and intestinal indigestion. 
 
 Causes of Nightmare. — P. R. A. writes: "What is the cause of night- 
 mare?" 
 
 Reply. — Mental tension is an important cause. Overeating, especially 
 at night, is another. The remedy, when these are the causes, is light sup- 
 pers and a mind at peace and resting. 
 
CHAPTER XXIV 
 
 Insanity 
 
 TO PREVENT INSANITY 
 
 Dr. Bayard Holmes says one person out of each 400 is insane be- 
 fore he dies; that there are 150,000 insane in hospitals in the United States, 
 and their maintenance costs the different governments $50,000,000 a year. 
 
 When a man stands one chance in four hundred of getting something he 
 does not want, it is time for him to sit up and take notice. 
 
 A great deal is known about the causes of insanity and how it can be 
 prevented, but those who have this information are off to themselves, and those 
 liable to go insane do not know of the means of prevention. The men having 
 the information are stuck off in corners running asylums to care for the 
 insane. The people who will go crazy unless something can be changed 
 are working in offices, factories, and on farms, caring for children or loafing 
 in red light districts. The state, which spends millions to care for the 
 insane, has much valuable information in the records of its asylums, in the 
 knowledge of the asylum officers. Some of the people of the state are losing 
 their minds because they do not get and do not apply the information which 
 is not "working at its trade." 
 
 Because a man is born of an erratic, neurasthenic or hysteric stock is no 
 reason why he should go insane. It is a reason why he should work harder 
 to control himself. Because a woman is goiterous is an additional reason 
 why she should work out a program of mental poise. Because a man has 
 had syphilis, he should not drift helplessly into insanity. It should be the 
 reason for shaping a career to avoid it. If a man who takes whisky, mor- 
 phin, or cocain goes "batty/' he should find in that a reason for cutting out 
 dopes and not a reason for taking more. Many times keeping on one's 
 mental keel is a matter of knowing how and then "living it" — two separate 
 things. 
 
 How can it be made possible for everyone interested to "know how"? 
 
 ERYSIPELAS IN THE INSANE 
 
 A few years ago it was noticed that there were certain diseases which 
 helped the minds of insane people. A woman who had been in a stuporous 
 condition from melancholia for weeks would contract erysipelas. As the 
 result of the toxins of that disease she would brighten up, take a rosier view 
 of things, and occasionally would recover. No other disease exercised 
 so favorable an influence as erysipelas, and no other mental state was so 
 much helped as melancholia, 
 
 413 
 
414 INSANITY 
 
 There is not much physical basis for melancholia. It is just a matter of 
 tangled ideas. There are people with troubles enough to depress a wooden 
 man, but they do not get melancholia. In fact, they are apt to get happy, 
 or, at most, resignedly accept the inevitable. The melancholies are those 
 who get that way without having any right to do so. They are below 
 par in their mental point of view. 
 
 The toxin of erysipelas is a booster. It may boost clean over the fence, 
 but it boosts just the same. Therefore it is like an antidote for melancholia. 
 
 Sometimes they are cured by something which gives them a mental 
 jolt. When an asylum burns some of the inmates go batty, others develop 
 some emergency ability, and some are cured by the experience. 
 
 Even typhoid fever in the insane leaves behind a trail of betterments. 
 While an attack of typhoid is becoming more trivial all the time, it disturbs 
 all the physical being profoundly. Twenty years ago cases went into a 
 profound stupor called the typhoid state. Now a doctor who does not keep 
 his patient clear eyed and quick witted through typhoid is a pretty poor 
 human engineer. Nevertheless, after typhoid the hair falls out and other 
 changes indicate that the process has been profound. Through profound 
 changes occasionally a sick brain finds a way back to sanity. 
 
 Insanity. — Sincerely writes: "Some five years ago before I was of age 
 I was an inmate of an insane asylum for two months and probably was 
 insane for six months. Under such a law as Indiana has would I have been 
 unsexed? I am now a fair specimen of physical manhood, ordinarily intel- 
 ligent, and of temperate habits. Do you consider me fit for marriage? Do 
 you think there is any danger of my children not being normal?" 
 
 Reply. — You probably are not greatly disturbed mentally. Properly 
 regulating your habits of mind, your trouble should never return. Answer- 
 ing your question as to Indiana, no, emphatically. Answering your ques- 
 tion as to marriage, you do not furnish me enough facts as a basis for . 
 an opinion. Write to H. H. Laughlin, Eugenics laboratory, Cold Spring 
 Harbor, N. Y., for a blank relating to inheritance of insanity. Fill it out 
 and submit to him. 
 
 Melancholia. — M. G. writes: "A woman, 45 years old, is afflicted with 
 unnecessary melancholy thoughts, such as wrong suspicions and foolish 
 imaginations, which cause her to quarrel with her husband and at times 
 send her into hysteria. This is a case of seven years' standing, and is grow- 
 ing worse every day. Woidd you advise an operation as a possible cure?" 
 
 Reply. — No. Nothing in your letter indicates need of an operation. 
 If you have ovariotomy in mind, it will not help matters. 
 
 Mysophobia. — Distressed Woman writes: "I am a sufferer from a dis- 
 ease which has been diagnosed as mysophobia by a Chicago specialist. 
 What do you know about this disease? Are there many cases of it in Chi- 
 cago? Do you consider it curable? I have had it for a number of years. 
 Dr. Edward Spitzka of New York told me it could not be cured, but would 
 probably wear off or pass away suddenly, and that it was foolish for me to 
 waste money on doctors to have them treat me. A few months ago I wrote 
 Dr. S. Weir Mitchell explaining the case and he gave me great hopes of its 
 being cured. Do you think some new remedy has been discovered for it? 
 
ERYSIPELAS IN THE INSANE 415 
 
 If so, can you tell me what it is? I am in good health and apparently nor- 
 mal. My best friends have no idea I have any such disease, but I suffer 
 constantly from it and would do anything to get relief." 
 
 Reply. — Stedman's Medical Dictionary defines mysophobia as a morbid 
 fear of defilement from touching familiar objects. The first case I ever saw 
 was a young man who, after shaking hands, could not be at ease until he 
 had washed his hands. I have known others who were disturbed by hand- 
 ling unclean paper. It is impossible to say how much of it there is in the 
 community, as few people think of it as being a disorder. Most people who 
 have it wonder why anybody will willingly touch an unclean thing. Un- 
 questionably the popular public campaign for greater cleanliness is making 
 an increasing number of people dread to touch unclean things. Some who 
 have this point of view hide it from others as you have done. Evidently 
 you are a nearly normal woman with a slight mental slant. It is hardly 
 worth doing anything about it at all. A good course in psychotherapy 
 should remove this minor mental kink. 
 
 Sign of Nervousness. — E. L. writes: "I am a working boy of 16 years. 
 I think I am nervous, as I am always drumming with my hands or feet or 
 go through funny motions; sometimes my head and sometimes my whole 
 body shakes about one-half inch back and forth. 
 
 "I work in a printing shop and have ink and benzin on my hands all 
 day. I have been working at this job for one month and I notice that my 
 hands are dried and shriveled up. I use a sand soap and jelly soap mixed 
 with a little lye {not enough to hurt my hands), but the dirt sticks in the 
 veins and will not come out altogether, which makes my hands look dirty. 
 Is it because my skin may not be hard enough?" 
 
 Reply. — Drumming with your hands is a sign of nervousness. Further- 
 more, it is a sign of an easily controlled nervousness. If you will make up 
 your mind to keep calm and quiet you will succeed in stopping your habit. 
 It is natural to sway when standing. Everybody does it. The body pitches 
 in one direction and the proper muscles in pulling it back cause it to sway 
 in the opposite direction. A man standing still sways like a pendulum. 
 You watch yourself too closely. You are too self -centered. You need to be 
 with boys and girls your own age. I think you need to play ball on Satur- 
 days and Sundays. 
 
 As your skin gets tougher you can clean it better. The ink gets in the 
 cracks. Do not use enough lye to make your skin crack. 
 
 Biting the Fingernails. — E. J. P. writes: "Is the biting of fingernails 
 injurious? I have been addicted to this habit for ten years. I have broken 
 myself of it every now and then for a short period, but found myself biting 
 and chewing away again before I even was aware of it. How can I stop 
 the practice?" 
 
 Reply. — No. You will infect your nails from time to time, causing 
 local suppuration, but otherwise it does you no harm. However, such a 
 habit means that you have not good brain control. You need psychotherapy 
 or suggestion, not for your nails but for your mental development. 
 
416 IXSArTITY 
 
 DEMENTIA PRECOX 
 
 PLEA FOR THE CHILD 
 
 Dementia precox is a form of insanity which affects young people. 
 That fact is indicated by the last half of the name. One's idea of dementia 
 is tied up with the word demented, and demented people, as most of us 
 picture them, are dull, listless, mindless, and, ofttimes, in a state of partial 
 paralysis. 
 
 This is the condition in the later stages of dementia precox, but the 
 conditions found in the earlier stages are so different that they do not fit 
 into the mental picture gained from knowledge of the later cases. If any 
 good is to be done these cases, it must be through finding them early. 
 
 Again, any amount of sin, and misery, and various types of vice have 
 resulted from leaving youths — boys and girls — in the early stages of de- 
 mentia free to follow their instincts, when there is almost a certainty 
 that those instincts will be determined by their mental twists. 
 
 Any physician with an asylum experience, or any juvenile or criminal 
 court officer can tell of more than one juvenile who got into serious trouble 
 because his oncoming dementia was not recognized. 
 
 Oettinger says: "The onset of dementia precox is at times so in- 
 sidious that its victim continues long in the home, and hence comes under 
 occasional care of the general practitioner. 
 
 "A young person, previously normal in his intelligence, in his activi- 
 ties and his affections, becomes indifferent, lazy, irritable, no longer amenable 
 to home or school discipline. Formerly cheerful and companionable, he 
 is now shy, taciturn, introspective, much by himself, yet at intervals domi- 
 neering, obstinate, supercilious, or passes suddenly from depression to gayety 
 of spirit. 
 
 "His school work lags, his duties are neglected. He ceases to acquire 
 new ideas or apply to his acts the lessons of experience. 
 
 "Such a change in character is apt to be attributed to perversity, bad 
 temper, or influence of companions ; but loss of appetite and flesh, insomnia, 
 or hysteriform symptoms, together with a complaint of headache, vertigo, 
 and indefinite malaise gradually result in a visit to the doctor to prescribe for 
 'nervousness/ " 
 
 At times the mental condition comes on suddenly with fainting or 
 epilepsy, like spasm or mental confusion and excitement, unaccountable 
 apprehension or depression, hallucinations, or even by suicidal attempts. 
 
 In the more slowly developing forms, dementia precox could be mistaken 
 by the parents for feeblemindedness, retardation, or even mental perversity. 
 
 The army is composed of young men who have passed a fairly rigid 
 physical test and a very simple mental test. As the young men in the army 
 are under very close observation the results of study of them give us informa- 
 tion as to conditions among young men in general. 
 
 One of every five men discharged from the army for disability is dis- 
 charged because of insanity. The rate of discharge for insanity is half again 
 as great as the number of discharges for consumption — second on the list. 
 
DEMENTIA PRECOX 417 
 
 These figures do not include those discharged for neurasthenia and hysteria. 
 About 60 per cent, of the insanity was dementia precox. 
 
 Captain King of the United States army says : "We are perfectly 
 justified in believing that dementia precox is the first condition to be thought 
 of when a soldier under 35 years of age is believed to suffer from mental 
 disease. The same is, of course, true of civilians." 
 
 In 1672 Willis wrote : "Many young people, in childhood intelligent to a 
 degree and extremely teachable so that by their learning and conversation 
 they swept everyone with a state of admiration, afterward as they grew 
 older turned out stupid and dull, and those who before were very beautiful 
 in person afterwards presented no gracefulness nor comeliness in their 
 appearance." 
 
 This is a very good description of rather advanced cases of dementia 
 precox, as we know it today. You will note that the children started off 
 normally bright. Thus the morons, idiots, and imbeciles were ruled out. 
 The latter part of the quotation applies to advanced cases. 
 
 About a hundred years ago Esquiral, also quoted by Captain King, 
 wrote : "Children are sometimes born in a state of perfect health and grow 
 at the same time their understanding develops itself, but possess an unusual 
 degree of susceptibility, are lively, irritable, choleric, of a brilliant imagina- 
 tion, a well developed understanding, and an active mind. Their under- 
 standing remains stationary, making no further advances and the hopes 
 recently raised so high are dashed forever." 
 
 Or to put it another way, a child is normally bright up to about puberty. 
 He then develops a general "cussedness," has no power of sustained atten- 
 tion, is of no account, lazy and shiftless, may run away from home, lacks 
 ambition, his personality changes, his ideas are incorrect or bizarre or 
 jumbled; later he becomes stupid and hallucinations and delusions develop. 
 
 The boy may be slipping for years before it becomes certain that he is 
 insane. The parents notice that he is not as bright as formerly, but they 
 do not think it of consequence. They think the boy is sulking or perhaps 
 that he is developing some of that antagonism to parents which is not very 
 abnormal in the rapid changing of the puberty period. 
 
 It is the natural time for new connections to be made and for the home 
 connections to lose some of their dominance. The parent does not differ- 
 entiate between these changes and the changes of dementia. 
 
 The school teacher is in a better position than the parent to judge 
 of developing dementia precox. Especially is this true of the university, 
 college, and high school teacher. The army discovers many dementia precox 
 boys. Do the schools? If not, why not? 
 
 That is the object of these two articles : To put before parents and 
 teachers the plea that children who are markedly different from other 
 children be not allowed to drift on, waiting for something to turn up, but 
 that they be carefully studied by someone qualified to advise. 
 
 Dementia Precox. — Mrs. N. W. writes: "What is meant hy 'dementia 
 precox'?" 
 
 Reply. — 1. Dementia precox is a form of dementia which develops in 
 young people. It is usually first recognized about the beginning of puberty. 
 
CHAPTER XXV 
 
 Diseases of the Nerves 
 
 CONVULSIVE DISORDERS 
 
 When one looks through medical books he finds little about convul- 
 sions. If the mother of a young baby were writing such a book she would 
 start with convulsions, and some of the present contents of the books would be 
 in the appendices. 
 
 Of course, convulsions are not a disease at all. They constitute only a 
 symptom. But of all symptoms, they are most dramatic and terrifying. To 
 a mother convulsions carry more meaning than do long Latin names and 
 talk about bacteria. 
 
 In babies the character of disorders is profoundly modified by con- 
 vulsions. Sometimes they usher in the illness; sometimes they come at 
 its height; sometimes they close the baby's lifebook. But at whatever period 
 they come, they constitute the bold, outstanding feature of the illness. 
 
 Many baby disorders start with spasms. Such is a case of infection with 
 the pneumonia germ and with the ordinary germs of contagion, such as 
 measles and scarlet fever. 
 
 Where an infection starts with a convulsion, there is little danger that 
 the convulsion will be repeated, the one outburst seems to have used up the 
 stock of powder. But an infection which begins with convulsions will be 
 of more than average severity. 
 
 We speak of convulsions beginning an attack, but they do not properly 
 begin it. A child, peevish and irritable all the morning, will suddenly go into 
 convulsions. Had the mother examined closely, she would have found the 
 child with fever and suffering from headache, but, at that, nothing in the 
 symptoms indicates that so alarming a condition as convulsions is on the 
 point of developing. 
 
 Perhaps the child has been left sleeping restlessly, when the mother is 
 summoned by a scream from someone who has discovered the baby with 
 head drawn back, eyes rolling, limbs jerking, and mouth frothing. When 
 the mother catches baby up, she notes that he is unconscious. 
 
 Presently the child sighs, as the convulsion passes off, but from time to 
 time a jerking indicates that he is still on the border line. Consciousness 
 returns slowly. If the temperature is taken, considerable fever is found. 
 
 When the doctor arrives he finds the baby unconscious, restless, grind- 
 ing its teeth, and starting from time to time. The cold head cloths and 
 the hot bath have reduced the fever a degree or two, but it is still around 105°. 
 
 As the child is still partly unconscious, he probably will not try to give 
 medicine by the mouth, but will give some sedative and something to pull the 
 
 418 
 
CONVULSIVE DISOEDEES 419 
 
 temperature down by injection under the skin, rectal, or both, giving an 
 opiate or emetic under the skin and an antipyretic by rectum. 
 
 Within a few hours the child is conscious; the temperature is down, and 
 the infection proceeds on its more usual course. 
 
 Why the convulsions in this group of cases ? The nervous system is pro- 
 foundly poisoned. The cells of every sort react. The reaction of the motor 
 cells produces the convulsions, and that symptom is so prominent that every- 
 thing else is forgotten. 
 
 The common idea that the infection has struck in has a grain of truth 
 in it. A hot bath to bring the poison to the skin, sedatives to steady the 
 nerve cells, to stupefy and thus protect them — these are the things to do 
 approved by custom and essentially right, although, like some of the other 
 things that are right, we do not yet know enough to know just why they 
 are right. 
 
 When contagion starts with convulsions the mother is more alarmed 
 than she need be. The immediate danger is not great. However, as I 
 have already said, the attack of the contagion will probably be a severe one. 
 
 When convulsions develop in the course of a disorder, it is a graver mat- 
 ter. Here, too, the nerve cells are being overpoisoned. If they are able to 
 react they do so. If the baby is thoroughly exhausted the nerve cells cannot 
 react. Convulsions imply a fair amount of vitality. 
 
 On the other hand, convulsions twang the cords of life. If the illness 
 has been running some time, the twanging of the cords may snap them. 
 
 Children with rickets are prone to have convulsions. Poisoning that 
 would not greatly disturb another child will throw a rickety child into 
 spasms. 
 
 Not infrequently epilepsy begins in infancy. A mother who has had 
 the scare of her life from finding her baby in convulsions cannot under- 
 stand how any mother would be willing to trust her baby to outgrow con- 
 vulsions, and yet many women follow this policy. 
 
 "Familiarity breeds contempt" for anything. After a mother has seen 
 her baby recover from convulsions a few times, she loses her fear. Some 
 of the repeated convulsion disorders of infancy may not be of great con- 
 sequence, but anyhow the condition should be carefully inquired into. 
 
 It may be that the baby is an epileptic. Epilepsy often shows itself in 
 infancy, to stop during childhood and reappear in later life. The question 
 blanks of epileptic colonies on which are recorded the personal history of the 
 applicant always contain questions about convulsions in infancy and child- 
 hood. 
 
 It may be that the convulsions mean nervous instability of some sort 
 other than epilepsy. However that may be, two facts of importance stand 
 out: Babies and children prone to convulsions should be differently watched 
 over, especially as to their mental and nerve habits and their digestions, from 
 other children. 
 
 Convulsive nervous disorders in infants and children are more amenable 
 to treatment than in older people. Convulsions in older children are gen- 
 erally laid to worms. 
 
 No kind of worms produces convulsions. 
 
 Therefore, when a child has convulsions, dig for the cause. To call 
 
420 DISEASES OF THE NEKVES 
 
 it worms and let it go at that is not fair. It may be the only manifestation 
 of a meningitis infection, a scarlet fever, or a pneumonia, or it may be 
 the onset of these, or some other infection. Possibly the worms may result 
 from errors in eating: whereupon a complete cure will follow free vomiting 
 and a big dose of oil. It may be epilepsy. 
 
 Grown people have spasms. The best known of these are the spasms 
 of epilepsy. By best known I mean many people know about epilepsy. As 
 to the nature of epilepsy and what causes it, little is known. 
 
 However, there is a vast difference between the watched over, the 
 controlled epileptic and one that is neglected — which means that much can 
 be done for epileptics. 
 
 Grown people have convulsions from the poisoning in the course of these 
 diseases in which waste accumulates in the body, such as the convulsions of 
 Bright' s disease and a kind of kidney tumor, known as hypernephroma. 
 
 Except in epilepsy, the convulsions of grown people are more serious 
 than those of children. The nerve cells are more solid ; they sit more securely 
 on their bases; they are not so easily turned over or fussed up. When they 
 do fuss up enough to produce a spasm it can be inferred with safety that the 
 cause is no matter of minor consequence. 
 
 On the other hand, the grown person has a better hold on life than 
 the baby. The twanging of the cords is not liable to break them. Where 
 death follows convulsions in Bright' s disease, a period of unconsciousness, usu- 
 ally of more than a day's duration, intervenes. 
 
 The element of spasm enters into a great many disorders. I mean here 
 local spasm — spasm of a group of muscles. Such spasm is a milder affair than 
 the general muscle spasm, known as convulsions. 
 
 Of these partial spasms an important one is St. Vitus' dance. St. 
 Vitus' dance is almost a matter of public health; it occurs so frequently in 
 school children as the direct result of bad governmental methods — that is to 
 say, bad school methods. 
 
 It is true that underlying it is an unstable nervous system, inherited 
 usually from parents who are nervous, neurasthenic, hysteric, or worse. But 
 the exciting cause is badly ventilated, overhot schoolrooms and school tasks 
 that result in fatigue. 
 
 The badly ventilated school rooms mean enlarged lymph glands, enlarged 
 tonsils and adenoids, frequent colds and rheumatic pains, called growing 
 pains. Another result is pallor. Fatigue causes the break to show itself 
 in the nervous system. Pallor, anemia, rheumatism, and St. Vitus' dance 
 all form parts of the same picture. 
 
 Why the jerk, the symptom which dominates when the case is one of 
 chorea? The fatigued, tired nerve cells explode about every so often, and 
 the muscles connected with them jerk. This, on a larger scale, is what hap- 
 pens in convulsions. 
 
 In chorea nobody treats the muscular contraction. I once read from 
 an old author that the treatment of convulsions was to hold the head still. 
 Somewhere about the same time effort was made to restrain the choreic 
 movements. 
 
 Now the proper procedure is to do everything possible to divert atten^ 
 tion from the movements. For the other children in the schoolroom to notice 
 
CONVULSIVE DISORDERS 421 
 
 them is bad for all concerned, including those who notice them. When they 
 are noticed they get worse. 
 
 The proper plan is to stop the cause. The cause is usually tied up 
 with the school. Ergo, stop the school. This is a gross way of stopping the 
 two causes in the school doing the harm. 
 
 A better plan would be to find a school where the teaching is by play 
 in the open air. The best tonics, by long odds, are play in the open air 
 and the features that attend. 
 
 The next best tonic, and the best tonic that comes in a bottle, is arsenic. 
 
 Don't let this escape you. The tonics that come in bottles are never 
 in the same class with those that come under the head of personal hy- 
 giene. 
 
 Coming to adult life, we find that there are many spasmodic disorders 
 that do not involve all of the motor apparatus, and many disorders that have 
 spasmodic features engrafted on them. 
 
 As an example of the latter we have asthma. Asthma is an ordinary 
 bronchitis on which there has been engrafted the element of spasm. The other 
 features of the bronchitis act on the spasm feature, making it worse, and 
 the spasm features act on the other features, making them worse. 
 
 In consequence asthma produces distressing symptoms, and tends to 
 persist indefinitely. But when the lungs are opened up and the tubes are 
 explored, little trouble is found. 
 
 There are cases of heart asthma. In such cases the heart is profoundly 
 changed. There are cases of kidney asthma. In those the kidney is found 
 profoundly changed. But whether it be heart, kidney, or plain asthma, little 
 is found in the lungs and bronchial tubes. 
 
 The element of spasm, besides producing discomfort, abets the bronchitis 
 enough to keep it going where otherwise so trivial a bronchitis would be easily 
 overcome. 
 
 Another of the partial spasms, disturbing, but of no great importance 
 otherwise, is the spasmodic tics. These are the jerks not infrequently 
 noted in people looking well otherwise. 
 
 The real physical harm is inconsiderable. Occasionally sleep will be 
 disturbed or nutrition will become poor; but, generally speaking, the harm 
 done may be classed as social. 
 
 The affliction is noticed and the affected man notes that it is noticed. He 
 is kept in a state of uninterrupted self-consciousness. It obtrudes when 
 he is discussing a business proposition. He cannot go on with his work on 
 the same basis as the ordinary man. Some occupations are entirely closed 
 to him by his infirmity. 
 
 If it were possible for him to live a successful, isolated life, he would 
 be just as well off as anybody, but that is seldom possible. 
 
 What the affected person wants is that his infirmity should not be noted. 
 Sympathy is about as foreign to his wishes as blame. Yet some people 
 are not disposed to be fair with these people. 
 
 The jerks usually stop at night. They get worse when they are ob- 
 served. From these two facts the conclusion is drawn that the condition is 
 due to hysteria, or an exaggerated ego, a liking to be odd, or some similar 
 mental perversity. 
 
422 DISEASES OF THE KEftVES 
 
 In the first place, if this were true, the individual is still a subject for 
 help and sympathy rather than censure. 
 
 These perversities, by wise help, can be reached. Censure does not ac- 
 complish any good. The victims are variations from the normal. In a 
 certain sense they are sick people. 
 
 In the second place, for these jerks and bad muscle habits there is 
 usually an organic basis. The matter is beyond the control of the subject. His 
 efforts to control it make it worse. The nerve cells or the nerve fibers are 
 diseased. 
 
 The cure is to cut the nerve or kill it with an injection of alcohol. 
 Sometimes this can be done. Just as often the nerve cannot be reached, 
 or it cannot be done for some other reason. 
 
 Thought about this class of disorders suggests this bit of personal 
 hygiene : 
 
 It is never wise to permit oneself to develop little muscle movement 
 habits — for instance, drumming with the fingers, working around the nails, 
 blinking the eyes, drawing down the corners of the mouth. 
 
 ST. VITUS' DANCE 
 
 Soon after the school work begins there is a moderate outbreak of 
 St. Vitus' dance. Some children, accustomed to the free life of the summer 
 season, chafe at once upon being confined during school hours, and from 
 this chafing results the form of nervous breakdown called St. Vitus' dance. 
 
 That is the exceptional course. The rule is that the nervous children 
 quiet down after a few days. Then they run an uneventful course for some 
 weeks. Then the mothers note that they tire easily; they complain of head- 
 aches often; they are flabby. Some of them have night terrors, some are 
 restless in their sleep, dream all night about their school work, and wake 
 up in the morning unref reshed. Some are irritable, cross, sensitive ; some are 
 fidgety. 
 
 A close observing mother will accept these symptoms for what they 
 mean — a lack of nervous poise — and, warned by them, will seek to avoid 
 trouble. Her child is suffering from overwork. It may be that the work 
 would not even be hard work for another child, but for this one it is over- 
 work. It may be that it would not be overwork in a cooler, or better ventilated, 
 or a clean or quieter schoolroom. Or it would not be overwork if the child's 
 sight were better, or the blackboard did not shine, or the light were not 
 so bad. 
 
 If the warning is not heeded the child persistently begins to jerk — 
 perhaps a hand, shoulder, or head; or there comes a facial twitch. It does 
 no good to scold or blame. In fact, it does harm even to notice the 
 peculiarity. 
 
 It may be that the mother knows that her child has seen some other 
 twitching child and is imitating him. The fact that the spasm is the 
 result of imitation does not mean that the imitating child should be whipped 
 or even scolded. 
 
 If the condition is left unattended to the jerking may be so violent 
 
 
 
EPILEPSY 423 
 
 as to keep the child in bed. Or the joints may become inflamed, the con- 
 dition being then called acute rheumatic chorea. 
 
 In reecnt years we have learned that in rheumatism bacteria are cir- 
 culating in the blood as well as resting in the joints. This explains why so 
 many girls with rheumatic chorea develop .heart disease and why some of 
 them die. 
 
 When the jerking is noticed the parents must get busy to discover 
 where the trouble lies. If the school ventilation is bad it must be improved 
 or the child must drop out of school. If the eyes or the throat are wrong the 
 condition must be remedied. 
 
 Whatever be the cause and however completely it can be removed, the 
 probability is that the child should drop out of school for a while; live 
 a simple life in the open air; take an iron and arsenic tonic, and eat simple, 
 nutritious food. 
 
 EPILEPSY 
 
 One of every five hundred persons is an epileptic. When a subject is 
 of immediate personal interest to one-five-hundredth of the people and 
 of interest to more than four times as many, it is time to talk about it. 
 Even if the majority feel that it does not interest them, and would prefer 
 not to hear about it, they should be willing to put their preference aside when 
 the interest is so wide and so appealing. 
 
 Epilepsy is so dramatic in its manifestations that it has always been 
 known. Even savage minds had no trouble in knowing epilepsy. In the 
 first writings that have come down to us the disease is described under 
 the name morbus sacer, the sacred disease. One who has seen an epileptic 
 in convulsions can readily understand why men at the dawn of civilization 
 thought epileptics possessed of spirits. 
 
 We have made but little headway since the first man knew epilepsy. 
 No cures have been discovered, no bacteriology or chemistry or other science 
 of its cause has been worked out. No Virchow, Cohnheim, or Welch has 
 used his scalpel or microscope to demonstrate a pathology. 
 
 In the history of the disease the dates are those of some unusual type 
 discovered in one year and some other type in another. But the record 
 of accomplishment does not run deeper than symptoms — the surface of 
 things — and, at that, the last entry was made nearly a hundred years ago. 
 
 Seventy-five per cent, of epilepsy is the ordinary convulsive type known 
 to almost everybody. The other 25 per cent, is divided between petit mal, 
 jacksonian epilepsy, psychic epilepsy, and three or four less typical forms. 
 No typical epileptic goes long without his condition being recognized. 
 
 However, probably more generalized information about night terrors, 
 violent dreams, momentary loss of consciousness, passing clouds that hold 
 one speechless for a fraction of a minute, momentary rigidities, sudden 
 frenzies, running amuck; more generalized knowledge and more careful 
 studies of these will show that many of them are epileptic manifestations. 
 When these are added to the list of epileptics the number will pass one- 
 five-hundredth of the population, and the more atypical epilepsies will make 
 up more than 25 per cent, of the whole. 
 
424 DISEASES OF THE NERVES 
 
 Spratling quotes Gowers, the great English authority, as saying: 
 
 "Epilepsy is an inherited disease. There are jew diseases in the produc- 
 tion of which inheritance has a more marked influence, and the influence 
 traceable is always far less than that which exists." 
 
 In a study of 2,523 cases Spratling found that 16 out of every 
 100 were due to inheritance. This was similar heredity. By similar heredity 
 is meant that some of the antecedents of the epileptic were epileptic. 
 
 There is another type of heredity called dissimilar. For instance, alcoholic 
 parents are liable to have epileptic children. Spratling found that 15 per cent, 
 of 1,070 epileptics had alcoholic parents — a form of dissimilar heredity. 
 Bearing collaterally on this point is the observation that hard drinking, 
 middle aged men, leading sedentary lives, are prone to develop epilepsy. 
 Of this 1,070 Spratling found that 13 per cent, of the men and 7 per cent, 
 of the women had insane parents. 
 
 About half a century ago Bemis of New Orleans came at the question 
 from another side. He studied 833 families of whom the parents were 
 close cousins. There were 3,942 children, of whom 1.5 per cent, were 
 epileptics — over seven times the general average of the community. 
 
 Davenport, in his chapter on epilepsy, says that it follows the same 
 law as feeble mindedness. In the inheritance laws, epilepsy and feeble 
 mindedness are almost interchangeable. Several family trees showing the 
 relation between the conditions are shown in Davenport's book. 
 
 Other writers have discovered that families in which there is an excess 
 of chorea, of migraine, or of neurosis also carry an excess of epileptics — 
 all illustrations of what is termed dissimilar inheritance. 
 
 Now, Spratling, combining similar and dissimilar inheritance, says 
 that 60 per cent, of epilepsy is inherited. Eight per cent, of epilepsy is due 
 to brain hemorrhage, and the kinds of brain hemorrhages most frequently 
 causing epilepsy are those due to injury at time of birth. Birth acci- 
 dents are largely responsible for epilepsy. They are responsible even in some 
 cases when the spasms do not start until the child is several years old. 
 
 Fright or shock was found to be the cause in 3 per cent, of the males 
 and 8 per cent, of the females in a study made at the Craig colony. However, 
 it was found that the people in whom fright had induced epilepsy had un- 
 stable nervous systems before the shock. Shock does not seem to be able 
 to cause the condition in a good, sound, level headed person. Blows on the 
 head, fracture of the skull, and similar injuries are responsible for 7 per cent, 
 of the epileptics. 
 
 An idea that eye strain causes epilepsy is fairly widespread. Acting 
 on this theory some men have sought to cure, in fact, have advertised cures 
 of epilepsy by fitting glasses. 
 
 Ten years ago some careful eye specialists went to the Craig colony 
 and studied 900 epileptics from this standpoint. Out of the number they 
 found 68 in whom there seemed possibility enough to warrant experiment and 
 observation for a year. 
 
 Their conclusion was "that cases of epilepsy due to eye strain are of ex- 
 treme rarity, if, indeed, they are ever encountered ; while cases due to this 
 cause that can be cured by glasses alone, not counting those whose attacks may 
 be suppressed, are more infrequent still." 
 
EPILEPSY 425 
 
 On the latter point, they say: "It appears that in some cases proper 
 glasses — just as the bromids — have the power to hold attacks in abeyance, but 
 they do not possess the power to cure." 
 
 Sometimes, under bromids and other forms of treatment, the attacks 
 miss for months, and, occasionally, for more than a year. The happy patient 
 is liable to conclude that he has been cured. It is this that Spratling refers 
 to in speaking of "attacks held in abeyance," "attacks suppressed" but not 
 cured. 
 
 A peculiar relation is that ivhich sometimes exists between the attacks 
 and sleep. Epilepsy that is characterized by night attacks is most insidious 
 and incurable. An individual may have night attacks for years before he 
 has any spell during his waking hours. If he changes his sleeping hours, he 
 finds that his spells also change. It is sleep and not the night attack which 
 "sets off the alarm." In some cases the attacks come just as the sick one drops 
 to sleep; in others just as he awakens in the morning; in still others some- 
 where in between. 
 
 Just why dropping to sleep should "set off the alarm," it is impossible to 
 say. But, for that matter, the sudden development of spasms or a momentary 
 catalepsy is a puzzler. Usually, there will be a few hours of a somewhat 
 muddy mind, then a sudden, violent explosion. Perhaps the breath is sud- 
 denly become offensive, the temperature almost instantly rises; the urine 
 is highly colored, scant, and full of indican. 
 
 As soon as the spell has been fully recovered from, the mind is acute, 
 and the muscles are sore. But the mind is more alert than for days, and 
 the urine is abundant and clear straw color in appearance. It is as though 
 a thunder shower had cleared the air. 
 
 We see much the same sequence in migraine. The attack usually begins 
 with an aura. Two thousand years ago Pelox wrote that the fit began "as a 
 spirituous vapor in the veins of the extremities and ascended to the head, 
 when the patient became unconscious." This is a pretty fair description 
 of this aura. 
 
 The aura sometimes consists of flashes of light or objects seen suddenly 
 to balloon out or shrivel up. Sometimes it is the ears that are disturbed. 
 Then there are "roarings" or "voices" or the "sound of sea waves." Or 
 sometimes it is the taste — with a bitterness like quinin or a sourness like 
 lemon. Or it is a gnawing at the stomach which floats up to the head. 
 
 In practically all cases there is some sort of mental aura — a feeling of 
 joy or a sense of doom, or a half-sensed appreciation of the oncoming spell, and 
 some kind of an attempt to forfend in some way against accident. Sometimes 
 no permanent register of this emotion remains in the brain, but anyone who 
 has studied the face of a patient toppling over has seen it written there. 
 
 After the spell, the patient who is indifferent to his condition is in 
 good mental shape. Ofttimes, however, the patient has been hoping for 
 better things, and his disappointment results in a few days of mild melancholy. 
 
 About 8 to 10 per cent, of the cases can get well, says Spratling. Nobody 
 can tell which of the cases are curable and which incurable, except as the 
 result of months of careful observation and study. That which is to be 
 studied is not the disease [for of that we know, and can know next to noth- 
 ing], but the patient. 
 
426 DISEASES OF THE NERVES 
 
 This serves to introduce the most important part of this article, in 
 view of the present shortcomings of our knowledge of the disease. Epileptics 
 differ from their fellow men. Things that their fellow men can do with 
 safety are too hazardous for them. They do not fit well into crowded streets, 
 rushing cars, and automobiles, into elevators, engines, and machinery. Oft- 
 times they can do their work, and do it well, but not under the conditions 
 safe for you and me. They are not insane; ofttimes they are sensitive - 
 and high strung. Some are excellent citizens. Healy says some are "the 
 most dangerous criminals," pleasant one day, vicious the next, committing 
 heinous crimes. 
 
 They are peculiar people. The liberty of the streets is not liberty for 
 them, for the fear of an attack, as well as the hazards of the streets, deprive 
 them of liberty. They are misfits in asylums, and asylums are misfits for 
 them. Prisons may be the place for a few, but so they are for those not epi- 
 leptics. It would be as sensible to confine all men as all epileptics. Poor- 
 houses? No. 
 
 The answer? Says Shanahan: 
 
 "A colony can be so arranged as to properly cope with the peculiarities 
 of the epileptic. Here a suitable occupation can be provided, such as his 
 physical and mental condition will permit. 
 
 "The epileptic is about normal about 95 per cent, of the time. A 
 proper plan for him is one in which he can be accomplishing something during 
 this normal time, content and happy because he knows that, in his 5 per 
 cent, abnormal time he will not be in danger of being run over by a street car, 
 or he will not be overcome in some school, church, public gathering, or in 
 business or social life, and be thereby horrifying to others and humiliating 
 to himself/' 
 
 The Illinois Committee of Fifty quotes the average per capita earning 
 at Sonyea, N. Y., as $35 a year. As time goes on and more early stage, 
 bright minded epileptics come to regard Sonyea as a refuge and as means 
 of individual work, each according to his talents, the per capita earnings 
 should increase to a figure materially beyond $35. 
 
 Dr. Peterson describes the employment as being many and varied. 
 The schools care for the children, the adults work on dairy farms and in 
 vegetable gardens, doing a dozen or more kinds of factory and shop work. 
 Nowhere, however, is there a field for the proper use of the capacities of brain 
 workers. 
 
 Dr. Flood of Massachusetts says, where, a few years ago, the epileptic 
 was stupefied with drugs and made to live a living death under colony regime, 
 sedatives are used as little as possible, and an effort is made to find the 
 best treatment in each case. 
 
 Strangely enough, the same agents which are beneficial in combating 
 tuberculosis are of the greatest benefit in these cases. Work in the fresh air 
 and good, wholesome, and carefully chosen foods are more essential than medi- 
 cine. In addition, there is the opportunity for prolonged and individual study 
 of the case — an absolute necessity, as stated above, for the proper care of a 
 case of epilepsy. 
 
 Nor should we forget that in colony life there is a partial solution of the 
 problem of inherited epilepsy, not a whole solution, for, as I have written, 
 
EPILEPSY 427 
 
 a part of the inheritance is dissimilar. Epileptics are born to alcoholic par- 
 ents, to migrainous parents, to neurotic parents, to insane parents, to feeble- 
 minded parents, to closely related parents, as well as to epileptic parents, 
 Therefore, the colony is but a partial solution of the problem of inherited 
 epilepsy. 
 
 The Committee of Fifty has issued a pamphlet entitled : "How the Un- 
 cared for Epileptic Fares in Illinois— Colony Care the Kemedy." From this 
 bulletin we learn that the colony plan originated in Germany in 1867. At the 
 present time Germany has fifty colonies; Switzerland, three; Holland, two; 
 Australia, one. In this country there are colonies in Massachusetts, Ohio, New 
 York, New Jersey, Kansas, Connecticut, Texas, Indiana, and Virginia, and, 
 in addition, Michigan and Minnesota provide a modified institutional care. 
 
 Ohio began twenty-three years ago. New York followed suit nineteen 
 years ago ; Massachusetts started four years after New York, and New Jersey 
 stepped out with the Bay State. Kansas and Texas began in 1902, Indiana 
 in 1905; Virginia and Connecticut were the last additions in 1910. 
 
 Amending the methods of airing for epileptics proceeds more slowly 
 than amending the constitution of the United States, but it develops a few 
 steps every few years. The colony method will presently be general in the 
 states. 
 
 Some epileptics can be cured. In most epileptics the frequency of the 
 convulsions can be lessened, and the seizures can be made less severe — all of 
 this in spite of the mystery of epilepsy, for concerning the cause of epilepsy 
 nothing is known. In the history of medicine theory has followed theory in 
 the speculation as to the cause of epilepsy. Every science has been made use 
 of in its investigation, and still the mystery remains. 
 
 A few inheritance facts are known. It sometimes runs in families. It 
 frequently manifests itself in the children of chronic alcoholics. It frequently 
 manifests itself in children born of parents or a parent drunk at the moment 
 of conception. In a stock it is frequently interchangeable with other neurotic 
 manifestations. 
 
 Clinically, it seems somewhat akin to migraine and to hysteria. It can 
 sometimes be connected with head injuries. 
 
 A few isolated facts of this nature are about all that is known, and these 
 facts do not tell us much about the nature of the disease. But here is one 
 observation that every epileptic should know about. It is that most epileptics 
 are greatly benefited by a proper regard for personal hygiene. 
 
 Caesar was an epileptic from childhood on. He was most abstemious in 
 his eating and drinking, kept his skin in perfect condition, his muscles always 
 elastic, and his secretions in good condition. 
 
 Mohammed was an epileptic. Few characters in history have lived more 
 simply and kept their bodies in better condition than did Mohammed. 
 
 Byron, whose father was an alcoholic and whose mother was a neurotic, 
 was in convulsions when born. For a while in his early manhood he neglected 
 himself and grew obese. By most abstemious living he reduced his weight 
 from 240 to 160 pounds, and by abstemious living and systematic exercise 
 kept his wind good ever afterward. 
 
 When a person learns that he is an epileptic he is prone to grow timid, 
 shy, diffident. In time he loses aspiration and ambition, and before long be- 
 
428 DISEASES OF THE NERVES 
 
 comes slouchy, both mentally and physically. Wood says epilepsy is not in- 
 consistent with a life of utility, nor even an important career. 
 
 Besides Byron, Mohammed, and Caesar, many other men of great achieve- 
 ments have been epileptics. Perhaps St. Paul was one; many say that Na- 
 poleon was an epileptic. 
 
 Many governors, mayors, senators, congressmen, professors, and men of 
 learning and letters have won out in spite of epilepsy. 
 
 In spite of the little known of the exact nature of epilepsy, experience 
 has taught us that the epileptic who obeys the laws of personal hygiene and 
 who refuses to give way mentally and spiritually leads a life of usefulness. 
 
 Treatment for Epilepsy. — Daily Reader writes: "In answer to my in- 
 quiry about mild epilepsy, you say: One out of ten can be cured; more are 
 often benefited. May I ask, what is the treatment for epilepsy? How can 
 this awful malady be cured? May I also know the main cause? You say 
 overwork is not the main cause. A person seems to get spells when he 
 worries over business. Blood only 66, is this too low? I do not understand 
 cubic millimeters. May I also ask how long treatment must be kept up 
 after the spells stop?" 
 
 Reply. — 1. [a] When possible, find the cause and remove it. 
 
 [b] Simple life in the open air, such as the inmates of colonies follow. 
 
 [c] An abstemious diet. 
 
 [d] Proper habits, particularly as to excretions. 
 
 [e] Freedom from worry, anger, or other violent emotions. 
 
 [f] Tonics, bromids, and other medicines, as required. 
 
 2. Among other causes are: 
 
 [a] Inheritance. 
 
 [b] Injuries to the head. 
 
 [c] Lack of balance between the secretions of certain ductless glands. 
 Attacks are precipitated by : 
 
 [a] Anger, worry, or other emotions. 
 
 [b] Constipation. 
 
 [c] Bad habits. 
 
 3. Sixty-six per cent, hemoglobin is too low. It means a fairly con- 
 siderable anemia. Ninety to one hundred is normal. 
 
 4. Blood corpuscle counts are usually expressed in number of cells per 
 cubic millimeter. A cubic millimeter is roughly one-six hundredth of a 
 drop. Do not try to remember that. Remember 5,000,000 red cells and 
 8,000 white cells as normal, and abnormalities in proportions of 5,000,000 
 and 8,000 respectively. For example, 4,000,000 red cells constitute 80 per 
 cent, of the normal; 16,000 white cells, 200 per cent. 
 
 5. Drug treatment but a few months; the hygienic treatment con- 
 tinually. 
 
 Care May Cure Epilepsy. — J. B. K. writes: "A 12 year old girl has had 
 epileptic spells for three years. Is there any probability of outgrowing it? 
 Is there a Hebrew institution for such afflicted children? If not, which 
 are the public or private homes for this ailment?" 
 
 Reply. — 1. Epilepsy will not be outgrown. Sensible care, persistently 
 carried out, cures one case in ten. In addition, in many cases not in the 
 incurable group, good care greatly reduces the frequency of the attacks. 
 To an exceptionable degree in epilepsy is there response to proper care — 
 
EPILEPSY 429 
 
 greater safety, greater happiness, an increase in general wellbeing, fewer 
 attacks, and, sometimes, cures. On the other hand, drifting — leaving the 
 patient to outgrow it — makes for harm. 
 
 2. I doubt it. I have not been able to learn of any. 
 
 3. Many states have epileptic colonies. Ohio, Massachusetts, New York, 
 New Jersey, Kansas, Connecticut, Texas, Indiana, and Virginia, and Min- 
 nesota and Michigan have some provision for care of epileptics. Outside 
 of these I know of no public or private homes for the disease. 
 
 Looks Like Epilepsy. — D. A. C. writes: "Are adults as subject to worms 
 as children, and how do these parasites become located in the intestinal 
 tract? Would a person having an inordinate appetite, especially for 
 sweets, being also subject to fits or spasms, in which he falls down, his 
 fingers twitching spasmodically and eyes fixed in a vacant stare, possibly 
 be troubled with worms? How should a person be treated while in one of 
 these spasms? Is it likely that a person would be troubled with worms and 
 worm spasms for a period of five years or longer? Would you advise any- 
 one so troubled to consult a physician, or is there some reliable medicine 
 on the market that will do the work?" 
 
 Eeply. — I suspect the party referred to has epilepsy. Certainly the 
 condition is not due to worms. Have a physician pass on the case. Worms 
 of the ordinary kind do little or no harm. They do not cause spasms. 
 Adults are subject to worms, but are not as frequently infested as children. 
 
 Epilepsy Rarely Curable. — L. M. wants to know if epilepsy is a curable 
 disease. What can be done with an epileptic? Are epileptics insane? 
 
 Reply. — As a general statement, epilepsy is incurable. There are some 
 exceptions. But many epileptics, by keeping in good physical and mental 
 condition, can cause their attacks to come at long intervals and the progress 
 of the disease to be slow. 
 
 On the physical side constipation is to be avoided. On the mental side 
 paroxysms of emotion, such as anger, grief, and melancholy, are to be re- 
 frained from. 
 
 Most epileptics are useful members of society for the first ten years of 
 their disorder, but attacks and the conditions which lead up to them are 
 very wearing on the brain substance. In time the central nervous tissue is 
 worn down and the epileptic becomes of poor judgment from overemotion- 
 alism, or insane, or demented, with a brain prematurely old — senile. 
 
 Careful living and, particularly, good control of the mind, decrease the 
 frequency of attacks and spare the brain some unnecessary wear. Some 
 states have colonies for epileptics. In those states epileptics get on best in 
 these colonies. Other states have no provision for them. 
 
 Value not Proved. — G. A. writes: "There has recently been brought to 
 my attention the work of Dr. Ralph Spangler of Philadelphia. He treats 
 epilepsy with rattlesnake venom, and I have been told has had great suc- 
 cess. Could you give readers an opinion on this method of treatment?" 
 
 Reply. — The treatment with snake venom is in the experimental stage. 
 The indications are that it is not of much service. 
 
 Mild Epilepsy. — M. L. S. writes: "1. Can mild epilepsy be cured in a 
 girl 19 years of age? Never had an attack until she was 19; had three then 
 in ten days. 2. Does bromid always affect the brain? 3. Would you 
 
430 DISEASES OF THE NERVES 
 
 advise discontinuing bromid in this case? What brought on these attacks 
 at this time of life?" 
 
 Reply. — Some forms of epilepsy are fairly curable. Most forms are 
 controllable; some are hopeless from every point of view. An epileptic 
 should remain permanently under good medical control to the end that the 
 most useful life possible may be worked out for him. Most states have 
 epileptic farms where the patients live under circumstances that give 
 them the best chance possible. 
 
 No Epileptic Colony. — H. A. M. writes: "I know of a man who, at the 
 age of 1^5, proved to be an epileptic. Will any of his children develop this 
 at the same age? Might his grandchildren inherit it? Is there any insti- 
 tution in or near Chicago where such people may be taken care of?" 
 
 Reply. — Probably not, especially if the other parent is of good, level- 
 headed stock. Illinois has no epileptic colony. Several states have. If the 
 man is sane, there is no institution for him. 
 
 One Chance in Ten. — Reader writes: "Can mild epilepsy, brought on 
 by overwork and nervous breakdown, be cured? A man SI* years of age has 
 had it about one year. What is normal blood count for a man?" 
 
 Reply. — 1. Mild epilepsy can be cured one time out of ten. It can be 
 benefited more frequently still. Overwork may be a contributing though 
 not a main cause. When overwork is a factor, rest will help. 
 
 2. The normal red blood count is 5,000,000 red cells per cubic milli- 
 meter; the normal white blood cell count is 8,000. 
 
 No Institution for Epilepsy. — Anxious writes: "Is there a cure for 
 cases of epilepsy? Is there any institution in the State of Illinois de- 
 voted entirely to the care of epileptics?" 
 
 Reply. — A small proportion of the epilepsy is curable. Most of the vic- 
 tims by properly regulating their lives can be spared many attacks, and the 
 progress of mental deterioration will be slow. Illinois has no institution 
 devoted entirely to the cure or the care of epileptics. 
 
 PARALYSIS AGITANS 
 
 Some men stand so solidly, so like a stone wall, that tottering, wavering, 
 tremors seem wholly out of the question; yet even those most like a solid 
 wall are constantly rocking like a ship at sea. They pitch forward a bit 
 and the muscles of the back pull them in the other direction, and so it goes 
 all day long. There is some tremor about even the most quiet, best con- 
 trolled hand, but effort of the will can control most of this. 
 
 Paralysis agitans is a disease in which this tremor is grossly exaggerated 
 and wholly beyond the control of the mind. Thinking about it makes it 
 worse. When the brain tries to control the trembling hand, the tremor 
 redoubles. 
 
 A common test for paralysis agitans is to give a man with a tremor a 
 full glass of water and ask him to drink without spilling it. The glass will 
 shake so as to spill a good part of the water. 
 
 Many people do things less well when they concentrate their minds on 
 
PARALYSIS AGITANS 431 
 
 them. In paralysis agitans this rather general propensity is exaggerated out of 
 all proportion. 
 
 A more important, though less easily recognized, symptom is a persistent 
 muscular rigidity. The muscles, conscious of their weakness, hold the head, 
 the body, the arms, and sometimes all in positions and attitudes of rigidity. 
 
 As to the cause very little is known. Some writers think the nerves 
 which control the muscles have grown old before their time. There is but 
 little basis for this opinion. 
 
 Some think that there are senile changes in the muscles themselves. 
 There is not much evidence to support this view, though there is more than 
 that behind the first. 
 
 Another group believes that it is due to disease in some of the ductless 
 glands. 
 
 Just outside of the thyroid in the neck is a small gland called the para- 
 thyroid. It has been noticed that when this gland has been wholly destroyed 
 the patient died in the midst of spasms and that when it was partially 
 destroyed the patient developed different kinds of jerks. 
 
 In a few cases of paralysis agitans changes have been found in these 
 glands. Such changes are not very marked nor very constant. 
 
 Acting on the little evidence of one sort and another, a few physicians 
 have given extract of parathyroid in paralysis agitans. In about two-thirds 
 of the cases in which it has been tried it has given favorable results. 
 
 That is not very conclusive, out it would seem wise, for early cases at 
 least, to give parathyroid an extended trial. Ordinary -drugs are of no 
 service, and nothing is lost by not making use of them. Old, long-continued 
 cases with advanced changes and settled conditions cannot expect much from 
 anything. 
 
 Causes Remain Mystery. — J. E. L. writes: "1. What are the symp- 
 toms of paralysis agitans? 2. What are the causes of this affliction?" 
 
 Reply. — 1. Trembling gets worse when one tries to control it. For 
 example, when it affects the hands, if the person tries to drink from a full 
 glass of water the trembling gets worse. 
 
 2. Nobody knows. 
 
 Marry Him. — Miss M. G. writes: "I am going with a young man and 
 he wants me to marry him. His mother is J^5 years old and has shaking 
 palsy. Her doctor tells her she cannot get over it. I have noticed the 
 young man when he takes a drink of water and his hands do not tremble 
 any more than anybody else's. If I marry him will our children have 
 shaking palsy? Will he get it when he is ^5?" 
 
 Reply. — There is no evidence that shaking palsy or paralysis agitans is 
 inherited. Your children will be in no special danger. Marry him. He is 
 no more liable to develop shaking palsy than anybody else. Live within 
 your income and otherwise do all you can to keep him from worrying. 
 Protect him so far as you can against shock and great nervous strain and 
 you will have done your part in shielding him against paralysis agitans. 
 
432 DISEASES OF THE NERVES 
 
 HUNTINGTON'S CHOREA 
 
 Many years ago a person suffering from a rather strange disorder came 
 into the state of Pennsylvania. He located in the country. He was con- 
 stantly jerking and twitching. His family grew np around him. In time 
 his twitching grew worse, and it was noted that his mind was failing. He 
 had the sympathy of the people of the neighborhood. 
 
 The children seemed healthy and well balanced. When he died the 
 neighbors went to the funeral, and then helped the widow and children to 
 readjust themselves. 
 
 Years passed, and the children, having become of middle age and them- 
 selves the parents of children, began to twitch and jerk. 
 
 The older neighbors remembered that the old parent, the first of the 
 family known to them, twitched in the same way. Time passed, and they 
 remembered that the progressive weakness, insanity, and death constituted 
 just the course the infirmity of the parent had followed. 
 
 Still the neighborhood had no emotion, and certainly no thought except 
 one of sorrow. For some reason a curse was laid on this man, and it had 
 remained to the second generation. 
 
 That right in the simple countryside there was growing up a great 
 menace, a great public enemy, or that the occasion called for governmental 
 control never occurred to those good-hearted people. 
 
 The disease was Huntington's chorea. It is inherited. It got its foothold 
 in a single family in western Pennsylvania, and down this strain it has run 
 into the other families to which this stock has contributed. Now it is rather 
 widely distributed over the United States. 
 
 But back of the Pennsylvania case there lies some history. On the tip of 
 Long Island there lived an isolated community of fisher folk. They lived to 
 themselves and married among themselves. Presently it was noticed that 
 some of the people began to develop a tremor when they got to middle life. 
 Those who developed this trembling in time became feeble minded. 
 
 Among the people of this community was a physician who did not look 
 on this nervousness as a part of the day's work. He noticed that it ran in 
 families. As it never showed itself until the middle of life had been reached, 
 the subjects were married and had families. The name of this doctor was 
 George Huntington. He observed all the facts and established the relation 
 between them. The disease was given his name. 
 
 During the first forty years of life the patient to be is free from 
 trouble. Then a twitching begins. As more or less unsteadiness is to be 
 expected in middle life, the disorder is unnoted. It becomes worse. 
 
 For a while the movements can be suppressed by effort of the will. 
 The speech gradually becomes slow and difficult. The movements, which at 
 first affected the extremities, extend to the face. They reach the stage 
 where excitement makes them much worse. 
 
 It is noticed that the mind is not of the former fiber. The mental de- 
 generation increases until insanity results. 
 
 For the cure of the disease nothing can be done. The afflicted should have 
 the care required. They should have sympathy. The sympathy, instead of 
 
S3 
 
 433 
 
434 DISEASES OF THE NEKVES 
 
 being temporary and intermittent, should be continuous. It should be far- 
 reaching. It should be so farreaching that it should protect the next genera- 
 tion. 
 
 As the disease does not manifest itself until after thirty, the hereditary 
 relations may be lost sight of. The sympathy extended should supply the de- 
 ficiency. 
 
 The eugenic laws of Huntington's chorea are well understood. Sympathy 
 will have no trouble in becoming intelligent. 
 
 My advice to a person contemplating matrimony is: Do not marry a 
 middle-aged person with trembling of the hands or head unless you know that 
 his disorder is not Huntington's chorea. As the disease does not develop 
 until middle life, do not marry any person either of whose parents had 
 Huntington's chorea. 
 
 
CHAPTEB XXVI 
 
 Stammering and Stuttering 
 
 STUTTERING SCHOOL CHILDREN 
 
 It is a peculiar anachronism that imitation is responsible for some of 
 the stuttering, and stutterers stutter most when they are afraid lest their 
 stutter and their stuttering be noticed. But then, when you inquire into 
 the subject further, it is not so odd. 
 
 Stutterers are above the average in intellectual activity and in mental 
 brightness, but they are lacking in mental poise. The same lack of level 
 mindedness makes them imitate stutterers, and, having become stutterers, 
 makes them sensitive about it. 
 
 In cities stuttering children can be gathered into special classes with 
 special instructors. In the country the stuttering child must be taught in the 
 same class with other children. Is there anything that can be done ? 
 
 To begin with, stutterers generally are of a nervous or even neurotic 
 stock. In their family trees are found a large number of people not of good 
 nerve poise. In the next place generally they have been badly brought up. 
 As babies they were rocked to sleep or trotted when they cried. As children 
 they were allowed too much excitement. 
 
 The statistics show that most children who stammer begin before school 
 age. The child learns how to talk properly, but somewhere between two and 
 seven years of age picks up the stuttering habit. 
 
 The teacher's problem is to take this child of a nervous stock with an 
 acquired habit and to teach him correct speech methods in addition to the 
 ordinary tasks of the schoolroom, and at the same time to prevent other chil- 
 dren from contracting the habit. 
 
 The first step is to have a frank talk with the subject. The next is to 
 have an equally frank talk with the students. The next is to discover the 
 fault with that particular child, and the next is to outline a plan of speech 
 training and mental training for that child. 
 
 The parents should equip the school library with Dresslar's "School 
 Hygiene" and Scripture's "Stuttering and Lisping." The next step is to study 
 the books and the next is to study the child. 
 
 Dresslar puts great stress upon studying the child as well as its defect 
 and adapting the treatment to the case. In the cure of stuttering in the 
 different stuttering schools the personality of the teacher is as much a factor 
 as the method employed. 
 
 To the school child the two personalities who rank supreme are mother 
 and teacher. No specialist will ever surpass them in personality as the child 
 sees them. 
 
 435 
 
436 STAMMERING AND STUTTERING 
 
 A study of these books will give them enough technical skill. When to 
 this their personalities and something of patient effort are added, a mother 
 helping the teacher and the teacher helping a mother should make a com- 
 bination capable of curing almost any stuttering child. 
 
 STAMMERING 
 
 Much the most comprehensive book on stammering that I know of is 
 one recently written by Prof. C. S. Bluemel of the University of Colorado. 
 Of stammering by young children he says: 
 
 "Much success has been achieved by a few stammering schools established 
 especially for young children. We have already emphasized the fact that 
 during childhood, when the secondary causes have not yet supervened, stam- 
 mering usually yields readily to rational treatment. But it is not by any 
 means necessary, and perhaps by no means desirable, that a young child be in- 
 carcerated in an institution. An intelligent mother can usually accomplish all 
 that is possible for a stammering child if, instead of supinely waiting for him 
 to 'outgrow' the difficulty, she will undertake to combat the impediment. 
 
 "In the first place the child himself must be induced to strive for fluency 
 in speech. He must be offered a substantial and much coveted reward for 
 ultimate victory, and must then be helped at every stage of the contest. 
 
 "He must be checked quietly and gently each time that he stammers. He 
 must be made to wait and reflect upon the words he is about to use — and to 
 utter these words slowly and with composure. If he then speaks fluently he 
 should be commended and encouraged and should be made to repeat the words 
 in order that he may gain assurance. 
 
 "The child should be made to feel that, although it is not reprehensible 
 to stammer, it is nevertheless highly commendable to speak with fluency. He 
 should never be laughed at, scolded, or punished for his impediment; for, 
 with such treatment, fear soon associates itself with speech. He should never 
 be mimicked, and for this reason and a hundred others should be kept from 
 school till the impediment has been eliminated. 
 
 "If much amnesia appears to be present the child should be told to 
 think, during speech, how his words are going to sound. If physical stam- 
 mering is in evidence he should be taught to inhale before speaking and to 
 speak at all times without effort. 
 
 "The child should be required, by way of practice, to learn and recite 
 simple rhymes. He should be told little stories, and should be made to repeat 
 each sentence slowly and carefully after the parent. Later, when progress 
 has been attained, he should be required to relate these stories by himself. 
 
 "If mothers would adopt these simple measures we should in a few decades 
 hear little more of stammering." 
 
 When Bluemel began to study stammering he wrote down certain facts. 
 No theory as to the reason for stammering could be acceptable to his mind 
 unless it explained all the facts. The facts to be explained were these: 
 
 "The true cause of casualty must explain all the facts. It must explain 
 the fact: 
 
 "That the stammerer can usually sing without difficulty. 
 
STAMMERING 437 
 
 "That the stammerer can often speak well when alone. 
 
 "That the stammerer is usually fluent when speaking in concert with 
 other people. 
 
 "That the stammerer can usually repeat fluently the words that are pro- 
 nounced for him by another person by way of assistance. 
 
 "That the stammerer can usually repeat a word that he has eventually 
 stammered out. 
 
 "That consonants at the end of a word never occasion difficulty. 
 
 "That the stammerer may have difficulty on words that commence with 
 vowels. 
 
 "That the speech defect may assume the most diverse forms, being in 
 one case passive and in another active and boisterous. 
 
 "That one can stammer in thought as well as in speech. 
 
 "That there are more male than female stammerers. 
 
 "That stammering is rarely acquired after the fifteenth year." 
 
 Starting out with an explanation of these facts as his task, he arrived 
 at the conclusion that the trouble was with the mental processes of the stam- 
 merer, and that treatment to be lasting must be directed toward the mind. 
 
 Stammerers differ. There are lispers, stutterers, and other types of stam- 
 merers. In some the physical side of the impediment is prominent. Various 
 habits of tongue, lips, facial muscles, and even of the body as a whole may 
 be superimposed on the speech habit in time. The stammerer may have been 
 started off with a speech defect in which physical factors are prominent. 
 
 Various modifications of habits, of thought, of demeanor, of temperament, 
 develop as a result of speech defects. Therefore, when the cure of a stam- 
 merer is undertaken there should be careful study of the individual to deter- 
 mine his type and also his peculiarities, his physical, mental, and social 
 makeup. 
 
 The simplest, easiest of all propositions is the cure of stammering in 
 young children. As indicated above, the problem then is so simple that it can 
 be left to intelligent mothers. A little knowledge combined with love, kind- 
 ness, tact, and patience is all that is required. 
 
 In fact, without any education except the haphazard education of life, 
 about three-fourths of the stammering children are cured of their infirmity. 
 Somehow or other they stop. Bluemel thinks that patient, careful, intelligent 
 mothers could cure nearly all of the remaining fourth. 
 
 Next easiest of cure are the physical additions present in certain stam- 
 merers. The mind having failed to work properly before, the stammerer 
 expects it to work improperly this time. He tries to overcome his defect 
 by unusual motions with his lips and tongue, thus producing strange sounds, 
 or he hesitates and then explodes out a jumble of sound, or he changes his 
 facial expression, or jerks his head, or neck, or arm. 
 
 The schools that teach by singing methods, elocutionary methods, most 
 any sort of method, are highly successful in relieving this annoying phase 
 of stammering. When relieved of this element most people think themselves 
 cured. 
 
 When it comes to pure stammering, the opinion of Bluemel is that there 
 must be a careful analysis of the mental processes of the stammerer and a 
 carefully planned system of mental training founded on it. Training mental 
 
438 STAMMERING AND STUTTERING 
 
 processes cannot be done in a day. The analysis must be done by the stam- 
 merer and a trained man of learning, working together. The plan must be 
 laid out by the man of science. The carrying out of the plan must be done 
 by the stammerer himself, with occasional supervision by his mentor. 
 
 Bluemel says that, when the quacks are eliminated, there will remain two 
 classes of persons treating stammerers — "the good hearted and well mean- 
 ing souls that know nothing about the malady and the ingenuous and more 
 intelligent students of stammering as a deep and intricate psychological 
 problem. Men of the latter class are almost exclusively physicians, and the 
 best of them undoubtedly are found in the German empire." 
 
 Bluemel began his study by a careful analysis of the speech of the stam- 
 merer. First he determined which sounds were difficult. Then he analyzed 
 the physical effort made by the breathing apparatus,- the larynx, the tongue, 
 and the lips in producing each of these sounds. Next he analyzed the mental 
 and nervous factors responsible for speech; and next, the relation of these 
 to the words and sentences which serve as impediments in stammerers. 
 
 Next he analyzed the social factors which have any relation to stammer- 
 ing, such as the age and sex of stammerers, station in life, the effects of 
 association, school, in social intercourse, the effect of ridicule, of the various 
 emotions, of imitation, of embarrassment, timidity, fear, anger. 
 
 With the results of these analyses of stammerers and stammering before 
 him, he began a study of the world's literature on the subject. In this study 
 he reviewed what had been written on stammering, stuttering, and speech 
 defects, and in addition whatever in literature, psychology, sociology, medicine, 
 and natural science was calculated to throw light on the subject. 
 
 Having laid the foundation, he studied every important method of treat- 
 ing speech defects in use in Europe and America. The results of these 
 studies are told in the two volumes. 
 
 It is unfortunate that the scientific study to be found in Volume I is, 
 probably of necessity, so technical that the stammerer will not be able to under- 
 stand it, unless he makes constant use of the glossary, and even then it will 
 be difficult. 
 
 In Volume I Bluemel is the analytical scientist — calm, philosophical, 
 unimpassioned, unemotional. In Volume II, a different Bluemel comes to bat. 
 He still is analytical, learned, well informed, and keen, but now these qualities 
 are made to serve the purpose of a crusader, a satirist, an honest man scourg- 
 ing the thieves and money changers from the temple. 
 
 He takes up the schools and methods of cure, group by group. First, he 
 analyzes the method to show the underlying principles made use of. He 
 found that the hundreds of methods fell into a few groups. 
 
 He then investigated the history of the subject. He found that in 
 methods for the cure of stammering there is nothing new under the sun. 
 Some part of it goes back a thousand years. Much of it originated with Eras- 
 mus Darwin, the grandfather of Charles Darwin, and every important detail 
 was in use at least one hundred years ago. Systems advertised as having been 
 revealed by God he proves to have been stolen outright. 
 
 Finally he dissects the business methods of the stammering schools, 
 showing them to be as bad as the advertising doctors in their palmy days. 
 
 He investigated carefully and found that the schools cured about five per 
 
STAMMEKING 439 
 
 cent, of their pupils. There is nothing remarkable in this. Seventy-five per 
 cent, of the children who stammer get well without treatment. Of course, 
 stammering schools do not get many of this group. The percentage of cures 
 without treatment among those of the age and station who patronize these 
 schools is almost as great as among the students. 
 
 What the best of the schools do is to cure the physical additions which 
 develop in stammerers. This helps, but it does not constitute a cure. 
 
 Speaking generally of the systems, he says : "Many of them are entirely 
 devoid of merit; they have been recorded (in this study) merely because 
 they are the gold bricks that are daily sold to stammerers by an infamous 
 fraternity of 'speech specialists/ . . . Progress is hampered by the charlatans 
 who rob the stammerer and bring everybody and everything connected with 
 the treatment or investigation of stammering into disrepute." 
 
 "The great secret" guarded by speech specialists is the fact that the 
 stammerer is being bunkoed. 
 
 "The charges are exorbitant ; but these frock-coated frauds operate chiefly 
 among the 'superior' classes. Of recent years a few cheaper schools have 
 come into existence. They are apparently no worse than the 'superior' insti- 
 tutions." 
 
 "The writer has never known of a worthless institution that was not 
 recommended by a body of bishops, colonels, mayors, postmasters, doctors, 
 and men that are usually credited with intelligence. The clergy are inveterate 
 recommenders. In America recommendations from mayors, former mayors, 
 and merchants often are obtained through commercial associations, boosters' 
 clubs, and organizations for mutual support among rotten concerns that can- 
 not exist on merit. 
 
 "Newspaper puffs in the local press (when not paid for) are usually 
 inserted in the interests of 'a greater Mudville.' 
 
 "When the man in the picture points his finger at you and says, 'I guar- 
 antee to cure stammering,' he is lying." 
 
 "The writer has an acquaintance that has taken eight courses at English 
 stammering schools. He still seems good for eight or a dozen more." 
 
 "The writer could name four principals (of stammering schools) who 
 have themselves relapsed. Correspondence schools are few and sporadic. 
 They probably do very little good and very little harm; they need not be 
 taken seriously." 
 
 Stammering. — B. D. B. writes: "1. What causes stammering and stut- 
 tering? 2. Can it he cured? 8. How?" 
 
 Keply. — 1. Stammering and stuttering are the same. The cause may- 
 be one of several. 
 
 2. Yes. The case will depend on the type, the cause, the age of the 
 subject, and the duration of the condition. 
 
 3. The method will depend on much the same factors as are set forth in 
 answer 2. In some children a single lesson suffices. In other cases years 
 are required for cure. When a person has been born with an unstable, 
 nervous system, has acquired a wrong speech method, and where this 
 method has been persisted in for years, it is reasonable to expect that much 
 time will be required to retrain the individual. Sometimes it is only the 
 speech method that requires attention; sometimes mental methods must 
 
440 STAMMERING AND STUTTERING 
 
 also be changed. My advice is that you get "Stuttering and Lisping," by 
 Scripture [Macmillan] , that you study it with the most caretaking, patient 
 physician in your town ; that, in the light of what you learn from the book 
 you study your child, and then follow the plan devised by you as a result 
 of this study. 
 
 Stammering a Nervous Condition. — B. Y. writes: "I am 27 and I stam- 
 mer. Sometimes I talk almost like the best speaker and all at once I can- 
 not get one word out, or stammer so badly that nobody can understand me. 
 I am perfectly healthy and don't think I am nervous at all. I have stam- 
 mered since I was a little girl." 
 
 Reply. — Stammering is purely a nervous condition. There is nothing 
 wrong except in the mind. While most stammerers are neurasthenics, some 
 are not. The remedy is by psychotherapy. 
 
 The different systems of cure are about equally good. Whenever the 
 patient has faith that the system is going to cure, the cure is half accom- 
 plished. After that it just means patience and grit. 
 
 Generally stammerers do not try for a cure until the habit has been on 
 them for years. A ten year habit cannot be cured in ten days. Go to any 
 one of the schools, pick the one where the teacher makes the best impression 
 on you, have faith and stick. 
 
 To Prevent Stuttering. — N. V. writes: "I have a little girl about 8 
 years of age. She is perfectly healthy and bright. She has been talking as 
 plainly as any child, but lately, say for the last month, I notice an inclina- 
 tion to stutter at the beginning of a sentence. Kindly advise me what to 
 do." 
 
 Reply. — Admonish her to speak slowly. 
 
 Children are prone to imitate. Speak slowly and deliberately when in 
 her presence. Do everything you can to cultivate poise in her. Keep her 
 away from everyone with a speech defect or a bad speech habit. 
 
 Cure Matter of Training. — La Grange writes: "There is a boy of my 
 acquaintance, Ik years old, who is afflicted with stammering. What can 
 be done in his case? Should he have medical treatment, or is there some 
 kind of a school or institution where he can be sent to be cured of his 
 trouble?" 
 
 Reply. — The Chicago public schools have a school for children with 
 speech defects. There are private schools, each teaching some one method. 
 Scripture, in his book on "Stuttering and Lisping," says the trouble with 
 these institutions is that the fundamental trouble differs in nearly every 
 case, and, therefore, the method must be changed for each case, or nearly 
 so. Medical treatment gains nothing. Cure is a matter of training. 
 
 How to Cure Stuttering. — A. W. writes: "Will you please let me know 
 whether stuttering or stammering is curable, and whether a surgical opera- 
 tion is necessary? I have stammered and stuttered badly for some time. 
 Now I at times find it difficult only to commence certain words. Some- 
 times I can speak almost without any difficulty. What would you advise 
 in my case?" 
 
 Reply. — I cannot see how a surgical operation would help you. Stutter- 
 ing is curable. A careful study of the individual case and persistence in 
 carrying out the cure bring success. Read Scripture on "Stuttering and 
 
PHRENOLOGY 441 
 
 Lisping," decide on a method, and patiently follow the method you have 
 selected. 
 
 May Help Yourself. — F. C. P. writes: "I am IJf and I stammer. I have 
 attended schools of stammering and have tried nearly everything. Nothing 
 seems to help. Would you please give me some advice?" 
 
 Reply. — No two stammerers can be treated exactly alike. Go to your 
 nearest library and get Scripture's "Stuttering and Lisping." Read it care- 
 fully. Through it you may be able to help yourself. 
 
 Suggestion for Stammerers. — J. A. E. writes: "I wish to state that a 
 number of years ago I stuttered on every word. I started to whistle as I 
 started to talk, and found I had no trouble talking. If you will watch the 
 faces of the majority of stutterers when they talk you will see that they 
 breathe in instead of breathing out. If they will only stop and whistle 
 they will be able to talk without stuttering. I stutter little at the present 
 time. I have been to stutterers'' schools, but found the whistling helped me 
 more than any other treatment." 
 
 Child Stammers. — A teacher writes: "Will you kindly advise how to 
 control stammering in a child of 5f" 
 
 Reply. — I would suggest that you get Scripture's "Stammering and 
 Lisping." It is a small and inexpensive book. There are many cures for 
 stammering. Scripture writes that each subject must be carefully studied 
 and then a plan outlined for that individual. Each cure is adapted to a 
 group of cases, but ineffective for others. Whatever the cure, it is a matter 
 of training and patient persistence is essential. 
 
 PHRENOLOGY 
 
 Not long ago I picked up a daily paper published in a city of some im- 
 portance. I was astonished to read of a combination for mutual advantage 
 between this newspaper and an archaic type of faker — a phrenologist. The 
 "professor" was writing daily character studies of prominent people, based 
 on bumps, for the newspaper. The newspaper was running editorials and 
 editorial notes about the "professor" and his bumpology, and everybody was 
 happy except the poor "suckers" who were being done out of their coin by the 
 Bump and Hump twins. 
 
 The quality of brain, to say nothing of the brain capacity, is in no way 
 related to the bumps on the head. The soft, brainy substance cannot push 
 knobs on the hard, bony skull, and, for that matter, the hard, bony skull 
 cannot change the type of brain inclosed therein. 
 
 No group of scientists, psychologists, anatomists, histologists, or physiolo- 
 gists has ever been able to find any evidence of relation between skull humps 
 and bumps and types of mind or mental capacity. This information is more 
 or less generally diffused, and yet these fakers still catch fair crops of suckers. 
 
 Don't waste your time watching for bumps, hoping thereby to estimate 
 character. If you have time to spare, however, put in some of it watching 
 children for mouth breathers and thumb suckers. Sometimes it will prove 
 as interesting as reading a "best seller/'' 
 
442 STAMMERING AND STUTTERING 
 
 HEAD NOISES 
 
 One of the most frequent calls for help coming to me is the call for relief 
 from head noises. Searching far and near, I have not been able to find a 
 suggestion simple of application and offering hope of relief for many sufferers, 
 and these are the reasons : 
 
 The ear is divided into three parts — the external ear, the middle ear and 
 the internal ear. The external ear opens to the outside and, at its inner end, 
 is closed by the drum. The middle ear opens into the throat, and, at its outer 
 end, is closed by the same drum. Then the purpose of the external and middle 
 ear is to receive the sound waves and convert them from air waves into bone 
 waves. The internal ear converts these bone waves into nerve impulses which 
 the brain interprets as sounds. 
 
 Incidentally, a part of the internal ear keeps the body in proper equili- 
 brium. The simple way to put the last point is to say that, when that part of 
 the internal ear is disturbed there is vertigo, swimming in the head, and 
 sometimes fainting. 
 
 When one is hit in the eye or so as to jar the eye, one sees stars; when 
 the bronchial tubes are irritated, there is cough. When the nerves of the in- 
 ternal ear are irritated, the irritation expresses itself not by stars, or cough, 
 or sense of heat or cold, or pain, but by "noise." 
 
 In the case of head noise the external ear should he examined. Wax 
 may he irritating the drum. If so, and it is cleaned out and the canal is kept 
 clean, the trouble will end in this group of cases. 
 
 Occasionally the ears are too keen. In this case, cotton in the ears will 
 bring relief. In some cases the throat man will find that adenoids or tonsils 
 are interfering with the canal from the nose to the ears. 
 
 These are the unusual causes of head noise. The usual cause is trouble 
 in the internal ear or the bones that surround it. Any inflammation or disease 
 of any sort in the internal ear such as would cause pain in another part of 
 the body causes head noise. 
 
 Head noise merely means that the internal ear is being pained and is 
 responding to the irritation in the only way known to it. Doctors try to find 
 out something more about the trouble by inquiring into the nature of the 
 sound. For instance, some say that a sharp, metallic, striking sound like that 
 of a hammer striking an anvil is due to disease in the bones. 
 
 Furthermore, they try to sound conduction of the bones. Bones get 
 denser and under other circumstances more porus, and the ear test is a fair 
 test for bone density. 
 
 One with head noise due to internal ear disease can do something by 
 keeping his bowels right and living a hygienic life. Ear specialists can cure 
 some of the cases. But the average man with head noises must make up 
 his mind patiently to endure, to calm himself, to train himself to forget the 
 noise. 
 
 Nor is this as difficult as we imagine. A street noise must be out of the 
 ordinary to attract attention. We forget, or never hear, or, better, never 
 notice — nine-tenths of the sounds we hear. We have so trained ourselves. We 
 could easily hear our hearts if we encouraged ourselves to listen for them. 
 
CHAPTEK XXVil 
 
 Headaches 
 
 The most helpful statement about headaches that I can make is that 
 one should not take coal tar headache cures. They are effective in just two 
 varieties of headaches. They give relief in bilious headaches — headaches due 
 to overeating or improper eating, and headaches due to constipation. But for 
 this variety of headache there is a better remedy. A full dose of purgative 
 taken on an empty stomach will act more quickly and better. 
 
 The source of poisoning having been removed, a short period of mental 
 rest will restore mental balance. The disadvantage of using headache powders 
 in this group of headaches is twofold. It begets the headache habit. Coal 
 tar headache remedies change the blood so as to produce headache. By fre- 
 quently taking headache medicine one can easily double the number of his 
 headaches in a month. 
 
 The second disadvantage is that the use of coal tar headache remedies 
 makes one forget that the essential thing to do is to eat less, exercise more, 
 and attend to his elimination. 
 
 The other group of headaches relieved by coal tar remedies are those 
 due to fever, sore throat, and infections generally. It is not safe to allow 
 headache from that source to run long without medical attention. The 
 danger is that the infection may be with an organism capable of doing great 
 harm. Certain quite serious disorders begin with headache. 
 
 Another reason why headache powders should not be used habitually is 
 that the habit leads people to overlook important causes. Bright' s disease and 
 arteriosclerosis are grave but subtle conditions. It is important to know 
 of them early; yet when they knock at our doors they do not bang. There 
 is no brass hammer business. They tap very, very gently, and, half awake, we 
 dream the sound to be of another nature, or we miss it entirely. 
 
 A persistent or frequently recurring headache may be the form taken 
 by the gentle tapping. Anything which makes us overlook the cause of the 
 tapping may harm us. 
 
 The habit may cause us to overlook the condition of the eyes. Of all the 
 causes of headache, eye strain is said to be the most frequent. I do not think 
 so. I think that if we could get a headache census we should find that bilious- 
 ness-overeating-constipation was the most frequent cause. Nevertheless eye 
 strain is a very important cause of headache. People who dismiss their 
 headaches from consideration by swallowing a tablet or a powder are liable to 
 suffer their neglect of their eyes to continue. 
 
 There are other causes which may be overlooked when the custom 
 is to take one or more doses of headache medicine and to let it go at that. 
 That the pain does not get better after the medicine has been taken makes 
 no great difference. 
 
 443 
 
444 HEADACHES 
 
 The two thoughts which should stand out are these: When one has the 
 headache habit he should know the reason why; and the use of headache 
 medicine does harm in several ways, among others by multiplying the spells. 
 
 FOUR KINDS OF HEADACHES 
 
 Any sensation of any sort anywhere inside or outside the skull or within 
 a few inches of the skull is liable to be called a headache. Worse still, not 
 content to throw all disagreeable sensations of the head into one bag labeled 
 headache, we have one remedy for headache — a coal tar headache cure. And 
 worse still, though this remedy may give temporary ease, it causes more head- 
 aches than it cures. Though this coal tar cure be called anti-this or anti- 
 that, or by one or another copyrighted name, essentially the medicine is the 
 same. 
 
 There are a dozen kinds of headaches, and what is proper for one is not 
 proper for another. Then where is the sense in having one headache remedy 
 for everybody that has headache and for every kind of a headache ? 
 
 In an annual address before the Iowa Medical Society Dr. Patrick told 
 his audience of some things that he had observed about four kinds of head- 
 aches. 
 
 If a headache be due to rheumatism, it is necessary, first, that it be 
 recognized as such. The cause of rheumatism is pus infection from some 
 source of infection. As in all other forms of rheumatism, the source of 
 infection must be found and remedied. For relief, nothing is better than 
 massage, heat locally, and aspirin internally. 
 
 The second form of headache discussed by Dr. Patrick was that from 
 sinus trouble. The pain from sinus headache is not especially liable to be 
 located near the sinus. In cases of sinus headache there is very apt to be a 
 little fever — a half a degree or so at some time during the day. A good 
 nose specialist can locate sinus trouble, and a blood examination shows some 
 increase in the white cells during the spell. 
 
 Sinus headache is helped by steaming the nose or soaking the face in 
 hot water. When the offending sinus is cleaned out, the headache gets well. 
 
 The third variety discussed is the neurasthenic headache. The headache 
 of neurasthenia is not a pain; it is an unpleasant feeling of pressure. This 
 sensation is liable to be geometric — a band, a circle, a point, a streak, a square, 
 or a parallelogram. When the pain is described in this way or emotion is a 
 factor, Dr. Patrick told the physicians that the headache is neurasthenic and 
 must be treated on that basis. 
 
 Much the most important of the four varieties of headache discussed was 
 migraine. This form of headache runs in families. It attacks women more 
 often than it does men. It begins in childhood, increases in frequency and 
 severity until the age of forty-five or fifty, and then lessens. 
 
 Migraine headaches go by a dozen names — sick headache, constipation 
 headache, menstruation headache, neuralgic headache, nervous headache, gouty 
 headache — all forms of migraine. 
 
 The prime necessity of treatment is to search out and remove every custom 
 which can be classed as wrong living; to change the eating habits, especially 
 
HEADACHE PREVENTION METHOD 445 
 
 if there is a tendency to overeat; to exercise vigorously in the open air; to 
 correct constipation; to search out and remove all sources of ill health such 
 as "pelvic pathology and pressure from a deflected septum, enteroptosis and 
 eye strain, constipation and overwork, excessive menstruation and loss of 
 sleep, excess of alcohol or tobacco, insufficient food, anemia and domestic 
 discord." 
 
 While proper attention to such of the above as may need attention in a 
 given case may not entirely prevent attacks of migraine, the attacks will be 
 less frequent and lighter. It is just in these headaches that coal tar headache 
 powders and tablets are most used. The great objection to their use is that 
 they increase the frequency of the headaches. 
 
 HEADACHE PREVENTION METHOD 
 
 In many people great activity in the large intestine, particularly in the 
 colon above the rectum, is accompanied by irritation of the nose. To be more 
 specific, for a short time preceding a copious bowel movement, particularly 
 if there is some griping and pain, sneezing will be frequent, and the nose 
 will discharge water freely. 
 
 This is especially noted, as stated above, when there is considerable ab- 
 dominal discomfort. It has been suggested that a pinch of snuff or a whiff 
 of ammonia be used 'as a laxative in lieu of salts and oil by the stomach. 
 
 It has been noted that women who suffer from painful menstruation 
 and monthly headaches are benefited and ofttimes cured by burning the nose. 
 
 Separating the nostrils from each other is a partition called the septum. 
 On the outer wall of each nostril are three bony ridges called the turbinate 
 bones. It has been found that there is a nerve connection between the uterus, 
 the breast, the brain, and the nose. 
 
 At the time of menstruation physicians have noted a swelling of the 
 membrane over this septum and over the lowest one of these ridges, called the 
 inferior turbinate. 
 
 They have gone farther than that. They have prevented monthly 
 headaches and painful menstruation by burning these areas two or three times 
 during the month with trichloracetic acid. 
 
 In the Journal of the American Medical Association there is a report 
 of 93 cases, and in Surgery, Gynecology, and Obstetrics there is a further 
 report of cases treated in this way. Most of the reports on the subject come 
 from Germany. 
 
 An able German authority, E dinger, says that the most frequent form 
 of headache is one where there is tenderness at certain points on the scalp. 
 An important part of this theory is that massage of the scalp over the tender 
 points relieves this pain. 
 
 The areas of soreness are as follows: An area one inch square one 
 inch above the inner end of the eyebrow; an area one-half an inch wide 
 and beginning one inch above the outer end of the eyebrow and running to a 
 point one inch above and just behind the ear; the top of the head directly 
 above the ears; the back of the head directly behind the ears, beginning two 
 inches back, where the back of the neck joins the back of the head; along 
 
446 HEADACHES 
 
 the sides of the backbone in the neck; along the spines of the backbone in 
 the neck. 
 
 HEADACHE MEDICINES 
 
 The powders, tablets, and capsules so frequently taken for headache induce 
 drug habits. He who takes them is a drug fiend. He may not relish the 
 association, but he belongs with the "coke" fiend, the morphin "dope" and 
 the whisky "soak." 
 
 When, in the '80's, this group of remedies began to appear, the medical 
 profession quickly saw their usefulness in relieving aches and pains. Before 
 many years it was seen that they led to habits, whereupon the medical pro- 
 fession became much more careful in using them. 
 
 However, in the meanwhile the people had learned by experience that 
 they would relieve headaches and the aches of colds and fevers. In consequence 
 the use of them at least holds its own, and possibly increases. 
 
 Occasionally a large dose of "headache" medicine kills suddenly by over- 
 whelming vital nerve centers, but these cases are so infrequent as not to be 
 the principal reason for not using the drugs. 
 
 The main reason for not using them is that they harm the blood cells 
 in such a way that they cannot properly carry oxygen to the cells of the body, 
 nor can they carry away body wastes — just as if a man were marooned in a 
 house with the grocery wagon only able to get to him twice a week, and the 
 garbage wagon twice a month. 
 
 The result is that his tissues are poisoned and starved — but more poisoned 
 than starved. He gets flabby and soft — suboxidized — physically and mentally. 
 Instead of a head-ache once a month he now has one a week. Instead of being 
 cured by a small dose of "headache" medicine, he now needs a large dose. 
 
 The more he takes the more "stippled" are his red blood cells, the more 
 his nerve cells cry out in pain. 
 
 This is the kind of habit and the reason for the habit known as the head- 
 ache medicine habit. It differs in many ways from the "coke" or "dope" 
 habit. It is a habit which affects the individual solely. It has no social 
 relations. 
 
 The alcohol fiend may shoot up the town, and the morphin fiend may 
 steal to get his drug. The headache medicine fiend has no disposition to bother 
 anybody. 
 
 A man is frequently justified in taking a dose of such medicine for the 
 relief of a headache, but the circumstances must be exceptional. Whenever 
 they become regular the man had better by far go after the underlying cause, 
 or rely on purges, or bear his suffering, or all combined. 
 
 He must fight it out some time, and he had better fight it out while the 
 water is shallow. To take headache medicine and let it go at that is con- 
 stantly drifting him toward water over his head. 
 
 Sick Headache. — W. A. B. writes: "What is the cause of chronic sick 
 headache? I have an attach of sick headache on an average of once a week, 
 at which times I suffer excruciating pain through the eyes, temples, and 
 back of the head and neck. These attacks are accompanied by violent 
 
HEADACHE MEDICINES 447 
 
 vomiting and usually last from five to eight hours. They are sometimes 
 brought on by an extra effort in the way of physical exercise or manual 
 labor and I have suffered with the ailment since* childhood" 
 
 Reply. — Such headaches, termed migraine, are closely related to gout. 
 To eat less and exercise in the open air more increases the interval be- 
 tween them. They are many times more abundant among inside people 
 than among out of doors workers. A good cleaning out brings relief. An 
 attack comes when clogging has recurred. With these facts in mind know- 
 ing what to do is easy. Doing it. is hard. One of the advantages of old 
 age is that gouty headaches have quit. Somewhere about fifty they 
 seem to say to themselves : "I cannot teach this fellow to live in the open 
 and eat less. I think I shall quit trying." Whereupon the man becomes 
 less and less subject to sick headache. 
 
 Cause of Sick Headache. — M. S. M. writes: "What causes sick head- 
 ache and what is the best remedy?" 
 Reply. — Sick headache is due to : 
 
 1. Nerve tire. 
 
 2. Condition of poisoning from chemical substances manufactured 
 by the body or manufactured in the body. 
 
 3. Eye strain. 
 
 Some cases are due to one of these alone. Most of them are due to sev- 
 eral combined. 
 
 Remedy : 
 
 For those cases due to nerve tire — rest. 
 
 For those due to eye strain — eye rest, including proper glasses. 
 
 For those due to what is called intoxications, gout, biliousness, and the 
 like — a laxative and, sometimes, some of the coal tar headache medicines. 
 It has been demonstrated that the promiscuous use of these increases the 
 frequency of gouty headaches, though they give temporary relief. 
 
 Headaches from Stomach. — J. C. F. writes: "I am 50, and at 30 got 
 
 my first headache. Headaches come once or twice every month. I took 
 great care of my stomach and for years warded off the headaches. Five 
 years ago I got it daily. My sight is good, my meals regular, also my sleep. 
 What course should J adopt?" 
 
 Reply. — The important causes of headaches are: 
 
 1. Eye strain. 
 
 2. Migraine. 
 
 3. Mental strain. 
 
 If your eyes have been competently examined, your case is limited to 
 one of two groups of causes, in all probability. You may be working your 
 brain or worrying too much. In that event you should have more mental 
 rest. Probably you have migraine. If so, as you get older your head- 
 aches will get less. 
 
 Have your eyes examined again. Cut down the quantity of your eat- 
 ing; fletcherize; double your physical exercise; do less brain work. This 
 is as much as I can suggest. 
 
 Migraine. — K. C. H. writes: "What is migraine and how can it be 
 cured? Is it not a new disease and is it not on the increase?" 
 
 Reply. — Migraine is a gouty headache. Inheritance is a large factor. 
 It runs in families. After forty attacks come with less frequency and 
 
448 HEADACHES 
 
 they usually stop soon after fifty. Attacks can be relieved by purges, 
 and mental and physical rest. Headache medicine gives some relief, but 
 the average woman is better off without it, particularly if she has to "lie 
 up" with it. It is not a new disease; people have always suffered with it. 
 
 Suffers from Migraine. — J. T. N. writes: "What is the cause of sick 
 headache? I have an attack of sick headache about twice a month. I have 
 pain through the eyes, temples, and back of the head and neck. These at- 
 tacks are accompanied by violent vomiting. What are the symptoms of 
 gouty headache? Will inflammatory rheumatism cause headaches?" 
 
 Reply. — You have what is commonly known as migraine. By keeping 
 your bowels regular, eating lightly, exercising in the open air, and avoiding 
 worry, you will reduce your spells somewhat. You will get some relief 
 during spells from purges. However, migraine gets to be a habit. It 
 usually lasts until past middle life, getting better as age comes on. It runs 
 in families. 
 
 Treatment for Migraine. — D. W. writes: "What is migraine? How 
 can it be cured or relieved?" 
 
 Reply. — Migraine is the name given to sick headache. It is one of the 
 features of what is sometimes called biliousness. Commonly, there is a 
 period of heavy logishness out of which a headache gradually develops. 
 The headache may be attended by nausea and dizziness. Following it the 
 mind is bright. It is something like the air after a storm. 
 
 A migraine tendency is inherited. The periodical attacks generally stop 
 coming after the sufferer has reached fifty. 
 
 To give relief nothing equals purgatives, particularly salines, rest in 
 bed, and, in some cases, headache remedies. To prevent attacks the free use 
 of water, temperance in eating, and a simple life in the open air constitute 
 about all that can be done. 
 
 Not a Headache Preventive. — N. L. writes: "Will the juice of a whole 
 lemon and one-half a spoonful of table salt in a glass of hot or cold water 
 ward off a headache if drunk before breakfast?" 
 
 Reply. — No. The salt will act as a mild saline laxative. There is the 
 same objection to it that there is to any other saline laxative as a daily 
 dose. A lemon, lime, or orange each morning is almost a necessity until 
 the spring fruits and vegetables come in. 
 
 Has Harmful Effect. — M. B. writes: "Will you please tell me what 
 effect a continued use of a coal tar product for headaches, etc., will have 
 on the heart if it is used in small quantities?" 
 
 Reply. — Such use is moderately harmful to the heart. It is much more 
 harmful in that it produces changes in the blood. Among other effects 
 produced by these blood changes are headaches. Headache medicines, long 
 continued, produce headaches. 
 
 Forbidden by Law. — Inquirer writes that a headache remedy is being 
 distributed on premises and sometimes is placed in mail boxes. Is the 
 remedy liable to do harm? Is it against the law to distribute medicine in 
 this way? 
 
 Reply. — Headache remedies are generally composed of coal tar deriva- 
 tives. They are moderately poisonous. A full dose for a grown person is 
 a highly poisonous dose for a small child. 
 
HEADACHE MEDICINES 449 
 
 The Legal Friend of the People in the Tribune informs us that to 
 distribute such medicine is against the law in Chicago. The fine is from 
 $5 to $50. The ordinance violated is found in Ch. 22, Art. IV, No. 811. 
 
 Where many mail boxes are found supplied with original packages, 
 there is a fair chance that the courts would hold that the company is 
 responsible, even if the distributor was not apprehended. 
 
 Dizziness. — J. B. writes: "What is it that causes one to become dizzy 
 directly after taking the first mouthful of food at dinner, the dizziness dis- 
 appearing at the second or third mouthful?" 
 
 Reply. — Dizziness always calls for investigation and change in one's 
 habits somewhere. There are many causes of dizziness, but no one who 
 gets dizzy frequently is normal. Find out, as the result of proper tests 
 and examinations by your physician, why you are dizzy frequently, and 
 change whatever it is necessary for you to change, since to allow frequent 
 dizziness to continue is unwise. The relation to the first mouthful of food 
 as compared with other mouthfuls is of no consequence. 
 
 Paraffin and Headache. — A. R. C. writes: "Can you explain the use of 
 paraffin oil? Also the benefits derived from it? Is there any danger if it 
 is bought from a reliable druggist? Would you advise the use of it for 
 headache? What is self-infection, and its cure? Is it similar to auto- 
 intoxication?" 
 
 Reply. — 1. Paraffin oil is not absorbed from the intestines. The theory 
 is that it acts as a lubricant. In crude oil there are substances which ab- 
 sorb, and some cases of harm have been reported. 
 
 2. So much depends on who is using the word reliable. So much has 
 been written on the subject of pure and impure paraffin oil that every 
 druggist has had it brought to his attention. The high grade ones should 
 have gone to some trouble to get a properly refined article. Buy from the 
 most dependable known to you. 
 
 3. If the headache were due to constipation, yes. 
 
 4. I do not know just what you mean by self-infection. I presume auto- 
 intoxication is synonymous. However, the answer would depend upon the 
 connection in which the term was used. 
 
 Too Much Aspirin Harmful. — J. R. S. writes : "A friend of mine uses 
 aspirin tablets. At first she used them for headaches; now she uses them 
 whenever she thinks she is going to have one. I have known her to take 
 a dozen in one day. The question is: Aren't they dangerous when one 
 takes as many as that? Does not a person acquire a Haste' for them the 
 same as one would morphin? Doesn't the constant use of them endanger 
 health?'* 
 
 Reply. — Aspirin as a habit producer is not in the class with morphin; 
 but you can be certain that anybody who takes a dozen aspirin tablets a 
 day is being harmed by them. Anybody who takes any headache medicine 
 systematically and regularly is being harmed by it. 
 
CHAPTER XXVIII 
 
 Foods 
 
 Foods are divided into two classes — organic and inorganic. Organic 
 foods are divided into proteids, fats, and carbohydrates. Proteids are the tissue 
 formers and are found in both animal and vegetable food substances. Fats 
 are the heat producers and are also found in the animal and vegetable foods. 
 Carbohydrates are the energy or work producers and are almost entirely ob- 
 tained from the vegetable world. 
 
 The common forms of the first class — the proteids — are lean meat, eggs, 
 milk, cheese, peas, beans, and cereals; of the second class — the fats — butter, 
 fat meat, bacon, lard, olive oil, cream, chocolate, and certain nuts ; of the third 
 class — the carbohydrates — potatoes, rice, cornstarch, arrowroot, many grains 
 like wheat and oats, the sugars (cane, beet, and milk), maple syrup, molasses, 
 honey. 
 
 The main inorganic foods are water and common salt. 
 
 It is a common belief, borne out by results of a large amount of experi- 
 mental investigation, that Americans use more food than people of Europe 
 of the same class. The dietary of the working people of America contains more 
 meat than that of the toilers of European and Asiatic countries. 
 
 The reason is that meat is more expensive in those lands than in America. 
 Fats occur in smaller, and carbohydrates in larger, quantities in European 
 dietaries than in American. 
 
 Cold storage has changed the dietary habits in some parts of this country. 
 Formerly, in the north, people were limited to cabbage, potatoes, onions and 
 a few other root crops in the winter and to eggs and salt meats during the 
 summer. 
 
 Circumstances determine the food of an individual or family to a great 
 extent. Statistics show that we Americans are on the whole overfed rather 
 than underfed. 
 
 Langworthy says : "Animal and vegetable foods are about equal as sources 
 of protein, some 48 per cent, of the total being supplied by animal foods and 
 some 52 per cent, by vegetable foods, of which 43 per cent, is contributed by 
 the cereals. Little fat is furnished by vegetable foods, the group as a whole 
 supplying only 11 per cent, of the total amount in the diet. 
 
 "Animal foods and dairy products are the most important sources of 
 fat, milk and cream furnishing 26 per cent, of the total fat of the diet and 
 meat as a whole furnishing a little over twice as much as is supplied by all 
 other animal foods. Of the different meats, pork is the most important 
 source of fat. 
 
 "Meats and poultry together furnish about twice as much protein as the 
 other animal foods, and of the different meats, beef and veal together furnish 
 about half of the total amount supplied by the entire group." 
 
 450 
 
BEEAD 
 
 451 
 
 . .. Com position. Functions. And Uses Of Food 
 
 U.S. Department of Apiculture Prepared by 
 
 Office of Experiment Stations C. F LANGWORTHY 
 
 A.C.True, Director Expert in charge of Nutrition Invesiigatiofls 
 
 FUNCTIONS AND USES OF FOOD. 
 CONSTITUENTS OF FOOD. 
 
 FOOD AS PUR- 
 CHASED CONTAINS 
 
 Water 
 
 EDIBLE PORTION 
 Flesh of meat, yolk Nutrients 
 and white of eggs, 
 wheat flour, etc. 
 REFUSE 
 Bones, entrails, 
 shells, bran, etc. 
 
 USE OF FOOD IN THE BODY. 
 
 PROTEIN Builds and repairs tissue 
 
 White (albumen) of eggs, 
 
 curd (casein) of milk, 
 
 lean meat.gluten of wheat.etc, 
 
 Protein 
 Fats 
 
 Carbohydrates 
 Mineral Matter Or Ash 
 
 FATS Are stored as fat 
 
 Fat of meat, butter, 
 
 olive oil. oils of corn 
 
 and wheat.etc. 
 CARBOHYDRATES— -Are transformed into fat 
 
 Sugar, starch, etc. 
 MINERAL MATTER OR ASH— Share in forming bone. 
 
 Phosphates of lime. assists in digestion, etc. 
 
 potash, soda. etc 
 
 All serve as fuel to 
 yield energy inthe forms 
 of heat and muscular 
 power 
 
 Food is that which, taken into the body, builds tissue or yields energy. 
 
 Fig. 163. 
 
 BREAD 
 
 That bread is "the staff of life" is an old saying hardly subject to contra- 
 diction. Everybody eats bread. It is more abundantly used than any other 
 article of food. 
 
 Bread is made of flour ground either from wheat, buckwheat, barley, rye, 
 
452 
 
 FOODS 
 
 Bread and other Cereal Foods. 
 
 U.SDepartment of Agriculture 
 
 Office cf Experiment Stations 
 
 A.C.True: Director 
 
 FVepared by 
 
 CrTLANGWOFrmY 
 
 Expert in Charge of Nutrition Investigations 
 
 COMPOSITION OF FOOD MATERIALS. 
 
 WHOLE WHEAT BREAD 
 
 amn 
 
 Proton Fat 
 
 WHITE BREAD 
 
 Carbohydrates 
 
 Ash 
 
 Fat: 1.3 
 
 Askil 
 
 mmxm 
 
 m 
 
 Carbo- 
 •':S : .v>'-T-V';:^V.;-v h^drjtgs: 53.1 
 
 Wat^n 35.3 
 Protein : 9.2 
 
 Ssg5snaSmmSB«/ ' 
 
 Fuel value- 
 
 OAT 
 BREAKFAST FOOD 
 
 1215 calories Water- rU 
 PER POUND WJKSL. 
 
 TOASTED BREAD 
 
 Fuel value- 
 
 ■ 
 
 1 1 40 CALORIES 
 PER POUND 
 
 hydrates: 11.5 
 CORN BREAD 
 
 FAfU 
 
 Fig. 164. 
 
 or corn. Enough water is added to the flour to make a uniform dough, after 
 which it is kneaded, either by hand or machinery. A pound of bread is com- 
 posed of three-quarters of a pound of flour and one-quarter of a pound of water. 
 To this is added enough yeast to excite a fermentative process. 
 
 As a result of the fermentative process starch is converted into alcohol, 
 carbonic acid, and water. Just enough salt is added to the bread to give it a 
 pleasant, wholesome taste. 
 
BEEAD 
 
 453 
 
 Cereal drains. 
 
 ULSOepartment of Agriculture 
 
 Office of Experiment Stations 
 
 A.C.Truej Director 
 
 Rrepared by 
 
 C.rTLANGWORTHY 
 
 Expert in Charge of Nutrition Investigations 
 
 COMPOSITION OF FOOD MATERIALS. 
 
 rmrn 
 
 Fat 
 
 CORN 
 
 Fat: 4. 
 
 Ash:! 
 
 mm ^s mm 
 
 Water 
 
 Water: 10. 
 FVotein:12 
 
 Carbohydrate* Ash 
 
 ater:10.8 
 in: 10.0 
 
 Fuel Value 
 
 i- Sain. Equals 
 
 1000 Cajories 
 
 WHEAT 
 
 rates: 73A Carbohydrates: 
 
 at: 1.7 
 
 sh:1.8 
 
 BUCKWHEAT 
 
 1800 calories r^tein.-10.0^D£-Water: 12.6 1750 calories 
 
 pcr pound •Carb J D^-~W?vXFat:2.2 p^ pound 
 
 hydrates: 73.2 ^^Ush: 2.0 
 
 F uel valu e 
 
 OAT RICK 
 
 ater: 11.0 1 600 calories Water: 12J 
 
 Fat: 5, 
 
 Ash; 3 
 
 otein.H.8 
 
 PER POUND 
 
 Carbo- 
 hydrates: 69.2 
 
 Fuel 
 
 Fat:1. 
 
 VALUE 
 
 Carbo- W<& 
 
 hydrates:73.9 W-Ash: 1.9 
 
 1720 CALORIES F UEL VALUE: 
 
 PER POUND ^mu> 
 
 1750 CALORIES 
 PER POUND 
 
 at:2£> 
 
 sh:1.0 
 
 1720 CALORIES 
 PER POUND 
 
 Fig. 165. 
 
 The object of baking is to kill the yeast germ and arrest fermentation. 
 The art of baking bread is all important, since it has much to do with 
 whether the bread is heavy or soggy and whether it is sour. When the baking 
 process leaves the bread in this state it has not been scientifically done, as the 
 germ of fermentation is still active. 
 
 Where bread is made from wheat flour it is usually referred to as white, 
 gluten, graham, whole wheat, and bran bread, the name being derived from 
 the particular kind of flour from which the bread is made. 
 
454 FOODS 
 
 Of these, the white is higher in nutritive value, hut it may not he- so 
 wholesome, as it is less bulky, contains less roughening, and hence is more 
 constipating. 
 
 Graham and whole wheat breads are supposed to be made from flour 
 which contains all of the constituents of the original grain in their same 
 proportions. In many cases, however, the graham and whole wheat flours have 
 been but partially bolted. 
 
 Bread is a mixed food, containing many classes of ingredients — fat, salts, 
 sugar, protein, and starch. While it contains fat, it does not contain enough 
 to make it a perfect food, which probably explains in part the reason why 
 people eat butter with their bread. 
 
 Bread does not seem to tire the appetite. No hetter explanation, perhaps, 
 could he given for its common consumption than this fact. 
 
 The free use of hot hread is usually tabooed by hygienists for several 
 reasons. Hot rolls, for instance, are not thoroughly chewed before swallowing, 
 and are, therefore, not properly mixed with the digestive juices. There may 
 be too great a quantity eaten, because of greater palatahility. Accordingly, 
 the habit of eating stale bread instead of fresh should be encouraged. 
 
 White bread usually is purer than the brown breads, because it is easier 
 to adulterate the brown breads than the white. White bread, however, may 
 be adulterated with chalk, gypsum, pipe clay, and similar articles. 
 
 The addition of a mineral acid to bread containing these adulterants 
 produces an effervescence when it comes in contact with the carbonates used 
 as such adulterants. 
 
 A man cannot keep in condition on a diet of bread alone. At the same 
 time he would come nearer succeeding than on a diet of only meat, olive oil, 
 milk or any other food article. It comes nearer meeting all the requirements 
 than any of them. Some have the idea that milk is a complete diet. It is for 
 a baby under six months of age, but after that, no. On the other hand, 
 every race and, for that matter, every individual, builds the menu around 
 bread. 
 
 Bread is out of balance in that the percentage of starch is too high. 
 Protein, fats and salts are too low. There is not enough roughage to prevent 
 constipation. Bread which contains a high percentage of bran comes nearer 
 being balanced than one that is freer. Second-day bread is somewhat more 
 nutritious than fresh bread. Bread crust is more easily digested than the 
 center of the loaf. 
 
 Fat people should eat little bread. Diabetics should eat still less. 
 
 Let us end by changing the quotation with which the first paragraph 
 began. Let it read — Bread is a staff of life. To make it the staff of life 
 causes ill health. 
 
 Sanitation in Bakeries. — Two reasons for sanitation in bakeries exist. 
 The first is that the bread may be wholesome ; the second, that the bakers may 
 keep in good health. 
 
 People buy bread because it is a wholesome, nutritious, easily digested, 
 economic food. They are willing to use bread made outside their own kitchens 
 when they are satisfied that the process of making is carried on under condi- 
 tions about as good as those prevailing in their own kitchens under their own 
 eyes. The cordwood way of distributing bread — stacked up in a fly-abounding 
 
MEAT 455 
 
 salesroom, stacked up in an open wagon, stacked up on the arm of a delivery 
 boy, stacked up on the floor of the back porch until someone takes it in — 
 prevents many a woman from buying bakery bread. 
 
 Miss Howell, one of Professor Jordan's students at the University of 
 Chicago, made a study of bread purchased from shops in different parts of 
 Chicago. She found wrapped bread much cleaner than unwrapped. Of the 
 unwrapped specimens 39 per cent were classed as dirty (bacterial average 
 14,000, maximum 120,000) ; 39 per cent as fair (bacterial average 4,000, 
 maximum 20,000) ; 22 per cent clean (bacterial average 2,500, maximum 
 14,000). 
 
 Of the wrapped bread 45 per cent was fair (bacterial average 848, 
 maximum 3,000), 55 per cent clean (bacterial average 371, maximum 2,200). 
 She found that a few of these bacteria, though but few, were possible disease 
 producers. A larger number, while not capable of producing disease, indi- 
 cated practices that the consumer does not like to think about in the midst 
 of his meal. 
 
 She thinks there is some possibility that the germs of consumption 
 and typhoid, when present in the dough, can survive the baking temperature 
 and exist in the bread capable of causing disease. The proof of this point 
 is not satisfying. The proof that germs, and especially tubercle and typhoid 
 bacilli, get on bread after it has been cooked and can spread disease is good. 
 
 The principal reason for bakery sanitation, however, is conservation of 
 the health of the bakers. Bakeries in operation are always too warm. It is 
 not possible to ventilate them perfectly. The bakery air usually contains a 
 good deal of dust. It is difficult to keep the premises clean. Much of the 
 work is done at night. The work is uneven. The mixing and doughing time 
 is one of fast, hard work. Then come several hours with little to do — when 
 the sponge is rising. This is followed by the hot, trying work of baking. 
 This distribution of work is responsible for much use of the bakery as a 
 sleeping place. 
 
 All in all, the work of baking puts such a strain on the vitality of the 
 baker that he cannot keep in health unless the bakeshop conforms to sensible 
 requirements as to light, ventilation, temperature, humidity, cleanliness, and 
 toilet facilities. 
 
 MEAT 
 
 We are great meat eaters in this part of the world. In spite of everything 
 that will be said, in spite of the prices that will prevail, we shall continue 
 to be heavy meat eaters. However, we should take the trouble to be dis- 
 criminating meat eaters, and that we are not now. 
 
 About one-third of the cost of food for an American family is spent for 
 meat, and yet we blindly order one of a small number of cuts and leave the 
 balance of the animal in little demand. 
 
 Hall and Emmett of the University of Illinois (Illinois State Bulletin 
 No. 158) say that one-quarter of the weight of the carcass (loins and ribs) 
 sells for one-half of the total selling price of the carcass. In other words, 
 the failure of the people to buy other parts just about doubles the price of 
 porterhouse and sirloin. 
 
456 
 
 FOODS 
 
 Meat Fresh and Cured. 
 
 U.SDepartment of Agriculture 
 
 Office of Experiment Stations 
 
 A.C.True: Director 
 
 Prepared by 
 
 C.rTLANGWOR"mY 
 
 Expert in Charge of Nutrition investigations 
 
 COMPOSITION OF FOOD MATERIALS. 
 
 (rrrm 
 
 Protein 
 
 Fat 
 
 C art) o h yd rate* 
 
 Ash 
 
 umiD 
 
 Water 
 
 Fuel Value 
 
 iMSah.Equab 
 
 1000 Calories 
 
 LAMB CHOP 
 
 EDIBLE PORTION 
 
 PORK CHOP 
 
 PORTION 
 
 154-0'CALORIES 
 
 PER POUND 
 
 BEEF STEAK 
 
 EDIBLE PORTION 
 
 1940 CALORICS 
 
 PER POUND 
 
 DRIED BEEr 
 
 EDIBLE PORTION 
 
 Pr-otein:3P.O 
 
 Fuel I 1 1130 calories 
 value! per pound 
 
 Fuel 
 value. 
 
 84-0 calorics 
 
 per pound 
 
 Fig. 166. 
 
 The "tastier" portions of the meat are those in the neighborhood of bones. 
 The great health need is for greater consumption of fiber, skin, and tendon, 
 and yet the premium is put upon muscle fiber — the portion which does not 
 become "tasty" and individual in flavor until a skillful cook seasons it with 
 substances to give it savor. 
 
 Hall and Emmett had a set of animals slaughtered under their eyes. 
 They then cut the carcasses according to the approved lines of division. They 
 
MEAT 
 
 457 
 
 ftftu* 
 
 L Neck. 
 
 2. Chuck. 
 
 3. Ribs. 
 
 4. Shoulder clod. 
 
 5. Fore shank. 
 Brisket. 
 Cross ribs. 
 Plate. 
 Navel. 
 
 10. Loin. 
 Flank. 
 
 12. Rump. 
 
 13. Round. 
 
 14. Second cut round 
 
 15. Hind shank. 
 
 Farmers' Bulletin, 34, U. S. Dept. of Agriculture. 
 
 Fig. 167. — Diagram of Cuts of Beef. 
 
 next determined the amount of lean, fat, and waste per pound in every eut. 
 From this, using the retail market price of the different cuts, they esti- 
 mated the cost per pound of nutritious elements in each cut. They found 
 that when a woman buys porterhouse hip bone at 25 cents she pays 29 cents 
 for the usable food purchased. At the other end of the line was hind shank, 
 middle cut (soup bone), selling at 5 cents and worth 6.3 cents. In between 
 came porterhouse, regular price 25 cents, cost 27.2 cents; sirloin (round 
 
458 
 
 FOODS 
 
 bone), 20 cents, cost 21.1 cents; round steak (first cut), 15 cents, cost 15.3 
 cents; roast beef (rump), 12 cents, cost 12.8 cents, and round pot roast, 10 
 cents, cost 10.1 cents. 
 
 On the whole, the data clearly show that the cheaper cuts of beef are by 
 far the most economical sources both of lean and of fat. Not only did they 
 find that the food value is not in relation to price, but that there is no rela- 
 tion between flavor and cost. Furthermore, cooking tests showed that waste 
 and shrinkage are not necessarily greater in the cheaper cuts. 
 
 In buying for the lean, the neck, shanks, and clods head the list, and 
 rump, rib, and loin bring up in the rear from the standpoint of fuel value. 
 The flank, plate, neck, and shank are cheapest at the price, and rib, loin, and 
 
 1. Head. 
 
 2. Shoulder. 
 
 3. Back. 
 
 4. Middle cut. 
 6. Belly. 
 
 6. Ham. 
 
 7. Ribs. 
 
 8. Loin. 
 
 Farmers' Bulletin, 34, U. S. Dept. of Agriculture. 
 
 Fig. 168. — Diagram of Cuts of Pork. 
 
 roast are the most expensive. From the standpoint of all combined, clod, 
 chuck, and plate hold the head of the list. 
 
 Too Much Meat. — In von Noorden's interesting paper before the Inter- 
 national Congress on Hygiene he had much to say about the use of meat. 
 In gouty people he did not think dieting was of the importance held by most 
 people. He agrees with Chittenden that brain workers do not need the large 
 amounts of meat taken by the average office man and that the excess throws 
 a strain on his organs. 
 
 In gout if the disease is well developed the person should go on a vege- 
 tarian diet until he is better. He should at all times keep away from foods 
 rich in purin bodies. 
 
 A meat that has much flavor, speaking generally, contains a good deal 
 of purin bodies. The fat tasting proteids, such as milk, eggs, and boiled beef, 
 are good. The extremely juicy steaks, the chops, roasts, ribs, backbone, and 
 
MEAT 
 
 459 
 
 the rich soups are bad. Other foods rich in purin bodies are coffee, choco- 
 late, tea, halibut, and salmon. Beef extract and beef tea lead the list of the 
 bad foods. 
 
 In fevers, meats are poorly borne. It is not so much the digestion 
 in fevers, for digestion of meat may be highly satisfactory, but it makes 
 the fever higher. 
 
 In goiter, meat is badly borne, especially in those who are losing flesh. 
 There is a very close connection between digestive trouble and goiter. Some 
 
 1. Neck. 
 
 2. Chuck. 
 
 3. Shoulder. 
 
 4. Flank. 
 
 5. Loin. 
 
 6. Leg. 
 
 Farmers' Bulletin, 34, U. S. Dept. of Agriculture. 
 
 Fig. 169. — Diagram of Cuts of Lamb and Mutton. 
 
 people with enlarged thyroids do well when their digestion is good and do 
 poorly when it is bad. 
 
 In addition to that von Noorden finds meat eating to be bad for the goiter 
 itself and bad for the general nervous system of the subject. This means 
 that the person with a goiter who is nervous thereby, who is losing flesh, and 
 whose pulse is rapid and irritable should eat some meat but not much. 
 
 In certain cases of chronic constipation the subject complains of pains 
 in certain nerve areas. These pains are so troublesome that the doctors often 
 call it gout or rheumatism. Hot baths, electricity, and drugs do no good. 
 
 Von Noorden says the condition is a toxic neuritis. This means that 
 the sore nerves are poisoned. The poison is generated in the large intestine. 
 "The neuritis disappears with astonishing rapidity when the abnormal 
 intestinal decompositions are stopped." 
 
 In certain of these cases he has got cures by stopping all meats for weeks 
 and giving large quantities of milk, and, better still, soured milk or yogurt. 
 
 At first there is a great deal of indican in the urine. After a while 
 
460 
 
 FOODS 
 
 this disappears from the urine. After some weeks or months these patients 
 can begin eating meat if they wish. 
 
 The old Mosaic law prohibited people from eating meat and milk to- 
 gether. Yon Noorden thinks the discoveries of the last few years justify 
 the prohibition. 
 
 1. Neck. 
 
 6. Ribs. 
 
 2. Chuck. 
 
 7. Loin. 
 
 3. Shoulder. 
 
 8. Flank. 
 
 4, Fore shank. 
 
 9. Leg. 
 
 6. Breast. 
 
 10. Hind shank. 
 
 Farmers 1 Bulletin, 34, U. S. Dept. of Agriculture. 
 
 Fig. 170. — Diagram of Cuts of Veal. 
 
 In fact, he believes generally in eating one kind of a food at a time. 
 
 He cannot see anything in favor of a heavy feed of mixed food from 
 to nuts." 
 
 FROZEN CHICKENS 
 
 soup 
 
 Ellis says those people who have nightmares about what will happen 
 when socialism comes forget that socialism has been here a long, long time. 
 He asks who would be an individualist as to his water supply. 
 
 The chicken industry is only partly brought under socialism. Some 
 people raise their own chickens. Such can and should eat fresh chicken, but, 
 unless a man can see the killing and cleaning, he had better stick to frozen 
 chicken. 
 
 But the balance of us are under socialism or collectivism so far as the 
 chicken industry is concerned. The city man who is not in a position to 
 see the killing and cleaning of the chickens offered him should insist upon 
 getting not only a chicken which has been frozen but one that is frozen at 
 the time" of purchase. 
 
 Dr. Pennington has been studying market chicken for the Department 
 of Agriculture. She knows more about chickens than anybody else. She 
 says city people get their chickens in very poor condition. The reason is 
 that the housewife goes to market and demands a fresh chicken "and she 
 gets the thawed companion of the frozen bird which may have deteriorated in 
 
FISH AS FOOD 461 
 
 the hands of the retailer, and will deteriorate every hour that it is in her 
 possession. As usual, ignorance and prejudice conduce to the disadvantage of 
 all concerned." 
 
 This particular part of Dr. Pennington's report is in support of her 
 advice to housewives in the city to buy no chicken that is not frozen at the 
 time of purchase. 
 
 A dry-picked chicken, undrawn and frozen, and kept between 30° and 40° 
 for twenty-four hours after killing, and so carried to the kitchen and there 
 thawed in the refrigerator, is the only city chicken that should be eaten. 
 The chickens killed by chicken killers in the city constitute no exception. 
 Without exception, so far as I have seen — and I have seen a great many 
 chicken killing establishments — the places are filthy. 
 
 The chickens are wet picked in hot dirty water. They are cleaned by 
 unclean methods. They are thrown into wet, soggy barrels with loose ice. 
 Then, ice packed, they are put on sale. 
 
 Dr. Pennington's researches show that wet picked, ice packed, soggy 
 chickens deteriorate rapidly. They may look good and they may taste good 
 at the end of twenty-four hours, but they will not keep good much longer 
 than that. From coop to stove in the. city is generally longer than twenty- 
 four hours. When Thursday is killing day, and the kill will be on sale until 
 the next Thursday, for instance, the consumer takes unwarranted chances. 
 The chicken which has been killed in the country, scalded, picked, cleaned, 
 packed with loose ice in barrels and thus shipped to market is still 
 worse. 
 
 Dr. Pennington studied two chickens bacteriologically. One (A) was 
 dry picked, then frozen and shipped. The other (B) was wet picked, ice 
 packed, and shipped. At the end of twenty-four hours A had, roughly, 
 100 bacteria, B, 300; at the end of seven days, A, 300, B, 11,800; twelve days, 
 A, 8,200, B, 102,000; sixteen days, A, 72,000, B, 307,000; nineteen days, A, 
 328,000, B, 1,083,000. 
 
 Demand that your market man send you an undrawn frozen chicken. Do 
 not receive it unless it is frozen. Thaw it out in your own icebox. 
 
 FISH AS FOOD 
 
 The man who catches his fish, cleans and eats them within six hours after 
 they leave the water gets a freshness and flavor that no possible treatment can 
 preserve for the city man. Whether or not he has any advantage after twelve 
 to twenty-four hours depends upon how well he has kept his catch from drying 
 out, and what were his facilities for keeping them cold. The city man must 
 eat fish that are days out of the water at the least. For him to try to get 
 fresh fish, in the sense that the brookside fish eater uses the word, is, of 
 course, rank folly. 
 
 The authorities have studied the keeping of fish along the same lines as 
 the keeping of poultry has been studied. One conclusion is that much of the 
 trouble arises because the housewife insists on buying thaived fish believing 
 that she thereby gets fresh fish. This is unfortunate, for what is sold for 
 fresh fish in a city has progressed far enough in deterioration to have lost 
 
462 
 
 FOODS 
 
 the savor of freshness, and sometimes to have gained harmful or dangerous 
 qualities. 
 
 When fish are thawed out, put on sale, and then not sold, they are 
 
 .. Fish, Fish Products, art d Oysters. 
 
 U.S. Department of Agriculture 
 
 Office of Experiment Stations 
 
 A.C.True: Director 
 
 FVepared by 
 
 C.rTLANGWORTHY 
 
 Expert in Charge of Nutrition Investigations 
 
 COMPOSITION OF FOOD MATERIALS* 
 
 HMD 
 
 Protein 
 
 COD 
 
 Lean Fish 
 
 Fert 
 
 Carbohydrates 
 
 ESS 
 
 Ash 
 
 Water 
 
 Fuel Value 
 \i. Sain. Equals 
 I 1000 Calories 
 
 SALT COD 
 
 Fuel value. 
 ater:82.6 I~""l 
 
 325 CALORIES PER POUND 
 
 FVotein:15.8 
 
 Fue l val uei 
 
 1 I Waten 53.; 
 
 4-10 CALORIES PER POUND 
 
 Protein:2l.5-J 
 
 OYSTER 
 
 at: ft Water:86. 
 Carbohydrates = 3- 7 J 
 Ash:12 
 
 SMOKED HERRING 
 
 Fat-.. 3 
 Ash,£4-. 
 
 Proteln:6.2 
 Fat:1.2 
 sh:2.0 
 
 MACKEREL 
 
 Fat Rsh 
 
 Fuel value 
 
 c 
 
 Water: 34.6 235 calor.es per found Water:73. 
 
 otein:36A FVotein:l8. 
 
 Fuel 
 
 Fuel value: 
 
 m 
 
 1355 CALORIES PER POUND 6^5 CALORIES PER POUND 
 
 Fig. 171. 
 
 refrozen, to be rethawed next fish day. How often this happens no one knows. 
 Experiments like this are harmful to the flesh of the fish. The consumer 
 reaps the result. 
 
 How well fish will keep depends much upon how they are cleaned. Fish 
 
OYSTEES 463 
 
 from cold water keep better than fish from warmer water. Fish taken while 
 feeding do not keep so well as others. Fish that have been bled and drained 
 keep better than others. Fish that have been handled in an insanitary place 
 and in an insanitary way spoil rapidly. 
 
 Fish that have been frozen hard keep better than fish mildly frozen — 
 refrigerated fish. Mild freezing merely prevents the multiplication of the 
 bacteria already in the flesh. Hard freezing crystallizes the water out of the 
 flesh, and in that way dries it. Hard, frozen meat, therefore, is both too cold 
 and too dry for bacterial growth, and therefore keeps extra well. 
 
 Every fisherman — and everybody is at times a fisherman — knows how 
 easily fish spoil. All sorts of fish strings, fish buckets, and fish baskets have 
 been devised to keep fish the few hours between catching and camp. The 
 need of having everything clean everyone knows. The hygienic standards of 
 commercial fish places must come up to kitchen standards. 
 
 Under all circumstances the consumer should demand a fish that has 
 been frozen hard. He should demand that it reach the kitchen frozen. It 
 should be thawed out in the kitchen refrigerator. 
 
 OYSTERS 
 
 Is it safe to eat oysters ? Can oysters be eaten with safety in the months 
 the names of which are without E? If it is safe to eat oysters at all, can 
 they be made safe enough to eat the year round? 
 
 When oysters do harm it is because they are infected with typhoid or 
 because they are spoiled. From time to time an epidemic of oyster-borne 
 typhoid is reported. 
 
 Typhoid fever is reported to health departments. Upon receiving a 
 report of a case of typhoid the source of the trouble is investigated by the 
 department. Sometimes the cause is found to be the drinking water, some- 
 times milk, sometimes people, sometimes flies and sometimes oysters. 
 
 The reports of oyster-borne typhoid, especially those of recent years, 
 have been closely investigated. It might appear that the danger of typhoid 
 from eating oysters is increasing. If so, it is because of the closer study of 
 the causes of the cases of typhoid fever. Actually, the danger of oyster-borne 
 typhoid is decreasing. 
 
 Why is there any danger? Oysters grow in shallow water. They feed 
 on the organic matter of the water. They feed most actively in warm weather. 
 It has been the practice to float oysters, that is, to remove them from the 
 growing beds and to leave them for a short time prior to marketing them in 
 water different from the sea water of the beds. Floating was often done in 
 badly sewage-polluted waters. The oysters were marketed in liquor, some 
 part of which was raw water. The methods of icing and shipping were 
 objectionable. 
 
 The digestive apparatus of the oyster is eaten. Oysters are eaten raw. 
 These are the reasons oysters convey typhoid. 
 
 Oyster typhoid is growing less rapidly because some states are super- 
 vising the oyster beds in their waters. They are not allowing sewage to be 
 discharged into oyster waters. They are not permitting oyster beds within 
 
464 FOODS 
 
 a certain distance of sewer outfalls nor in the course of currents of sewage. 
 They are controlling the practice of floating. Shipping is now done with 
 some regard to sanitary law. 
 
 A careful purchaser can now eat raw oysters without danger of typhoid. 
 The question arises : Has not the time come when it is safe or it can be made 
 safe to eat oysters at all seasons of the year — in summer as well as in winter ? 
 It has been found that oysters are safer from typhoid in winter than in sum- 
 mer. Perhaps this is because typhoid bacilli which get into the water near 
 oyster beds die off more rapidly in cold weather. Possibly it is because when 
 the water is very cold the oyster closes his shell and feeds but little. 
 
 But the difference in the typhoid content of oysters in the summer and 
 winter does not equal the difference between clean oysters from clean beds and 
 oysters that have been grown on polluted beds and floated in dilute sewage. 
 Therefore, improvement in practices should make oysters from the typhoid 
 standpoint safer in summer than they were in winter in the past. 
 
 The fear of oysters in summer time was due to the danger from spoiled 
 oysters. The methods of handling have improved so much that I can see no 
 reason why the eating of oysters in summer time can not be made safe. It is 
 easy to foresee the oyster industry developed on the basis of a twelve months' 
 supply and demand. 
 
 That there may be safety in eating oysters, demand as well as supply 
 must have sanitary standards. The purchaser — demand — must refuse to 
 purchase oysters unless they come from supervised waters, have been shipped 
 in cold, clean containers, are on sale in cold, clean packages and are in good 
 condition. 
 
 EGGS 
 
 It is not due to accident or chance or freakish fancy that eggs are in such 
 general use as food. They have great food value; they are convenient; they 
 are neutral in taste. When combined with fruit and bread they make a well 
 balanced morning meal. Nothing else fits so well into the dress-eat-and-run 
 policy so often necessary in the morning. 
 
 Aside from the nutritive qualities that can be analyzed, there are chem- 
 ical substances in eggs, the uses of which the test tube cannot tell us much 
 about — certain delicate phosphorus compounds whose work seems to be to 
 stimulate other substances to help. 
 
 In order to get this effect from eggs, the consumer wants them fresh, 
 with a certain delicate quality that is as baffling to analysis as are the organic 
 chemical compounds. 
 
 The physicians even go so far in their quest of this fresh effect as to 
 order sick people to eat their eggs raw — a procedure that is much safer with 
 eggs than with milk. 
 
 However, to the city dweller fresh eggs seem to have disappeared. If we 
 believe the advertisements, and try to make them fit the facts, we cannot escape 
 the conclusion that hens are now laying eggs that are weeks old. 
 
 Several years ago the Department of Agriculture came to the res- 
 cue. It has issued three bulletins on eggs — circular 140, bulletins 141 and 
 160. Its investigators have found ample reasons for the prevailing conditions. 
 
EGGS 
 
 465 
 
 The complaint of the consumer is justified. Eggs are neither as good 
 nor as cheap as they ought to be. 
 
 The complaint of the farmer and egg merchant is justified. There is 
 not the money in eggs that there ought to be. 
 
 Eggs and Cheese. 
 
 U.S. Department of Agriculture 
 
 Office of Experiment Stations 
 
 A.C.Trua: Director 
 
 R-epared by 
 
 C.FLANGWORTHY 
 
 Expert in Charge of Nutrition Investigations 
 
 COMPOSITION OF FOOD MATERIALS. 
 
 lllllll B3S8c33 tov*vl 1\\\\\\1 ITT ■ .Fuel Value 
 
 Protein 
 
 fat Carbohydrates 
 
 WHOLE EGG 
 
 Ash 
 
 tuna 
 
 Water 
 
 i Sq. In. Equals 
 1000 Calories 
 
 EGG 
 
 WHITE AND YOLK 
 
 Water.4-9.5 
 Protein.- 16.1 
 
 FVo tein:14-.8 
 
 Fat:10.5 
 AsM.C 
 
 FuEL VALUE OF 
 
 WHOLE EGG: 
 
 Water:862 
 
 700 CALORIES 
 PER POUND 
 
 CREAM CHEE<SE 
 
 Water.34,2 
 
 Fuel value or yolk« 
 
 1608 CALDRIEF 
 
 PER pound 
 
 Protein.- 13.0 
 at: 0.2 
 
 Sh:0.6 
 
 Fuel value of white: 
 
 c 
 
 265 CALDRIES 
 PER POUND 
 
 COTTAGE CHEESE 
 
 Water: 72.0 
 
 Frotein:20.9 
 
 Fuel value -. 
 1950 calories per pound 
 
 Fuel value- 
 
 E 
 
 510 CALORIES PER POUND 
 
 Fig. 172. 
 
 The reasons are several. The consumer has been shying away from cold 
 storage eggs, when there is no way of marketing eggs in cities except by stor- 
 age. The farmer and merchant have been losing because they have had no 
 system in their business. 
 
±66 FOODS 
 
 Nobody had ever studied the keeping qualities of eggs. There was no 
 accurate information on the subject, and the old rule of thumb practices 
 mixed a lot of foolishness in with some facts. 
 
 The five basic principles for the producer set forth by the bulletins are: 
 Give the hens clean nests; gather eggs at least once daily; keep eggs in a cool, 
 dry place; market eggs at least twice a week; kill or sell all mature male birds 
 as soon as the hatching season closes. Of these the last is the most important. 
 
 The investigators found that an unheated room in a dwelling house is 
 not conducive to good quality in eggs. The farmer should keep his eggs on 
 ice or in a cyclone cellar. 
 
 The storekeeper should keep his eggs in the refrigerator, or at least in 
 the cellar. 
 
 The railroad should transport eggs in a cold car. Refrigeration, at least 
 partial, from the hen to the consumer is advisable with infertile eggs and 
 absolutely necessary with fertile eggs. 
 
 Fertile eggs were found to spoil almost as readily as milk. The investi- 
 gators found that washing eggs does not help much. While getting rid of the 
 dirt is a gain, the washing removes a protective mucilaginous coat from the 
 shell and is about an equal offset. 
 
 During the latter part of the month of March, all through the month of 
 April, and until the middle of May is the natural time for hens to lay. At 
 this season everybody can buy new laid eggs, for a very good reason — there 
 are no other eggs to be had. The surplus of the previous year has been dis- 
 posed of and all storage places are cleaned out and prepared for the new 
 supply. 
 
 The eggs are produced so fast in the spring that farmers rush them to 
 market to get them out of the way and for the further reasons that they have 
 more time, and in some localities there is danger that the eggs may freeze. 
 The spring eggs are firmer and of better flavor than at any other season, 
 because it is the natural season for laying and the hens are then grain fed. 
 
 During the rest of the year only a limited number of newly laid eggs 
 reach the general market. Some of the better groceries receive a small quan- 
 tity of eggs within a day or two after they are laid, and some, indeed, have 
 the date upon which they were laid stamped on the shell; but they cannot 
 depend upon the shipments all the year through. 
 
 Aside from the limited number, the fresh eggs that are offered in the 
 market during most of the year are three weeks old. The farmer is at least 
 a week gathering a sufficient number to make it worth while to take them to 
 market. The country dealer takes another week to get enough to make a 
 shipment to the city, and another week is consumed before the eggs are placed 
 on sale. 
 
 Market Classification. — In the public market eggs are divided into 
 eleven different classes by the trade, and sometimes more than eleven. The 
 best the market affords is called "extras," 80 per cent fresh; the second is 
 called "prime firsts," 65 per cent fresh; then follow "firsts," 45 per cent 
 fresh; "ordinary firsts," 30 per cent fresh. In all the grades that follow the 
 word "fresh" is not used; presumably they are just eggs. They are "No. 1 
 dirties," "No. 2 dirties," "seconds," "checks," "broken," and "spots." 
 
 One would think there was nothing in the egg line worth less than a 
 
EGGS 467 
 
 broken egg, but the trade has given eggs that show a decayed spot before the 
 candle light the name of "spots." Lower down in the scale of infamy it is 
 not possible for an egg to go and still find a place in the market 
 reports. 
 
 Flavor of Eggs. — Eggs, like milk, readily absorb odors about them. 
 They should never be packed in musty straw nor in bad smelling boxes. They 
 should never be allowed to get wet. Such treatment will be noticed in the 
 -flavor within a few hours. 
 
 The seasons also have an influence upon the flavor and keeping quality 
 of eggs. The March and April eggs are the best and can be kept the longest. 
 The October and November eggs are the next best. 
 
 The green grass and other things that hens eat while running at large 
 in the summer injure the flavor, while the summer heat debilitates the hen 
 and robs the eggs of firmness and keeping quality. 
 
 Storage. — Eggs are put into cold storage whenever there is a surplus. 
 The month of April produces more eggs than any other month, hence April 
 leads all other months in storage. As the April eggs are of better keeping 
 quality than those of any other month, they are the best for storage purposes. 
 An April storage egg is better at Christinas than an August storage egg, 
 because it is of better quality to start with. Taking the market as a whole 
 there are more eggs in storage about May 1 than at any other season. The 
 quantity grows less each month and is exhausted in February as the spring 
 supply begins to arrive. 
 
 Less than 10 per cent of all the eggs produced go into cold storage, and 
 it may be said that cold storage offers the only good way to keep eggs. 
 
 Great care is required in storing eggs. The lofts where they are kept 
 must be scrupulously clean and kept clean as well as ventilated. There must 
 be no other article capable of giving off an odor stored in the same room. 
 
 A whole roomful of eggs has been known to be tainted by the odor of 
 lemons stored in an adjoining room and separated from the eggs by a brick 
 wall. Eggs in cold storage will give up an odor acquired in storage when 
 the source of the odor is removed. 
 
 The temperature required is about 32° F. Under proper conditions eggs 
 can be stored for ten months and come out in remarkably good condition. 
 The less an egg is handled and the sooner it can go into storage after it is 
 laid the better. Little change takes place in eggs in ten months of storage. 
 
 The eggs that come out of storage wrong were wrong before they were 
 put in, or perhaps an accident may have occurred in storage and an even 
 temperature not been maintained. 
 
 The popular notion that eggs are stored for two years at a time or even 
 longer is an error. It is not done for the reason that the eggs would not 
 keep, and it would not pay if they did keep. Cold storage of eggs has been 
 blamed in other ways for sins it did not commit. The best stored eggs to be 
 had in seasons of scarcity are those of cold storage. 
 
 Country Held Eggs. — A large part of the stale eggs that find their way 
 to the market are what is known to the trade as country held stock. They 
 are held on the farms or at the country stores where the facilities are bad. 
 
 There is no regular way of keeping eggs on the farm. Sometimes they 
 are kept in a receptacle in a damp cellar with cabbages, onions, and other 
 
468 FOODS 
 
 produce. Sometimes they are kept behind the kitchen stove or other unsuit- 
 able places. In such circumstances the eggs are off in flavor in two or three 
 days, and in two weeks they are stale. 
 
 In the summer time hens steal their nests away and they are not found 
 until some or all the eggs are faulty. These go to market in due season. 
 These eggs, if kept in country stores in the same room with all sorts of goods, 
 are still further injured. It is from such sources that a large part of the 
 stale eggs come that are found in city markets. The cold storage eggs 
 are good by comparison. 
 
 There is real need for some plan that will place the new laid eggs at once 
 in the cool temperature that is necessary for their preservation. There also 
 is need for a campaign of education that will reach the farmers and inform 
 them how eggs should be cared for and the necessity of rushing them to the 
 cooler at once. Perhaps the butter and cheese factories that are scattered 
 over the country could be made agencies for egg collection as well as milk 
 collection. It would at least have the merit of taking the eggs away from 
 the farmer every day, and as a cool room is necessary for butter, a moderate 
 extension would do for the cold storage of eggs until shipped to the large 
 warehouses. 
 
 Retailing Eggs. — After eggs come out of storage and before they are 
 placed in the retail market they are usually candled and graded. Candling 
 is done by holding each egg before a candle or other bright light in a space 
 where the diffused light of the room is excluded. Expert candlers can detect 
 the changes in the eggs and grade them with wonderful accuracy. 
 
 By this process several grades of eggs are sometimes obtained, each 
 grade worth less than the other. In the retail markets two of these differ- 
 ent grades may appear side by side. The patron is permitted to believe 
 the best grade are new laid eggs and that the others are cold storage eggs. 
 Indeed, the better grades are sometimes labeled fresh eggs, and the joke 
 of it is that usually the buyer does not know the difference when the eggs 
 are used. 
 
 The average palate cannot tell the difference between a newly laid egg 
 and one that may be called near fresh. This is especially true of eggs that 
 are taken from the shell before they are cooked. Those who prefer to eat 
 their eggs from the shell must have them newly laid, as whatever flavors the 
 egg contains are all retained. Even stale eggs may be used for cooking as a 
 part ingredient of a dish and give little or no offense to the taste. 
 
 Season of Greatest Scarcity. — When hens are moulting they will not 
 lay eggs, and the moulting season is in the fall. The only newly laid eggs to 
 be had at this time are the products of the early spring chickens. Well con- 
 ditioned pullets will lay at the age of nine months. Chickens that are hatched 
 February 1 will begin laying November 1, and sometimes earlier. These are 
 practically the only new laid eggs to be had in November, hence the limita- 
 tions of the supply. 
 
 In very cold weather hens do not lay, and this accounts for the short- 
 age of newly laid eggs during the winter. During the season of shortage 
 housekeepers should avoid eggs that have been held in the country. All 
 labels on eggs in the grocery, such as "fresh country eggs," are deceptive. 
 The eggs may be fresh arrivals from the country but may have been held 
 
CHEESE 469 
 
 in the country for weeks and even months. Such signs should be regarded 
 with suspicion. 
 
 The best stored eggs are those of cold storage. In the lean egg season 
 the buyer should ask for fresh tasting cold storage eggs. By knowing the 
 history of the eggs he has for sale and after careful candling the dealer can or 
 should be able to know which eggs are fresh tasting and which grade are stale 
 to the taste. It may be laid down as a rule that all eggs that are held by any 
 other process than cold storage will be stale to the taste. 
 
 Cold storage eggs should be used the same day they are taken from 
 storage, especially if they are to be eaten from the shell. If the eggs are 
 taken from storage and allowed to lie around the grocery a few days, and a 
 few days more at home, they all will taste stale. Here again the patron should 
 inquire of the dealer and learn when the eggs left the cold storage. It is the 
 duty of the housekeeper to know and to take advantage of all these points. 
 When that is done there will be no more trouble with bad eggs in the 
 market. 
 
 The future is full of promise of better things for dwellers in cities in 
 the way of food products from both farm and garden. The parcel post, if 
 rightly used, is an agency that will bring newly laid eggs directly from the pro- 
 ducer to the consumer. In addition to the shortening of the time between 
 the producer and the consumer it should make better prices for the farmer, 
 and, by cutting out express or freight charges and the miscellaneous profit, it 
 should reduce the cost to the consumer. 
 
 As the business of the parcel post increases in volume new means of 
 transportation doubtless will be established and probably be publicly owned 
 and operated. The new lines will be run by electric power and will have 
 branches extended into the country around so that the perishable food products 
 that are gleaned in the country today may be brought to the city tonight and 
 served on the tables tomorrow. 
 
 CHEESE 
 
 Milk in the form of cheese is wholesome. The type of cheese called 
 American is liable to produce constipation for the same reason that milk 
 produces it — because it is so concentrated, so free from ivaste. The more 
 highly flavored cheeses have enough of bacterial products in them to overcome 
 this objection. 
 
 Eaten slowly, well masticated, and well mixed with other food, cheese is 
 highly digestible. The rarebit fiend develops nightmare, not because of the 
 cheese, but because he eats a heavy meal while in a condition of mental ex- 
 citement, and then goes to bed. The fault is not with the cheese. 
 
 Cheese is good, nutritious food. Cheese is man-made. It follows that 
 some cheese is well made, made in a cleanly fashion, and properly protected 
 against dirt and contagion. It also follows that some cheese belongs in the 
 other group. 
 
 Probably most cheese, when stored, is, like most natural ice when stored, 
 sca'rcely to be called safe food. But before the green is out, the contagion is 
 out. This, however, is not true of tuberculosis. Galtier Harrison in Canada, 
 and Mohler at Washington have proved that tubercle bacilli can stay alive in 
 
470 FOODS 
 
 Cheddar cheese for more than four months; in Emmenthaler they die 
 more quickly. 
 
 The flavors of cheese are due to bacteria. Cheese makers have been try- 
 ing for years to grow the bacteria of the different cheeses so that the milk 
 could be first sterilized and then the culture added. In this way they could 
 get a more uniform product, a better product, and one that would never 
 contain live consumption germs. 
 
 These efforts began more than ten years ago, but Sammis tells us 
 that when the Chicago ordinance requiring that cheese be made only from 
 pasteurized milk was passed in 1908 no practical way of making American 
 cheese in this manner had been found. 
 
 However, the experimenters got busy. Soon signs advertising cheese 
 from pasteurized milk appeared, and now the agricultural department is 
 out with a bulletin in which it tells of two years' practical experience with 
 the new method of cheese making. 
 
 The cheese was made at the University of Wisconsin. It was put out as a 
 regular market commodity without letting the purchaser know that it was 
 out of the ordinary. 
 
 Samples were submitted to cheese graders. The cheese was graded higher 
 than ordinary market cheese. It was much more uniform. It kept better. 
 
 From the market standpoint it was more economical to make, it went 
 away less frequently, and the trade liked it. 
 
 It was all right in practical use as well as in theory. And it was free 
 from live tubercle bacilli. 
 
 MUSHROOMS 
 
 Mushrooms have considerable food value; they appeal to the taste; 
 they can be had for the searching; and as a search for mushrooms adds 
 zest to an outing, many people go to the woods basket in hand. 
 
 Before writing this I asked a librarian how to tell harmful mushrooms. 
 He told me that the eating test is about the only one of value. Unfortunately 
 this test will never become popular and the "before taking" tests are mostly 
 worthless. Certainly the silver spoon test is no good. 
 
 The government bulletins give testing points that, in a general way, 
 are of some value. They say mushrooms are fairly safe if they come from a 
 clean looking place, show firm white flesh when broken, and smell like freshly 
 ground meal ; that they are dangerous if, on pressure, a milky fluid exudes, if 
 the flesh is soft and spongy or hard and "corky," if it turns green or blue, 
 if the odor is bad, or the taste is acrid or unpleasant. 
 
 As a matter of fact the mushroom hunter generally knows one or two 
 edible varieties and he sticks to what he knows, rejecting all others. If 
 he applies the spoon test or any other he does not pay much attention to 
 the results. He is not guided by them. Following this plan, he rejects many 
 kinds of edible mushrooms, but, at that, he is wise. He searches farther to 
 fill his basket and lives to search another day. The wise man is he who leaves 
 wild mushrooms to themselves and cultivates the mushrooms he eats. 
 
 Mushrooms are not so nutritious as meat, bread, corn, peas, tomatoes, or 
 any of the ordinary foods. A pound of round steak is nearly five times 
 
FEUIT AS FOOD 471 
 
 and a pint of milk nearly twice as nutritious as a pound of mushrooms. 
 They are not as wholesome a summer food as are fresh vegetables and fruit. 
 Where their value comes in is that they can be grown fresh for midwinter 
 use, at which time the human system does not get all the fresh vegetables 
 needed. There is no other vegetable that can be grown in a crowded city 
 in winter and that, therefore, can come on the table but a few hours after 
 coming out of the soil. This gives mushrooms distinctly a health phase. 
 They can be preserved in summer and Icept for winter use, but, as a canned 
 vegetable they are less wholesome than peas, tomatoes, corn, peaches, or pears. 
 
 Perhaps half the people in a large city and practically all of those in 
 small cities and towns are so situated as to make mushroom growing possible. 
 The spawn can be had in any seed store, bulletins telling how to prepare 
 the soil and how to care for the crop can be had from the Department of 
 Agriculture and a basement space eight feet square is within easy Teach. Pre- 
 paring the soil is an art; but the rudiments of it can be learned from these 
 bulletins, or probably there are expert mushroom soil preparers who furnish 
 soil ready to use. 
 
 Many fungus growths are edible when they first come through the ground. 
 All are dangerous when they are old or begin to shrink. Even the familiar 
 mushrooms should be rejected when old. They are only prime when fresh. 
 
 FRUIT AS FOOD 
 
 The eating of fruit, like working on water colors, is considered a refined 
 indulgence. Those who would consider it improper to launch into a slice 
 of buttered bread outside of home or a regular eating place, will gravely 
 and with dignified viciousness hack into an apple in the office or even in the 
 street. 
 
 Fruit probably was the first food of man. It still is universally recom- 
 mended and eaten. There are those who use it sensibly as a part of their diet; 
 there are others who would make a meal of it. 
 
 Many growing children are given an apple for their lunch at school. 
 We have seen young women in office and factory who take little else than an 
 apple or two for their noonday lunch. 
 
 Cheating the body by the esthetic holes and savory flavor of fruit is no 
 better than cheating it in any other way. 
 
 The nutritive value of fruits is very small. About 80 per cent of 
 the bulk of fresh fruits is water. The tissue building substances, the pro- 
 teids, are present in less than 1 per cent. Sugars and starches are present 
 in considerable quantities — from 6 to 15 per cent in fresh fruit. Wood 
 fiber, a very important element, averages about 5 per cent. Acids vary from 1 
 to 3 per cent. Of salts and extracts, there is about J per cent of each. 
 
 Plums are richest in water and acids, grapes and cherries in sugar, cher- 
 ries and peaches in fiber, apricots in salts. Bananas are the lazy man's 
 food in all tropical countries. They contain 20 per cent, of sugar, 2 per 
 cent of proteid, and some starch and fat. Dried fruits have greater nutritive 
 value, containing less water and considerably more sugar, proteids, and salts. 
 
 The value of fruit as a food is in the following order : 
 
472 FOODS 
 
 Fruit and Fruit Products. 
 
 USDepartment of Agriculture 
 
 Office of Experiment Stations 
 
 A.C.True: Director 
 
 FVepared by 
 
 C.rTLANGWORTHY 
 
 Expert in Charge of Nutrition Investigations 
 
 COMPOSITION OF FOOD MATERIALS. 
 
 Carbohydrate* A 9 h Water ■ 1000 Calories 
 
 FVotein 
 
 Fat 
 
 CRAPES 
 
 EOBLE PORTION 
 
 RAISINS 
 
 EDIBLE PORTION 
 
 Carbo- 
 
 rates:19.2 
 
 GRAPE JUICE 
 
 UNFERMENTED 
 
 4-50 CALORIES 
 PCR POUND 
 
 CANNED 
 
 FRUIT 
 
 Water:92.2 
 
 Fuel value-- 
 
 1,605 CALORIES 
 PER POUND 
 
 R-otein.-0.2 
 
 Carbo- 
 hydrates:7.4- 
 
 Ash: 0.2 
 
 FRUIT 
 JELLY 
 
 Water: 21.0 
 
 150 CALORIES 
 PER POUND 
 
 Carbq 
 
 AshT0.5 
 
 Fuel value 
 
 hydrates:78.3 IffijaaSSa 
 
 N^hiO.7 
 
 E 
 
 Carbo- 
 hydrates: 21.1 
 
 415 CALORIES 
 PER POUND 
 
 Fuel value: 
 
 1,455 CALORIES 
 PER POUND 
 
 
 Fig. 173. 
 
 1. Because it is appetizing and palatable. 
 
 2. Because it is refreshing and thirst quenching. 
 
 3. Because of its nutritive properties. 
 
 4. On account of its salts and acids. 
 
 5. On account of its action on the kidneys. 
 
 6. Because of its laxative properties. 
 
 For its appetizing value, fruit should be eaten before meals. Fruit 
 
FRUIT AS FOOD 
 
 473 
 
 Nuts and Nut Products. 
 
 U.S. Department of Agriculture 
 
 Office of Experiment Stations 
 
 A.C.Tr ue: Director 
 
 R-epared by 
 
 C.rTLANGWORTNY 
 
 Expert in Charge of Nutrition Investigations 
 
 Protein 
 
 COMPOSITION OF FOOD MATERIALS, 
 
 nnm ^ mm ^ num. ■/a , l v *» I 
 
 Water ■&%££ 
 
 CHESTNUT 
 
 'ater:5.9 
 : at:7.0 
 
 Ash:2i 
 
 3285 CALORIES 
 PER POUND 
 
 Protein.^o.O FalT38.6 
 
 Fuel value: 
 
 Ash:2.0 1875 CALDRIE5 
 
 PEANUT BUTTER 
 
 JJJJJJJJJ. ' JJ 
 
 -Protein:29.3 
 
 2500 CALORIES 
 PER POUND 
 
 Ash: 5.0 i^VAVAV^ 
 
 PER POUND 
 
 COCOANUT 
 
 DESICCATED 
 
 Water: 3.5 
 
 Carbo- 
 hydrates: 17.1 
 
 Fuel 
 
 VALUE: 
 
 2825 
 
 CALORIES PER POUND 
 
 3125 
 
 Fuel value: 
 
 CALORIES PER POUND 
 
 Fig. 174. 
 
 soup, a dish extensively used in Germany but little known in this country, 
 would serve the purpose very nicely. 
 
 For its nutritive value, fruit is best taken as dessert at the end of the 
 meal. 
 
 As a laxative, it should be taken on an empty stomach, preferably soon 
 after rising in the morning, instead of before bedtime, as many people 
 are in the habit of taking it. An apple can stay in the stomach for three 
 
474 
 
 FOODS 
 
 Roots and Succulent Vegetables. 
 
 U.S. Department of Agriculture 
 
 Office of Experiment Stations 
 
 A.p.Troe: Director 
 
 B-epored by 
 
 C.fTLANGWOR"mY 
 
 Expert in Charge of Nutrition Investigations 
 
 COMPOSITION OF FOOD MATERIALS* 
 
 anni ^ an ^ unra WM&Fi** 
 
 Proian Fat Carbohydrate, A,h ^ater HittoVSaK 
 
 F>t:0.3 
 
 !fSA3h:0.6 
 
 Fuel value: 
 
 £25 calories 
 per pound 
 
 Fuel 
 
 VALUE 
 
 C 
 
 230 CALORIES 
 =ER POUND 
 
 Carbohydrates: 1o. 
 
 POTATO 
 
 Protein.- 2.2 
 
 Water: 78.3 
 
 Fuel value 
 385 calories per pound 
 
 Carbohydrates: 3. 
 Ash7T.( 
 
 UEL VALUE: 
 
 85 CALORIES 
 PER POUND 
 
 Fig. 175. 
 
 hours, and, if taken just before bedtime, often will disturb sleep. Laxative 
 fruits are figs, raisins, prunes, apples, grapes, gooseberries, plums, and 
 currants. 
 
 Fruit should not be eaten to excess, is best eaten at mealtime, and 
 should not be eaten when unripe or overripe. Persons suffering from sour 
 stomach should eat fruit guardedly. Fruits and grains make a good combina- 
 tion at meals; sour fruits and milk do not go together. 
 
FRUIT AS FOOD 
 
 475 
 
 Fresh and Dried Fruit. 
 
 US Department of Agriculture 
 
 Office of Experiment Stations 
 
 A.C.True: Director 
 
 R-epared by 
 
 C.FLANGWORTHY 
 
 Expert in Charge of Nutrition Investigations 
 
 COBffiPOSITION OF FOOD MATERIALS. 
 
 nxnD 
 
 Protein 
 
 Fat 
 
 APPLE 
 
 EDIBLE PORTION 
 
 Carbohydrate* 
 
 Ash 
 
 cnLTro 
 
 Water 
 
 .Fuel Value 
 4. Sa In. Equal: 
 1000 Calori* 
 
 DRIED F1C 
 
 PORTION 
 
 >in.-0.4 
 
 F¥otein:4, 
 
 'at: 0.5 
 
 Carbohydrates: 14; 
 
 Fuel 
 value 
 
 AshtO.3 
 
 290 CALORIES 
 PER POUND 
 
 STRAWBERRY 
 
 EDIBLE PORTION 
 
 90.4 
 
 Carboh 
 
 Dl OU CALORIES 
 PER POUND 
 
 Fuel 
 
 180 
 
 Carbo 
 
 Fuel 
 valued 
 
 H75 CALORIES 
 PER POUND 
 
 BANANA 
 
 EDIBLE PORTION 
 
 CarboijN 
 
 D 
 
 Fuel I ] 460 calories 
 
 VALUE: II | PER POUND 
 
 Fig. 176. 
 
 Fruit always should be thoroughly washed before eating. Dirt and 
 filth are not more esthetic nor less harmful because they perch themselves 
 on the glowing cheek of an apple or the graceful lines of a pear. Cooked or 
 stewed fruit is easier to digest but not so nutritious. 
 
 The "grape cure," practiced in Germany for obesity, consists of an ex- 
 clusive grape diet. Nothing else is allowed. From one to eight pounds 
 are gradually allowed daily. The significant fact is that the patients are re- 
 
476 
 
 FOODS 
 
 Legumes and Corn. 
 
 US Department of Agriculture 
 
 Office of Experiment Stations 
 
 A C.True: Director 
 
 Prepared by 
 
 C.rTLANGWORTHY 
 
 Expert in Charge of Nutrition Investigations 
 
 COMPOSITION OF FOOD MATERIALS. 
 
 nmn mm mm ^ mnni ■usffe* 
 
 Carbohydrate* Ash Water ■lOO^CalorS 
 
 NAVY BEAN, DRY. 
 
 teten1£.6 
 
 Fat Carbohydrates Ash 
 
 SHELLED BEAN FRESH. 
 
 -Water*58.9 
 Carbohydrates: 29 .1 
 
 -Ash:2.0 
 
 Carbohyarates:59.6 \&S 
 
 at:1.8 
 Sh:3.5 
 
 740 CALORIES PER POUND 1600 CALORIES PCR POUND 
 
 STRING BEAN. GREEN. 
 
 ^Sh:0.8 
 
 Carbohydrates: 7. 
 
 Water: 89.2- 
 
 CALORIE5 PER POUND 
 
 CORN, GREEN 
 
 EDIBLE PORTION 
 
 Carbo hydrates:1 9.7 
 Ash:0.7 
 
 at:1.1 
 
 Fig. 177. 
 
 quired to pick all the grapes themselves, thus securing the advantages of open 
 air exercise. 
 
 Use fruit as an adjunct to your diet. Use it to prevent scurvy, to over- 
 come constipation, to prevent overeating. Do not use it to replace meat and 
 bread ; to build up the body, to repair waste. Eat it because you need it but do 
 not eat it with the idea that it is cheap food. And finally clean it before 
 eating it. 
 
COTTONSEED FOOD 
 
 477 
 
 COTTONSEED FOOD 
 
 The Public Health Service is telling the people that they need not 
 have pellagra. It says that pellagra is preventable. There is no doubt but 
 that the people are afraid of pellagra. Their attitude about it is different 
 from their attitude toward malaria. They are not indifferent about malaria. 
 
 There is a fair chance that people will listen to what these authorities 
 
 Butter and other Part -Yielding Foods, 
 
 FVepared by 
 
 OFLANGWORTUY 
 
 Expert in Charge of Nutrition Investigations 
 
 COMPOSITION OF FOOD BIATERIALSo 
 
 U.S. Department of Agriculture 
 
 Officeer" Experiment Stations 
 
 A.C.Trues Director 
 
 mnD 
 
 Protein 
 
 OLIVE OIL 
 
 Fat 
 
 Carbohydrate* 
 
 Ash 
 
 nun 
 
 Water 
 
 , Fuel Value 
 iSa In. Equals 
 1000 Cdariee 
 
 R-otein.- 
 
 BACON 
 
 Water:l8.8 
 
 U87A 
 
 3030 CALDRIE5 PER FOUND 
 
 ater.13.2 
 otein:^-./ 
 
 Aoh:0.3 
 
 BUTTER 
 
 Fat:85 
 
 3510 CALORIES PER POUND 
 
 r.11.0 
 
 LARD 
 
 3410 
 
 EALDRIE5 PER POUND 
 
 4080 CALDRIE5 PER POUND 
 
 Fig. 178. 
 
478 FOODS 
 
 say. They say that pellagra results from prolonged eating of an ill balanced 
 ration — too much corn bread, too much sow belly, too much molasses, too 
 much plum pie, and too many blackberries in summer, too little lean meat, 
 fresh vegetables, fruit and milk. 
 
 They advise especially that the farmers plant peas and beans and that 
 these become very staple articles of diet. There is no tastier vegetable than 
 cornfield peas. They grow well in every part of the country where pellagra 
 abounds. They contain just the ingredients which the public health people 
 say are needed to prevent pellagra. Cornfield peas should be growing 
 in the rows of every cornfield in the South. 
 
 I do not know that the Public Health Service men have experimented 
 with cottonseed meal cakes and cottonseed flour biscuits, but they might 
 profitably do so. Anyone might try them. Cottonseed meal and flour are 
 rich in protein. Dr. Goldberger says many of the Southern people do not eat 
 enough protein and that pellagra develops as the result of the short- 
 comings. 
 
 The Texas Experiment Station Bulletin No. 163 gives the result of feeding 
 tests with cottonseed baking goods. One part cottonseed meal or flour to four 
 parts of cornmeal or wheat flour were mixed for cakes, biscuits, and muffins, 
 using the same recipes as for cornmeal or wheat flour. For instance the 
 recipe for cottonseed corn cakes was as follows : 
 
 Cottonseed meal or flour 1-3 cup 
 
 Cornmeal 1 1-3 cups 
 
 Eggs 2 
 
 Lard 1^ teaspoonf uls 
 
 The cottonseed meal used was a fresh meal from fresh seed. It was 
 free from lint and hulls. It was sifted through a twenty mesh sieve. It 
 was a fine yellow powder made by roller process. 
 
 Professor Eather says that cottonseed meal bread is a substitute for 
 meat. It should be eaten instead of meat or by people who do not eat 
 enough meat. It is very digestible. It is cheap. A pound of protein in 
 cottonseed meal costs one-twentieth as much as a pound of protein in eggs 
 or one-fifteenth as much as a pound of protein in meat. 
 
 It is so rich that people are disposed to eat too much without know- 
 ing it. Eather says that a man does not need and should not eat more 
 than two ounces of the meal a day. 
 
 PASTEURIZED BUTTER 
 
 One of the striking exhibits at the International Tuberculosis Congress 
 at Washington showed that butter made from tubercular milk could cause 
 tuberculosis. The proof is overwhelming and it comes from every part 
 of the world. Whether the butter was salted or unsalted, fresh or stored, 
 the results were the same. 
 
 Some will remember the Asheville story of an epidemic of typhoid along 
 a certain butter route, back of which was a woman nursing her child sick 
 
PASTEURIZED BUTTER 479 
 
 with typhoid and making fresh country butter for a discriminating group 
 of city people. 
 
 Schroeder, in "Milk and Its Relation to the Public Health/' says : 
 
 "Tuberculosis among dairy cows is so common and widespread that we 
 cannot hope to clean all dairy herds for some time to come ; hence it is neces- 
 sary for the protection of health to avail ourselves of the one expedient which 
 is immediately at hand, and that is pasteurization, and pasteurization should 
 not be restricted to milk, but must be extended to all dairy products." 
 
 Acting upon this opinion (an opinion so general in the Agricultural De- 
 partment that it may be interpreted as the official opinion), the federal govern- 
 ment has been testing out the different pasteurizing methods as applied 
 to butter. 
 
 Butter was made of raw milk and of milk pasteurized at temperatures 
 ranging from 140° to almost 200 °, almost up to boiling. The butter was tested 
 in many different ways. Some of it was submitted to butter experts, one of 
 whom was Mr. Newman, assistant food commissioner of Illinois. 
 
 The opinion of these experts was that butter made from pasteurized 
 milk, in addition to being safe, was the better butter. The temperatures which 
 gave the best butter were 155° to 180°. Over 180°, the butter tasted scorched. 
 Under 155°, the scores were not quite so good. 
 
 One reason was that the ferments of the milk were not destroyed and 
 these caused the butter to go off a little after forty days of storage. The 
 ordinary ferments of milk are peroxidase, catalase, galactose and lipase. 
 There are those who think that milk should not be heated enough to destroy 
 these. These butter tests showed that the butter is better if the milk has been 
 heated enough to destroy them. 
 
 Peroxidase is killed at about 170°, catalase at 168°, galactose is weak- 
 ened materially at 160°, but is still present at 200° ; lipase disappears at 
 about 160°. 
 
 The conclusion of Dr. Rogers is that held pasteurization, 140° for thirty 
 minutes, does not make as good butter as flash pasteurization or retarded 
 pasteurization at 165° or over. This is the first time that flash pasteurizers 
 have had an inning. The commissioners studying fresh milk favor the other 
 method. 
 
 Incidentally, the men working on ferments found the scientific reason for 
 throwing away the rusty cans. Butter and cheese made from milk kept 
 in rusty cans will not score up to grade. 
 
 Half the butter is now made from pasteurized millc. It is the safest 
 butter now on the market. 
 
 The Milk Standards Commission voted unanimously that all butter should 
 be made from pasteurized milk. The danger that raw butter will carry 
 infection they regard as considerable enough to warrant this precaution. With 
 butter it is safety first. Flavor is less important. Then, too, tastes differ. 
 Some of the speakers at the Commission hearing on butter thought the flavor 
 of butter from raw milk was better. As noted above some authorities hold 
 the flavor of pasteurized butter to be better. 
 
480 FOODS 
 
 MILK 
 
 Skim Milk and Buttermilk. — Milk contains about eighty-eight parts 
 water and twelve parts solids. Of these twelve parts, four are fats. The use of 
 the fat is to make heat. As it is burned up in the body it has no power 
 to repair waste and only moderate power of furnishing energy. 
 
 Recognizing it as a heat maker, why pay good money for it when you 
 are paying other good money for things to keep you cool? You buy ice 
 to put in your glass of milk to keep you cool, and you buy cream with your 
 milk to keep you hot. 
 
 Skim milk contains every particle of the milk except the fat. At that, 
 about one-tenth of the fat is left behind, if the milk is creamery skimmed, 
 and even more if hand skimmed. 
 
 A pint of skim milk will repair more tissue, furnish a little more 
 energy and make about half as much heat as a pint of whole milk — and it will 
 cost less. Five pints of skim milk will furnish as much food value as a 
 pound of round steak, and cost a quarter as much. A glass of skim milk 
 and a half pound of bread will furnish one-third enough nutriment for an 
 entire day, and will cost five cents. And skim milk is good for babies in ex- 
 tremely hot weather. 
 
 Another advantage is that the cream always contains three times as 
 many bacteria as whole milk. Therefore, where cream is skimmed from 
 milk a large proportion of the bacteria is carried with it, and the skim 
 is left with but few bacteria. 
 
 However, a better form of milk for hot weather is buttermilk. It, too, 
 is skim milk. If the butter man has been after results he has left but 
 Y 2 of 1 per cent of fat in the buttermilk. 
 
 Buttermilk has still another advantage. Its albumin is more easily 
 digested than the albumin of sweet milk. The albumin of sweet milk is 
 mildly alkaline. When it is swallowed it always curdles in the stomach. The 
 stomach and intestinal juices must get into and the stomach muscles must 
 break up these curds. Occasionally they are leathery and tough. 
 
 The albumins of buttermilk are acid. They do not form leathery curds. 
 They are more easily digested. When babies are fed buttermilk they do not 
 pass the so-called curds composed of masses of fat. 
 
 Buttermilk is always a better hot weather food than whole milk for 
 grown people, and sometimes it is for babies. On a hot day it is better to 
 drink buttermilk than beer over a bar. 
 
 If the saloonkeepers want to do the right thing let them keep butter- 
 milk on tap. 
 
 Sour Milk as Pood. — Men have always eaten sour milk. Cottage cheese, 
 curd, whey, and buttermilk as foods are used all over the world and always 
 have been. Sweet milk furnishes a baby about what it needs and in an 
 easily digested form. For the human baby, human milk contains ingredients 
 in about the proper proportions. The proportions of the ingredients in 
 cows' milk is not right for babies and, as a further consideration, when babies 
 have grown into youths and adults, sweet milk is do longer a perfect 
 food. 
 
MILK 
 
 481 
 
 Milk and Milk. Products. 
 
 Prepared by 
 
 C.r7UNGW0R"mY 
 
 Expert in Charge of Nutrition Investigations 
 
 COMPOSITION OF FOOD MATERIALS. 
 
 U.S Department of Agriculture 
 
 Office of Experiment Stations 
 
 AC.Iroe: Director 
 
 mum 
 
 Protein 
 
 Fat 
 
 Carbohydrates 
 
 Ash 
 
 nTTTTfl 
 
 Water 
 
 .Fuel Value 
 
 U. So. In. Equals 
 ^CK>0 Caloriee 
 
 WHOLE MILK 
 
 SKIM MILK 
 
 ^— Water: 87.0 
 < — FVotein:3.3 
 
 Carbohydrates: 5.0 
 
 c 
 
 FuEL VALUE:310 calories per pound 
 
 -Waten90.5 
 
 JPrMn:3/t 
 Carbohydrates-.5.1 
 
 D 
 
 Fuel value:165 calories per pound 
 
 BUTTERMILK 
 
 CREAM 
 
 <— Water* 91.0 
 
 Protein: 3.0 Fat:18.i 
 
 H-Water:74-.( 
 
 Carbohycirates:4-.8 Asht0 * 
 
 Fuel value:160 calories per pound 
 
 83§S§§§8 
 
 'ater:74-.0 
 in; 2.5 
 
 Carbohydrates: 4-.5 
 
 D 
 
 Fuel value: 8 65 calories per poind 
 
 Fig. 179. 
 
 When milk is taken into the stomach, it is at once converted from a 
 liquid to a solid food. One-eighth of it is made use of as food and the 
 other seven-eighths as water. The albumin, normally present in milk as alkali 
 albumin, is converted into acid albumin, whereupon digestion begins. 
 
 Men have always anticipated these two preparatory steps of digestion 
 by drinking soured milk, sometimes with the albumin in large, solid masses 
 as in clabber and sometimes in small mixed particles, solid particles and 
 albumin in solution as in buttermilk. 
 
482 FOODS 
 
 But the people who have made most use of soured milk are the Bulgarians 
 and their neighbors. Almost ten years ago a Swiss scientist studied Bul- 
 garian milk-souring cultures, for in that country every housewife has her 
 culture just as with us every housewife has her yeast. Among the three 
 germs always found present was a long, heavy bacillus, which had a pro- 
 digious capacity to make acid and a remarkable capacity to live in the acid 
 produced, for it is a universal law of nature that what we make kills 
 us. 
 
 This bacillus is what people expect, and occasionally get, when they buy 
 lactic acid tablets, cultures in tubes or bottles of culture. It is impossible 
 to say which is best, since there has been no effort made to standardize any of 
 them. A few laboratory workers have tested the different kinds on the 
 market, but nobody has gone far enough with it to help the situation prac- 
 tically. Certainly it has not reached the standardization of the bread yeast 
 and beer ferment industries. 
 
 If the tablet kinds are to be used, one to three tablets are to be put 
 into a glass of sweetened water (several lumps to the glass), which is allowed 
 to stand until they are broken up. Then the mixture, sediment especially, is 
 to be swallowed, preferably during the meal. If the culture in sealed tubes 
 is used, the culture should be diluted with sweetened water and used in the 
 same way. If the culture in bottles is used, the prescribed dose can be 
 taken straight or in sweetened charged water. 
 
 Other things being equal, the dried cultures in tablets are best. It is 
 better that the bacillus awaiting use should be dry and inactive as they are 
 in tablets. 
 
 Three days after the use of bacillus has been begun, it can be proved 
 that it has passed through the intestinal tract. It then takes about eight 
 days for it to become fairly well acclimated and that acclimatization having 
 been effected the bacilli will remain in the intestine about twelve days over 
 the last dose taken. To make it live longer in the intestine is the end sought 
 by Metchnikoff in his recommendations that patients eat sugars and starches 
 in abundance and take this second bacillus recently recommended. 
 
 Condensed, Evaporated, and Desiccated Milk. — These milk products 
 have advantages over fresh milk. They likewise have disadvantages. The less 
 milk is tampered with the better, which means that a baby at the breast is 
 the only arrangement that meets with full approval. 
 
 His milk cannot be tampered with. All other forms of baby milk 
 have been tampered with. When a milk has been drawn from a cow into a 
 can, manhandled on the farm, hauled for miles to a railroad station, shipped 
 on a milk train, hauled to a dairy, clarified, pasteurized, bottled and de- 
 livered, it has been tampered with. The only question is which tampering 
 is best for the baby — that to which fluid milk is subjected or that undergone 
 by evaporated, condensed and desiccated milks. 
 
 Evaporated milk has been put through the following process: Good 
 milk is taken. Some of the fat is taken from it. The milk is heated almost to 
 the boiling point. It is evaporated about one hour at a temperature of 140° in 
 a vacuum pan. The temperature is then raised almost to the boiling point 
 and the product is canned. It contains 68 parts of water instead of 88 as 
 in the case of fresh milk. The solids are about 2% times those of fresh milk. 
 
 
Drow- b a - KATnCRINC FIELD WHITE - 1914 
 
 Tie &EMEE ©EMlIMM wfa® BlSTMDBIDTES 
 
 'MiLKj^©™ & Wmn ©fBwkt w Wimcjki^ G&se 
 
 «DF CdDNTAGJKDUS DISEASE Em§T& Is ^^^ 
 
 Vi.±/*>0/S 3T«« BOAK.D or HEALTH 
 
 ILLINOIS STATE BOARD OF HEALTH. CARTOON NO. 10 
 
 Fig. 180. 
 
484 FOODS 
 
 It is sterile. A can when opened contains neither disease-producing bacteria 
 nor bacteria of decomposition. 
 
 By condensed milk is meant what is often spoken of as sweetened con- 
 densed milk. The process is the same as for evaporated milk except that 
 the temperature is not raised at the end of the evaporating process. Enough 
 cane sugar is added to make the mixture 40 per cent sugar. It is then 
 canned and sealed. Sweetened condensed milk does not contain any disease- 
 producing bacteria when the can is opened but there is nearly always a con- 
 siderable number of other bacteria. 
 
 Desiccated milk is milk evaporated down to dryness. 
 
 And now for the advantages and disadvantages of the different milks 
 as compared with fresh milk. The great advantage is that they do not 
 contain tubercle bacilli or typhoid or any other bacteria of that group. They 
 do not contain bacteria of decomposition. Those are great advantages. The 
 disadvantage is that the food ingredients are in different proportions from 
 those of fresh milk. The sugar is too high in all kinds and especially in 
 sweetened condensed milk. The fats are too low. And they are all cooked 
 milks. 
 
 Babies fed on condensed milk are liable to be overfat, soft and flabby. 
 Some of them get scurvy and others get rickets. Babies fed on these milks 
 must be closely watched for these conditions. Almost every one of them 
 will need fruit juice, meat juice and strained vegetable soups at times. 
 
 If a mother cannot have an icebox or if she cannot get cold, clean, fresh' 
 milk she had better feed her baby on the canned milks. For her the 
 advantages are greater than the disadvantages. 
 
 Two other groups of people should use canned milk by preference — 
 travelers, including picnickers, and soldiers. 
 
 When the cow has taken the woman's place and when, in between 
 the cow and the baby, cow trains and wagons, pails, cans, and many hands 
 have been run, it is late in the game to introduce objections to tampering. 
 
 If there is no ice to keep the milk, and if it is reasonably certain that the 
 milk is not typhoid free, then evaporated, condensed, or desiccated milk should 
 take the place of fresh milk. This about means that three groups of people 
 should use these milks — babies in homes where there is no ice, travelers, in- 
 cluding picnickers, and soldiers. 
 
 Evaporated milk is milk from which some of the water has been driven. 
 Instead of being 88 parts water, as is whole milk, it has 68 parts water. The 
 solids are about twice and a half the proportions found in whole milk. 
 
 Grown persons can use it for years without special precautions. Babies 
 fed on concentrated milks for a long time may develop scurvy or rickets, 
 or may get too fat. Therefore, when concentrated milk is being used as a 
 baby food it is necessary to watch the baby with unusual care. If somebody 
 will stay on guard the danger of scurvy, rickets, and obesity will be of no 
 importance. 
 
 On the other hand, concentrated milks are sterile when they go to the 
 consumer. They are sterile when the consumer opens the package. The 
 consumer can be certain that there is no tuberculosis, typhoid, scarlet fever, 
 diphtheria, or septic sore throat in the can. Furthermore, after being opened 
 the milk will keep twice as long as will ordinary milk. 
 

 FOOD ECONOMICS 485 
 
 Sweetened condensed milk is evaporated milk to which sugar has been 
 added. It was evaporated at a lower temperature than evaporated milk, 
 and, in consequence, it is not so much cooked. But, on the other hand, the 
 excess of sugar goes to make fat rather than health and resistance. 
 
 The desiccated milks, or powdered milks, are those from which still more 
 water has been driven. They have not come into general use for baby feeding, 
 but grown people find them convenient as well as wholesome and nutritious. 
 
 The federal government is beginning to control the condensed milk busi- 
 ness, which means that the product will be more uniform, truer to label, and 
 generally more meritorious. 
 
 FOOD ECONOMICS 
 
 In the purchase of food for a family allowance must be made for waste. 
 The average waste in an American household is 10 to 20 per cent, accord- 
 ing to the way the kitchen is run. Another, say 5 per cent, should be 
 allowed for the loss in cooking. 
 
 Take milk. Ninety-seven per cent is digested and absorbed. Figured on 
 the basis of usable calories it is a good purchase. 
 
 It takes food forty-eight hours to pass through the alimentary tract. 
 Five hours are required for the passage through the stomach and small 
 intestine; forty-three hours for the large intestine. What happens to the 
 large intestine must not be left out of the calculation. The three per cent 
 wastage from milk is not enough for the work of the large intestine. 
 
 After the food has been eaten the digestive apparatus fails to digest 
 and absorb all of the food values. There is about 9 per cent loss on this 
 score. Therefore, a very learned housewife will calculate the number of 
 calories needed to nourish her family and then she will increase the figures 
 by about 35 per cent to allow for these elements of waste. 
 
 If she is wise she will figure which foods furnish her the calories 
 estimated to be necessary at the lowest cost. But if she has more common 
 sense in addition to her knowledge and her wisdom, she will buy some articles 
 of diet not because they show up well in the calculation but because the 
 system needs them for one reason or another. 
 
 Some foods should be used for reasons that do not show on a balance 
 sheet. Fruits on analysis do not show well, yet the freest use of them 
 is to be recommended. A food, the use of which cannot be justified on a food 
 value basis, may be a good "buy," because it furnishes bulk to the intestinal 
 contents. 
 
 To illustrate, let us use milk. Of milk 97 per cent is absorbed 
 and so little bulk is left that constipation results. Of the forty-eight hours 
 which food takes in its passage through the body five is taken in passing 
 through the stomach, five in passing through the small intestines, and forty- 
 three in passing through the eight feet of large intestines. 
 
 And for another reason, rough foods must not be lost sight of. A man 
 needs about 300 grains of minerals a day — mostly common salt and phos- 
 phates, small amounts of lime and iron, and a trace of sand. These are 
 not of much service when physically mixed with food — they must be in 
 
486 FOODS 
 
 chemical combination. For instance, salt sprinkled on food passes through 
 the system without being stored, while salt which is a chemical part of 
 food, which has been grown into it by the cabbage plant or the beef steer, 
 phosphorus which has been mixed in the milk by the cow or formed into the 
 egg by the hen, is that which counts. 
 
 Therefore bran, peelings, shreds, fibers, skin, crusts, husks — all have 
 values which do not show on the balance sheets. 
 
 DIGESTIBILITY OF FOODS 
 
 There is no doubt but that the preparation of food influences its diges- 
 tion. Foods having a pleasant odor and an attractive appearance stimulate 
 the appetite. Pawlow got a world-wide reputation for discovering these facts 
 — facts known always and by all men. 
 
 Atwater says: "Generally speaking, the most readily digested animal 
 foods were materials of soft consistency. White meats, for example, chicken, 
 leave the stomach more quickly than red meats or dark meats, for in- 
 stance, duck. 
 
 "The method of cooking also exerts a very marked influence on stomach 
 digestion. Fresh fish was found to be more readily digested than meats. 
 
 "As regards vegetable foods in general, the consistency and the amounts 
 of solid material were again principal factors affecting the time required for 
 digestion in the stomach. Mealy potatoes, for instance, were more easily 
 digested than waxy potatoes, and mashed potatoes more readily than potatoes 
 cut up in pieces. Fine bread was more quickly digested than coarse bread." 
 
 Experiments have shown that the addition of butter to bread and vege- 
 tables lengthens the time the food remains in the stomach and upper in- 
 testines. Sugar, bread, and potatoes remain only a short time in the 
 stomach and upper intestines, and make the least demand on the digestive 
 secretions. Flour gruels, cream, and beef are completely assimilated. Cooked 
 fruit digests more easily than raw. Potato with fat pork remains in the 
 stomach longer than potato mixed with butter or cream. Experiments have 
 shown that mutton, like beef, is almost completely assimilated. 
 
 Generally speaking, dried vegetables are much harder to digest than when 
 fresh. A large part of the vegetables contain tough cellulose or fiber which 
 is not digested. The laxative vegetables are spinach, tomatoes, and most 
 green vegetables when fresh and well cooked. As a general rule, the vegetables 
 which grow above ground are more digestible when fresh and young (with the 
 exception of celery), and those which grow below ground are starchy and 
 more indigestible. 
 
 The digestibility of fruits depends largely upon the ripeness and fresh- 
 ness. Some people have an idiosyncrasy against fruits, such as strawberries, 
 pineapples, and so forth, and cannot, therefore, digest them properly. 
 
 The more digestible fruits are grapes, oranges, grapefruit, lemons, cooked 
 apples, figs, peaches, cantaloupes, blackberries, strawberries, and raspberries. 
 
PEESEEVE FEUITS FOE WINTEE USE 487 
 
 PRESERVE FRUITS FOR WINTER USE 
 
 During his service in the United States Senate reporters told us that 
 Senator Stephenson, of Wisconsin, was "doctoring" the senate. It ap- 
 pears that, nearly a half century ago, Senator Stephenson got an aloes 
 prescription from one of Chicago's great physicians of that day — Dr. E. N. 
 Isham. That prescription, containing aloes, he has since used and is now 
 using to prolong the lives of senators beyond the Biblical limitation. 
 
 Now, the use of aloes for this purpose is good, but the discovery that 
 constipation makes for senility cannot be patented by Senator Stephen- 
 son. 
 
 One variety of aloes is known as the Socratine aloes. Whether Socrates 
 used it I do not know, but we do know that the drug has been used on 
 the Socratine island since the time of Alexander the Great. 
 
 A few years ago Metchnikoff gave the relation of constipation to old age 
 careful and scientific study and suggested a plan which he thought an im- 
 provement over the Stephenson plan. While these scientists, Professor Metch- 
 nikoff at the Pasteur Institute in Paris, and Senator Stephenson and his lieu- 
 tenant, Tillman, in Washington, are contending there is something which the 
 housewife can be doing in July and August about which there is no room for 
 argument. 
 
 Constipation contributes to senility. Deficiency of fruits and vegetables 
 in the daily diet contributes to constipation. Many more people suffer 
 from constipation in winter than in summer — at least four times as many. 
 Why? Winter foods are more concentrated. In saving for the winter, 
 we store the kernel and throw away the hull. When winter comes, we live 
 on meat and white bread. In case we buy fruit and vegetables, we eat 
 sparingly of them since their use, in winter, runs into money. The way out 
 of this is to pick up fruit and vegetable bargains when they are plentiful 
 and cheap and can, can, can. Then next winter the mother will feel that 
 the family can afford to eat fruits and vegetables lavishly and better health 
 will result. 
 
 The object of cooking and preserving is to sterilize. If sugar is not used, 
 the vegetables canned must be sterile else they will not keep. If the peaches 
 and other fruits are mixed with an equal quantity of sugar, they need not 
 be completely sterile since sugar prevents some bacterial growth. Canned 
 fruits and vegetables are clean and sterile. As winter foods, preserves, jellies, 
 pickles, and canned vegetables are better than medicine. 
 
 The housewife, though she has not known it, has been a working 
 bacteriologist all along. Professor Koch had nothing on her. What he 
 discovered in the late seventies, she had been doing for a century. Had 
 the laboratory scientists gone into the kitchen or the housewives into the 
 laboratory the science of bacteriology might have gotten under way in 
 1779 instead of 1879. 
 
 Constipation leads to ill health and induces premature senility. The 
 Stephenson aloes plan for preventing the effects of constipation is better 
 than nothing. 
 
 The Metchnikoff plan along the same general line to prevent the forma- 
 
488 
 
 FOODS 
 
 tion of senility-inducing chemicals in the large intestine is better than the 
 Stephenson aloes plan. 
 
 Sugar and Similar Foods. 
 
 U.S. Department of Agriculture 
 
 Office of Experiment Stations 
 
 A.C.True: Director 
 
 R-epared by 
 
 C.FXANGWORTHY 
 
 Expert in Change of Nutrition Investigations 
 
 COMPOSITION OF FOOD MATERIALS. 
 
 (mm sm hip ess] cnnn WMHslE&L* 
 
 Protean Fat Carbohydrates A 3 h Water MM fooVcalcries 
 
 MOLASSES 
 
 :p&£%? Carbohydrates: 100.0 
 
 FVefein.-£A- 
 
 .|^7^Wat9r^5.1 
 
 fUEL VALUE" 
 
 1860 calories 
 per pound 
 
 STICK CANDY 
 
 Carbohydrates: 96.5 
 
 1290 calories 
 per pound 
 
 WSter: 3.0 r Ash:0.5 
 
 rUEL VALUE: 
 
 MAPLE SUGAR 
 
 1785 CALORIES 
 PER POUND 
 
 HONEY 
 
 Ash:0. 
 
 1540 
 
 Watent 
 Frotein:0, 
 
 ^Water:16.3 
 
 Carbo- Carbo- 
 
 hydrates :8£.8 hydfSes:81.2 
 
 CALORJE5 PER POUND 
 
 1520 
 
 Fuel valueT^ 3 ^-* 
 
 CALORIES PER POUND 
 
 Fig. 181. 
 
 The plan of eating fruit, especially in winter, is still nearer to nature. 
 Canning fruit and vegetables in August is better than taking aloes in 
 December, 
 
TOXINS IN FOODS 489 
 
 TOXINS IN FOODS 
 
 Scientists have extracted toxins from many different plants. From 
 the castor bean, the source of castor oil, ricin, a violent irritant, has been 
 obtained. But for this, castor oil would be a bland food like olive oil 
 rather than the purgative it is. From Croton oil, crotin is had; from mush- 
 rooms, phallin. Furthermore, scientists, proceeding as they do in making 
 tetanus and diphtheria antitoxins, have made an antitoxin to cure castor 
 oil poisoning, and another to cure mushroom poisoning. 
 
 To those who decry antitoxins, saying that they are fantastic conceptions 
 since, as bacteria are the products of overheated imaginations, and toxins 
 are the imaginary products of imaginary bacteria, antitoxins are the 
 imaginary products of the stimulation of imaginary toxins produced 
 by imaginary bacteria, it will be a poser to be told that such vege- 
 tables as potatoes, mushrooms, peaches, and castor beans produce toxins, 
 and that, for some of these toxins, antitoxins have been discovered. For 
 example, snake venom is a toxin and for it antivenoms, or antitoxins, are in 
 practical use. 
 
 In fact, toxins and antitoxins are found everywhere in nature, and 
 bacterial toxins and antitoxins, far from being peculiar, are a part of a great 
 nature-wide scheme. 
 
 Diphtheria antitoxin is not a new fangled conception. The old way 
 of saying it was that we got used to a thing and, therefore, it did not 
 affect us any longer — the same statement, but said differently. 
 
 The evidence is strong that beriberi is due to an exclusive diet of rice — 
 probably of polished rice. We have not much beriberi in the United 
 States, but there formerly was a good deal around Panama. Now comes a 
 physician with an account of beriberi among the people on certain Cana- 
 dian Atlantic islands — a people who are forced to live on oatmeal alone for 
 months on a stretch. The conclusion is that beriberi comes from long 
 continuance of a single article of vegetable diet, usually rice, occasionally oat- 
 meal. 
 
 One of the most violent of poisons, ergot, is due to a mold or smut 
 growing on grains of corn. 
 
 The question whether food is wholesome often depends more upon 
 how clean, how fresh, and how well kept it is than upon commercial fabri- 
 cations. Food inspectors have usually overlooked this. 
 
 The object of the above is not to cause distrust of food. Most of the 
 safety rules for foods are known. In fact intelligent people apply them 
 so universally that in spite of the wide separation between consumer and 
 producer and the many things that happen in between cases of food poison- 
 ing are very infrequent. 
 
 The object of the article is to call attention to the fact that the principles 
 underlying the use of toxins and antitoxins are not man-made. In learn- 
 ing to make antitoxins man has merely discovered how to do something 
 that nature has always done. And so it is with toxins. 
 
 It would seem reasonable, therefore, to decide whether or not to use anti- 
 toxins on the merits of the case. The charges that men are serum mad, 
 
490 
 
 FOODS 
 
 Dietary Standards. 
 
 U.S. Department of Agriculture 
 
 Office of Experiment Stations 
 
 A.CTrue. Director. 
 
 Prepared by 
 
 C.F.LANGWORTHY 
 Expert in charge of Nutrition Investicjations 
 
 DIETARY STANDARDS. 
 
 DIETARY STANDARD FOR MAN IN FULL VIGOR 
 AT MODERATE MUSCULAR WORK. 
 
 Condition considered 
 
 Protein 
 
 Energy 
 
 
 Grams 
 
 Calories 
 
 Food as purchased 
 
 115 
 
 3,800 
 
 Food eaten 
 
 100 
 
 3.500 
 
 Food digested 
 
 95 
 
 3,200 
 
 ESTIMATED AMOUNT OF MINERAL MATTER 
 REQUIRED PER MAN PER DAY. 
 
 Grams Grams 
 
 Phosphoric acid (F£0 5 ) 3to4 Calcium oxid 0.7 to 1.0 
 
 Sulphuric acid (50 3 ) Eto35 Magnesium oxid 0.3 0.5 
 
 Potassium oxid 2to3 Iron 0.006 to 01Z 
 
 Sodium oxid 
 
 4to6 Chlorin 
 
 6 to 8 
 
 Fig. 182. 
 
 toxin mad and germ mad is tommyrot. Nature points the way. They are 
 really nature cures. 
 
 QUANTITY OF FOOD 
 
 There is a great deal of misinformation about what to eat and wliat 
 not to eat from the standpoint of food values. It is true that lean meat is 
 
OVEREATING AT DINNER 491 
 
 rich in protein and is good for building up tissue. Starches and sugars are 
 rich in carbohydrates and are good in furnishing energy. Vegetables, as 
 compared with meats, are rich in carbohydrates and sugars and low in 
 protein. Fats are rich in hydrocarbons and are especially useful in making 
 heat. Salts are needed for nourishment, and water is needed for digestion 
 and assimilation. 
 
 Meats are not, however, all protein, and vegetables contain a good 
 deal of protein. It is not possible to draw a hard and fast line between 
 the use of foods since tissue building protein can make heat, and vice versa. 
 
 A few variations have been exaggerated into all sorts of absurdities. 
 We hear of fish as brain food, and so forth. 
 
 The fact is, it does not make much difference what food you eat. It 
 does make a great deal of difference how much you eat. While there is some- 
 thing in quality, the very important point is quantity. 
 
 Almost any man can eat almost anything if he will eat it slowly and chew 
 it very well, and then, having swallowed it, will forget about it. A period of 
 quietude after eating will increase his latitude in things which can be eaten. 
 
 The harm which is done by eating is in the main from eating too 
 much. Children over two years of age and men doing hard physical labor 
 seldom eat too much. 
 
 The advice to cut down the volume of food applies to office workers, clerks, 
 and other men and women who do not get much muscle work. 
 
 More food is required during the winter than during the summer. As 
 the weather gets colder it is advisable to increase the quantity of food. 
 More heat is needed and that calls for food. The colder weather stimulates 
 one to take more exercise, and that demands more tissue building. 
 
 The advice to go on a tropical diet when the weather is tropical indicates 
 that when the weather ceases to be tropical the proper thing to do is to change 
 the volume and, in some measure, the kind of food to match, especially to 
 increase the amount of fats and meat. 
 
 OVEREATING AT DINNER 
 
 The dinner meal is that in which there are most sinners. The day's 
 work is done, and the succeeding hours are to be spent at physical ease and 
 in a warm, comfortable room. At breakfast the man has held his appetite 
 in check. Knowing he had work before him, that he was going out into 
 the cold air, he has eaten lightly. He sits down to his dinner with different 
 prospects in mind. He usually eats until his stomach is uncomfortably dis- 
 tended. Therefore he should know something of the food values of his 
 evening meal. 
 
 One portion of soup — 
 
 Soup, one pint, equals 200 calories and 180 grains protein. 
 Chowder, one pint, equals 360 calories and 480 grains protein. 
 
 Fish, game, chicken, beef, turkey, lamb, goose, lean ham — Ordinary help- 
 ing, about one-quarter pound, equals 125 to 250 calories, according to 
 how much fat it contains, and 300 grains protein. 
 
492 FOODS 
 
 Butter — One pat, one-third ounce, equals 80 calories; practically no protein. 
 
 Butter beans — One-quarter pound equals 160 calories and 150 grains protein. 
 
 Green corn — Four ounces equals 100 calories and 45 grains protein. 
 
 Green peas — Four ounces equals 100 calories and 105 grains protein. 
 
 Turnips — Four ounces equals 50 calories and 30 grains protein. 
 
 Fodder vegetables and their juices, having but little food value, are aspar- 
 agus, string beans, brussels sprouts, cabbage, cauliflower, celery, cucum- 
 bers, greens, spinach, lettuce, pumpkin, radish, rhubarb, tomatoes. 
 
 Apples — One-quarter pound equals 60 calories. 
 
 Raisins — One-quarter pound equals 350 calories. 
 
 Figs and prunes — One-quarter pound equals 80 calories. 
 
 Pineapple — One-quarter pound equals 40 calories. 
 
 Almonds — One-quarter pound equals 650 calories and 300 grains protein. 
 
 Pecans — One-quarter pound equals 750 calories and 150 grains protein. 
 
 Bread or rice pudding — One-quarter pound equals 175 calories and 60 grains 
 protein. 
 
 Custard — Large cupful [8 ounces] equals 240 calories and 180 grains pro- 
 tein. 
 
 Cake — Large slice [one ounce] equals 85 calories and 20 grains protein. 
 
 A man needs about 2,500 calories and 800 grains protein. Take the 
 list given below (Food Values) and figure your breakfast. Add about an equal 
 amount for your lunch, and then figure your dinner from the above list. If 
 you have eaten some article not given figure it in terms of that food most like 
 it. Add the three together and see whether you should be getting fat or 
 thin. 
 
 Thanksgiving Dinner. — The custom of overeating on Thanksgiving is 
 well established. Overturning a custom is no easy matter. The comfortable 
 thing to do is to abide by it. Maybe we can say something to lessen the bur- 
 den. It may not seem a burden now, but it will about four o'clock in the 
 afternoon of Thanksgiving day. 
 
 Drink no wine, beer, nor whisky with the meal. The stomach 
 juice will be loaded up. Do not decrease its efficiency by diluting it with 
 alcohol. No chemist has ever been able to mice alcohol and pepsin so as to 
 make an efficient dig est ant. 
 
 Eat slowly and chew your food well. Your stomach muscle will be carry- 
 ing an overload. The more work your teeth do, the less your stomach 
 muscle will have to do. 
 
 Eat lightly of the earlier courses. By the time the meal is about half 
 through you can form a good idea of how your stomach space is holding out, 
 and, if you conclude you can stand more, you can make up on later courses. 
 
 Do not eat the dressing. It taxes the digestion all out of proportion to 
 the excellence of its taste or its nutritive properties. 
 
 Drink a good deal of water during the meal. All of that food must go 
 into solution, and water u needed. 
 
 After the dinner is over get plenty of air in the room. You will 
 make a lot of heat in digesting that food, and you will need fresh air 
 to get rid of that surplus heat. 
 
 An hour after dinner you will get thirsty. Drink plenty of water. It 
 will help your stomach to digest that food and move it on into the small 
 intestine. 
 
FOOD VALUES 493 
 
 Be sure to have some chewing gum on hand. I am opposed to chew- 
 ing gum on the grounds that it is not esthetic and that it is not the most 
 worth while means of whiling away the time. It should not replace gos- 
 siping, novel reading or the picture snow. But it has a place on Thanks- 
 giving day. 
 
 When you have overeaten so that you feel heavy and sleepy, when 
 you gape and sneeze, when your stomach feels full and you unbutton your vest, 
 then comes the time for gum. It beats pepsin a mile. In spite of what 
 you have been told you have overfilled your stomach. For several hours 
 the stomach muscle has labored. Overworked it shows a disposition to lag. 
 If you will drink some water and then chew gum your discomfort will 
 lessen. The explanation is as follows: The stomach contents were too dry, 
 hence the help from drinking water. The stomach muscle needs stimulation; 
 this gum-chewing supplies. 
 
 About two hours after eating go for a walk in the open air. Walk 
 slowly for a while. After you have got well under way, begin to move 
 faster. Do not come in until you have burned up the surplus. 
 
 If you begin to sneeze, be certain to get out into the fresh air. 
 
 Finally, if you wish to escape a bilious spell the next day, take a dose of 
 castor oil before retiring. 
 
 FOOD VALUES 
 
 For the benefit of those who desire to regulate their diet for some one 
 of many reasons a list of the more common foods, with their heat unit, or 
 calorie, value is given. Much of the information is taken from Atwater's 
 "Principles of Nutrition and Nutritive Value of Food" (Farmers' Bulletin 
 142, Department of Agriculture). 
 
 Calories. 
 
 Bread, one ounce (one slice) 80 
 
 Lean bacon (one slice) 65 
 
 Small lamb chop, broiled (about one-eighth of a pound) 92 
 
 Medium size pork chop (about one-sixth of a pound) 150 
 
 Beef, one pound (five helpings) 1,000 
 
 Potato of medium size 240 
 
 Milk, one-half a pint 140 
 
 Buttermilk, one-half a pint 100 
 
 Butter, one inch cube 140 
 
 One lump of sugar (heaping teaspoonful) 40 
 
 One inch cube of American cheese 100 
 
 One teacup of mashed potato 180 
 
 One teaspoonful of cream 20 
 
 One egg 70 
 
 Peas, heaping teaspoonful (fresh or canned) 25 
 
 Beans, heaping teaspoonful (dried) 90 
 
 Apple, medium sized 60 
 
 Orange, medium sized 50 
 
 Banana 50 
 
 Dried fruit, saucerful 150 
 
 One rice croquette 150 
 
494 FOODS 
 
 Calories. 
 
 One teacup bread pudding 150 
 
 Combination salad, oil dressing (one helping) 75 
 
 Vegetable soup, one portion 150 
 
 Chicken soup, one cup 60 
 
 Oyster (large), one 10 
 
 One Parker house roll 110 
 
 Cocoa (powder) , 40 
 
 Chocolate (powder) 90 
 
 The average man working at moderately hard labor requires about four 
 ounces of proteids, three ounces of fats, and eighteen ounces of carbohydrates. 
 In the selection of a diet in order to maintain a proper food balance this re- 
 lation should be approximately maintained. 
 
 Graham Lusk tells us that "it is evident that a hard working, laboring 
 man requires 3,500 calories daily in his diet in order that he shall have 
 fuel for the maintenance of his life and for furnishing power to accomplish 
 his daily tasks." Those doing light, muscular work require about 2,500 
 calories. 
 
 Lusk gives a table of the number of calories for a family of five : 
 
 Calories. 
 
 Father, a clerk 2,500 
 
 Mother 2,500 
 
 Son, nine years 1,250 
 
 Daughter, six years 1,000 
 
 Baby, one month , 500 
 
 7,750 
 
 Economical Dishes. — We are again told that the baby death rate de- 
 pends upon the earnings of the family. This time the telling is based 
 upon an investigation made at Montclair, New Jersey. The same story has 
 come from so many sources that we are safe in accepting it as a fact that the 
 largest single factor in baby death rate is the family earnings. 
 
 Money buys other things needed by a baby, but a considerable part of 
 the baby death rate among the poor is because not enough money is spent 
 directly and indirectly for the babies' food. But the relation between 
 food and health embraces much more than baby food. The leading health 
 departments in every portion of the world know that there is a. relation 
 between the food, its cost, its quantity and its quality, and health. 
 
 When it comes to personal hygiene, thousands are interested. The in- 
 comes of many are so small that, they must be careful in their expenditures 
 for food. They want to know what foods furnish ample nutrition for a small 
 sum. 
 
 Taken as a class, pastries and desserts furnish the largest amount 
 of energy for five cents. Analyzing forty-seven pastry orders bought at well- 
 known moderate priced restaurants, Mr. Kephart found that five cents bought 
 an average of 233 calories. The most economical was Napoleon — 453.6 
 calories. The least economical was strawberry shortcake — 91.8 calories. Nutri- 
 
FOOD VALUES 495 
 
 tion as shortcake was five times as expensive as that of Napoleon. Other 
 classifications were as follows : 
 
 Average calories in 24 orders of beans 204.5 
 
 Average calories in 56 orders of sandwiches 180.3 
 
 Average calories in 12 orders of dairy dishes 174.4 
 
 Average calories in 87 orders of meats • 174.1 
 
 Average calories in 44 orders of miscellaneous 164.7 
 
 Average calories in 6 orders of oysters 149.4 
 
 Average calories in 33 orders of eggs 140.7 
 
 Average calories in 4 orders of salads 135.9 
 
 Average calories in 17 orders of soups 116.0 
 
 Average calories in 14 orders of fruits 88.8 
 
 The most economical pastries and desserts were Napoleons, crullers, and 
 cabinet pudding with vanilla sauce. The most expensive were strawberry 
 shortcake, strawberry ice cream, strawberry corn starch with whipped cream, 
 cup custard, and pineapple fruit jelly with whipped cream. 
 
 The most economical bean dishes were Boston baked beans and Boston 
 pork and beans. The most uneconomical were Boston beans on the side 
 and New York pork and beans. 
 
 The most economical sandwiches were roast beaf sandwich with a roll, 
 minced ham sandwich with bread and butter, and ham sandwich with a 
 roll. The most uneconomical were chicken sandwich, club sandwich, and 
 hot roast beef sandwich. 
 
 The most economical dairy dishes were milk crackers and Graham 
 crackers. The most uneconomical were the various forms of breakfast 
 cereals. 
 
 The most economical meats were lamb croquettes with mashed^ potatoes, 
 German meat cakes with French fried potatoes, and Vienna roast with 
 French fried potatoes. The most uneconomical were deviled crabs, sirloin 
 steak with onions, and tenderloin steak. 
 
 The most economical forms of egg dishes were plain omelet and tomato 
 omelet. The most uneconomical were two poached eggs and chicken omelet. 
 The omelet orders included bread and butter. 
 
 The most economical salad was potato salad. The least economical salads 
 were crabmeat, tuna fish, and egg. 
 
 The most economical soups were beef stew and lamb stew. The least 
 economical were tomato soup with rice, bean soup, and vegetable soup 
 with bread and butter. 
 
 Eaw oysters were very uneconomical; fried oysters and oyster pie made 
 a better showing on account of the flour and grease added to them. 
 
 The most economical vegetables were stewed corn and creamed asparagus 
 on toast. The least economical were sliced tomatoes and tomatoes and lettuce 
 with dressing. The most economical fruit was baked apple with or without 
 cream. The least economical fruits were sliced pineapple and cantaloupe. 
 
 The pastry in :'rawberry shortcake and other fruit and pastry dishes 
 consists of cooked starch, a little raw starch, sugar, a fat and albumin. The 
 berries consist of some raw starch, sugar, and two fruit acids, malic and 
 citric. The percentage of starch in berries is about 7. Thompson gives the 
 
496 FOODS 
 
 proportion of sugar to acid as 4.4 to 1. The milk contains fat, sugar, and 
 albumin. Sugar contains sugar only. 
 
 On account of the large proportion of pastry to berries the mixture 
 is but slightly acid. The acidity is due to weak organic acids. The point I 
 wish to make is that the acidity is not great enough nor the acids power- 
 ful enough to interfere materially with the digestion of starch. As 
 sugars are absorbed -unchanged just as they are, they do not need to be con- 
 sidered. 
 
 The starches must be converted into sugars before they can be absorbed. 
 An out and out starch is called a polysaccharid. A starch halfway to sugar 
 is called a disaccharid. The straight sugars are called monosaccharids. 
 When starch is eaten it is first converted into a disaccharid and then into 
 a monosaccharid, whereupon it is absorbed. Sugars, being monosaccharids, 
 are absorbed without change. 
 
 The juices which bring about the changes in the polysaccharid starches 
 are the saliva, the pancreatic juice, the intestinal juice, and a ferment in the 
 interior of the cells of the intestinal wall. 
 
 The known ferments which do the work are the amylose and maltose. 
 Amylose converts the polysaccharid into disaccharid, and the maltose changes 
 the disaccharid into a monosaccharid. 
 
 Starches are best digested by ferments in mixtures that are weakly 
 acid. When the acid becomes too strong starch digestion stops. When pastry 
 is chewed saliva is mixed with it. The amylose and maltose begin to convert 
 the starch first into maltose and then into glucose. 
 
 In the mouth little digestion occurs, as the time is too short. Digestion 
 proceeds in the stomach until the percentage of free acid surpasses 1-10 of 1 
 per cent. When it reaches 2/10 of 1 per cent digestion stops. 
 
 From 5 to 25 per cent of the starch eaten is digested in the stomach, 
 the percentage occurring in the mouth being too small to be estimated. 
 
 The work of the stomach having been finished, the food passes into 
 the intestines. Here the starch digestion is resumed by the pancreatic and 
 intestinal juices. These juices as starch digesters are much more powerful 
 than is the saliva. In addition, the food is kept in contact with these ferments 
 for several hours instead of minutes, as is the case with the saliva. 
 
 Now how do the people who hold that strawberry shortcake cannot 
 be digested go wrong? They assume that because a strong mineral acid, 
 muriatic, when as strong as 2/10 of 1 per cent, stops starch digestion, 
 the weak acid of strawberries will also stop it. We make a mistake when 
 we conclude that because muriatic acid will cause a certain effect, malic acid 
 will do likewise; also that because a high acidity (2 per cent) will cause a 
 certain effect, a low acidity will do likewise. 
 
 All the salivary digestion that occurs takes place in the stomach where 
 the contents are always more acid than strawberry shortcake ever is. The 
 greater part of starch digestion is done in the small intestine after the acid 
 of the stomach has been neutralized. Neutralizing the acid of strawberry 
 shortcake is child's play as compared with neutralizing the muriatic acid of 
 the stomach juice. 
 
 If anybody tells you that breaking down the polysaccharid starch to disac- 
 charid is done only by the saliva and that that is the difficult part of starcti 
 
FOOD VALUES 497 
 
 digestion tell him that he does not know what he is talking about and you 
 can prove it. 
 
 Taylor says (and there is no better authority) that the mouth is essentially 
 an organ of trituration, not of digestion. Starch digestion is essentially a 
 function of the small intestine and pancreas. In the presence of the master 
 acid, that of the gastric juice, the acid of strawberries is a puling paralytic, 
 to use the language of Colonel Watterson. 
 
 Finally, if the starch of strawberry shortcake did not digest it would 
 be found in the feces. Examination does not show it there. 
 
 Starches digest best when the mixture is slightly acid and a fair propor- 
 tion of the starch eaten is digested in the stomach in which the mixture is 
 acid. When the free muriatic acid present equals 1 to 500 of starch, digestion 
 stops but the starch digestion is resumed when the stomach acid has been 
 neutralized. Most of the starch is digested in the intestine. If the intestine 
 neutralizes the strong acid of the stomach and digests starch, where is the 
 difficulty in neutralizing fruit acid? 
 
 In taking the position that starchy foods and fruit eaten together are 
 not harmful, I do not overlook that some people are harmed by the com- 
 bination. For several years, without much contradiction, the statement has 
 been widely circulated that such a combination was harmful to digestion. 
 A great many people have accepted the statement as true, because it has 
 not been contradicted. That is the largest factor in the belief. But some 
 people are actually harmed. Why? 
 
 In the first place some people are poisoned by fruits. This is especially 
 true of strawberries with these people. With them it is an idiosyncrasy. They 
 are harmed. 
 
 Some forms of fruit, especially fruit not quite ripe, contain a good 
 deal of starch. As the fruit is eaten uncooked, the starch is raw starch. 
 Raw starch is hard to digest. It is especially difficult for some people. 
 The starch which fails to digest in the stomach and in the small intestine 
 passes beyond the limits where the digestive juices are active; whereupon 
 it is seized upon by bacteria and fermentative processes ensue. 
 
 Some harm results from eating fruit and starch by reason of the fermenta- 
 tion of undigested starch within the intestines. 
 
 Of more importance are the results of the digestion and absorption of 
 more starch than the system needs — a surfeiting of the system with sugars 
 derived from starches. One very important disease is due to too much 
 sugar — diabetes. In this disease the kidneys eliminate the sugar from the 
 blood. 
 
 Diabetes is not a kidney disease. One theory as to the cause of diabetes 
 is that glucose, instead of pouring through the liver and being there changed, 
 is poured into another set of ducts, called the lacteals, and by these is trans- 
 ported to a large duct which pours its contents directly into the blood. 
 In other words that glucose has found a by-pass into the general blood 
 stream by which it escapes the liver. 
 
 Another theory is that the liver is overwhelmed by the great amount 
 of glucose brought to it and allows some of it to go by unchanged. There 
 are still other theories. Whatever the theory may be, the fact is that in 
 most cases of diabetes the body is suffering from too much sugar, the result 
 
498 FOODS 
 
 of the digestion of too much starch and the absorption of too much sugar 
 from starch and other sources. 
 
 A large proportion of the people eat too much starch. Bread is 
 thrown in, and they eat it without limit; or, having eaten a heavy meal, 
 they eat strawberry shortcake or some fruit and starch concoction on top of 
 it. Some of these have diabetes; more suffer in other ways. 
 
 With. this group the trouble is not with the digestion of starch. The 
 trouble is that they overeat, overdigest, and overassimilate starch and sugar. 
 
 Salt in Food. — The body of a man of average size contains about 1,500 
 grains, or about three ounces, of salt. This mineral forms a part of the 
 tissues and some of it wastes with the ordinary wear of the tissues. Ex- 
 perimenters have found that when a man is fed on salt-free food he throws 
 off sixty-nine grains of salt the first day, thirty-seven grains the second, 
 twenty-two the third, and three on the thirteenth. This salt represented 
 the wear of tissue cells of which salt was one of the ingredients. 
 
 A fasting man will excrete 150 to 200 grains of salt. The amount of 
 salt in the excretions above these amounts represents excess of salt in the 
 food. 
 
 Salt taken in with food goes in part to the cells to replace that lost 
 by wear. The excess passes from the body unchanged, forming one of the 
 ingredients of the excretions. Herbivorous animals need to get salt in addi- 
 tion to their ordinary food. Wild animals will not remain in a country 
 where they cannot find salt licks. On the other hand, countries that abound 
 in licks abound in wild animals of the grass eating kind, whenever other 
 conditions are fair. 
 
 Meat eating wild ( animals do not care for outside sources of salt. 
 They get enough salt from the blood and flesh of the kills. Cy De Vry will 
 tell you that he salts his herbivorous, but not his carnivorous animals. 
 
 Since man eats a mixed diet he needs some salt in addition to that 
 derived from his food supply. But Bunge is authority for the statement 
 that, given an inch, he takes an ell. He says: 
 
 "The use of salt enables us to employ a greater variety of the earth's 
 products as food than we could do without it/' 
 
 At the same time he holds that "we are accustomed to taking far too 
 much salt with our viands. Salt is not only an element, it is also a con- 
 diment and easily lends itself, as all such things do, to abuse." 
 
 Sherman says: "Salt equilibrium can apparently be maintained on less 
 than one-fourth the amount of salt ordinarily eaten." 
 
 The prevailing opinion now is that when scurvy develops among people 
 who have been living on salt meat almost alone the disease results from 
 vegetable starvation and not from excess of salt, as was thought to be the 
 case at one time. 
 
 When salt is eaten in excess the chemical is passed into the urine, the 
 sweat and the bowel content without change. However, it is somewhat 
 irritating to the cells through which it passes. Excess of salt causes the 
 cells of the body to break down somewhat more rapidly than they normally 
 would. It acts as an artificial whip to the kidney cells. It is bad judg- 
 ment to stimulate the kidney cells continuously for years. 
 
 Table salt acts somewhat as a saline purge, as would a very small daily 
 
FOOD VALUES 499 
 
 dose of salts kept up for years. That, too, is bad judgment. It acts as a long- 
 continued mild stimulant to the sweat glands. Perhaps the people who com- 
 plain of night sweats or of sweating under the arms, may find a suggestion 
 here. 
 
 No Brain Foods. — T, J. writes to know if there is a diminishing death 
 rate equaling the improvements in hygiene and sanitation. Does eating 
 the livers and hearts of animals strengthen the same organs in the person 
 eating ? 
 
 Reply. — 1. The death rates are much lower than they formerly were. 
 The Chicago death rate for 1881 was 26. That of 1911 will be under 15. 
 Figures for the years before 1881 are not accurate enough to be taken 
 unreservedly. 
 
 The sickness rate is less, but we cannot say how much less. About 
 the only entire sickness figures of value are those furnished by the armies 
 and by controlled populations such as those of the canal zone. 
 
 The best evidence of improvement was a comparison between the figures 
 of the Japanese army in the war with Russia with those of the American 
 armies in the Civil War, or between the United States army along the Rio 
 Grande in 1911 and the same army in 1898. 
 
 Some people know hygiene and practice it, some know it and do not 
 practice it, some do not know it and do not practice it. 
 
 The diminution of the rates does not keep pace with the growth of 
 knowledge. 
 
 2. No. An idea prevails that to nourish the brain one should eat brains ; 
 to nourish the heart, eat hearts ; that a nursing woman can drink milk and 
 have it pass directly to her breast for her baby. 
 
 The idea is wrong. "When brains are eaten they are broken up by 
 digestion into new chemicals, and these are built up into new substances. 
 These new substances have no special affinities for the brain cells of the 
 person who has eaten brains. 
 
 The way to build up and nourish any organ is to exercise it in modera- 
 tion and then to feed it food which is good along general lines. There are 
 no brain foods, or heart foods, or kidney foods, or toe foods. 
 
 Not Blood Builders. — E. E. M. writes: "Is it not true that carrots are 
 Mood builders; also beets? Does not corn make heat and rice build muscle? 
 It occurs to me that physicians warn against meat as producing kidney dis- 
 eases. Will you kindly enlighten me as to other foods that produce red 
 corpuscles? Would not boneset tea (a pint a day), a good foot bath each 
 night, and a good-sized carrot or a handful of dates to keep the liver regu- 
 lated, do much to aid the system in overcoming the bacilli which give 
 the infection of colds?" 
 
 Reply. — 1. Carrots and beets are not blood-builders. 
 
 2. Meat only produces kidney irritation when eaten in excessive quan- 
 tities, and is usually only one of a number of causes. 
 
 3. The articles you name and the daily foot bath can possibly do no 
 harm. Greater security can be gained against the various bacilli producing 
 colds by simple living, absolute cleanliness, and up-and-about habits. 
 
 Food Value of Grapes. — H. W. M. writes: "As many people are now 
 eating grapes, would not a few suggestions as to their value as food and 
 the proper* way to eat them be helpful? 1. What food value does the pulp 
 
500 FOODS 
 
 alone containf 2. What food value does the shin contain? S. Should the 
 pulp and shin both be swallowed? Jf. Should grape seeds be swallowed? 
 
 5. Is there any danger of producing appendicitis by swallowing grape seeds? 
 
 6. If there is no danger in swallowing grape seeds and grape shins, would 
 they not be as beneficial to the bowels as eating agar?" 
 
 Reply. — 1. Has some heat value, but it is not great. 
 
 2. Practically none. 
 
 3. Yes. 
 
 4. Yes, after being chewed. 
 
 5. None if the seeds are chewed. The danger is but slight under any 
 circumstances. 
 
 6. Eating grapes, pulp, skin, and seed, is an excellent cure for constipa- 
 tion. 
 
 How to Tell Butterine. — M. B. J. writes: "Is butterine, properly and 
 cleanly made, a wholesome and readily digestible fat? Is it inferior to 
 butter as a food? Why shoidd the poor man have to pay the national gov- 
 ernment 10 cents a pound tax on his fatty food in the shape of butterine, 
 while the rich man pays the national government no tax on the butter he 
 consumes? Is there an easy way for the housewife and cooh to differentiate 
 butter from butterine?" 
 
 Reply. — 1. Yes. 
 
 2. No. 
 
 3. No reason except that the law requires it. 
 
 4. Yes. When butterine is vigorously boiled in a spoon it sputters and 
 does not foam. Butter foams but does not sputter. Get Farmers' Bulletin 
 No. 131, by Patrick, on "Household Tests for Oleomargarine and Renovated 
 Butter." 
 
 Evaporated Milk. — W. K. H. writes: "Please tell me if, in the evapora- 
 tion of milh, any food qualities are lost. Is the evaporated milh offered in 
 the market in cans better and safer than the milh usually sold by the milh 
 dealer? They claim, the evaporated milh being sterilized, there are no 
 germs left to do harm." 
 
 Reply. — For adults none of the qualities is lost. For babies there are 
 certain chemical changes which make the milk not quite so well balanced 
 a ration. It is safer, but not better. Evaporated milk is practically always 
 germ free. 
 
 Mixed Diet Most Helpful. — J. S. writes: "1. Is it healthy to live on 
 vegetables and milh only? 
 
 "2. Is there any record that such diet would prolong life? 
 
 "3. Is there any truth in the statement that people living on vegetable 
 diet only can withstand sichness in the same degree that people eating 
 mixed foods do? 
 
 "If. Is it possible to reduce weight by fasting thirty or forty days with- 
 out injuring health? 
 
 "5. Do you consider it wise to fast until noon and eat only two meals 
 or even only one a day?" 
 
 Reply. — 1. No. The highest opinion is that the average man thrives 
 best on a mixed diet. 
 
 2. No. The histories of men who have lived to a great age record 
 that they varied their diet. 
 
FOOD VALUES 501 
 
 3. Chittenden and others whose opinions are entitled to great weight 
 believe that people who live on a low protein diet (generally a very small 
 proportion of meat) resist certain diseases better than others. In certain 
 other directions these people are less resistant. 
 
 4. Fasting for thirty or forty days to reduce weight is as foolish a 
 procedure on the one hand as gluttony on the other. The gradual reduction 
 of fat by the gradual reduction of food eaten is sensible. 
 
 5. No. It leads to overloading the stomach at the two meals. 
 
 No Reason for It. — N. P. writes: "Will you kindly tell me why the 
 eating of fresh eggs, either soft boiled or fried, act as a physic? Cream 
 has the same effect. Is this liver or bowel trouble?" 
 
 Reply. — There is no reason why fresh eggs or cream should act as a 
 physic. If you have noticed the effect described frequently and carefully 
 enough to be certain that it is an effect and not a coincidence, it means 
 some peculiarity in your makeup, an idiosyncrasy, or else some condition 
 which your physician should investigate. I should rank the chances as 
 follows: Coincidence, first; idiosyncrasy, second; condition, third. 
 
 May Eat Too Much. — H. L. writes: "I am a healthy, strong, active 
 young man, but for the last two weeks upon awakening in the morning I 
 find my nose has been filled with blood. I am rather worried about this." 
 
 Reply. — You are getting up too much arterial tension. Probably you 
 are eating too much. Your nosebleed helps you. It would be better, how- 
 ever, to prevent it by eating less and exercising more. 
 
 Bulk of Food. — J. R. F. writes: "Does drinking moderately of tea or 
 coffee with meals help or retard digestion? In answering one of your 
 inquisitors you have stated tliat, in a great many cases, lack of bulk of food 
 was the main cause of constipation. Do the liquids, such as tea, coffee, 
 or water, which are consumed with the meals, help to make up this bulk?" 
 
 Reply. — 1. Moderate drinking of tea or coffee with meals will not help 
 or retard digestion. 
 
 2. Liquids do not increase the bulk of food in the sense meant in the 
 answer. The bulk should be made up of vegetable and meat fiber which 
 pass through not much changed. For example, the bran of wheat, unbolted 
 cornmeal, the woody parts of vegetables, the rinds of fruits — substances 
 which correspond to hay, fodder, stalks, and other forms of roughening in 
 feeding live stock. 
 
 Bran and Agar for Human Food. — G. W. P. writes: "Kindly tell me 
 what kind of bran to use and how to cook it. What is agar?" 
 
 Reply. — Bran for human food is put up in packages. Ordinary bran, 
 as sold in the feed store, is not so nice. It can be eaten like a cereal 
 uncooked, but warmed, and served with cream and sugar, or it can be 
 cooked in gems. Agar is a seaweed. Any druggist can get it for you. It 
 comes in rough, shreddy strips. It is eaten raw. It is to be thoroughly 
 chewed. Several handfuls can be eaten a day. It is just roughage without 
 taste and with no food value. It acts by increasing the bulk of the intes- 
 tinal content and by taking up moisture. 
 
 Buttermilk Tablets. — R. M. H. writes: "Can you tell me anything 
 concerning certain 'buttermilk tablets' supposed to convert sweet milk into 
 
502 FOODS 
 
 buttermilk in a few hours? Where are they sold? 2. Do they make butter- 
 milk which is wholesome?" 
 
 Reply. — 1. If you cannot obtain them from your druggist, have him get 
 them from the manufacturers. 
 2. Yes. 
 
 Fresh Buttermilk Better. — W. W. writes: "Is freshly churned butter- 
 milk good for the health? Is it as good as buttermilk which is tart?" 
 
 Reply. — The name buttermilk is given to the milk left after churning. 
 Most of the reputation of buttermilk is due to the fresh buttermilk just 
 out of the churn. 
 
 Those who live in the country we advise to stick to freshly churned 
 buttermilk. The same advice is given those who live in the city and know 
 where and how to get this kind of buttermilk. 
 
 Buttermilk made from the churning of sweet cream is better than that 
 made by churning sour cream. 
 
 Buttermilk. — F. H. H. writes: "Can you tell me something about 
 Chicago buttermilk? I get it at the downtown fountains. It looks and 
 tastes like buttermilk of the country with small clots of butter showing 
 in it. It agrees with me. I order buttermilk of my milkman — one of the 
 largest dealers in the city — and I get something very thick and sour and 
 so white that it looks like a mixture of chalk and water. It does not sepa- 
 rate on standing as does buttermilk from the churn. I cannot digest it. 
 An employee of a milk concern told me it was made of skimmed milk and 
 everything else that was left over. Most doctors recommend buttermilk as a 
 summer drink — a little information from you as to the different varieties 
 offered I know would be welcomed by many." 
 
 Reply. — We might divide buttermilks, in a rough way, into three kinds 
 — old-fashioned churn buttermilk, culture buttermilk, and ordinary market 
 buttermilk. The old-fashioned churn buttermilk had more of the fat left 
 in and was usually consumed when it was fresh. Most people like it best 
 of all and I think it probably was and is the most wholesome kind. If you 
 can get it made in the city from a good grade of milk it is the best for you. 
 Be careful that it is' not churned from left-over job-lot milk. You must 
 trust to the honesty of a high-grade merchant on that point. Don't buy 
 from any Tom, Dick, or Harry just because you see it churned. He may 
 be feeding the churn with aged milk. 
 
 Culture buttermilk is made from pasteurized milk to which a laboratory 
 culture of lactic acid bacillus has been added. It is smoother than the 
 other sort, but it generally does not taste as well. When it gets old it sours 
 as does any buttermilk. It is the second best kind and it is the safest 
 kind. 
 
 Ordinary market buttermilk may be made from raw or pasteurized 
 milk. The lactic acid germs in it have fallen in from the air, mostly from 
 the stable air. When it gets old it sours. All buttermilk "wheys out" as 
 it ages, some quicker, some slower. It is a bad sign rather than a good 
 one. Buttermilk is much the best summer drink. In hot weather it beats 
 sweet milk a mile and beer ten miles. But there is more difference in the 
 flavor and wholesomeness and nearly as much difference in safety in 
 buttermilks as there is in sweet milks. Be careful to get good butter- 
 milk in good condition from a good dealer. 
 
FOOD VALUES 503 
 
 Colored Butter. — E. K. C. writes: "Is annatto coloring in butter pro- 
 hibited by law? If not, is it objectionable?" 
 
 Reply. — It is not prohibited by law. From the health standpoint it 
 is not objectionable. It is the cleanest ingredient of butter. Commer- 
 cially, of course, it is a means of fabrication, of making a poorer article 
 look like a better article. Many of the most expensive hotels and 
 restaurants now sell uncolored butter, giving the customer a chance to 
 judge whether it is good or not. Probably, in time, this form of fabri- 
 cation will go the way that commercial frauds seem to be headed. 
 
 Bran Gems. — A correspondent sends in the following recipe for bran 
 gems, which, she says, have proved efficacious in cases of constipation of 
 long standing: 
 
 Two cups of clean wheat bran, a little salt, one cup of graham flour, 
 one cup of sour or buttermilk, one teaspoonful of baking soda, six table- 
 spoonfuls of molasses. Add chopped figs or raisins to taste. Mix thor- 
 oughly and bake in gem pans twenty or twenty-five minutes. This 
 quantity should make not more than twelve nor less than eight gems. 
 Eat one, two, or three a day, as necessary. 
 
 Baked Beans Good Food. — A reader from Crown Point, Ind., writes: 
 "Should foods that are difficult to digest, such as baked beans, be in- 
 cluded in the diet of the ordinary person? Or should the diet consist 
 entirely of easily digested foods? Is it possible for a person to chew 
 his food too much?" 
 
 Reply. — 1. Baked beans is a good food, easily digested and highly 
 nutritious. Anyone with whom it disagrees should leave it off his bill 
 of fare. 
 
 2. Practically, no; theoretically, yes. 
 
 Dried Fruits. — E. N. writes: "1. Do dry fruits tend to cause con- 
 stipation? A doctor advised one troubled with constipation to avoid 
 dry fruits. Would you so advise? 2. Why is whole wheat flour more 
 healthful than fine white flour?" 
 
 Reply. — 1. No. If you cannot get plenty of fresh fruit eat an 
 abundance of dry fruit. Keep it up until May. 
 2. Has more bran in it. 
 
 Value of Oysters. — C. S. P. writes: "In making an oyster stew 
 what is the minimum amount of heat required to render the oysters safe 
 from any danger of infection? Why are oysters so insipid and tasteless 
 as compared with a few years ago? What is their food value, by weight, 
 as compared with lean beef or milk?" 
 
 Reply. — 1. A temperature of 120° continued for twenty minutes will 
 kill the typhoid germ that may be found in oysters. 
 
 2. The taste and succulence of oysters depends upon the kind, quality, 
 and quantity eaten. After eating a considerable quantity of oysters, at 
 frequent intervals, the relish for them is lessened, and the palate per- 
 haps is not so appreciative. We have not heard anyone else complain 
 that oysters are more insipid than they formerly were. Maybe you have 
 been unlucky in getting tasty ones. 
 
 3. A pound of oysters in shell has a fuel value as food of 235 calories. 
 
504 FOODS 
 
 A pound of lean beef of the various cuts has an average fuel value as 
 food of about 850 calories. 
 
 Candy Concentrated Food. — 17. G. writes: "Would a bar of choco- 
 late a day injure me in any way? What benefit is candy to a person?" 
 
 Keply. — 1. No. 
 
 2. Candy is concentrated food, particularly heat-making food. It is 
 bad for diabetics, and also for those who are overfat. If a man has 
 trouble in keeping from overeating, a little candy half an hour before 
 eating will take some appetite away. Banquets arranged on a gor- 
 mandizing basis would do less harm if candy, instead of cocktails, were 
 served fifteen minutes before each meal. 
 
 Cottonseed Meal. — R. S. H. writes: "I have been informed that cot- 
 tonseed meal is prepared the same as evaporated corn. The seed is first 
 steamed for an hour under pressure of 120 pounds to remove the phos- 
 phoric acid and soften the hulls. Then it is thoroughly dried by being 
 heated with air passing over pipes at a temperature of 850 degrees. 
 It takes about half an hour of this treatment, and, when cool, the seed 
 can be ground into meal. There is another plant which has a very high 
 protein content which makes an excellent soup or salad. It is the hudzu 
 vine, which grows on thousands of porches through the Middle West. 
 As it carries as much protein as beef, or mutton, or chicken, it can be 
 used as soup stock, and in salad will take the place of chicken. Five 
 cents' worth of seed will supply a family with all the plants needed for 
 the summer's use, and, if the leaves and stems are cured and stored in 
 the attic, they can be used all winter for soup slock or with potatoes and 
 onions as a salad. It is a Japanese plant and is said to have carried 
 the Japs through several severe famines during the last few centuries. 
 In the hot moist summers of the gulf states it grows with remarkable 
 rapidity and is extensively used as pasture for stock; but it is too val- 
 uable for stock feed at this time, when there is such a scarcity of protein 
 in the food the poor are forced to consume." 
 
 Reply. — The literature on cottonseed meal and flour which has re- 
 cently come to my attention advises the use of four parts ordinary meal 
 to one part of the cottonseed product. Cottonseed products are of great 
 nutritional value, and it is to be hoped that the objections to them as 
 such have been removed. 
 
 Cottonseed Oil Nutritive. — F. E. C. writes: "Is there any nutritive 
 value to cottonseed oil? The magazines say so much about the adultera- 
 tion of olive oil with this product that it has raised a lively curiosity in 
 my mind. I priced a registered brand of olive oil, and it was 95 cents 
 a quart; then asked for cottonseed oil and vms shown a bottle labeled 
 salad oil. This was 35 cents. Do you recommend olive oil as a part of 
 the daily diet of ordinary people or is it for special cases only?" 
 
 Reply. — 1. Cottonseed oil is just as nutritious as olive oil, but lacks 
 the fine flavor of the latter. 
 
 2. Olive oil, as usually found on the market, is most always adul- 
 terated, containing cottonseed oil. The fraud in this instance is more 
 of an economic and moral issue. It is put up in fancy bottles with 
 gaudy labels and sold as imported. The bad French sometimes displayed 
 
FOOD VALUES 505 
 
 on the labels frequently testifies to the adulteration of the domestic 
 product. 
 
 3. Olive oil may be used as a part of the daily diet with salads. 
 
 Foodstuffs. — J. W. C. of Utah writes : "Nature has provided many ways 
 of keeping well, and probably if all its laws were strictly observed as to 
 body and mind, there would be less work for the doctors. It is said 
 various foods, both animal and vegetable, contain certain chemical ele- 
 ments which are necessary to good health and proper functional opera- 
 tions of the human body. Whether this is true or not I know not. 
 I know that asparagus gives a very decided odor to the urine, whether 
 beneficial or not I cannot say. Fish has been said to provide brain food 
 and strawberries and lettuce iron. I have understood that administration 
 of lime in some form or other to growing children improves their bones. 
 What I would like especially to know is whether there is anything ad- 
 ministered either as a medicine or through elimination from foodstuffs 
 which will retard to any considerable extent the decay or diminution 
 of usual functions of the bones with regard to the nerves; and if so, I 
 would like to know what it is and how administered. In other words, 
 to keep the bones in the condition they are at 50 years of age in status 
 quo as long as possible. The bones of some are 0. K. at 80 to 90 years." 
 
 Reply. — I think it is definitely proved that the claims that certain 
 foods feed certain organs and that by giving certain foods you stimulate 
 the growth or function of certain organs are fallacious. The men who 
 advertise to do these things are quacks. In fact, people having become 
 too intelligent for the old style quackery, the born quacks are exploiting 
 this field. 
 
 This matter of bone foods lends itself to investigation. Stock men 
 have tried it from every angle and they have found there is nothing in 
 it. Of course, absolute lime starvation results in harm, but a certain 
 minimum quantity of assimilable lime having been reached any changes 
 made above that make no difference either way. 
 
 Another field thoroughly explored by the stock men is that of foods 
 to produce milk, particularly cow's milk. What counts is the cow — her 
 inheritance, her digestion, and her health. If she is starved, her milk 
 product suffers with her other functions but, given enough food of proper 
 balance and easy of digestion, her milk is not influenced by varying the 
 articles therein. There are no brain foods or bone foods. 
 
 Water at Meals. — /. writes: "Will you kindly publish the name of a 
 good book on diet, something concise? What is the latest conclusion as 
 to eating meat? I notice you advise drinking water between meals. 
 What ill effect is there from drinking a pint [two glasses'] per meal? 
 What advantage is there in refraining from this and drinking between 
 meals?" 
 
 Reply. — 1. "The Fundamental Basis of Nutrition," by Lusk; price, 
 50 cents. 
 
 2. There is no general conclusion, and there is no machinery for 
 arriving at any. Some writers hold one way and some another. The 
 subject is handled well by Lusk. 
 
 3. A moderate amount of fluids with meals does no harm; it doe* 
 good. Too much retards digestion by overdistending the stomach and 
 oyerdiluting the gastric juice. One pint is not too much. 
 
506 
 
 FOODS 
 
 Tomatoes Not Harmful. — C. P. J. writes: "I have read that toma- 
 toes contain oxalic acid; that they destroy the iron in the blood, and 
 leave the system a prey to rheumatism. I have also read that they 
 contain calomel and should not be eaten to excess. Which is correct? 
 Is it a fact that strawberries are indigestible and unfit for food?" 
 
 Reply. — Someone has given you much misinformation. Tomatoes 
 do not contain any harmful chemical substance. They do not cause 
 rheumatism or destroy the iron in the blood. Strawberries are not indi- 
 gestible. They are not unfit for food. 
 
 No article of diet should be eaten to excess. Some people cannot 
 digest strawberries. Some are poisoned by tomatoes. But the same may 
 be said of milk, eggs, and meat. 
 
 Fruit Acids Weak. — M. T. D. writes: "The statement is made that 
 oranges, four to six a day, neutralize the effects of heavy smoking. Do 
 you agree? It is also said that a whole grapefruit, eaten in the morning, 
 will have a tendency to promote indigestion as to other foods eaten at 
 the same meal, on account of the large amount of acids contained in the 
 fruit. Will you kindly give your opinion?" 
 
 Reply. — 1. No. 
 
 2. Do not agree. The stomach secretion contains a much stronger 
 acid than that contained in grapefruit. Fruit and vegetable acids are 
 weak acids and are quickly changed into substances other than acids. 
 
 FOOD PRESERVATION 
 
 On one occasion Woodrow Wilson, then a candidate for president, gave 
 an opinion on the benzoate question. It will be remembered that Dr. Wiley, 
 making use of a poison squad, had decided that a small dose of benzoate of 
 
 soda eaten each day with the 
 food was harmful. Presi- 
 dents Roosevelt and Taft had 
 not indorsed the opinion of 
 Dr. Wiley as he felt they 
 should and he was attacking 
 them. Thus benzoate became 
 a matter of enough interest 
 to demand an opinion from a 
 candidate for the presidency. 
 Mr. Wilson said that he 
 was opposed to the use of 
 benzoate in food whether Dr. 
 Wiley was right or wrong. 
 His reason was that by us- 
 ing benzoate spoiled or over- 
 ripe products could be pre- 
 served and the consumer would be harmed by them. 
 
 This statement opens up the entire question of preservatives. The 
 same argument has been used against refrigeration. It has been asserted 
 
 Farmers' Bulletin 84, Dept. of Agriculture. 
 
 Fig. 183. — For Sterilizing by Heat, as in Canning 
 Tomatoes. 
 
REFRIGERATION 507 
 
 that some of those who opposed preserving with benzoate were preserving 
 with peppers and spices, and that these substances not only are more harmful 
 than benzoate but also are better preservatives, and therefore permit the use 
 of even worse foods — an important point and an interesting one, especially as 
 women have always used spices to preserve with. 
 
 Professors Hoffman and Evans of the University of Wisconsin have 
 spent some time trying to find out whether spices will preserve and how they 
 compare with benzoate. They found ginger, black pepper, and cayenne of 
 no service. Nutmeg and allspice have some preserving power, but not much. 
 
 Cinnamon, cloves, and mustard are fine preservatives — even better than 
 benzoate. Cinnamon and mustard would preserve even when the amount 
 present did not change the taste much. They took some spoiled tomato 
 catchup and tried the relative powers of cinnamon, mustard, and benzoate 
 to stop further spoiling in it. They found cinnamon the best, mustard 
 next, while benzoate acid was much the least efficient. 
 
 Now, if the manufacturers want to go to school they can learn the art of 
 preserving with cinnamon and mustard from the women folks who prac- 
 ticed it long before anybody ever heard of benzoate. 
 
 It is clear that there are many methods of preserving foodstuffs. 
 Refrigeration is one; sterilizing and canning another. Among the chemical 
 methods are preservation of meat with salt, of hams by cures, of corned 
 beef with pickle, of dried beef with smoke, of tomatoes with spices and 
 oils, and other foods with benzoate, and still others with boracic acid. 
 Any one of them will permit the use of foods that are overripe in some 
 sense. 
 
 What are we going to do about it? I cannot see any other way out 
 of it except a national licensing system, with inspectors in every food 
 factory. The duty of the inspectors will be to pass on the wholesomeness of 
 products that are to be preserved, embalmed, or refrigerated. 
 
 REFRIGERATION 
 
 In ten years the rural population of the United States increased 
 4,000,000, the city population 12,000,000. In Canada the increases were 
 500,000 and 1,200,000 respectively. 
 
 "This movement cityward/' Dr. Mary E. Pennington of the govern- 
 ment service says, "makes development of the art of refrigeration a necessity." 
 
 Dr. Pennington has been studying market eggs all over America 
 for several years and when she speaks on the subject the wise housewife 
 will listen. The woman who lives close enough to the farm to hear the 
 roosters crow and the hens cackle will get the best by using fresh eggs for 
 ten months in the year. The rest of the world had better eat refrigerated 
 eggs. 
 
 The amount of faking in the fresh egg business makes the wooden 
 nutmeg business look amateurish. Even on the farm, July and August "fresh 
 eggs" are frequently "bum." The mowing machine frequently uncovers 
 many an undated nest. In addition, unchilled eggs deteriorate rapidly in the 
 summer heat. 
 
508 FOODS 
 
 Dr. Pennington says: "We have traced eggs less than twenty-four hours 
 old, shipped by express in a hot car nineteen hours, and found them lower in 
 quality when they reached the market than fresh eggs shipped for a six day 
 haul in a refrigerator car." 
 
 And elsewhere — "The summer egg, as it comes now to the packing 
 house, is at best a very unsatisfactory product to ship on long hauls. More 
 and more one finds the packer who is supplied with refrigerator rooms 
 holding back a few carloads of late May or early June eggs to be sent to 
 his clamoring customers in August or September when the egg supply 
 is the worst of the whole year and when the highest grade eggs on the 
 market are those cold stored in the early spring." 
 
 Eggs begin to go stale immediately upon being laid. The rate of de- 
 terioration depends upon the temperature at which they are kept, and in 
 some measure upon how well they were cleaned immediately upon being 
 gathered. The warm pantry of the farmer's wife, the hot store of the country 
 merchant, the hot ride in a hot car, the hot places in which they are kept 
 in the city, all suffice to cause a loss of 10 per cent before the eggs get to 
 the customers. Of course, they go stale continuously after they get to 
 the kitchen, unless they are kept in the refrigerator. This 10 per cent 
 loss referred to only means the loss from decomposed eggs. The loss of 
 freshness of taste cannot be computed. 
 
 When the farmer gathers eggs they should be chilled to as near 40° 
 as they can be. As soon as possible they should be placed in a moist, 
 ventilated, chill room held at 40°. They should go to market in a refrigerator 
 car, iced but not salted. 
 
 If they are not chilled before shipping it will take four or five days 
 to reduce the egg temperature to the car temperature. All the while de- 
 terioration is going on. They should be held at 40° in the stores. Eggs 
 handled in this way will keep for nine months and may even keep longer. 
 Such eggs in the city will average better than city fresh eggs. 
 
 COLD STORAGE 
 
 At one of its meetings not long ago the American Public Health As- 
 sociation received a report from its committee on cold storage. At the same 
 meeting Professor Barnard read a paper on "Cold Storage in Eelation to the 
 Food Supply" in the course of which he indicated the nature of a report to 
 be made to the National Association of Food Officials by a committee appointed 
 to draft a model cold storage bill. 
 
 I think the conclusion is justified that these two organizations, national 
 in scope and composed of men and women of character and standing, are in 
 favor of cold storage under proper regulation. Their ideas as to regula- 
 tion are set forth in the report of the public health committee. 
 
 The first three articles of this report I omit, as they do nothing but define 
 "Cold Storage," "Cold Storage Buildings," and "Articles of Food." The 
 others follow: 
 
 "4. No article of food should be placed in cold storage which is not 
 mature, fresh, free from disease, or deterioration of any kind. 
 
COLD STORAGE 509 
 
 "5. It is essential that all foods possessing a temperature favoring some 
 degree of deterioration should be cooled to a proper temperature as rapidly 
 as possible with a view to maintaining it in its natural condition of fresh- 
 ness. 
 
 "6. After placing in cold storage it is essential to successful storage that 
 the temperature and humidity found best for each particular food be 
 maintained as evenly as possible. 
 
 "7. It is further essential that with certain types of food products 
 circulation of air be maintained in the cold storage warehouse, and that 
 an adequate amount of fresh cooled air be introduced each twenty-four 
 hours; or, that the circulating air be passed through some solution depriving 
 it of the volatile emanations of food. 
 
 "8. Every storage warehouse should be constructed of such materials as 
 will not cause organic emanations and in such a manner as will facilitate 
 maintenance in as good sanitary condition as maintained in the most modern 
 plant employing the most modern methods for the preparation and handling 
 of perishable food products. 
 
 "9. The periods of time during which food products should be allowed 
 to remain in cold storage should depend upon their original freshness of 
 condition, the continued maintenance of their optimum cold storage conditions, 
 and on the results of further investigations on each class of food products. 
 
 "10. It is desirable that frozen cold storage food products be raised gradu- 
 ally to higher temperatures varying according to the size and nature of 
 the article of food in order to preserve the tissues in their natural condi- 
 tion. 
 
 "11. Articles of food should not be returned to cold storage which have 
 once been released and raised to materially higher temperatures. When 
 it becomes necessary to transfer food products from one cold storage ware- 
 house to another the temperature should not be allowed to rise to a point 
 favoring deterioration. 
 
 "12. In order both to maintain cold storage foods in the best condition 
 possible and to preserve the credit of cold storage methods it is essential that 
 municipal control of foods placed in retail stores for consumption be of the 
 most practical and scientific character/' 
 
 CONTROL OF COLD STORAGE 
 
 Cold storage is a public servant. Like the railroads, it gets the pro- 
 ducer and consumer within reach of each other. Like the railroads, it makes 
 new producers for consumers and new consumers for producers. Also (but 
 to a much greater extent than the railroads) it scrambles the seasons. It 
 carries winter foods to the people who need them in summer; it admin- 
 isters summer foods to those who in winter are liable to develop ills by reason 
 of the want of them. 
 
 Like the railroads, cold storage needs regulating. When the proposi- 
 tion to regulate railroads was suggested, the railroads were not anxious 
 to have the proposal succeed. The cold storage people have shown no great 
 anxiety for regulation. The railroads now do not oppose some regulation, 
 and some railroad officials want even more railroad regulation than now 
 
510 FOODS 
 
 prevails. Eventually, the cold storage people will ask more regulation than 
 governments will feel like giving. Many railroads were subsidized. Canada 
 and Argentina are subsidizing certain of the cold storage equipments of 
 their country. 
 • So much for the industry side of the question. 
 
 Sedgwick of the Massachusetts Institute of Technology comes out 
 strongly for cold storage from the health standpoint. He says : 
 
 "I believe that by cold storage today, rightly supervised by boards of 
 health, as it should be, the public health has been and will be immensely 
 promoted/' 
 
 To the use of cold storage food Sedgwick ascribes much of the credit 
 for the practical disappearance of scurvy. 
 
 "In the past, without cold storage, the public health was endangered 
 by the temptation to use food that had not been properly kept and by 
 the lack of sufficient variety at certain seasons." 
 
 Professor Barnard, food and drug commissioner of Indiana, agrees with 
 Professor Sedgwick. However, he is anxious that cold storage laws should not 
 pass until pure food and sanitary food laws are in efficient operation. He 
 says: "The committee of the National Association of Food Officials is unani- 
 mous in its belief that cold storage legislation should not antedate pure food 
 and sanitary food legislation, but rather should follow and supplement it." 
 
 ICE BOX ODORS 
 
 The ordinary household ice box is usually neglected. People proceed 
 upon the theory that the temperature of the ice box being low everything 
 about it will be sanitary and healthful. There is truth in this opinion, 
 but the little truth in it is overworked. Food will spoil in an ice box but the 
 spoiling proceeds more slowly than at room temperature — so slowly, in fact, 
 that the food is usually consumed before spoiling time has come around. 
 Nevertheless, food absorbs ice box odors and, although that does no harm, it 
 does no good, and nobody relishes the idea. As a rule, ice boxes smell or can be 
 smelled. Sometimes the former way of putting it better expresses the ag- 
 gressiveness of the odor. 
 
 Ice box drain water has a temperature of 35° to 55°, and slimes, molds, 
 and some bacteria grow well at that temperature. The jellylike masses of 
 slime commonly found in the refrigerator drain is a vegetable, low temperature 
 growth. The odor from this cold water growth goes into the refrigerator. 
 Sometimes refrigerator drains are connected, without traps, with the sewers 
 and sewer odors travel up the pipes to the refrigerator. 
 
 In addition, the slow bacterial and chemical changes in cold food 
 generate odorous gases. In the ordinary household refrigerator these gases 
 flow out when the door is opened. In the large business establishment 
 refrigerator, door ventilation is far from being enough. Their refrigerators 
 never smell perfectly sweet. 
 
 But the reader is more interested in the cure. 
 
 The cure for slime in the drains is to rod them out, wash them out 
 with ammonia, and then with a chlorinated lime wash. 
 
ICE BOX ODORS 
 
 511 
 
 The washing must be done periodically since nothing prevents the slime 
 from growing. 
 
 The remedy for the odors in the refrigerator proper is periodic airing 
 and sunning. Antiseptic and deodorizing washes only temporize. Once 
 every so often the entire outfit must be thoroughly washed out with ammonia 
 water or soap and water, dried, and then so placed that the sun can shine 
 into the interior for several hours. 
 
 If the household has no ice box, one can be made from a soap box, a tin 
 
 IN. i.UMB£« 
 
 VENTILATING 
 SPACES %IN 
 
 ■>SN££r3 OT /V£WS f>Af£4 
 ' S*££T or wst/rE TABL£ 
 OIL CLOTH 
 
 SIDES, ENDS ANO BOTTOrl 
 OF INSlOE 0£ WOODEN BOX 
 LINEO WITH HIDE fir SCHICK. 
 
 SPACS AfOl/nlD Z/NC TANK 
 
 to &£ jt/lleo r\/*o packeo r/c#r 
 
 WITH S-/NE WOCO SfMVWCS . 
 
 Health Bureau, Rochester, New York. 
 Fig. 184. — Rochester Homemade Ice Box. 
 
 can, a few newspapers, and some sawdust. To make this homemade ice 
 box follow these directions : 
 
 Take a soap box or fruit packing case. In this is placed a tin pail 
 surrounded with a sheet of tin bent in circular form which makes an air space. 
 Between this and the walls of the box pack sawdust. Place a pail in the 
 circular chamber, place the milk bottle in the pail and pack ice round the 
 bottle. Fold a dozen thicknesses of newspaper the size of the box and place 
 over top with the lid. The cost for ice for a box of this kind would be 
 but a few cents a day and will keep the baby's milk cool. The box as here 
 
512 FOODS 
 
 suggested is practically that known as the Hess ice box, and is furnished 
 by the Department of Health, New York City. 
 
 The Chicago Health Department gives away a "Save the Baby" circular 
 in which are directions for making this ice box, directions for home pasteuriz- 
 ing milk and a great deal more of valuable information. 
 
 Refrigeration. — J. K. A. writes: "1. Is one and a quarter inches of 
 granulated cork enough insulation in a refrigerator? , 
 
 "2. What should he the temperature in a first-class refrigerator? 
 
 "3. What sort of insulation is best? • 
 
 "Jf. Which is the better, a refrigerator made of metal or one made of 
 wood? 
 
 "5. What lining is best?" 
 
 Keply. — 1. No. Three inches is little enough; four is better. 
 
 2. 45° or under. 
 
 3. Corkboard. 
 
 4. Metal is a better heat conductor than wood. A metal refrigerator 
 will require more insulation than one of wood. 
 
 5. The lining should be metal, porcelain, glass, enamel, or some other 
 easily cleaned, dirt-showing substance. 
 
 To Cleanse Refrigerator. — M. writes: "My refrigerator has an odor, 
 although I think I keep it clean. Can you tell me how to get rid of 
 the odor?" 
 
 Reply. — Empty and scrub ail parts inside with soap and water. 
 Then sprinkle with chlorid of lime and add enough water to make a 
 paste. Scrub thoroughly with this paste and then rinse thoroughly with 
 boiling water. Put some of the chlorid of lime in the pipes and pour 
 some boiling water through them. Then leave open for twenty-four 
 hours, sunning if possible. 
 
CHAPTEE XXIX 
 
 Milk 
 
 COW'S MILK 
 
 Cow's milk enters largely into the food supply of the present day. Its 
 products — butter and cheese, condensed milk, malted milk, and ice cream — 
 are among the staples. It is used in the culinary department of every house- 
 hold in many ways. Its most important use as a food is in the raw state 
 and especially by children. 
 
 Any criticism that applies to raw milk as a food for children applies 
 also to adults but in lesser degree for with adults it rarely is the sole article 
 of diet at any meal and in any evil event adults are better able to withstand 
 the harm it may do than children are. 
 
 It is claimed for cow's milk that it is a natural human food; that it 
 contains the necessary elements of nourishment ; and that it is easily digested 
 and is especially commended in the diet of children. 
 
 These ideas of milk gained currency in the days when practically every- 
 body kept his own cows, when the milk was obtained twice every day and was 
 consumed while it was fresh. It was not then necessary that any of it should 
 be more than twelve hours old and much of it could be used before it was 
 two hours old. 
 
 City dwellers rarely get their milk now before it is twenty-four hours old. 
 Some of it is not used before it is seventy-two hours old and sometimes it is 
 still older. m 
 
 Nature provides that milk go direct from the mother to the offspring 
 without exposure to the air or to any contamination and without change of 
 temperature; and it may be laid down as an elementary principle that the 
 nearer we keep to nature and its methods the nearer we are to being right. 
 
 Bacteria grow and multiply in cow's milk at room temperature with great 
 rapidity. In addition to the filth bacteria of the barnyard, milk may become 
 infected with the germs of contagious disease. 
 
 The older the milk the greater has become the increase of the infection; 
 and the larger the dose of such infection the more certain is the development 
 of the disease in the victim who drinks it and naturally the more virulent the 
 attack will be. 
 
 If the milk be consumed within a few hours after the milking time 
 and before any germ has had time to multiply the disease may be escaped; 
 or if contracted the chance of recovery will be greatly increased. 
 
 Epidemics of typhoid fever and scarlet fever have been traced directly 
 to the milk supply where persons suffering from these diseases handled the 
 milk and infected it at the dairy. 
 
 513 
 
514 
 
 MILK 
 
 Cow's milk begins to deteriorate as to its digestibility and wholesome- 
 ness from the moment it has been exposed to the air. Under the best methods 
 of production it has caught up from the air from 300 to 1,000 bacteria to 
 each teaspoonful. In twenty-four hours, unless checked by cold, they have 
 multiplied to 1,000,000 or even more to the teaspoonful. 
 
 Many of these germs are the bacteria of stable manure and when taken 
 in large numbers are irritating to the stomach and intestines of infants. 
 
 They cause vomiting and diarrhea, a disease of children which is com- 
 monly called "summer complaint.-" It is highly fatal in hot summer weather 
 and occurs in the bottle-fed more or less all through the year. 
 
 AGE OF MILK 
 
 For six hours after cow's milk is drawn bacteria do not grow readily in 
 it, which indicates that until it is six hours old it has some power to retard 
 
 the growth of germs. 
 After milk is six hours 
 old the bacteria multiply 
 hour by hour in increas- 
 ing ratio until it becomes 
 sour. 
 
 The exact age at 
 which milk becomes sour 
 to the taste depends upon 
 the amount of dirt bac- 
 teria that get into it at 
 milking and its tempera- 
 ture. 
 
 In summer heat it 
 may sour within twenty- 
 four hours. If it is clean 
 to start with and if it is 
 speedily reduced in tem- 
 perature to 50° Fahren- 
 heit or below and con- 
 stantly kept at that tem- 
 
 New York Health Dept. 
 
 Fig. 185. — Straus Home Pasteurizer. 
 
 perature it will keep from souring for several days. 
 
 It must, however, be kept in mind that long before it is sour to the taste 
 it is dangerous for children's diet. As the uncountable generations of bacteria 
 multiply, live, and die they consume much of the nutrient principle of the 
 milk and leave the useless, if not toxic, properties of their dead still in the milk. 
 
 Such milk is less nourishing for adults and to expect a child, with its 
 delicate digestion, to thrive when fed with it is wholly irrational. 
 
 As milk stands the cream rises and it can never again be mixed as com- 
 pletely as it was originally. This is an additional reason for using it fresh. 
 
 Consumers of milk must learn that poor milk or cheap milk is worth 
 nothing as an article of diet. It is even worth less than nothing for it cer- 
 tainly will disarrange a delicate stomach while new, fresh milk produced 
 under clean conditions from healthy cows is of priceless value if used as an 
 article of diet for the young. 
 
COW'S MILK 515 
 
 Six-hour-old milk is worth very much more than twelve-hour milk. 
 Twelve-hour milk is worth double that of forty-eight-hour milk; while milk 
 more than forty-eight hours old is not fit diet for children except that it be 
 produced and constantly kept under the most favorable conditions. 
 
 AS INFANT DIET 
 
 Milk in nature is infant diet only. Not alone is this true of man but 
 throughout the animal kingdom. As the young grow the teeth appear and 
 they should be used on solid food. Liquid food may be a useful adjunct 
 but it should not predominate. 
 
 Physicians sometimes prescribe milk for adults; but it may be pointed 
 out that in patients sick with typhoid fever (where a milk diet has had its 
 greatest vogue with physicians) the infant conditions in some particulars are 
 again set up — the patient is helpless and partakes of no other food. 
 
 Even in the treatment of this disease medical opinion is changing and 
 milk as a sole diet has fewer advocates than formerly. 
 
 Milk is repugnant to many people and often is quite indigestible in both 
 young and old even at its best. 
 
 MILK PRODUCTION 
 
 As a substitute for mother's milk in the feeding of infants fresh pure 
 cow's milk modified in strength to suit each child stands at the head of the 
 list of infant foods. For this reason the character of a city's milk supply is 
 of vital importance and every effort should be put forth to reduce the hours 
 between the milking time in the country and the time of delivery to the 
 consumer in the city. 
 
 In modern dairies the cows are almost wholly stall-fed all through the 
 year. They are permitted to graze as a rule for two or three months in the 
 year, but dairymen do not attach much importance to the value of grass as 
 food for milk cows. 
 
 The balance of the year the cows are stall-fed and are turned into a 
 paddock every day for air and exercise — and this seems to answer every 
 purpose. 
 
 There is a growing feeling among dairymen that grazing is not advan- 
 tageous to the herd from the food standpoint and that grazing is the least 
 profitable use for arable land. 
 
 If it ultimately be demonstrated that cows can get along healthfully 
 without grazing the dairies may be moved nearer to or even within the limits 
 of the city. 
 
 If this were done it would permit of delivery to consumers twice a day. 
 Milk then would never be more than twelve hours old and it would permit 
 of delivery within three or four hours of the time of milking. 
 
 MILK TRANSPORTATION 
 
 The milk of cities is produced mostly within a radius of fifty miles. The 
 milk of the night before and that of the morning are brought to the railroad 
 station in the forenoon. 
 
70 percent of city babies get their 
 food through a tube 60 miles long. 
 
 It takes about 36 hours — often 
 42 hours — for the milk to run from 
 the cow end of the tube to the 
 baby end of the tube. 
 
 This tube is open in many places 
 and baby's food is frequently pol- 
 luted. It is often wrongly kept in 
 overheated places. 
 
 Then there may be a diseased 
 cow at the country end of the tube. 
 
 And Yet Some People Wonder Why 
 So Many Babies Die ! 
 
 On the other hand the mother- 
 fed baby gets its milk fresh, pure 
 and healthful — no germs can get 
 into it. 
 
 To Lessen Baby Deaths Let Us Have 
 More Mother-Fed Babies. 
 
 You can't improve on God's plan. 
 For Your Baby's Sake— Nurse It! 
 
 PRE5H W. **- 
 
 J 
 
 Fig. 186. 
 516 
 
 Chicago Health Department. 
 
COW'S MILK 
 
 517 
 
 The milk reaches the city between noon and three or four o'clock in the 
 afternoon and is delivered to the consumer the following morning. 
 
 Half of the milk, then, is twenty-four hours old and half thirty-six hours 
 old before it reaches the consumer and, as there is but one delivery a day, 
 half of the milk is forty-eight hours old and half is sixty hours old before 
 it is used and before the next delivery is made. 
 
 Such delay in shipping milk so short a distance is unpardonable in this 
 day and age and it is* death to the babies. 
 
 Shipping milk by steam railroads is altogether too clumsy a method. 
 Electric lines could do better. They can make as much speed while run- 
 ning as the steam roads and by running over the city's system of passenger 
 transportation they could deliver the milk at widely distributed points in 
 the city. 
 
 While the electric lines were hauling milk they could haul in addition 
 eggs and garden truck and other things that are only at their best when 
 fresh. 
 
 CITY DELIVERY OF MILK 
 
 So long as there is but one delivery of milk a day from the country there 
 is not much sense in hauling milk twice a day to the consumer. The milk- 
 man properly argues that there is no gain in bringing back to the consumer 
 the same milk that he had at his door in the morning. 
 
 HtRLb A Cheap Home-Made: let Box 
 
 CotX 30 cer?t6 ; Ice, 2 centt pef db^ 
 
 Department cj VjefcltK Cb«ca$c>^ 
 
 Fig. 187. 
 
 His argument cannot be disputed when the consumer owns an ice box, 
 but it is another story in the homes of the poor who cannot afford the luxury 
 of an ice box. A twelve-hour supply cannot be cared for without ice during 
 the hot months of the summer. 
 
 If we are to have but one delivery a day why not have the milk delivered 
 in the evening instead of in the morning? That would put the milk into the 
 hands of mothers twelve hours earlier and add mightily to the chances of 
 the babies. 
 
 It would have other advantages. The delivery wagons in large cities now 
 start upon their routes at the unearthly hour of two o'clock in the morning 
 and are through in time to go to the railroad station to remove the fresh 
 
518 MILK 
 
 supply from the cars and haul it to the depots of the dealer. Everybody then 
 rests while the milk goes on aging until the following morning. 
 
 It would be more sensible to deliver the milk in the afternoon and eve- 
 ning when the household is awake to take care of it instead of putting it on 
 the doorstep at two, three, four, and five o'clock in the morning to freeze and 
 break in the wintertime or sizzle and rot in the morning sun of the summer. 
 
 It would be worth something to the sick, suffering, and sleepless ones 
 to be rid of the noise of the rattling wagons in the early morning hours. 
 
 One naturally wonders why the delivery wagons should not meet the 
 trains at the depot when they arrive from the country and start at once with 
 the milk to the consumer. Why should it be loaded on the wagon, hauled to 
 a depot, allowed to rest twelve hours or more, and then be reloaded again 
 for delivery? 
 
 One more item of error in the delivery of milk is that of too many dealers 
 with interlacing territory for delivery. One may see the wagons of half a 
 dozen different dealers deliver milk in the same block. 
 
 Upon whom does all this delay and extra cost fall ultimately? It falls 
 upon the helpless infants. 
 
 The trouble with the whole retail milk business is that it is gauged upon 
 the culinary needs of milk and is not sufficiently considered from the standpoint 
 of the babies' welfare. 
 
 INDORSED MILK REPORT 
 
 The American Public Health Association indorsed the report of the Milk 
 Standard Commission of the New York Milk Committee. It had been 
 rumored that there was to be opposition to the adoption of this report. The 
 International Milk Dealers' Association sent a representative to the meeting 
 and he traveled there in company with certain men known to be opposed to 
 adoption of the report by the association. 
 
 When the report came up for consideration it was opposed by two speak- 
 ers. One declared himself in favor of the principles of the report though he 
 was not in favor of certain details. His objection was to the precedent estab- 
 lished by the action. 
 
 For many years the laboratory section has been getting out standards. 
 Being reports on laboratory methods by the laboratory section they had never 
 gone into administrative methods. They had covered such standard methods 
 as those for the analysis of water, air and milk. The public health officers' 
 section had never reported any standard methods. In consequence the asso- 
 ciation had not gone on record in recent years as approving any administrative 
 method. 
 
 The second speaker objected to allowing the sale of grade C milk. Grade 
 C milk is milk for cooking purposes. It is allowed to contain one million 
 bacteria before pasteurization. In cities where the milk is more than a day 
 old before it is delivered a large percentage of the milk is grade C. 
 
 If this milk is not allowed on the market the supply will be far less than 
 the demand and the price of milk will be doubled. The report allowed this 
 milk to be used for certain purposes after being properly pasteurized. 
 
 These were the only two speakers against the report. The Association, 
 
MILK STORE SCORE CARD 519 
 
 having listened to the objections, voted to approve the report. The American 
 Veterinary Association had approved it the week before. It is very much to be 
 hoped that the International Milk Dealers' Association will approve it when 
 it meets in December. 
 
 After some years of talk the authorities adopted chemical standards for 
 milk several years ago. At first the milk dealers opposed those standards 
 because they did not know much about buttermilk percentage ; they knew the 
 farmer did not and, all in all. they did not see how they could conform. 
 Xow every up to date farmer has his hand Babcock and knows about the 
 chemical standards. He has found that they are the very backbone of the 
 business. 
 
 After many years of talk it is now proposed to establish sanitary stand- 
 ards. The way to measure the fat of 'milk was a chemical-mechanical test 
 known as the Babcock. The way to judge of whether the milk is clean, fresh 
 and cold is by the bacteriological test. The dealers are somewhat afraid of 
 it as they were a generation ago of the fat test. In time it will be the salva- 
 tion of the business. Standards should be expected to advance at least one 
 step in a generation. 
 
 MILK STORE SCORE CARD 
 
 The Department of Agriculture does not think bulk milk should be sold. 
 By bulk milk is meant milk that is shipped or hauled into town in cans 
 and then, without being bottled, is loaded into wagons or kept in stores. 
 When the customer buys a few cents' worth the dealer dips into the can with 
 a ladle and fills a bottle brought by the customer. This latter part of the 
 custom is responsible for the name, dipped milk, by which the commodity 
 is known in some towns. 
 
 The Department of Agriculture has found that bulk milk means dead 
 babies. Milk is too delicate. It will not keep when the dealer is constantly 
 taking the lid off and dipping the ladle in. The milk, started bad, is made 
 worse by the dirty bucket or bottle into which it is put and the warm room 
 in which it is kept. 
 
 The agricultural department has watched thousands of babies indirectly 
 for years and it knows. But the poor woman who has watched but one or 
 two babies does not know and she has no way of finding out until it is 
 too late. 
 
 Knowing that the selling of bulk milk in stores cannot be stopped at 
 once the department has compiled a score card for use in such stores. It 
 describes this card in Circular Xo. 217, Bureau of Animal Industry. 
 
 The dairy farm score card started with a score card devised by Health 
 Commissioner Woodward of Washington. It has been perfected and pushed 
 by the Department of Agriculture until it is in general use all over the 
 country. 
 
 The milk store score card cannot be so effective but while a town is 
 accumulating public sentiment against dipped milk its use will help to keep 
 the death rate down. 
 
 On the score card 100 is perfect. If the utensils are steamed and thor- 
 oughly cleaned and kept so the fact counts 20. If the store is properly 
 
520 MILK 
 
 equipped to clean and sterilize the utensils it counts 15 — a total of 35 for 
 
 utensils that are right. A good ice box counts 10 ; cleanliness of the ice box, 
 3; placed on ice as soon as received, 5; temperature of milk below 50°, 10; 
 51° to 55°, 8; 56° to 60°, 5; 61° to 65°, 2; a total of 28 for proper attention 
 to cooling. 
 
 The remaining thirty-seven points are divided between items of lesser 
 importance. Screening and freedom from flies gets a total of 9 ; so that the 
 building, the attendant and a few miscellaneous items divide 28 between 
 them. 
 
 In Boston 45 per cent of the dipped store milk contained over half a 
 million bacteria. In St. Paul the average count of the dipped store milk was 
 over 8,000,000 bacteria. 
 
 The Department of Agriculture thinks that where its score card is used 
 the bacterial counts of dipped milk will decline. 
 
 HOW BAD MILK DOES HARM 
 
 How good milk does harm is another story. This one relates to bad 
 milk. Unfortunately good and bad milk look much alike, smell much alike, 
 taste much alike and act much alike on many of those who drink it but 
 differently on others. Men differ greatly in their susceptibility to disease. 
 
 Nobody tries to judge of milk by its looks. AYhen we come to the taste 
 and odor the dealer habitually, and customers occasionally, make use of this 
 method of judging. 
 
 Most of the milk odors and flavors are of stable origin — but the people 
 have acquired a stable palate. When a pure milk (and therefore an odorless 
 and almost tasteless milk) is introduced the public palate must be reeducated. 
 The odor and flavor test is not much help in determining the wholesomeness 
 of milk. 
 
 This is what is meant by varying susceptibility : If one hundred grown 
 people were to drink a quantity of tuberculous milk, few of them would contract 
 tuberculosis. If one hundred children were to drink from the same milk 
 many of them would get abdominal tuberculosis. If the germ in the milk 
 were that of scarlet fever or diphtheria, the difference between the sickness 
 rates of grown people and the children would be greater still. When it comes 
 to typhoid fever the shoe would be on the other foot. It is in the disease 
 known as summer complaint that the greatest difference lies. 
 
 Every now and then we read of a picnic party being poisoned by ice 
 cream. In such cases at least 80 per cent of the party is poisoned; few 
 escape because of immunity. 
 
 The milk poison which harms babies is much more subtle. It misses 
 all of the grown people and even many of the babies. If a mother concludes 
 that because the milk has not made her baby sick it has not made other babies 
 sick or that it may not make her baby sick next week or that it is good 
 milk for all time she will be in error frequently. If she is to protect the 
 health of her baby she must be constantly vigilant. 
 
 The most important quality to watch for is freshness. Where the cow 
 is kept on the lot or the milk is bought from a neighbor little watching is 
 
CERTIFIED MILK 521 
 
 needed; but when the cows are in one state and the babies in another and 
 all sorts of trains, wagons, and people in between, getting fresh milk is 
 difficult. 
 
 In some towns all of the dealers and in Chicago some of the dealers 
 stamp or write the day of the week on the cap of the milk bottle. I wonder 
 if consumers always look for the date on the cap and I wonder how many 
 refuse to take a bottle on Tuesday because it is stamped "Monday." Milk 
 may be thoroughly wholesome on Monday and by Tuesday be bad enough to 
 knock down one of every ten babies who drink it. 
 
 Taking it all in all the milk which does most harm is that which is not 
 quite fresh enough to be good for all the babies who drink it and yet is too 
 fresh to harm all — dangerous but not showing it. 
 
 CERTIFIED MILK 
 
 "Certified milk is the product of dairies operated in accordance with 
 accepted rules and regulations formulated by authorized medical commissions 
 to insure its purity and adaptability for infants and invalids." 
 
 This is the opening paragraph of the report on methods and standards 
 for certified milk adopted by the American Association of Medical Milk 
 Commissions and published as the June 14, 1912, report of the Public Health 
 and Marine Hospital Service. 
 
 The steps to be taken by a community to get certified milk are as follows : 
 
 "Sanction for a commission with the right to use the word 'certified' 
 is to be had from the above named association through its secretary, Dr. 0. P. 
 Geier of Cincinnati. 
 
 "The commission having been formed, it may receive applications from 
 any who desire to enter into contract with them. 
 
 "The commission investigates the applicants and decides whether or not 
 any or all of them are equipped to produce milk up to the certified standard. 
 With those that pass they then enter into contract. 
 
 "The commission contracts to allow the milkmen contracting to use the 
 
 label, 'Certified by medical milk commission/ and to provide for such 
 
 inspection as is provided for in the contract. 
 
 "The milkmen contracting agree to live up to the ninety-seven require- 
 ments of the contract and to pay the cost of the required inspection service. 
 
 "The ninety-seven provisions of the contract relate to the milk, the herd, 
 the helpers, and stable and milkhouse hygiene. Some of them are: 
 
 "The milk must be fresh — less than thirty-six hours old. 
 
 "It must be cold — under 45 degrees. 
 
 "It must be clean. 
 
 "It must have a low bacterial count — less than 10,000. 
 
 "It must be produced from cows proven free from tuberculosis by the 
 tuberculin test, and otherwise healthy as certified by a veterinarian. 
 
 "The cows must be properly housed in sanitary barns. 
 
 "The handling of the milk must be by clean, healthy men employing 
 clean methods." 
 
 In order that these results may be accomplished there must be a corps of 
 
522 
 
 MILK 
 
 bacteriologists, physicians, veterinarians and inspectors and these must make 
 systematic inspections at short intervals. 
 
 The requirements of the contract are set forth in great detail. 
 
 With this report as a manual a certifying commission will know just 
 what to do. The purchaser of certified milk should read this document 
 that he may know what he has a right to expect when he buys this milk at 
 double the market price. 
 
 Milk made by men holding such a contract is entitled to the confidence of 
 the community. Those who seek to cheat in the use of the term "certified 
 milk" are not entitled to such confidence. 
 
 CLEAN MILK 
 
 "All is not gold that glitters." Not all white substances are clean. The 
 cleanest appearing of all foods — virgin white milk — is the dirtiest of all foods. 
 One can eat a good deal of dirt with safety if it has been cooked but raw 
 dirt is dangerous. If one can eat a peck of dirt with safety it must be 
 cooked dirt. 
 
 Dirt gets into milk from the milkers hands, from the cow's udder, from 
 
 nV 
 
 flys? 1 1 &&k 
 
 A GOOD 
 MILK PAIL 
 
 Chicago Health Dept. 
 
 Fig. 188. 
 
 Fig. 189. 
 
 the swish of the cow's tail, from the milk pails and milk cans, from the air 
 of the stable and from any faulty handling after it leaves the farmer. 
 
 Simple procedures are all that are necessary to keep the dirt down to 
 small proportions. They are clean hands, clean udder, and clean pails and 
 cans. 
 
 Clean hands and clean udders require just a little time and some soap 
 and water. Absolutely clean pails and cans require steam under pressure and 
 this will not be available for the farmer unless he can persuade the factory to 
 do it for him. If the factory will sterilize the cans the farmer need not expose 
 them to the dust, air and sun as he must do now to keep them from stinking. 
 
A FLYLESS, ODOELESS DAIEY 523 
 
 There is one other necessity that the farmer should meet and that is the 
 use of the small mouthed milk pail. 
 
 A consumer who uses milk from a small dealer can form a fair idea of 
 the cleanliness of milk production by looking for dirt in the milk at the 
 bottom of the bottle. The consumer who buys milk from a large dealer cannot 
 judge by this method because it is the custom among large dealers to filter 
 the dirt out before bottling the milk. 
 
 Even a better method is to filter a pint of milk. Milk will filter slowly 
 through ordinary filter paper particularly if it is well warmed. It will filter 
 better through a pledget of absorbent cotton placed in a funnel. The dirt 
 left behind will show up plainly on the paper or the cotton. 
 
 One of the most effective procedures used by the Chicago health depart- 
 ment is the dirt test applied on the farms, at the factories, in the stores 
 and in the streets. 
 
 The method is described in its annual report for 1911. It consists of a 
 little filter in which the milk filters rapidly because it goes into a bottle 
 from which some of the air has been exhausted. 
 
 Most of the visible dirt in milk is stable manure. However disgusting that 
 may be the real harm is done by the growing bacteria washed from the stable 
 manure. 
 
 The best test of dirt is the bacterial count. If fifteen drops contain less 
 than 10,000 bacteria the milk is, and has always been, clean. If more than 
 10,000 and less than a few hundred thousand it is, and always has been, 
 moderately clean. If in the millions it is, or has been, dirty. 
 
 A FLYLESS, ODORLESS DAIRY 
 
 For a number of years the big, husky boys at the Annapolis Naval 
 Academy had a good deal of bowel trouble from time to time. Several epi- 
 demics of typhoid fever occurred. Paymaster Bryan investigated and came 
 to the conclusion that milk was the cause. He made his recommendation 
 on that basis. He was turned down. Even the medical staff would have none 
 of it. 
 
 In 1910 a pretty fair epidemic of typhoid occurred. An investigation 
 showed that there was a good deal to support the view of Paymaster Bryan. 
 
 The navy department put in its dairy, acting, however, with the advice 
 of the dairy division of the Department of Agriculture. There has been no 
 typhoid since. 
 
 What is remarkable is the drop in "excuses from duty" for minor in- 
 testinal disorders. For instance, the number of days lost for this cause was 
 in April, 1911, 102 ; in April, 1912, 6 ; in April, 1913, 20. 
 
 In no month since the good milk was provided has the time lost from 
 duty been more than one-fifth of what it was before and it is usually only one- 
 tenth. 
 
 Mind you, these are not nursing babies. They are great, husky, resistant 
 men. They each drink nearly a third of a gallon of milk a day. And you 
 would drink milk, too, if you could get it as fresh, as safe and as good as 
 they get it. 
 
WHY? 
 
 Mary 8<?n Sam 
 
 A FLY VISITED AN 
 COLLECT E.0 SOME 
 THEN GATHERED 
 GERMS FR0T1 SAM'S 
 DROWNED IN THE 
 FAMILY DRANK 
 
 OPEN PRIVY AND 
 TYPHOID GERMS. 
 TUBERCULOSIS 
 SPIT. AND LATER 
 MILK PAIL THE 
 THE MILK 
 
 
 ^ A LITTLE LATER PA AND MA AND \ 
 LITTLE BEN BEGAN TO FEEL TIRED 
 
 ALL THE TIME AND TO COUGH A GREAT ) 
 DEAL. JOHN AND MARY CAME DOWN 
 WITH TYPHOID FEVER — — _ 5AM 
 
 DIED-NOBODY CARED, AND 
 
 EVERYBODY AVOIDED THEM 
 
 HOG CHOLERA GERMS GOT INTO T«E 
 PIGS FEED, AND THE HOGS BECAME 
 SICK 8UT NOT FOR LONG HOG 
 CHOLERA SERUM WAS RUSH- 
 ED TO Jntn AND EXPERT VET- 
 ERINARIANS WERE HURRIEDLY 
 CALLED 
 
 THE REfULT 
 
 "** THE RESULT 
 
 State Board of Health, Jacksonville, Florida. 
 Fig. 190. 
 
 524 
 
LA SALLE (ILL.) MILK 525 
 
 The site chosen for the dairy farm was about a quarter of a mile from 
 the hospital. The hospital authorities objected. They said the odors and 
 flies would disturb their patients. Paymaster Bryan and Chief Eawl said : 
 
 "We'll have no flies to disturb your patients but your flies may disturb 
 our cows and infect our milk." 
 
 The dairy went in. There were no flies in the barns when we were there. 
 They say they never have any. 
 
 They bought four dozen fly traps and put them around the barns, the 
 lots and the pastures. Fly traps are easy to make and cheap to buy. 
 
 What perhaps does even better is that everything is extremely clean. 
 There are no odors. No odors being in the air none get in the milk — which 
 is also true of flies. 
 
 The cows are tuberculin tested; they are healthy. The milk is cooled 
 to a little above freezing almost immediately upon milking and it is held at 
 that temperature until it is ready for use. The barn is a, long shed with a row 
 of stalls down each side and a passage down the middle. 
 
 The ventilation and light are of the best. The drainage is so good that 
 the yard does not get muddy. In consequence it is easy to keep the cows 
 clean. 
 
 Things are so clean that there are no flies and, since this is true, the doors 
 and windows may be thrown wide open. No screens are required. This means 
 better air and fewer odors. 
 
 However, these are not the main points. The main points are that clean, 
 fresh, cold, good milk reduces the sickness rate among grown people enough 
 to pay for itself. When people can get high grade, clean milk they will drink 
 a lot of it. 
 
 LA SALLE (ILL.) MILK 
 
 Dr. Greaves of La Salle, Illinois, set out to investigate the condition of 
 milk in Illinois cities ranging from 6,000 to 15,000 inhabitants. He sent six 
 questions to the proper officers. To this circular letter he received twenty- 
 five replies. It is safe to say that the towns which did not reply all belong 
 to the group of nothing-being-done. 
 
 In regard to the twenty-five from which replies were received there are 
 milk ordinances in twelve but there are no efforts to enforce them. In four 
 there were laboratory examinations for percentage of cream but in none was 
 there an examination for dirt. In one there was a biennial visit from an in- 
 spector to the dairies. In the others there were no inspectors. 
 
 It is as a result of such conditions that the statistics show the infant 
 mortality of towns of that size is as high as that of the large cities. In 
 fact, the babies of the people of high intelligence are now much safer in the 
 large cities than they are in the small. 
 
 The milk of the small place has the advantage of being close at hand. 
 It is distributed while still fresh. On the other hand in and around the small 
 place milk production is an on-the-side business, an extra-money, pin-money 
 maker. 
 
 The highest grade city milkman, to whom the sale of milk is his one 
 thought, will do his job so much better than the extra-money producer as to 
 
526 ' MILK 
 
 much more than offset the disadvantage of distance. The highly intelligent 
 parents use milk but only from the highest grade dealers and in consequence 
 their children are safer than the babies of small cities. 
 
 However, it is easy for the people in smaller cities to have good milk if they 
 will go after it. La Salle determined to have good milk. There is a level 
 headed old time moneymaker, Matthiesen, who was willing to lend his brains 
 as well as his money. Within two years La Salle was getting milk that ran 
 below 10,000 bacteria — merely another way of saying the people were get- 
 ting clean milk. Within two years they were subscribing to the following 
 creed: 
 
 "1. That it was not necessary for milk to smell of the cow to be real 
 milk. 
 
 "2. That milk which would never sour was preserved. 
 
 "3. That a certain percentage of the healthy looking cows was tubercular. 
 
 "4. That milk must be cooled immediately after milking and kept cooled. 
 
 "5. That milk could not be successfully delivered in open wagons in ordi- 
 nary cans. 
 
 "6. That the good old family cow might be diseased, and if not milked 
 under sanitary conditions the milk could be as infectious as any dealer's 
 supply. 
 
 "7. That milk carried contagious diseases." 
 
 The school laboratories of any city of 5,000 are all that is needed to secure 
 a clean milk for it. Let the milk brought to it be examined by the pupils 
 for dirt and bacteria and publish the results in the local papers each week. 
 The trick will be turned. 
 
 MILK OF RICHMOND, VA. 
 
 When at meetings of the Milk Standards Commission Dr. Levy had told 
 of the excellent milk of Eichmond, Virginia, the members of the commission 
 had felt like asking the question asked about the hen : "Has she laid or lied ?" 
 So they voted to hold their 1913 meeting at Eichmond to see for themselves 
 what the answer was. 
 
 The milk of Eichmond is produced in dairies licensed by the city health 
 department. They are located about five to fifteen miles from the city hall, 
 outside the city limits. The cows are milked about 5 A. M., and the milk 
 reaches the retailers in town about 8 to 11 a. m. 
 
 The morning's milk is delivered before supper time. The evening milk- 
 ing is done about 2 p. M., and the milk reaches the dealer about 6 p. M. 
 The evening's milk is delivered in time for breakfast the next morning. 
 
 The barns are not expensive as barns go in the Middle West. In fact, 
 from that standpoint they are cheap. They are light and airy and clean. 
 Most of them are of poured cement. All of them have cement floors and 
 excreta troughs. They are all whitewashed and clean. 
 
 The cows were as clean as a dining-room table. The milk is cooled by 
 spring and well water. The temperature of water in that vicinity is 60°. 
 The milk heats up to 70° by the time the wagon gets to the bottling plant. 
 By the time it is three hours old the milk has been chilled to 50° and bottled. 
 
MILK AT SUMMER EESOETS 527 
 
 The bacterial counts are phenomenally low; more than half of them 
 run below the standard for certified milk. A count in the millions is rare. 
 In April the number of counts above 500,000 was but two. 
 
 Of course we expect the raw milk of a large city to run into the millions. 
 There seems no way to avoid it. But the counts of Eochester, New York, a 
 city not much larger and with a larger percentage of wagon-hauled milk, 
 average much more than ten times as high. 
 
 There are but two cities in America as large as Chicago. Its large- 
 ness makes its milk problem different. There are many cities as large as 
 Eichmond. What Eichmond has done Peoria, Lexington, Charleston and 
 Pueblo ought to do easily. 
 
 TJie smaller cities have been content to do little because they have thought 
 the dairy problem was a big city problem. In consequence the dairy division 
 of the Department of Agriculture usually finds their dairies the worst of all. 
 
 They have usually done nothing because the way to do, as written about, 
 is the way to do for the city of a million or more. If they followed the 
 same plan it might not be the proper plan for them. The Eichmond plan is 
 one that fits their needs better. 
 
 The farms are scored on the government score card. They average more 
 than 70 and some of them go as high as 90. When the government sent its 
 inspectors through New England the scores averaged 43. When Mr. Whit- 
 taker would occasionally come through the Chicago district checking the 
 local inspectors he rarely found a farm scoring over 5. Somehow we take 
 it for granted that scores of 80 and 90 never can be attained by any except 
 certified farms. 
 
 MILK AT SUMMER RESORTS 
 
 "The person who contracts typhoid fever as a consequence of drinking 
 city water contaminated with city sewage has a moral, if not a legal, 
 claim against the municipality for damages." 
 
 The above statement occupies the front page of Public Health, June, 
 1912, the bulletin of the Michigan Board of Health. 
 
 The Minnesota Supreme Court held Mankato, Minnesota, liable for the 
 damage done to individuals by typhoid fever due to polluted city water. Eng- 
 lish decisions hold hotelkeepers responsible for damages to those of their 
 guests who have contracted typhoid fever fyom milk. 
 
 The resorter should be as careful to patronize a hotel with a good milk 
 supply as he is to select one with a good water supply. The responsibility, 
 legal and moral, for the safety of the milk supply is the same as that for the 
 water. 
 
 It is easy for most resorts to have good milk. The cow and the consumer 
 can get close together and that makes the milk problem simple. As a general 
 proposition a resort community has no adequate municipal milk inspection; 
 but there is no reason why the proprietor should not have his dairies scored on 
 the government score card and the milk tested in his hotel for dirt, tempera- 
 ture and freshness. These are simple tests. He can put in a fairly satisfac- 
 tory pasteurizer for the cost of a horse. 
 
 He can pasteurize his supply and be certain that he is not making his 
 
528 
 
 MILK 
 
 patrons sick. He can see that his milk is dated. Having taken proper 
 precautions he can advertise the fact. He can post his dairy scores, the 
 results of dirt tests and other data. These things he can do easily. The 
 trouble is little enough and he should do them. It should not be difficult at a 
 summer resort to get clean milk with no dirt in the bottom of the bottle, cold 
 milk less than 50° Fahrenheit, and fresh milk less than twenty-four hours 
 from the cow. 
 
 Now comes the guest's duty. It is his duty to be discriminating, to refuse 
 to patronize a place that does not have clean milk or does not give the facts as 
 they are, and on the other hand, to patronize the proprietor who goes to some 
 
 lfeepD&i}\/6 Milk Clean. m\& Cool 
 
 Uae only 
 
 Good 
 
 Bottled 
 
 Milk. 
 
 Keep The cap 
 onlbe bottle— 
 Keen the 
 
 P 
 bottle m & 
 
 clean, cool place 
 
 NlvLr A llow FIies Near M ilk. 
 HtRtb A Cheiap Hoiy^-Made. let ho/. 
 
 CotX 30 cerrtt,; Ice, 2 cents pef dtoj. ' 
 
 Department <A rlea-ltK Cfotc&go. 
 
 BT 
 
 Department of Health, Chicago. 
 
 Fig, 191. 
 
 f 
 
KEEPIXG MILK COLD 
 
 529 
 
 trouble and expense to have things right and then tells the truth to his cus- 
 tomers. 
 
 If the resorter cannot get good milk he will be moderately safe if he sticks 
 to hot milk — hot milk in his coffee in place of cream, hot milk as a drink 
 instead of cold. It may not suit his taste so well but if he be forced to 
 stay in a dangerous place it will decrease his danger. 
 
 KEEPING MILK COLD 
 
 Fig. 192. — Arrangement of 
 Apparatus for Rapidly 
 Cooling Milk after 
 Pasteurization or Ster- 
 ilization {Kilmer). 
 
 Cow's milk is not fit for baby food unless it has 
 been cooled within thirty minutes of milking and 
 maintained cold until it comes to the baby. Cheap 
 coolers are now on the market. These are to be 
 used by the farmers to chill the milk just as soon 
 as the milking has been finished. 
 
 Unless the farmer uses ice he usually cannot 
 reduce temperature in this way below 60°. Some 
 farm wells and springs, however, run as low as 55°. 
 The milk should be delivered as soon as pos- 
 sible at some central' point where a lower tempera- 
 ture is possible. 
 
 At the different meetings of the Commission 
 on Milk Standards Dr. Levy took the position that 
 milk could be marketed in good shape without ice. 
 
 He thought so because the farmers did 
 not have ice in and around Eichmond, 
 Va., and the Eichmond milk was low in 
 bacteria. When the commission went to 
 Eichmond it learned the reason. 
 /( EfjS^^ v ""^ jf ^^fff The dairymen chill the milk on the 
 
 v^JJ /5M^^^^^^|^9i§§f|3b ' farm with well water. They get it to 
 
 about 60°. They deliver it twice a day 
 (within four hours of milking) at the 
 central plants where it is iced down 
 to 50. 
 
 Eichmond milk is about the best 
 iced milk that we found anywhere al- 
 though no icing is done on the farms. 
 The double daily delivery of milk less 
 than four hours old at the factory makes 
 it possible for the Eichmond dairyman to 
 do without ice and still market good milk. 
 Where milk is shipped into town on 
 cars the custom (where things are done 
 right) is to ship in refrigerator milk cars. 
 The railroads easily meet the require- 
 ment when they have to. 
 Milk in cans on wagons is kept cold by wrapping the cans with wet 
 
 Fig. 
 
 193. — Pasteurization at Home. 
 
530 MILK 
 
 cloths. When in bottles the boxes are packed with ice and wrapped with 
 wet cloths. 
 
 To keep the milk cold from the time of delivery till getting-up time a 
 covered bucket in which some water and a lump of ice is placed the night 
 before suffices. After the milk is taken into the home it should be kept on 
 ice in the ice box. 
 
 Rarely is the temperature of the ordinary domestic refrigerator cold 
 enough to keep the baby's milk. 
 
 Bacteria multiply exceedingly rapidly in warm milk. The multiplication 
 almost stops at 50°. It is extremely slow at 55°. It is slow enough at 
 60° to make it possible to keep milk for a day or more in good enough condi- 
 tion for a baby. At 65° within a few hours the changes are so great that it is 
 too risky for baby. 
 
 WARM AND DIRTY MILK 
 
 Aside from lack of freshness milk may do harm because it has not been 
 kept cold. If baby is to drink milk less than four hours old it does not matter 
 much that it was not chilled as soon as it was milked. But when the cows are so 
 far away that the milk is several days old when it comes to baby temperature 
 does not matter. 
 
 Under such circumstances there is only one plan to follow — the farmer 
 must chill the milk as soon as it is drawn. (The Omaha farmers have 
 cheap, effective milk chillers.) He must keep it cool until he turns it over 
 to the railroad; the railroad must keep it cool until it turns it over to the 
 milkman; the dealer must keep it cool until he turns it over to the house- 
 wife and she must keep it cool until she gives it to the baby. Nowhere, at no 
 stage must it go over 55°. 
 
 And the next point is that milk may do harm if it is dirty. If the 
 housewife will always look at the bottom of the milk bottle she will protect 
 herself against some, but not all, dirty milk. Many milkmen clarify their 
 milk before they bottle it. Some farmers strain it as they milk it and others 
 soon after. Clean cows, clean hands and clean pails standing at one end 
 of the line and clean refrigerators, clean nursing bottles and clean nipples 
 at the other end and everything in between clean is the ideal, though seldom 
 attained. If the milking has not been as clean as it ought to have been 
 straining is better than leaving the dirt in. If milking has been dirty and 
 straining has not been done clarifying is better than doing nothing — but each 
 is far from ideal. 
 
 Certainly, wherever there is visible dirt in a bottle of milk the milkman 
 should be swatted and he in turn should swat the man who passed the dirt on 
 to him. 
 
 There is a way by which the central office can tell whether the milk is or 
 has been dirty or warm or old, or whether in it several of these bad qualities 
 are combined. It is the bacterial count. Milk with a high bacterial count, 
 with large numbers of germs, may do harm. Not all milk which has a high 
 bacterial count will make the baby sick but such milk is that doubly dangerous 
 borderline — good looking, bad acting milk, milk which tastes all right and 
 which does not harm all the babies who take it. That it harms only 10 per 
 
ANOTHER MILK EPIDEMIC 531 
 
 cent of the babies makes it worse for that partial safety throws mothers off 
 their guard. The ninety should stand with the ten in efforts for protection. 
 
 THE GOVERNMENT'S POSITION ON MILK 
 
 Milk has a high bacterial count when it is dirty, or old, or warm. When it 
 is clean there are few bacteria to multiply. When it is cold the bacteria 
 multiply slowly. When it is young the bacteria have not had time to multiply. 
 
 To see that milk is cold inspectors are provided but as these inspectors 
 cannot stand over every milk producer as the meat inspector stands on 
 the killing floor the inspection service needs to be supplemented. 
 
 To see that milk is cold ordinances are passed and inspectors provided; 
 but controlling the temperature by law has proved difficult. 
 
 To watch milk to prevent the sale of old milk has proved difficult. The 
 method worked out to check the man in the field, to make certain that the 
 milk sold is clean, cold and fresh is the bacterial count. 
 
 At this point comes the crucial test. Eight here is to be fought out the 
 battle for standards of wholesomeness in milk. Such standards have been 
 indorsed not only by the national government but by the state and municipal 
 governments — at least by a large number of them. They represent a crystal- 
 lizing, a focusing of all the talk about clean milk. 
 
 These standards are being fought as were the fat standards ten to twenty 
 years ago. 
 
 The Bureau of Chemistry of the Department of Agriculture has just 
 issued a bulletin which sets forth : 
 
 "All statements that the Department of Agriculture has abandoned or 
 will abandon the bacterial examination of milk shipped in interstate com- 
 merce as a means of determining its cleanliness and fitness for human con- 
 sumption are without foundation. While the department has not fixed any 
 specific bacterial count as a standard in the enforcement of the food and drugs 
 act, it does use bacterial examinations in reaching its conclusions, and will 
 continue to use these methods, irrespective of what action any association 
 may take. 
 
 "The only change in the policy of the department has been to discon- 
 tinue basing prosecution upon a bacterial examination of a single specimen. It 
 now collects a number of samples at different times and examines them. If 
 the bacterial examination shows the milk is not clean but is not a serious 
 menace to health, and the bacterial deviation from clean milk is a small one, 
 the department, through the bureau of animal industry, endeavors to teach 
 better methods. If this fails, the department prosecutes the offender/' 
 
 This statement of the position of the national government commends 
 itself as being fair to consumer and producer. 
 
 ANOTHER MILK EPIDEMIC 
 
 In Wakefield, Massachusetts, in February a few years ago, a milker on a 
 dairy infected about 200 people with streptococcus sore throat. The man was 
 
532 MILK 
 
 taken sick with quinsy on February 3. His abscesses discharged within a few 
 days and the man was able to go back to work by February 25. His wife also 
 had a sore throat and cold in the head but she, too, was able to go back to 
 bottling on February 25. 
 
 Cases of tonsillitis among consumers of milk from this dairy began to 
 develop on the evening of February 26. The cases multiplied rapidly from 
 that date to March 4. On March 3 the health authorities discovered the 
 source of infection and took action. 
 
 The number of cases reported declined rapidly from the fourth to the 
 seventh and after the latter date a few cases developed from contact with the 
 existing cases. But it was evident that the source of the infection had been 
 done away with. About two hundred cases of sore throat were brought to the 
 attention of the health authorities in ten days. 
 
 The infected people were not very sick. They had sore throat, head- 
 ache, suppurating ears, quinsy and enlarged neck glands. In some cases 
 the neck glands remained swollen for several weeks. 
 
 The infection did not travel to the abdomen or elsewhere in the body. It 
 remained localized in the head and neck. 
 
 This is noted because occasionally someone asks if milk-borne streptococ- 
 cus infections are not always fatal. They are not. 
 
 The state laboratory found the infecting coccus to be a streptococcus. 
 The field inspectors traced the infection back to one dairy and then to the one 
 milker and his wife. 
 
 What was done? The milker and his wife were made to stop milking. 
 The milk was pasteurized. As the dairyman had no facilities for pasteurizing 
 it was necessary to carry on the process without apparatus. 
 
 The milk was placed in bottles. The bottles were set in a wooden vat 
 which was filled with water to the top of the bottles but not over them. 
 Then live steam was run into the vat until the temperature of the water 
 reached 145°. It was held at that temperature for thirty minutes. 
 
 These two simple expedients stopped the epidemic within two days. 
 
 It never occurred to the milker that he and his quinsy could harm 
 anybody. Yet he did more harm in three days than he will live long enough 
 to offset. 
 
 The average milker knows about as much about the harm that he can do 
 as did this man. It is just this fact which makes so many health officers 
 believe that no raw milk should be sold. The law should require all milk 
 to be pasteurized. 
 
 MILK SOLD IN SMALL CITIES 
 
 If you live in a city of 25,000 and want to know the condition of the 
 milk that is being fed your babies read the report on the milk supplies of 
 Urbana and Champaign (111.) made by Professor Barker of the University of 
 Illinois. 
 
 The twin cities use 1,200 gallons of milk a day. Of this 115 gallons 
 is brought in by interurban cars an average distance of twelve miles, and 
 seventy-six gallons by steam roads an average distance of sixty miles. The 
 
"PLAIN TALK TO CHICAGO MILK PRODUCERS" 533 
 
 remaining 1,000 gallons is produced by small dairies located within ten 
 miles of the university. 
 
 The milk is produced by twenty regular milk producers (possibly entitled 
 to be called dairymen) and by twenty-five farmers who are intermittent and 
 casual milk producers. Two dairies deliver 30 per cent of the supply and 
 seven 70 per cent of it. The report does not say whether milk is delivered 
 once or twice a day. 
 
 The price of bottled milk is ten cents a quart ; of dipped milk, eight. 
 
 A few years ago Professor Rickards persuaded the councils of these cities 
 to pass a good milk ordinance. No provision for enforcing the ordinance was 
 made. No prosecutions have been made. The ordinances are dead letters. 
 This everyone will recognize as about an average situation. And now for 
 the interesting part of the report. 
 
 The university scored most of the dairies on the government score card. 
 The average for twenty of the more permanent dairies was 25.5 out of a 
 possible 100. Professor Parker says: 
 
 "This is believed fairly to represent the state of the average dairy 
 farm in the vicinity. Under such conditions it is difficult to produce 
 milk that is of uniform quality, or even milk that is tolerably clean." 
 
 Professor Whittaker, for many years of the Department of Agriculture, 
 held that milk from dairies scoring 40 should not be a marketable commodity. 
 It was either indecently dirty all the time or else at times was indecently 
 dirty and dangerous ; and there was no way of knowing which were the times 
 of danger. 
 
 An average bacterial count of thirty-seven samples of milk from one 
 dairy was 14,900 ; an average of seventeen samples from another was 453,000. 
 The average counts of three dealers was over 100,000. Nineteen samples 
 from one dealer averaged 664,000; twenty-one from another averaged 
 8,383,000; one sample contained 50,000,000, another 32,000,000, a third 
 27,000,000, a fourth 26,000,000. 
 
 The temperature of the milk ranged from 60° to 75°. The cows are 
 not tuberculin tested. No effort is made to protect the milk from typhoid, 
 tuberculosis, scarlet fever, diphtheria or septic sore throat bacteria. 
 
 The agricultural college of the university has some influence on the 
 neighboring producer. Therefore, Mr. Reader, in a small city consider that 
 the milk fed your children is, say, 10 to 20 per cent worse than that of 
 Urbana and Champaign. 
 
 Milk that has been handled less than ten miles away and that is less 
 than twelve hours old and yet has a bacterial count as high as this has 
 been produced under conditions that are grossly wrong. 
 
 " PLAIN TALK TO CHICAGO MILK PRODUCERS" 
 
 This title we borrow from the Orange Judd Farmer. It heads one of the 
 most sensible articles on the milk situation that has come to my notice recently. 
 While it was written especially for the producers in the dairy district sup- 
 plying Chicago, by leaving out names and incidents and using principles it 
 applies to dairy districts everywhere. 
 
534 MILK 
 
 The readers of the Orange Judd Farmer are farmers; therefore the 
 article properly considers the question from the standpoint of the producer. 
 
 It begins with the agreement that tuberculosis is present in milk cows 
 in increasing amounts; that human beings can be and are infected from 
 drinking tuberculous milk. It says there are two ways of protecting the con- 
 sumer. The best of these is pasteurization. 
 
 If pasteurization in operation could be made 100 per cent perfect and 
 could be applied to all milk the tuberculosis-in-cows question would be 
 exclusively a question of economics and the farmer the person most con- 
 cerned. 
 
 The advice is given the farmers to exercise every bit of influence they can 
 to obtain universal, closely controlled pasteurization. The nearer they can 
 come to obtaining that result the more they will help to eliminate tuberculosis 
 from their herds. 
 
 "Isn't this straight doctrine, milk producers?" the article says. "Get 
 together on the pasteurization proposition and in so doing make the agitation 
 on tuberculin testing unnecessary. Settle later the tuberculin test." 
 
 As to the second part of the above quoted advice they advise the farmer 
 to get the best advice possible. "By sending speakers at $15 per speech 
 who know nothing about the subject to talk about the unreliability of the 
 tuberculin test, the producers are made ridiculous before the public," they 
 say. 
 
 For some years the milk producers have been misled by those who have 
 made money through misleading them. Is it not time now for them to break 
 away from their exploiters and accept leadership from the editors of 
 Orange Judd Farmer, Hoard's Dairyman, and other well informed papers 
 and people? 
 
 TREATING TAINTED MILK 
 
 August is the season for tainted milk. The pastures are dry and the cows 
 nibble at weeds that they do not touch when the grass is good. In conse- 
 quence the cows eat bitter weed, wild onion, and garlic, and about four 
 hours later the odor and taste of the aromatic foods appear in the milk. 
 
 While there is no evidence that these flavors poison children they render 
 the milk less palatable and sometimes they disturb digestion by disturbing 
 appetite. 
 
 I know a physician who holds that the infant diarrheas of August result 
 from certain weeds eaten by cows during that month of poor pasturage. His 
 remedy for the baby illness problem of the great city is a requirement 
 that all milk cows be stabled during the months when cows are apt to eat 
 weeds. This, however, is speculation and the doctor alluded to does not 
 claim to be able to prove his point. 
 
 The Department of Agriculture has been experimenting to find a way 
 to remove the flavor from such tainted milk. The experts found that the 
 following method worked satisfactorily: The milk is heated to 145° and 
 while it is held at that temperature a current of air is passed through it. A 
 ten minute treatment makes the milk fairly palatable; a thirty minute treat- 
 ment removes all the flavor. 
 
TIML AND TEMPLRATURL 
 MILK PA5TE.URIZATI0IN. 
 
 FOR 
 
 20' 30 40' 
 
 Tl ME. IN MINUTES 
 
 Public Health Service Report. 
 
 Fig. 194. — Time and Temperature at which Some Bacteria are Killed and at which 
 the Composition of Milk is Changed. Example: At temperature 140-149 for 20 minutes 
 the bacteria of diphtheria, tuberculosis, typhoid fever and septic sore throat are killed; but 
 neither the cream line, the enzymes, the albumen, the taste or the fats, sugar 'casein or salts 
 is affected. 
 
 535 
 
536 MILK 
 
 The apparatus devised by Ayres and Johnson consists of the following 
 parts : 
 
 A tank (A) is surrounded by a water jacket. From the bottom of 
 this tank a pipe leads to a tank (B) set on top of tank A. The milk is 
 pumped through this pipe from A to B by a small pump. The tank B has a 
 bottom perforated with holes one-thirty-second of an inch in diameter, placed 
 at a distance of one-half an inch from one another. The milk flows in a fine 
 spray through these holes into tank A. An air pipe leads into tank A, 
 delivering air under pressure near the bottom of the tank. The air must be 
 washed clean. 
 
 The milk is placed in tank A and by heating the water in the jacket the 
 temperature is brought to 145°. If the milk is to be made into butter the 
 temperature should be carried to 160°. The milk having been heated the pump 
 is started and the steam travels from tank A through the pipe to tank B and 
 then through the perforations back into A. Meanwhile the air is running 
 into the milk in tank A at the rate of one-fifth of a cubic foot of air per 
 gallon of milk per minute 
 
 The evaporation is 3 per cent — which can be made up with boiled water. 
 The cream line suffers slightly. 
 
 The process continued for thirty minutes will result in a fairly satisfactory 
 pasteurization. 
 
 ICE CREAM 
 
 The ice cream manufacturers are willing to spend money to prevent 
 the government from having much to do with the control of their product. 
 When Dr. Wiley set chemical standards they went to a great deal of trouble 
 and expense to set the ruling aside. Now Dr. Alsberg is considering sanitary 
 standards and the manufacturers are again active. 
 
 They object particularly to having bacterial standards incorporated as 
 one of the requirements. When the question was before Dr. Alsberg they 
 had a number of bacteriologists contend that bacterial standards as applied 
 to ice cream were valueless. The investigations of these men have been made 
 into a pamphlet which is circulated by the National Association of Ice Cream 
 Manufacturers. 
 
 The following important statement was made by Professor Gordon : 
 
 "Given raw materials of low bacteria content, it can be said in absolute 
 assurance that the ice cream manufacturers can produce with great ease 
 ice cream of low bacteria count." 
 
 One of this group appeared before the recent meeting of the American 
 Public Health Association, presented this report, and argued that ice cream 
 should not be subjected to a bacterial standard. His argument was that, 
 since ice cream commonly contained one to one hundred million bacteria, a 
 variation of a few hundred thousand bacteria was of no great signifi- 
 cance. 
 
 The discussion of the presentation for the ice cream men is worthy of 
 consideration. The general consensus of opinion was that the variations noted 
 were to be found and were unavoidable in the ice creams with bacterial 
 counts running into the tens of millions but that they were not found in ice 
 
ICE CREAM 537 
 
 cream with low bacterial counts; furthermore, that it is possible to market 
 ice cream with very low counts. 
 
 Dr. Wiley said: "The experiments made by these gentlemen were not 
 made on real ice cream, but on some other frozen products, unfit to be fed 
 to hogs." 
 
 Dr. Freeman, secretary of the Virginia Board of Health, asserted that 
 ice cream properly made from proper ingredients had a low bacterial count and 
 that the reason these investigators had found such high bacterial counts was 
 because they worked with ice cream made from ingredients that were unfit 
 to eat. 
 
 Drs. Rogers, Kenyon, North and several other speakers said that ice 
 cream could be made in such a way as to have a low bacterial count. It was 
 a matter of starting with proper ingredients, freezing them while fresh and 
 operating always in a sanitary fashion. 
 
 Many epidemics have been traced to ice cream as the source of infec- 
 tion. Improperly made ice cream has the highest bacterial count of any 
 food substance. The Commission on Milk Standards is now at work on 
 standards for ice cream. The national government is gathering information 
 on which to make a ruling on ice cream. 
 
 Regulation of the manufacture of ice cream is certain to come. If the 
 manufacturers are good business men they will help to bring it about. 
 
 What Constitutes Fresh Milk. — Daily Reader writes: "In a recent 
 article you said that milk that is not absolutely fresh is not wholesome. 
 Do you mean that milk left from one day's supply to the next is not safe 
 to use? Why is it that sour milk is supposed to be more wholesome and 
 beneficial than fresh milk? Do you consider certified milk enough better 
 to warrant the additional price? Do you think milk left standing in the 
 glass bottle in which it is received, with the cap on it, fit to use in the raw 
 state next day?" 
 
 Reply. — Milk properly kept — covered, cold and clean — is safe to use 
 when left from one day's supply to the next. That is, it is safe for every- 
 body except children under two years of age. Children under two should 
 not use milk which has stood a day in the refrigerator. Occasionally, and 
 for some people, properly soured milk is better than fresh milk but this is 
 by no means an argument for old milk. If the certified milk is certified 
 by a certifying body holding a permit to certify the certified milk for the 
 baby is worth the difference in cost. 
 
 Flesh Made by Milk.— P. S. C. writes: "1. Will milk, if taken daily, 
 make flesh? If it will, how much ought to be taken, and how? 2. Is olive 
 oil good for the system and does it make flesh? 3. Will either of these 
 force pimples to appear?" 
 
 Reply. — 1. Yes. Three pints a day in addition to plenty of other 
 nutritious food. 2. Fairly good, but not especially so. 3. Yes — both. 
 
 Use of Milk Diet.— IF. B. F. writes: "Please tell me what benefits, if 
 any, can b% derived from an exclusive milk diet. How should it be carried 
 
 out?" 
 
 Reply. — The milk cure is frequently recommended for Bright's disease, 
 gout, neurasthenia, intestinal putrefaction and a few other diseases. The 
 
538 MILK 
 
 treatment usually begins with four ounces of warm, skimmed milk every 
 two hours; after a few days, six to eight ounces every four hours. Some- 
 times it is given flavored with weak tea, coffee or diluted with vichy. Con- 
 stipation needs to be overcome. After four to six weeks other food is 
 gradually added to the dietary. 
 
 One number of the Clean Milk Bulletin quotes an article from Nickel 
 (Milch Zeitung, 1911, No. 39) in which it is stated that Pope Pius X par- 
 takes of boiled milk in the morning and during the forenoon and fre- 
 quently has milk soups, milk dishes and milk puddings at his meals. He 
 says the pope is half a vegetarian and from the beginning of his ecclesiasti- 
 cal life has used milk freely. 
 
 Effects of Milk Diet.— Mrs. G. W. J. writes: "A diet of milk only for 
 a period of four weeks is recommended in a health magazine as a cure for 
 constipation and minor ills. It is stated that the arterial blood pressure 
 will be permanently improved and organic functions restored. Will this 
 increased pressure be beneficial or will it be accompanied by any danger?" 
 
 Reply. — It will help your minor ills; may lower your pressure some; 
 will probably help you in every way except that it will make your constipa- 
 tion worse. 
 
 Milk Disagrees with Her. — E. B. W. writes: "I am fond of milk, but 
 it gives me what old-fashioned people call a 'bilious attack' violent head- 
 ache and nausea. I have been intensely nervous all my life. I have always 
 lived at high pressure, but have never indulged in liquor. I am a woman 
 1$ years old. Why can I not drink milk? Lime water does no good. I've 
 a fine digestion." 
 
 Reply. — You have an idiosyncrasy against milk. Many people have it. 
 Send to the Bureau of Animal Industry, Department of Agriculture, to 
 get its bulletins on "Milk as a rood" and read about it. 
 
 Milk as Food. — J. S. W. writes: "I read an article some time ago by 
 some doctor, whose name I do not remember, stating that milk is not good 
 for middle-aged persons. Kindly give me your opinion." 
 
 Reply. — You misunderstood the statement. I imagine good, wholesome 
 milk is good food for people of any and all ages. There are exceptions; 
 but the rule holds. 
 
 Be Careful of Milk. — A. K. K. writes: "We have a seven months baby 
 whom we have been feeding with modified milk for the past three months. 
 Our success is rather indifferent, for although the baby weighs seventeen 
 pounds, he gets upset frequently. Do you think that the addition of oat- 
 meal or barley water to the milk might help?" 
 
 Reply. — Adding barley water will not help much. While you do not 
 say how the milk is modified or what the trouble is my guess is that the 
 baby has occasionally spells of diarrhea but that in the intervals the bowels 
 are normal. If this is true it probably means that the milk is a little off at 
 times. • 
 
 Be certain that the modification is proper. Be certain tha£ the milk 
 is proper. See that it is properly pasteurized for at least six weeks yet. 
 
 Care of Milk. — J. S. C. writes: "Some time ago you had an article 
 on the care of milk and said it should not be kept in the bottles in 
 
ICE CEEAM 539 
 
 which it is delivered. Please state what it should be kept in and any 
 further details regarding care of milk, particularly in an ice box, where 
 sanitary conditions and circulation are none too good" 
 
 Reply. — You misunderstood me. Milk should be kept in the bottle until 
 it is consumed. Especially is this necessary if the ice box is not sanitary. 
 
 Grape Fruit with Milk. — B. W. W. wants to know if grape fruit eaten 
 with milk is liable to make it curdle in the stomach. 
 
 Reply. — Milk should curdle in the stomach. Something is wrong if it 
 does not. Grapefruit does not make milk indigestible. 
 
 Thermos-Kept Milk. — R. W. writes : "I should like to know your opin- 
 ion of the use of the thermos bottle for keeping warm during the night the 
 baby's modified milk. The nurse prepares the warm milk about 8 o'clock 
 and feeds the baby after midnight, sometimes not until 3 or k o'clock. 
 The thermos seems a blessing for nurse or mother. But is it safe for the 
 baby to keep the milk warm so long?" 
 
 Reply. — The habit of keeping food in vacuum bottles is growing. Some 
 years ago some ladies appeared before the finance committee of the Chicago 
 city council asking that an appropriation be made to furnish bottles to 
 poor people. 
 
 The convenience is so great that such use should be encouraged if it 
 is hygienically proper. It should be prohibited if it is doing harm. 
 
 It is not enough to say that babies six months to one year old should be 
 fed but once during the night and that babies over one year old should not 
 have any night feeding. 
 
 If parents are going to feed more frequently than this at night the in- 
 formation must be furnished them. 
 
 Dr. F. A. Tonney, director of the city laboratories, made bacteriologic 
 examinations of milk held in thermos bottles with the following results : 
 
 If the milk as it is put into the bottle has a temperature of 115° or be- 
 low the bacteria multiply very rapidly and in a few hours the milk is 
 unfit for baby use. If the milk is put in at 140° or above the bacteria 
 diminish until in a few hours the milk is sterile. 
 
 The conclusions are these: 
 
 1. Putting the baby's milk into a thermos bottle is never justified unless 
 the temperature of the milk is first taken. 
 
 2. If the temperature of the milk is under 135° it will be unfit for use 
 in a few hours. 
 
 3. If it is 135 to 140° it can be kept in a vacuum bottle with safety. 
 
 Is Centrifuged Milk Safe? — W. J. C. writes: "Is the process of run- 
 ning milk through a centrifugal cream separator (and again mixing the 
 milk and cream together) any benefit or improvement to the health con- 
 ditions of it? 
 
 "Does the centrifugal force remove the bacteria or microbes?" 
 
 Reply. — No. The centrifuging is done to remove the cream. The 
 milk and cream are then mixed in the proportions required by law. 
 
 The number of bacteria is higher in the cream than in any other part 
 of the milk. That is to say that when the milk is centrifuged most of 
 the bacteria stick in the cream part and few are thrown out. 
 
 It is the custom of men having centrifuges to filter the milk in addi- 
 
540 MILK 
 
 tion. Filtering takes out the gross dirt and a fair part of the bacteria, 
 though not all of them nor even most of them. 
 
 Proper pasteurizing kills 99 per cent, of the bacteria. As compared 
 with the result filtering and centrifuging may be said to have no effect. 
 
 My advice to you is : patronize no dairyman who does not sell "tubercu- 
 lin tested" or pasteurized milk. 
 
 How to Get Safe Milk. — M. A. S. writes: "How is a person to know 
 that milk is free from tubercle bacilli? I was brought up in the old- 
 fashioned way, but what of the new way I am learning has certainly 
 been a benefit to me and I will keep on. I have an idea how hard it is to 
 convince others of this truth from my own experience." 
 
 Eeply. — You are on the right track. Keep it up. The way to get milk 
 free from tubercle bacilli is to patronize only responsible people who guar- 
 antee that their milk is from non-tuberculous cows or who guarantee their 
 pasteurization ; or else heat the milk before you use it. 
 
 Do Not Drink Raw Milk. — Taylor writes: "I am living in the eastern 
 part of North Carolina, where the weather is hot and malaria prevails 
 abundantly. Am troubled every summer with dysentery. Please publish 
 how that could be prevented?" 
 
 Reply. — If you are certain the condition is not pellagra but is dysen- 
 tery proceed as follows : 
 
 From June to November each year drink no new milk. Heat every par- 
 ticle taken. Drink no raw water unless you are certain it is good. That 
 about limits raw water to artesian water. Eat about half as much as in 
 winter. 
 
 Questions on Milk Answered. — C. C. J. writes: "I read an article in 
 the Chicago 'Tribune' recently entitled 'Sterilized Milk Is Bad.' It gives 
 the conclusions of a London chemist and other authorities and points out 
 that sterilized milk is not only less nutritious than plain milk, but is ac- 
 tually dangerous. What is sterilized milk and what is pasteurized milk? 
 Do these processes of preserving the milk injure or spoil it as a food? 
 How does pasteurized milk compare with natural milk in nutritive prop- 
 erties?" 
 
 Reply. — I judge the article refers to milk that has been sterilized by 
 boiling. Some authorities are of the opinion that boiled milk is less nutri- 
 tious than unboiled milk. Others hold the contrary opinion. The opinion 
 is rather general that boiled milk putrefies but does not sour. When milk 
 is boiled most but not all of the bacteria are killed. Those which survive 
 are the putrefiers. Some authorities hold the milk is dangerous on that 
 account; others hold the contrary opinion. They say the milk becomes 
 offensive and nobody will drink it. Pasteurized milk is milk that has 
 been heated to somewhere between 140° and 170° Fahrenheit. This amount 
 of heat kills the disease germs but does not kill the souring germs. Pas- 
 teurized milk sours but the process is delayed one to two days. The nutri- 
 tive properties of pasteurized milk are the same as those of ordinary milk. 
 
 Good Milk Proposal. — T. C. L. writes: "Since milk, next to water, is 
 the chief necessity of life, why should it not be imperatively a city's busi- 
 ness to supply it as well as to supply water? Could not Chicago have a belt 
 of municipal milk laboratories surrounding the city, one laboratory to each 
 railroad supplying a dairy region, to which milk could be brought by the 
 
* ICE CEEAM 541 
 
 quickest possible route? In such a laboratory the quality of the milk sup- 
 plied by each farmer could be recorded, and the milk treated as the scientific 
 staff of the laboratory should direct. The cans could be sterilized and 
 sealed, and sent back to the farmer all ready for him to use. He should 
 not waste time straining or separating the milk through imperfectly 
 sterilized utensils, and he would be saved much time, and we should be 
 saved having an easily contaminated food handled by a person not properly 
 equipped for it. The morning milk could probably be delivered by late 
 afternoon to specified areas and save night work for the milk wagon drivers. 
 Downtown could be cared for by subways. Since all children, rich and 
 poor, and all invalids, rich or poor, need the same grade of milk and need 
 it badly, cannot public opinion be aroused to an activity that will eventuate 
 in the city's supplying it as cheaply as possible and thus lessen the diseases 
 and deaths that come from a lack of clean cheap milk and plenty of it? 
 The many surveys of the milk supply of cities, as at present carried on, 
 show that the present method is far from being an economical one." 
 
 Reply. — The proposal, subject to some modification, is a good one. 
 Portions of it are in use in different parts of the world. In time the 
 general plan will be in universal use. 
 
 Milk Safety. — N. S. writes: "Please advise as to what preventive meas- 
 ure should be taken by milk consumers of Chicago in the present prev- 
 alence of foot and mouth disease. How are we to know whether our supply 
 is safe? What is to be done about butter, buttermilk, sour milk, and 
 sweet and sour cream?" 
 
 Reply. — Use no milk that has not been pasteurized. This advice ap- 
 plies also to butter, buttermilk, sour milk, sweet and sour cream. Beyond 
 this you need not go. 
 
 The best guarantee available is the reputation for integrity of the 
 dealer who gives you the assurance that his product has been pasteurized. 
 
 Until the danger is past the people should be on the watch for sore 
 mouth, especially in their children. 
 
 Certified Milk Safer. — P. B. writes: "A friend has advised me to use 
 certified milk for my baby. Will you please inform me the difference be- 
 tween this and the ordinary milk and if it is better for the baby? Also 
 how to obtain it?" 
 
 Reply. — Certified milk contains 4 per cent fat. Certified milk is 
 fresher and cooler, and has fewer bacteria. It is produced by healthy, tu- 
 berculin tested cows and the milkers themselves are subject to inspection. 
 Carefully inspected certified milk is safer than market milk. It costs 
 about twice as much as market milk. 
 
 The Chicago Medical Society (see telephone directory) will furnish 
 you a list of certified milk producers. 
 
 Is Boiled Milk Nutritious? — Mrs. A. T. Z. asks: "Is the nourishment 
 impaired in any way by boiling milk? Is it harder to digest than raw or 
 pasteurized milk? Does cottage or 'Dutch' cheese, made from raw milk 
 clabber, contain wholesome nourishment? Is it easy or hard to digest? 
 Should boiled milk or cottage cheese have a tendency to constipate?" 
 
 Reply. — Probably the majority of practicing physicians believe boiled 
 milk is hardly less nutritious pint for pint than unboiled milk. The dif- 
 ference is slight. It is probably harder to digest than raw or pas- 
 
542 MILK * 
 
 teurized milk of the same grade. The bacterial products in raw milk are 
 harder to digest than any changed albumins in boiled milk. The bacterial 
 changes in raw milk decrease its nourishing power more than does the 
 boiling of boiled milk ; therefore boiled milk taken soon after being boiled 
 is both more nutritious and more easily digested than raw milk as you get 
 it under ordinary circumstances. 
 
 Cottage cheese is highly nutritious and when of good quality is thor- 
 oughly wholesome. It is easy to digest. All milk and cheese has a slight 
 tendency to constipate. This is not through any definite action. The 
 largest factor in ordinary cases of constipation is lack of bulk; and milk 
 and cheese, especially after the water is absorbed, are concentrated foods; 
 therefore constipation follows a milk and cheese diet unless some bulky 
 food is added to it. In milk with a high bacterial count there are occa- 
 sionally bacterial products that are laxative. These sometimes produce 
 violent diarrheas and cholera infantum. In boiled milk there will be less 
 of these products and therefore the use of boiled milk is more apt to be 
 productive of constipation than the use of raw milk. 
 
 Refers to Boiled Milk. — M. C. W. writes: "In a recent number of 
 'The Tribune' an article appeared giving the views of an eminent scien- 
 tist on the use of sterilized milk for children, pronouncing it an unfit ar- 
 ticle of food. I am sure many mothers would appreciate it if you would 
 give your ideas on this subject. 1. Do the leading dairies use the sterilized 
 milk? 2. How can one know whether the milk one is buying is sterilized 
 or not?" 
 
 Reply. — 1. The milk referred to in the article is boiled milk. No dairies 
 furnish boiled milk. 
 
 2. There is a test known as the Storch test. It will tell whether or not 
 milk has been heated to 170 or over. It is not dependable when milk has 
 been heated from 140 to 160. Any laboratory will make a Storch test. 
 
 Heating Water and Milk. — J. A. M. writes: "Does not boiling the 
 water precipitate nearly all mineral matter or the vital salts in the same 
 and render them impossible of solution and assimilation afterwards? If so, 
 does it not affect milk similarly?" 
 
 Reply. — Boiling the water does not precipitate the mineral matter or 
 the vital salts in the same. Mineral matter is more soluble in boiling water 
 than it is in cold water. A kettle of water boiled until it is pretty well 
 evaporated will precipitate its mineral matter because of the concentration 
 from evaporation. 
 
 There are no vital salts in water. 
 
 Boiling milk does not precipitate its salts unless the boiling is kept up 
 until most of the milk is evaporated. Mineral matter thrown out of solu- 
 tion through concentration will go back into solution when enough water 
 is added so that concentration no longer exists. 
 
 Vary Warm and Cold Milk. — N. E. F. writes : "I am drinking three 
 quarts of milk each day in an effort to gain in weight. Would you advise 
 it taken warm or cold, and do you think three quarts is enough to get 
 results? In addition to the milk I have my breakfast and dinner at 
 night with the family. I am perfectly well in every way, but need a few 
 more pounds. I am also taking a physical course" 
 
ICE CEEAM 543 
 
 Reply. — It does not matter whether you take the milk warm or cold. 
 Vary it that you may not grow tired of it. 
 
 If three quarts of milk in addition to your regular diet does not 
 fatten you you cannot get fat. Some people cannot. I would not advise 
 you to continue using so large a quantity for many months. It strains 
 your eliminating organs a great deal. 
 
 Are you certain that you do not worry? Peace of mind and regular 
 habits are nearly as effective as milk. 
 
 Condensed Milk Safe. — J. P. writes: "Is this so-called evaporated 01 
 condensed milk as good as fresh milk, or is it injurious to the health? In 
 several instances, when using evaporated milk, I have found in the hot- 
 torn of the can tiny bits of lime or some other substance. On account 
 of fresh milk being so poor in the winter we have decided to use evap- 
 orated milk, but have been told that it is not vjell to use it continuously." 
 
 Reply. — If it is to be used by grown people, condensed milk is just as 
 wholesome as fresh milk. It is somewhat safer. It is a better summer 
 food than a winter food since it is somewhat low in fats. It is better to 
 give babies fresh milk. This is especially true in winter. If in summer, 
 say for three months, the choice lay between a dirty whole milk and a 
 condensed or evaporated milk the decision would be in favor of the latter. 
 If the whole milk is clean it would be in favor of the former. 
 
 Try Cheese and Milk. — R. A. writes: "Every summer at the beginning 
 of the hot weather I have something like summer complaint. The doctors 
 have called it colitis. The first attack generally starts with dysentery 
 and much pain. I am troubled all summer and I generally can control it by 
 taking a strong astringent. I took an astringent all last summer and, 
 unless I do this, I become terribly run down and nervous. Can you tell 
 me any diet that would help me get through the hot weather without the 
 usual attack? I am now 38 years old and don't believe the attacks are 
 quite so severe as when I was younger. I fatten up every winter and eat 
 anything in reason." 
 
 Reply. — Write to the Department of Agriculture at Washington for 
 its bulletins on cheese and milk as foods. Try living on cheeses, boiled milk 
 and bread. 
 
 Ice Cream Poisoning. — F. C. writes: "On Sunday last a man, his wife, 
 and two children were all taken sick with the following symptoms: Fever, 
 vomiting, and a severe diarrhea. All had chills, and the temperature 
 ranged around 102 to 103 degrees. All had eaten ice cream the evening 
 before. Was this ptomain poisoning, or was it from the cream, freezer, 
 or from the vanilla flavoring? Two of the neighbors ate of this cream and 
 were attacked in the same manner. All recovered." 
 
 Reply. — They certainly had some form of food poisoning. The evi- 
 dence you present points clearly to ice cream poisoning. The poison in 
 that case was tyrotoxicon. It is the custom to age milk before freezing it 
 into cream. Sometimes the aging is overdone. 
 
 Pasteurized Milk. — B. F. W., Jr., writes: "You say 'always and ever 
 drink no raw milk.' Bo you mean that pasteurized milk should be heated 
 or boiled to insure safety?" 
 
544 MILK 
 
 Reply. — Pasteurized milk is not classed as raw milk. Unless you are 
 certain the pasteurization is properly done you had better heat the milk 
 at home during June, July, August and September. 
 
 Pasteurization Enough. — J. 8. writes : "I saw a statement in a newspaper 
 recently in which the claim was made by some physician that pasteuriza- 
 tion of milk was not sufficient protection against foot and mouth disease. 
 This doctor claimed that all milk should be boiled in order to insure 
 protection." 
 
 Reply. — Pasteurization is enough. Boiling is recommended by Euro- 
 pean physicians where the milk is from cows having the disease or sus- 
 pected of having it. In this country such cows are killed. 
 
 Pasteurized Milk Constipating. — E. G. S. writes: "Will pasteurized 
 milk, used as a drink, cause constipation?" 
 
 Reply. — Yes, it will contribute somewhat. Milk is indirectly constipat- 
 ing ; that is, it is not bulky enough to be an ideal food. Pasteurized milk 
 is somewhat worse in this particular than raw milk because the germs 
 in raw milk may be slightly laxative at times and may cause diarrhea. 
 Continue using boiled milk to be safe against tuberculosis and typhoid. 
 Eat vegetables, fruit and bran enough to cure constipation. 
 
 Pasteurize the Milk. — C. E. writes: "In a country town where there 
 is no such thing as certified milk or inspection of dairies, how can we pro- 
 tect our children from tuberculous milk?" 
 
 Reply. — Keep a tuberculin tested cow, for one thing. Pasteurize the 
 milk, for another. The Illinois Food Commission distributes a circular 
 on home pasteurization of milk. 
 
 Sour Milk. — H. A. T. writes: "Professor Metchnikoff suggests the 
 drinking of sour milk, on account of the lactic acid it contains, as a cure for 
 colon infection. If the use of enemas and cathartics has ceased to destroy 
 the colon bacillus what is your opinion regarding use of sour milk? Would 
 there be any harmful results besides the good it might do? How much 
 should be taken during one day?" 
 
 Reply.- — The souring germs in sour milk are not very strong. It 
 will help some. Eat as much as you like. 
 
 Sweet Milk and Buttermilk. — H. N. W. writes: "Will you please tell 
 your readers what you think of thick milk, clabbered milk, and buttermilk 
 as regular articles of diet? Will you tell us what you know about their 
 nutritive value?" 
 
 Reply. — When buttermilk retails at 4 cents a quart and sweet milk at 
 8 cents $1.00 buys 1.8 times as much protein in buttermilk as in sweet milk 
 and $1.00 buys the same amount of heat and energy in buttermilk as it 
 does in sweet milk. Buttermilk is, generally speaking, more easily digested 
 than sweet milk. Therefore, buttermilk is somewhat of a bargain in winter 
 and much of a bargain in summer. 
 
 Clabber and sour milk have all of the nutrition of sweet milk. When 
 the human stomach starts digesting milk the first step is to sour and 
 "clabber" it. 
 
ICE CREAM 545 
 
 It is generally held that good soured and "clabbered" milk is not only 
 nutritious but easily digested. 
 
 Buttermilk Safer. — L. C. W. writes: "Will you kindly inform me 
 
 whether buttermilk, as ordinarily sold in Chicago, is as apt to contain 
 
 typhoid germs as regular milk? What is the relative nutritive value of 
 milk as compared with buttermilk?" 
 
 Reply. — Buttermilk as sold in Chicago is somewhat safer as regards 
 typhoid fever than is sweet milk. Typhoid bacteria in milk tend to die 
 out, especially in the acid of buttermilk. A large part of the buttermilk 
 sold in Chicago has been pasteurized preliminary to churning. However, 
 we will make a mistake if we are careless about buttermilk. There is the 
 same necessity for getting it from clean and careful people as there is with 
 sweet milk. 
 
 The nutritive value of milk as compared with buttermilk is about as 
 20 to 18 — that is to say, you get about as many energy units out of a pint 
 and a quarter of buttermilk as you would out of one pint of sweet milk. 
 The difference between the two is largely in heat making qualities. The 
 fat of milk goes in the main to the making of heat. 
 
 The albumins of buttermilk, however, are somewhat more easily di- 
 gested and absorbed unit for unit than those of sweet milk. I mention 
 these things in order to make it clear that a measure of calories is not the 
 only thing to be taken into consideration in the selection of foods. 
 
 Buttermilk. — F. A. H. writes: "1. Is not buttermilk wholesome to drink 
 when it is sour? 2. I am fond of thick or loppered milk and have sup- 
 posed it was healthful, although sour. Do you consider it so? 3. Why do 
 we guard against sour milk for babies and others if the loppered milk is 
 healthful?" 
 
 Reply. — 1. Yes. 
 
 2. Yes. 
 
 3. Clabbered milk is wholesome for grown people, but not for babies. 
 
 Buttermilk as Beverage. — Mrs. A. L. S. writes: "For how long a period 
 will buttermilk remain in condition for drinking purposes, supposing of 
 course it is kept in a chilled atmosphere?" 
 
 Reply. — Under the proper conditions buttermilk will remain in a con- 
 dition for drinking purposes about twenty-four hours longer than sweet 
 milk. 
 
 Kind of Buttermilk. — Constant Reader writes: "What kind of butter- 
 milk is the most effective, artificially soured milk or the regular butter- 
 milk?" 
 
 Reply. — If you can get freshly churned buttermilk made from milk 
 known to be right it is the kind to use. If this cannot be had get the 
 artificially soured milk made from pasteurized milk. If your dealer does 
 not handle this kind of buttermilk patronize one who does. Do not buy 
 buttermilk churned in a store in the city unless you know they churn 
 good milk. Some churn bargain milk bought here and there — milk that 
 dealers have had left over. Buttermilk from whole milk is not as whole- 
 some as buttermilk from soured skim milk or buttermilk left after butter- 
 making. One of the advantages of good buttermilk is that it is low in 
 fat or grease. 
 
546 MILK 
 
 Gives Buttermilk Formula. — G. M. S. writes: "Will you please give 
 me a formula for the proper preparation of soured milk, to he used for the 
 prevention of intestinal putrefaction?" 
 
 Reply. — The method of making culture milk is as follows: 
 Take one quart of skimmed milk without preservatives. Heat it until 
 it begins to simmer, put bottle in cold water, add one-sixth quart hot 
 water. When the temperature of the mixture is about milkwarm, add 
 one lactone of culture tablet, cover it up and let it ferment at room 
 temperature for thirty-six hours, then keep cold until it is used up. Shake 
 before using it. If you wish to make a buttermilk out of the home milk 
 instead of the skimmed, use one-third quart of hot water instead of one- 
 sixth. Note that skim milk and not buttermilk is used. 
 
 Culture Buttermilk Better. — Daily Reader writes: "1. Is the natural 
 buttermilk from the churn any more wholesome than the artificial or cul- 
 ture buttermilk? 2. Which would have the better effect against intestinal 
 putrefaction? 3. Would impure or carelessly handled milk lose its un- 
 healthy quality when turned into buttermilk? Jf. Are dairies under any 
 compulsion to label buttermilk according to whether it is churned or arti- 
 ficial milk? I know of only one large dairy selling buttermilk that is labeled 
 f culture' but most people seem to think that we do not get any natural 
 buttermilk from any of the dairies." 
 
 Reply. — 1. No. Some people prefer the taste of old-fashioned churn 
 buttermilk. From the standpoint of wholesomeness the culture product has 
 the better of it. 
 
 2. Probably the culture kind. In the one the acid producers are hit 
 and miss. In the other the added acid producers are more uniform. 
 
 3. No. 
 
 4. No. 
 
 Value of Buttermilk. — F. L. F. writes : "Please inform me why butter- 
 milk is healthy and in what way it is conducive to put one in good con- 
 dition?" 
 
 Reply. — Buttermilk contains less fat than sweet milk. For this reason 
 it is the better summer drink. The casein in buttermilk is chemically and 
 physically in better condition for digestion by grown people at least than 
 is that in sweet milk. The idea that the lactic acid bacilli of commercial 
 buttermilk are conducive to health of themselves is not correct. 
 
 "When Buttermilk Disagrees. — M. W. D. A. asks: "Is buttermilk harm- 
 ful to me, subject to acid conditions? Have fancied when I drank it that 
 sensations were unpleasant in digestive tract and that indirectly the 
 nervous system was affected." 
 
 Reply. — There are many people who are not pleasantly affected by 
 buttermilk. You may be one of those. If it does not agree with you by 
 all means discontinue it. 
 
CHAPTEE XXX 
 
 Lymphatic Glands 
 
 About every so often when reading the morning paper your attention is 
 claimed by an account of where, and how seriously, a herd of cattle is 
 afflicted with lumpy jaw (actinomycosis). Sometimes this disease attacks the 
 lymphatic glands in and about the region of the neck and jaw. It may 
 attack the lymphatic glands in other regions of the body. Usually, however, 
 it attacks the bony structures of the jaw. 
 
 Lumpy jaw is caused by a specific, vegetable parasite. These parasites are 
 unusually large. For this reason it is difficult for them to trail along the 
 lymphatic system. Hence, the gateway through which they enter the system 
 is perhaps through cavities in the teeth. 
 
 Lumpy jaw as a disease is not confined to cattle. It attacks man as well. 
 It may attack any organ or structure in the human body. Osier refers to the 
 fact that Dr. Hektoen makes the statement in an unpublished paper that this 
 disease attacks the myocardium even more frequently than syphilis. 
 
 If you chance to visit the Stockyards be sure to observe the method of 
 handling hogs in the various steps of slaughtering. You will notice that 
 after the hog is slaughtered it is placed in a guideway for transportation to its 
 final destination in the preparation for ultimate consumption. 
 
 Stationed along this guideway at points some distance apart are two 
 men. These are inspectors. They are experts. They are supposed to be, 
 and, in fact, are, able to detect disease by examining the kernels (lymphatic 
 glands) in and about the neck and jaw of the carcass. 
 
 The first inspector thrusts his hand into the gap in the flesh about 
 the neck, made for the purpose of affording free bleeding, to examine the 
 glands in and about the neck. On account of his acuteness of touch and 
 wide experience he is able to tell quite accurately and quickly if the glands 
 are diseased. If they are, he places his sign somewhere about the carcass 
 (ears perhaps), so that its final disposition may be in accordance with the 
 rules and provisions of constituted authority. If they do not indicate 
 disease he signifies that it has passed inspection by not marking it at 
 all. 
 
 The second inspector makes his examination after the animal has been 
 drawn. Like the first inspector, he places his approval as to whether it is 
 or is not of a certain grade by some predetermined mark for identification. 
 By this means much of the unfit meat and by-products are identified and 
 prevented from being worked in with the final food products for general 
 consumption. 
 
 As a matter of historical information, it will be interesting to know that 
 the first facts concerning the lymphatic glands and lymphatic system were the 
 results of some observations made by a number of eminent scientists upon 
 
 647 
 
548 
 
 LYMPHATIC GLANDS 
 
 living animals. Although the lymphatic glands and lymphatic system were 
 known to Hippocrates their true significance and functions were not under- 
 stood until within comparatively recent years. 
 
 In the early part of the sixteenth century Asellius noticed the behavior of 
 the lacteals in the living dog. This skilled anatomist saw that the lacteals, 
 when cut, exuded a whitish liquid. This led him to conclude that he had 
 discovered a new kind of vessel. 
 
 A series of experiments and observations made by him established beyond 
 question that there existed a relation between the presence of a white liquid 
 (lymph) in the lacteals and the products of digestion. 
 
 While it is rather unfortunate, especially for 
 him, that he failed to comprehend the true sig- 
 nificance of this phenomenon, his discoveries served 
 as a stimulus to those who followed in their efforts 
 to determine the part played by these organs in 
 the general metabolic processes. 
 
 About the middle of the sixteenth century 
 the general functions, origin, distribution, and 
 structure of the lymphatic glands and the lym- 
 phatic system, as we understand them today, were 
 discovered, and worked out more in detail by 
 Pecquet of France, Bartholin of Denmark, Jolive 
 of England, and Eudbeck of Sweden. 
 
 A few years later another set of scientists 
 began the refinement of the work already done. 
 About this time the work which was done was 
 preserved in books and in the form of charts. 
 
 These documents, even at the present time, 
 are considered authoritative. Among these workers 
 might be mentioned Hunter, Hewson, Cruickshank, 
 and Mascagni. 
 
 A still more delicate refinement of the lym- 
 phatic system and its functions as we know them 
 today was worked out and handed down to us by 
 Sappey, a noted French scientist. 
 
 It is hardly saying too much, I believe, to say 
 that in the discovery of the lymphatic system Sap- 
 pey, Starling, and the other scientists and investiga- 
 tors who labored in this field of useful endeavor did as much, or even more, 
 when they discovered the lymphatic system and its function for the science of 
 medicine and surgery than Harvey did when he discovered the circulation of 
 the blood. 
 
 In discussing the diseased conditions of the lymphatics, Osier has the 
 following to say : 
 
 "The great majority of the diseased conditions of the lymphatic glands 
 are secondary in nature, and are the direct result of the part played by 
 the lymphoid structures in the protection of the body. In the exercise of 
 their function as niters of the lymph stream, whereby they remove from the 
 latter both the bland and the harmful substances gaining entrance into the 
 
 Fig. 195. — Lymph Vessels 
 and Glands of Arm 
 and Hand. 
 
LYMPHATIC GLANDS 549 
 
 lymphatic vessels, their own integrity is often sacrificed to the welfare of 
 the organism as a whole. 
 
 "Into the lymph stream of any region of the body a great variety of 
 formed elements may pass, such as dust, carbon, bacteria, disintegrating red 
 and white blood cells, blood pigment, dead tissue cells, inflammatory exu- 
 dates, tumor cells, toxic substances, etc. Usually the regional lymph nodes 
 filter out such foreign substances, and retain them either permanently or 
 temporarily, in some cases rendering them harmless or destroying them, 
 while in other cases the injurious agent is able to cause degeneration or 
 necrosis and inflammation within the lymphoid tissue itself. 
 
 "In this conflict, particularly when pathogenic bacteria are concerned, the 
 lymphatic glands may suffer severe inflammatory processes, even to the 
 extent of total destruction by suppuration; but in the great majority of 
 cases the infective agent is disposed of by the gland after a more or less 
 marked local inflammatory reaction. . . . 
 
 "Since the involvement of the regional lymph glands is usually secondary 
 to some primary infection within the region tributary to them, we find, for 
 example, involvement of the axillary and cubital glands in the case of in- 
 fection of the hand, arm, of mammary gland; involvement of the cervical 
 glands in infections of the mouth cavity and pharynx, of the bronchial glands 
 in pulmonary infections, of the mesenteric glands in intestinal diseases, of 
 the inguinal glands in infections of the external genitals and lower extremi- 
 ties, etc. 
 
 "Such an involvement of the regional lymph glands occurs also in 
 chronic inflammations of the corresponding regions, and in the case of 
 malignant tumors occurring therein, particularly carcinoma." 
 
 Some years ago a baby show was held in Chicago. The babies were all 
 registered. As a precaution, the officers conducting the show provided for 
 the physical examination of all of the babies entering the contest. 
 
 Stationed at the entrance of the hall where the show was held were a 
 number of physicians, whose duty it was to examine the lymphatic glands in 
 and about the neck and jaw of each baby as it entered the hall, to see if they 
 were diseased. 
 
 If they showed evidence of disease the baby was excluded from enter- 
 ing the contest. If they did not the child of course was permitted to enter. 
 By this means the health of the entire body of children was greatly safe- 
 guarded. 
 
 Diphtheria, scarlet fever, measles, mumps, and the like usually cause en- 
 largement of the kernels {lymphatic glands) in and about the neck and jaw. 
 Even a bad sore throat, particularly when the tonsils are involved, may, and 
 often does, cause enlargement of the glands at the angle of the jaw, and where 
 the inflammatory process extends to and involves the ear, those just back of the 
 ear within the region of the mastoids. 
 
 Occasionally the glands under the tongue just back of the chin become 
 enlarged. This is usually the result of an infection that has got in through 
 the cavities in the teeth. 
 
 Enlargement of the glands under the arm is usually caused by some dis- 
 ease of the mammary gland. Because of the nearness of these glands to 
 the primary seat of infection they are exposed to a concentrated form of- toxin. 
 
550 LYMPHATIC GLANDS 
 
 The inflammatory processes resulting from this form of infection is some- 
 times so severe that the glands become large and soft, and then suppurate. 
 
 A general inflammation of the lymphatic glands may occur in any one 
 of the several infectious diseases. It may occur in either the adult or the 
 child — usually the latter. 
 
 The most common form of this inflammatory process is that which 
 results from so-called scrofulous conditions and tubercular infection. These 
 conditions are ofttimes neglected and terminate in suppuration. 
 
 A similar chronic suppurative condition of the glands is not infrequently 
 found in children who have rickets. Where these and similar conditions of 
 the glands are recognized early enough by proper treatment resolution may be 
 established without a dissolution in the continuity of the tissues which results 
 in the formation of so many unsightly scars. 
 
 The lymphatic glands are globular, ovoid bodies, made up of a fibrous 
 framework, lymph sinus and lymph follicles. They are widely distributed 
 throughout the body. They follow all of the blood vessels to their remotest 
 ramifications, in many cases being even more remote than the blood vessels. It 
 is through these canals that the lymph must percolate in its course to 
 join the blood vessels. 
 
 The lymphatic glands enter into the formation of the lymphatic system. 
 Other organs of the lymphatic system are minute and larger spaces of defi- 
 nitely walled capillaries and vessels containing lymphatic glands. It is 
 through these canals that the lymph must percolate to join the venous sys- 
 tem. 
 
 The lymphatic glands probably stand at the gateway of all lines of dis- 
 ease invasion. Up to the present time disease of the lymphatic glands have 
 not received as much consideration as they possibly deserve. 
 
 When anything interferes with the normal flow of lymph the lymph 
 glands and vessels soon become distended. Since their walls are of low 
 resistance their fluid is easily forced into surrounding tissues. 
 
 If the obstruction continues the tendency to set up various diseases 
 greatly increases. While many of these diseases are only secondary in nature 
 they should more often be considered of primary importance, as by so doing 
 the more serious sequelae of many infectious diseases can be prevented or 
 at least greatly mitigated. 
 
 A tolerably correct pictorial idea of the relation of the lymph to the 
 tissues of the body can be formed by considering the tissues as made up of 
 the structure of a sponge, and the sponge as having been suddenly immersed 
 in water and then withdrawn. In other words : 
 
 "All the cellular elements of the tissues are to be considered as bathed in 
 a sea of lymph." 
 
 Since this is true, it can be readily understood that a thorough knowl- 
 edge of how disease attacks the lymphatic system becomes of highest im- 
 portance. 
 
HODGKIN'S DISEASE 551 
 
 HODGKIN'S DISEASE 
 
 A London brewer dying in 1724 without issue left his property as an 
 endowment to found a hospital bearing his name, Guy. One hundred years 
 ago a physician at that hospital described a disease observed in the ward. 
 The physician was Hodgkin, and the disease took his name. 
 
 In Hodgkin's disease the lymph glands swell. These small hard nodules 
 under the skin, in the neck, under the arm, in the groin, and in the in- 
 ternal organs make one think of infection. Such enlargements, as we or- 
 dinarily see them, are due to infection, and, in many instances, the ordinary 
 man knows just when the infection entered and what was the nature of it. 
 
 Hodgkin's disease has all the earmarks of a mild, slow, relentless 
 infection — one that never kills tissue and causes abscesses but one that weakens 
 the person little by little and causes death in a few years. But no laboratory 
 examination of Hodgkin's showed the infection, and so nearly a hundred years 
 went by. However, the money of the London brewer and the brain of 
 Hodgkin, the hospital physician, had laid the foundation. 
 
 Recently Bunting, at the University of Wisconsin, announced that he 
 had found the cause of Hodgkin's. When these glands begin to grow the 
 customary thing to do is to run to a surgeon to have them cut out. But cut- 
 ting them out does no good. New ones grow back almost at once. 
 
 Many people with Hodgkin's go to Rochester, Minnesota, to the Mayos. 
 Bunting asked them for some material and they removed a few glands from a 
 patient and sent them to him. Bunting found a bacillus, grew it, and, in- 
 jecting it into monkeys, produced a disease with the symptoms of Hodgkin s. 
 
 Then Billings took some glands, grew the bacillus described by Bunting 
 (and perhaps also described by Erankel) and made from them a vaccine. This 
 vaccine he gave to a dozen patients. The dose ranged from 5,000,000 to 
 100,000,000 bacteria. The injections are given hypodermically once every 
 five to seven days. Following the second or third injection there is a high 
 fever lasting a few hours. Some of the patients are apparently well now. 
 
 Neither Bunting nor Billings makes any positive statements yet. They do 
 not say they have found the cause or the cure of Hodgkin's. They tell 
 what they saw and what they thought of what they saw and they ask others 
 to check what they did and then tell how it impresses them. 
 
 It seems fairly certain that the vaccine will not be of service in late 
 cases of Hodgkin's — that is, for people too weak to stand a day of high fever ; 
 that it will not be of service where the glands in the chest are large enough 
 to be shutting oft the wind or interfering with the heart. Other cases of 
 Hodgkin's are proper for trial. Physicians who want to use it can secure it, 
 I am sure, through their druggists. 
 
 Let us hope that the problem of Hodgkin's has been solved. If so, the 
 next step will be to work out a cure for its kinsman, leukemia. 
 
 Leukemia and Hodgkin's.— There are a few diseases which are char- 
 acterized by enlargement of lymph glands but in which, if germs be present, 
 their presence has not been proved. The most important of these is leukemia. 
 
 The white blood corpuscles are highly serviceable. They are the fight- 
 ing forces of the body. They are powerful in repelling any invading enemy. 
 
552 LYMPHATIC GLANDS 
 
 Unlike the red blood cells, they can do their work wherever the work is to be 
 done, either within or without the blood vessels. 
 
 They are constantly going through the walls of the blood vessels and 
 over to some nook where there is a job to be done and then back through 
 the vessel wall into the blood stream. 
 
 They are so efficient that not many of them are needed. The red 
 blood cells are six hundred times as numerous. 
 
 In leukemia the number of white cells is increased. Instead of a 
 count of 8,000 there may be a count of 400,000 in each cubic millimeter, 
 merely meaning that they are fifty times as plentiful as normal. In pneu- 
 monia, in blood poisoning, and in a few other diseases, the leukocytes are in- 
 creased three or four fold because their work is increased three or four 
 fold. In leukemia they are increased fifty fold and if their work is in- 
 creased nobody has ever been able to prove it. 
 
 Leukemia in older people is characterized by an enormous enlargement 
 of the spleen without much enlargement of the lymph glands. Leukemia in 
 younger people is characterized by enlargement of the lymph glands without 
 much enlargement of the spleen. There are other cases in between. 
 
 If the lymph glands enlarge and no local reason can be found the blood 
 should be examined to decide whether leukemia is present. 
 
 Protect Lymph Glands.— When a lump can be felt the person most 
 interested is liable to become greatly alarmed. Sometimes this alarm is 
 justified and sometimes it is not. It all depends on what caused the lymph 
 gland to swell for the lymph gland in swelling was merely doing its duty. 
 
 If fear stimulates one to find out what lies back of the swelling and 
 to try to remedy it, it does good. If it is carried beyond that point, of course 
 it does harm. 
 
 The sane course to follow when one discovers an enlarged gland is to 
 find where the absorption is taking place (if possible), what is being absorbed, 
 and then to devise a method of preventing the absorption. 
 
 Lymph flow is not as uniformly in one direction as is blood flow. The 
 arrangement is comparable to the stream arrangement at the mouth of the 
 Mississippi river where the water, though usually flowing down one channel, 
 is rather easily diverted to another. 
 
 Nevertheless, the lymph flow is regularly enough in one direction so 
 that, given an enlarged lymph gland, we can guess pretty well where the 
 absorption got in. For instance, enlarged glands in the neck well to one side 
 directly below the ears mean absorption from the throat. 
 
 As nearly all of the infections of the throat get in through the tonsils, 
 the wise procedure, when the neck glands enlarge, is to examine and re- 
 examine the tonsils. If kernels come under the arm the wise procedure 
 is to go over the arms and fingers minutely for the focus of infection. 
 
 The old plan of treating enlarged lymph glands was to paint them with 
 iodin or to poultice them, and finally to lance them — as though the real seat 
 of the trouble were in the gland. It may be necessary to lance kernels. If they 
 are full of pus it is the proper policy. 
 
 It may be necessary to remove them radically by operation. If they are 
 damaged beyond service and beyond repair, it is proper to remove them. 
 But no kernel that is not damaged beyond repair should be removed. It is 
 
HODGKIN'S DISEASE 553 
 
 better by far that it should be there filtering out poison, even though swollen 
 and hurting, than that the poison should reach the blood. 
 
 What should we say about the person who allows absorption to proceed 
 uncared for until his faithful servant, the lymph gland, breaks down and must 
 be removed ? 
 
 What can he do? That depends upon the glands. If they are the neck 
 glands, let him clean up his tonsils and his teeth. If the crypts of the 
 tonsils cannot be cleaned and kept clean let him have them removed. If 
 the trouble is with the teeth and gums, let them he cleaned and kept clean. If 
 the kernel is in the groin and there is an ingrowing toenail, that must be 
 cleaned up. 
 
 Wherever the focus, if it be made right, the glands will get right in time. 
 
 Lumps on Neck. — Subscriber writes: "I have had enlarged lymph 
 glands for two years. Lumps come and go on both sides of my neck. 
 Recently I have felt them in the bach of my neck. When they swell they 
 cause considerable pain and stiff neck. I have consulted three physicians. 
 They can't discover anything wrong with either lung, but say these en- 
 larged glands indicate a 'tuberculous condition.' If the infection is tuber- 
 culous, what would you advise me to do for it? Would a change of climate, 
 say to southern California, be of benefit? Do the lungs become affected 
 from these glands in time? I am on a farm and live an outdoor life. I am 
 well otherwise, but get run down every spring." 
 
 Reply. — 1. Ask them to make sure of the diagnosis by a blood examina- 
 tion and a tuberculin test. If the glands are tubercular, have them give 
 you appropriate treatment, including tuberculin. As there seems to be a 
 recurring infection, probably your tonsils are feeding tubercle bacilli into 
 your glands. 
 
 2. Some, but probably not much. It is better for you to change your 
 tonsils rather than your climate. 
 
 3. Sometimes. 
 
 4. A good tonic would benefit you. 
 
 Hodgkin's Disease Symptoms. — L. N. writes: "What are the symptoms 
 of Hodgkin's disease? Is it curable? How can it be cured? Are tuber- 
 cular glands in the neck liable to cause consumption? Are tubercular 
 glands painful? Would an infection from the tonsils be painful?" 
 
 Reply. — 1. Enlarged glands, anemia, general weakness. It is especially 
 liable to be confused with leukemia and with tubercular glands. A blood 
 examination will show whether it is leukemia or not. A tuberculin test 
 will show whether the enlargement is tubercular or not. 
 
 2. No. 
 
 3. Yes. 
 
 4. Yes, moderately so. 
 
 5. Yes, moderately so. 
 
 Consult Family Physician. — A. H. writes: "I have a daughter, not 
 quite lJf., who is healthy and has never been sick. In the last year she has 
 grown rapidly, but shows absolutely a normal development physically and 
 mentally. Recently we have noticed a little swelling or enlarging of the 
 right side of the throat. Sometimes it is not noticeable, but at certain 
 movements of the head or when she is laughing it will show distinctly. 
 
554 LYMPHATIC GLANDS 
 
 What is the cause and what kind of treatment do you recommend to stop 
 it growing, or, if possible, to make it disappear?" 
 
 Reply. — She may have a goiter; she may have enlargement of some 
 of the other glands in her neck. An examination is necessary to deter- 
 mine this; it is also necessary before prescribing. Consult your family 
 physician. 
 
 May Need Draining. — I. C. writes: "I have a lymph gland directly 
 underneath the chin and it stands out prominently when I raise my chin. 
 Do you advise having it cut out? It pains sliglitly when touched." 
 
 Reply. — If it is red, soft, and sore it probably contains pus and should 
 be drained ; otherwise not. The infection is getting in through your teeth 
 or gums, mouth or lips. Have the focus of infection cleaned up. 
 
 Are Easily Cured. — Subscriber writes: "Are little balls which have 
 come in the neck and are apparently loose from the glands a form of tuber- 
 culosis? Fresh air seems to have a tendency to lessen the enlargement, 
 also quiet and rest. No pain is attached. What will they develop into? 
 Are baths and dieting helpful?" 
 
 Reply. — They may or may not be. Tubercular glands of the neck 
 frequently seem to be "little balls not attached to the glands." Tubercular 
 glands of the neck are usually easily cured and therefore develop into 
 nothing. 
 
 Swollen Lymph Gland. — S. T. G. writes: "I have a swelling on my neck 
 near the ear. I have had it for two months. I have not consulted a physi- 
 cian about it but I think it is a swollen gland. Do you think that has 
 anything to do with tuberculosis?" 
 
 Reply. — It is a swollen lymph gland, the result of some infection, prob- 
 ably of a tubercular infection. You should have it attended to to prevent 
 it from softening and suppurating. More important still, you should find 
 where the infection is getting in. 
 
 Enlarged Lymph Glands. — Irene writes : "1. 1 am bothered now and then 
 with lumps about the size of a marble in my neck just under my jaw- 
 bone. What causes these? 2. Is antitoxin a poison? 3. Does it affect the 
 heart?" 
 
 Reply. — 1. They are enlarged lymph glands. Such enlargement indi- 
 cates the presence of germs of consumption, or pus, or something similar. 
 The germs get there from the tonsils or from the teeth. By all means have 
 your teeth, tonsils, mouth, and nose looked after. 
 
 2. No. 
 
 3. No. 
 
CHAPTER XXXI 
 
 Ductless Glands 
 
 The ductless glands have been a neglected field in practical medicine and 
 surgery. From the surgical standpoint nothing has been done except to im- 
 prove the method of operation on goiter; to determine when a given case 
 should be operated on or when it had gone too far for an operation to be 
 safe; to remove a few adrenal tumors, and to do an occasional removal of 
 some one of the other glands. 
 
 On the medical side more has been done, but not much headway has been 
 made. There were many practical difficulties in the way. It was difficult 
 to get the secretions of the glands for analysis and research; it was difficult 
 to operate experimentally on the glands without disturbing neighboring 
 structures in such a way as to make it difficult to decide what part of the 
 effect was due to the operation and what part of the effect was due to the 
 removal of the gland. 
 
 When glands were given by the stomach the first necessity was to know 
 whether the digestive juices broke the gland chemicals up into simple sub- 
 stances and thus made them ineffective. For example, on the one hand, 
 snake poison can be swallowed without injury, because the digestive juices 
 change it to harmless substances; on the other hand, the virus of infantile 
 paralysis when swallowed is probably not changed. 
 
 Over growth in stature three influences preside — first, heredity; second, 
 food supply; third, secretion of the ductless glands. 
 
 We learn from the Journal of the American Medical Association of some 
 experiments by a physician in Neiv York City who fed tadpoles on thymus 
 and thyroid glands. Those fed on thymus retained their youth and remained 
 immature frogs overlong. Those fed on thyroid began to develop legs at once 
 and speedily dropped their tails. Maturity without much growth was reached 
 ahead of time. It seemed that the impulse to grow came from the thymus 
 and the impulse to mature from the thyroid and these qualities of these glands 
 were not modified by the digestive juices. 
 
 If we can apply this to human beings it would indicate that the great, 
 large, gawky, overgrown youths would be helped by thyroid. Those who are 
 small, old before their time, mature in advance of the years for maturity, 
 would be helped by thymus. 
 
 However, it is well to bear in mind that ductless gland therapy is now 
 a field of active study and many halfway facts will be discovered from time 
 to time. It will be some years before our stock of information will be great 
 enough to support far reaching or final conclusions. 
 
 555 
 
556 DUCTLESS GLANDS 
 
 ACROMEGALY 
 
 Growth is not a matter of chance. One determining factor is heredity. A 
 child is born destined to reach a certain size. However, circumstances, such 
 as an attack of summer complaint or measles, may intervene to prevent 
 the child from developing as destined. More than that, the person is destined 
 to grow after a certain fashion until about fourteen ; then to radically change 
 his growth so as to fit a new set of specifications ; then, at about twenty-five, to 
 quit growing, but to fatten ; about the forties to fatten more rapidly ; about the 
 seventies to lose fat ; and finally, about the eighties, to dry out and shrink. 
 
 These changes are not matters of chance. The growth in childhood is 
 due to the secretions of the ductless glands and principally to those of the 
 thyroid (in the neck), the thymus (in the chest, just over the heart), and the 
 pituitary (in the train, just back of the eyes). 
 
 At fourteen, the rapid growth along new lines is due to the absorption of 
 the internal secretion of the sexual glands. The changes in percentage of fat 
 which come later in life are the result of thyroid changes. 
 
 Acromegaly is a disease in which the bones grow to giant size as the 
 result of overactivity of the pituitary body. Many of the museum giants are 
 acromegalics. Dock says: 
 
 "The sculptures of many French and Italian churches show interesting 
 examples/' 
 
 Jack the Giant Killer and perhaps also David, who slew Goliath, had 
 rather an easy time of it, as giants are generally weak both physically and 
 mentally, "furnishing more drum majors than academicians," and dying 
 before they reach middle life. 
 
 Acromegaly is somewhat different from giantism. One out of every 
 five acromegalics is a giant, and one out of every two giants is an acromegalic. 
 
 In acromegaly the bones grow large — sometimes rapidly, sometimes slowly; 
 the brow bulges, the cheeks become prominent, the chin protrudes, the fingers 
 and hands, feet and toes, become heavy and "bony." 
 
 In acromegaly the bones grow large at one end and not at another. 
 Certain bones may be enlarged and not others. In fact, it is the unevenness 
 of development which makes the difference between an acromegalic giant and 
 a so-called normal giant. 
 
 In acromegaly the pituitary body is found enlarged or overactive, 
 without being enlarged. The gland oversecretion poured into the blood 
 causes certain bones to overgrow. 
 
 Some day somebody should discover an antibody to neutralize this 
 secretion or some surgeon should find a way to remove a part of the gland. 
 
 Irregular and abnormal growth, whether resulting in giantism, acromegaly, 
 or some less obtrusive deformity, is a fair field for the investigator. 
 
 THYROID MALADIES 
 
 Lying on the front of the trachea, or breathing tube, just below the 
 Adam's apple and just above the breast bone, lies one of the most important 
 
 
THYROID MALADIES 557 
 
 organs in the body. It is located just under the skin and therefore is 
 easily felt. It is known as the thyroid gland. 
 
 The painters and sculptors knew of it in the earlier days of art, for the 
 old Grecian statues and pictures show it plainly; yet the physicians were 
 slow in discovering it. The first medical man to recognize definitely disease 
 in the thyroid was Paracelsus, who wrote on goiter and cretinism about 1500. 
 
 The reason for the tardiness with which knowledge of the thyroid 
 has grown is that it is a ductless gland. Its secretion is absorbed directly 
 into the blood stream. The peculiarity which made this gland secretion 
 of the very greatest importance served to hold back knowledge of it. It 
 was not possible to tap a duct, gather the secretion and analyze it, as can 
 be done with the secretion of the duct glands. 
 
 Paracelsus, the Swiss scientist of the sixteenth century, was deprived 
 of one of his glands having a ductless gland function. In consequence his skin 
 was smooth and his face grew no beard. 
 
 Possibly he had some thyroid disease when he was young, for it is said 
 that he was rickety. Possibly the bony changes of rickets are due to the 
 effects of poor food and poor air acting through some of the ductless 
 glands. 
 
 Robinson says that, compared to Paracelsus, "the magpie is shy and the 
 peacock modest/' Be that as it may, Paracelsus recognized that the thyroid 
 was an important organ. 
 
 The thyroid gland weighs from one to two ounces. It is about two inches 
 long, three-quarters of an inch broad and an inch thick at the thickest part. 
 Shaped like a pair of old fashioned saddle bags, it lies across the windpipe. 
 The two main bodies, called lobes, rest on the sides of the windpipe, and they 
 are joined by a band of thyroid tissue, called the isthmus, lying on the front 
 of the windpipe. 
 
 In the ordinary person the edge of the thyroid is about three-quarters of 
 an inch above the top of the breastbone. In some people some part of the 
 thyroid is behind the breastbone in the upper portion of the chest. 
 
 The secretion of the thyroid cells is poured into microscopic cysts or 
 tanks and from these it is absorbed by the blood. If the amount of thyroid 
 secretion is just enough and not too much the work of the body is liable 
 to go along about right. 
 
 The thyroid is the master gland. More than any other gland it governs 
 the work of other glands. The other organs are tied rather narrowly to their 
 accustomed tasks. The thyroid has special tasks and in addition it has some 
 capacity to help out with the tasks of other glands. 
 
 If there be a general infection the thyroid is liable to swell. Indigestion 
 causes it to enlarge. It enlarges during menstruation. Some pelvic troubles 
 in women cause it to swell. 
 
 If there be very much of an excess of thyroid secretion the heart beats 
 too rapidly and is irregular ; there is a tremor in the hands and the breathing 
 is shallow. The change in the mental state is very striking. There is great 
 nervousness, excitability and general on-edge-ness. 
 
 If there is too little thyroid secretion absorbed, the pulse is slow and 
 strong, the skin is thick and dry, and the hair is lifeless. The mind is 
 dull. 
 
558 DUCTLESS GLANDS 
 
 The amount of thyroid substance absorption has a great deal to do 
 with size and weight. Children with thyroid deficiency are small. Dr. 
 Hertoghe dwarfed small animals by removing their thyroids in their early 
 youth. He caused dwarfed animals to grow larger by the use of thyroid. 
 
 Children with an excess of thyroid are nervous and learn and grow 
 rapidly. 
 
 As people approach the meridian of life the thyroid begins to show the 
 effects of its great activity during the earlier years. The pathologist says 
 that there is an overgrowth of the framework of the organ, the interstitial 
 tissue — a sign of wear. 
 
 The person says he is getting bald, is taking on weight, is less aggressive 
 mentally, and that his judgment is better. The physician puts together the 
 testimony from the two sources and says that the thyroid is secreting less. 
 
 When the thyroid oversecretion is enough to bring the condition into the 
 realm of disease the name given is hyperthyroidism, or too much thyroid. If 
 the thyroid is enlarged, the condition is called goiter. There can be goiter 
 without the on-edge-ness due to hyperthyroidism. There can be hyperthy- 
 roidism without any goiter. 
 
 If the absorption of thyroid secretion is too small in amount the condition 
 is called hypothyroidism. If the deficiency is very great the condition is 
 known as cretinism. A less marked stage is called myxedema. If the amount 
 of secretion is still nearer normal the condition is known as partial myxedema. 
 
 In cretinism the gland is very small and the amount of secretion is 
 almost at the zero point. In consequence none of the life processes goes right. 
 The subjects are somewhat dwarfed in body and very much dwarfed in 
 mind. 
 
 Cretins are such by inheritance. In fact, heredity is a prominent factor in 
 both goiter and cretinism. Of cretinism, the Sardinian Commission reported : 
 "Sometimes cretins are born to cretinous parents. Sometimes the children 
 of such parents have no more than a disposition toward cretinism." 
 
 In a considerable group of people there is a temporary condition known 
 as partial myxedema. In others this condition of slight hypothyroidism is 
 persistent. French described six groups of people who surfer from partial 
 myxedema as follows: 
 
 "1. Certain infants who without being true cretins, present symptoms 
 of idiocy. 
 
 "2. Certain backward children between two and five years of age showing 
 various symptoms, of which the two most familiar are slowness in learning to 
 talk and delay in learning to walk. 
 
 "3. Growing boys and girls suffering either from general mental back- 
 wardness or a persistence of the habit of wetting the bed at night. 
 
 "4. Certain stout, sterile women of the child-bearing age. 
 
 "5. Certain females at or about the menopause who have rapidly become 
 too stout. 
 
 "6. Sufferers from certain nerve affections which closely resemble and 
 are frequently called neurasthenia and tic douloureux." 
 
 There is no better way to discover that a given condition is the result 
 of too little thyroid than giving thyroid for a while and noting the effect. 
 
 If the physician who is observing the case notes that the symptom 
 
THYROID MALADIES 559 
 
 is disappearing he is justified in feeling fairly sure that hypothyroidism 
 was the underlying cause. For instance, if a child is noted to be months 
 behind in walking or talking, or if a boy wets the bed years after he should 
 have stopped, there is evidence enough to warrant a trial of thyroid. 
 
 Belladonna, worm medicine and scores of other remedies have been 
 tried in vain, for none of them is worth anything for bed wetting. Thyroid, 
 under proper control, is worth a trial. 
 
 An idea of another type of thyroidism can be had from a description of 
 a case given by Dr. Barton in the Journal of the American Medical Asso- 
 ciation. 
 
 A woman forty-four years of age, the mother of three children, noticed 
 that she could not comfortably put on her shoes or her gloves. Her feet and 
 hands would swell and stay swollen for a while, then the swelling would 
 go down. Examination of the urine showed that she did not have Bright's 
 disease. This came on slowly and lasted for four years. 
 
 Then she noticed that she was getting stout; her mouth was feverish; 
 she felt cold when others did not, and her hands and feet would "go to 
 sleep" easily — in fact, they had that feeling most of the time. Her skin 
 was dry, glossy, and rough, and she never perspired. She had pains in her 
 legs, especially when she went up and down stairs. 
 
 In time her gait became very wabbly. Her memory became poor, 
 she spoke slowly, and was disposed to cry a good deal. 
 
 Her lips thickened a little and her tongue swelled. One consequence 
 of this trouble with her lips and tongue was that her speech got a little 
 thick. For instance, she pronounced s as sh. 
 
 From her speech, her gait, and her mental impairment the neighbors 
 got the idea that she was mildly intoxicated most of the time. 
 
 Finally she went to a doctor and had a thorough examination made. 
 He found a stout woman whose weight had recently increased from 170 to 
 189. The lips and tongue were thick and stiff. There was enough of the 
 appearance of dropsy in the skin to blot out the lines which ordinarily give 
 expression to the face. At the same time there was no typical dropsy. 
 
 She said she sat at a window for hours at a time, aimlessly looking 
 out. Her mind was clear, but there was no snap to it. Her speech was 
 thick. Her pronunciation was a mild imitation of that of the stage drunk. 
 
 Dr. Barton decided that she was not suffering from Bright's disease. 
 The near dropsy in the face and legs was suspicious but there were no albumin 
 or casts in the urine. He decided that she was suffering from partial 
 myxedema. 
 
 He gave her two grains of thyroid extract three +imes a day. Her 
 pains kept up for several days. Then she had flashes like a woman passing 
 through the change of life. 
 
 Then her disagreeable symptoms began to clear up and within a few 
 weeks she was a well woman again. That is to say, she was well in so far as 
 her symptoms were concerned. Her thyroid deficiency was permanent. At 
 her time of life that could never be cured. 
 
 After she had got over her symptoms her dose of thyroid was reduced 
 to one two-grain tablet a day. That dose she will probably be compelled to 
 keep up until her other organs have grown as old in structure as her 
 
560 DUCTLESS GLANDS 
 
 thyroid is. She may be able to leave it off when she gets to be an old 
 woman but not before. 
 
 Of the six groups outlined by French those in Nos. 4 and 5, having 
 begun thyroid, will probably need to continue it for many years. The 
 members of Nos. 2 and 3, being young, should only take thyroid long enough 
 to get well started towards cure. The elasticity of youth ought to bring 
 them out and should be given a chance to. 
 
 The members of group No. 1 will need to take thyroid longer than those 
 in groups 2 and 3. How long will depend upon how near they are to being 
 cretins. The members of group 6 must be guided by the circumstances of the 
 individual case. 
 
 In those days when the only variety of hypothyroidism known was 
 cretinism thyroid, deficiency was thought to be a very rare condition in this 
 part of the world. Then came knowledge of the milder condition, myxedema, 
 but still the condition was regarded as rare. Then came knowledge of partial 
 myxedema. 
 
 Now it is known that a minus thyroid condition may complicate almost 
 any disease condition. It may cause various kinds of aches and pains, various 
 kinds of mental disturbance, and various symptoms that appear in other 
 diseases, but which are the result of lack of thyroid. A few days of thyroid 
 treatment may unravel more than one puzzling case. 
 
 Fortunately the discovery of the remedy preceded the full knowledge 
 of the disease. Thyroid extract bears much the same relation to this disease 
 that quinin does to malaria or antitoxin to diphtheria. 
 
 Difference in Goiters. — The general run of people are very well in- 
 formed about goiters. They know a goiter when they see one. They even 
 know how to protect themselves against goiter fakes of various sorts. Those 
 who have goiters are not indifferent about them. In fact, as a rule, they 
 are rather more uneasy than the danger warrants. There is need for in- 
 formation on which to base judgment as to which of the goiters need 
 treatment and especially which need surgical treatment. 
 
 The thyroid gland goiter is very apt to enlarge as a result of disturbance 
 somewhere away in the body — disturbance with the digestive organs or with 
 the pelvic organs, for example. Plainly it would be a mistake to operate 
 on such goiters. Whatever treatment is given should be given the organs 
 in which the disturbance is located. The thyroid is not at fault, except it be 
 a fault to help out. 
 
 In young men and women it is not infrequent to see a certain amount 
 of enlargement of the thyroid, but with no symptoms. These cases do not 
 require treatment, either medical or surgical. The young woman who does 
 not like the "looks" given her neck should console herself by remembering 
 that the beautiful women painted and chiseled by the Greek artists had some 
 simple goiter. 
 
 If the goiter is pressing on important nerves or other important structures 
 in the neck and causing either cough or suffocation operation may be called 
 for. 
 
 People older in years sometimes have simple goiters without any symp- 
 toms. The goiter is there and that is all there is to it. Most of these cases 
 require no treatment, medical or surgical. If in such a case the goiter 
 
THYEOID MALADIES 561 
 
 grows rapidly, or gets very large, or produces pressure, or causes cough, opera- 
 tion may be called for. A good surgeon must decide the question. 
 
 The goiters for which good judgment is required, if the ship is to be 
 properly steered, are what is known as toxic goiters. In the toxic goiter 
 cases the subjects are nervous and flighty. The heart palpitates, races a 
 while, and then pounds hard and slowly. The hand trembles. Breathing 
 is shallow. In some of the cases, perhaps half of them, the eyes bulge and 
 much of the white of the eyeball shows. The superficial observer sees the 
 bulging eyes easily. It is for this reason that the name exophthalmic goiter 
 is given to this disease. Some cases in which the eyes bulge do not show 
 the other signs of poisoning. 
 
 The essential signs of thyroid poisoning are the mental excitability, 
 nervousness, the tremor of the hands, the nervous heart, the nervous diges- 
 tive organs, and the bulging of the eyes. 
 
 Some of these cases can be cured without operation. Antithyroid prepa- 
 rations, iodin preparations, electricity locally, resting in bed are the meas- 
 ures which succeed in some cases. Most of them need operation. 
 
 Good judgment is required to decide when to operate and when not to 
 operate. A case may pass quickly from an operable to an inoperable stage. 
 Some inoperable cases can be treated medically and brought back to the point 
 where they are operable. 
 
 The Thyroid Gland.— When you encounter an unduly irritable, flighty 
 woman and are upset by her unreasonableness, before you condemn her notice 
 the size of her neck. She may have a goiter and by that token be entitled to 
 your patience. 
 
 When you encounter a logy, heavy, phlegmatic man, before you condemn 
 him, think of the possibility that he is a cretin or cretinoid and entitled to 
 your help. 
 
 There are glands like the liver and kidneys that take chemical sub- 
 stances out of the blood and discharge them from the body. They have been 
 well studied, because it is easy to collect their secretions, to examine them 
 chemically, to look at them under the microscope, and to inject them into 
 animals. These glands are important just as the garbage man is im- 
 portant. 
 
 There are other glands, called ductless glands, which secrete substances 
 that are poured into the blood stream, not out of it. These glands are im- 
 portant just as the milkman is more important than the garbage man. 
 
 The most important of the ductless glands is the thyroid — a gland located 
 on the front and sides of the neck just above where the collar is worn. The 
 thyroid secretion is poured into the blood and by it is carried to all the tissues 
 of the body. ^Yhen the gland is wholly removed, death results in a few days. 
 When a child is bom with too little thyroid it is dwarfed physically and men- 
 tally, the limbs are short, the skin thick, the lips protruding — the child is 
 idiotic, it hears and sees poorly and comprehends imperfectly. 
 
 So much for those having far too little thyroid secretion — the cretins, 
 the cretinoids, and, perhaps, the Mongolian idiots. 
 
 Those having far too much thyroid have bulging eyes, a flushed face, 
 irregular pulse, a flighty, irrational, illogical, quick, nervous, fidgety mind, 
 asthma, and nervous diarrhea. Below this, which is the extreme, there are 
 
562 DUCTLESS GLANDS 
 
 cases which grade all the way down through exophthalmic goiter, goiter 
 thyroid enlargement, goitrous states, hyperthyroidism — through inexplainably 
 nervous people to the absolute normal. 
 
 Having established as a base line the man into whose blood the thyroid 
 gland is pouring just the right amount of secretion each day and who in 
 consequence is well nourished, well developed, well muscled, not obese, and 
 whose mind works coolly, calmly, collectedly, alertly, judiciously, we recognize 
 men and women both above and below, some in low and others in the high 
 registers, and still others in the deep basses. 
 
 Cretins. — It is probable that there always have been cretins. The 
 ancients had a habit of deifying that which they could not understand and, 
 therefore, stood in awe of. Dr. Parrot says that the ancient Egyptian god, 
 Ptah, especially venerated at Memphis, was a cretin. An examination of 
 the models of this god in the Egyptian galleries shows that he was big 
 bellied, squat, with short limbs — not unlike a cretin. At the present time 
 there is no romance and no legend attaching to the cretin. He is just 
 plainly unfortunate in having less than his share of thyroid gland, or a 
 thyroid gland secretion which is less rich than it should be. 
 
 Most cretins are born with so little gland that they are doomed to cretin- 
 ism; a few acquire this deficiency. There are parts of Switzerland where 
 cretins abound. In a district in Styria there are 1,045 cretins for every 
 100,000 population. In certain parts of Austria the rate is 71 per 100,000. 
 In Piedmont, Lombardy, and Venetia there are 12,882 cretins in a population 
 of 9,565,000. In this country there are a fair number of cretins, but far less 
 than in the region of the Alps. 
 
 Going above the line, we get into a field of greater interest. 
 
 If the Egyptians worshiped a cretin god, the Greeks showed a fondness 
 for those with an excess of thyroid. Greek statues were usually modeled after 
 men and women with- enlarged thyroids. The earlier Eoman art, among 
 other ways, showed the influence of the Greeks in that the women portrayed 
 had necks that were overfull. If this evidence is to be accepted goiter was 
 frequent and not a thing to be ashamed of in those early days. 
 
 Goiters. — Goiter occurs so frequently as to make it worth while con- 
 sidering. Ma jet says that in France there are 400,000 people with goiter. 
 Ewald said that 12,277 recruits were rejected for goiter in Switzerland in 
 three years. Hocher says that 80 per cent of the school children of Berne 
 have it. Munson found that one in fifty Indians had it. Dock found a lot of 
 it around the Great Lakes. Adami found that in certain French Canadian 
 villages about two out of every thousand had goiter. Of the young women, 
 10 per cent had it. 
 
 A slight projection in the lower part of the neck is frequently seen, 
 especially in women, on the streets of Chicago and generally among the people 
 of the upper Mississippi valley. Many of these cases have not only enlarged 
 glands but also the prominent eyes which designate them as exophthalmic. 
 Some are goiter, some exophthalmic goiter. 
 
 The amount of disturbance is not proportionate to the size of the gland. 
 The real cause of the trouble is the pouring of too much or too rich thyroid 
 juice into the blood. While we naturally expect a big gland to make more 
 juice than a small one sometimes the little fellow is the more active of the 
 
 
THYROID MALADIES 563 
 
 two. The large gland may be made up mostly of gristle and the little fellow 
 mostly of secreting cells. A gland that is not too large may slip around 
 in front of the muscles of the wind pipe and seem to be larger than it is, 
 or it may slip back under the muscles and appear to be smaller than it is — 
 in fact, may be hard to see at all. It may be so situated that it catches, 
 pinches, squeezes nerves or blood vessels, causing the eyes to protrude, the 
 breathing to be asthmatic, the face to flush, or it may be so placed that it 
 does not pinch. Whether or not it does many of these things is a matter 
 of chance. The real question is : Is the thyroid gland over- or underactive ? 
 
 The cause of goiter has not been worked out to the complete satisfaction 
 of anybody. Many causes have been discovered. No doubt these are factors, 
 but nobody has given to these different factors their proper values. 
 
 One of these causative factors is the drinking water. There is much 
 reason for believing that water is of some importance as a causative factor; 
 another of some importance is the soil. Osier's "Practice of Medicine" tells 
 us that the belief that water causes goiter goes back as far as Pliny, and is to 
 be found in Africa, India — in fact, in all parts of the world. In several 
 places in Italy and Switzerland whole goitrous districts have been improved 
 by getting water from a nongoitrous region. 
 
 Then we have some pretty good proof that while some goiter comes from 
 water, some is inherited. Occasionally it breaks out in epidemics in schools, 
 barracks, and neighborhoods. Some develop from mental strain, some about 
 those times in life when the body is undergoing profound changes, particularly 
 adolescence and change of life. 
 
 But much more important than any other cause is inheritance. Hirsch 
 says: "There is very nearly unanimity among observers that goiter is trans- 
 mitted by inheritance. That cretinism is influenced by inheritance is now 
 quite generally accepted. The Swiss, acting on this view, regulate marriage 
 among those with thyroid abnormalities. This procedure is eliminating cre- 
 tinism from certain highly cretinous districts. Goitrous families are prone to 
 contain a number of cretins. 
 
 What is to be done about it? What can a person with thyroid do? 
 
 Certain of them are operative cases and no other course is open to them. 
 Goiters, just as certainly as cancers,' pass into an inoperable stage. After 
 the thyroid has for years poured a daily poisonous dose of secretion into 
 the blood there comes a time when no surgeon is justified in operating. 
 The nervous control of the vital processes, particularly the heart action, gets 
 to be so badly impaired that operation is unwarrantably dangerous. 
 
 Xo surgeon is justified in operating on a case of goiter unless he has 
 kept watch of the case long enough to know the patient as well as his 
 goiter, and no patient with goiter is justified in allowing himself to be 
 operated on, or even to take an anesthetic for any purpose, until the anes- 
 thetist and the operator have had a chance to size up the entire situation. 
 Therefore, any woman who has goiter should carefully consider lest she 
 pass from a stage where operation is advisable to one where operation is 
 inadvisable. 
 
 Can anything be done for those who have too much thyroid but are 
 not in need of operation? Yes; much can be done in teaching them how to 
 control themselves, how to maintain an equilibrium. Various drugs have 
 
564 DUCTLESS GLANDS 
 
 been used with benefit in certain cases. In the main these are made from 
 other ductless glands — those that are supposed to be antagonistic to the 
 thyroid. One is made from the milk of goats whose thyroids have been in 
 part removed. 
 
 What can be done for those that have too little thyroid? Fairly satis- 
 factory results follow continued giving of thyroid gland and various kinds 
 of extract of thyroid gland. Preparations of iodin, especially organic iodin, 
 are valuable. The thyroid secretion is rich in iodin. But the trouble 
 is that these are only remedies. They must be kept up as long as life lasts. 
 If stopped, the patient relapses. Now, this is tiresome and quite unsatis- 
 factory. 
 
 Therefore, surgeons occasionally take a thyroid from a lower animal 
 and implant it into a cretin or a cretinoid. 
 
 Of the greatest interest is the subject of moderate hyperthyroidism and 
 hypothyroidism — people who are irritable, nervous, and flighty because they 
 have not much thyroid, or who, because they have too little, are phlegmatic 
 and heavy. Some, being young, have too little and are undersized, or, becoming 
 old, are having their thyroid shrink and are, therefore, getting obese. 
 
 While we do not have many cretins in this country, we do have many 
 phlegmatic, thick skinned persons who are suffering from thyroid deficiency. 
 When there is a poor bony development the thyroid may be at fault. Small 
 people are usually such as the result of inheritance but occasionally a person 
 is undersized without having this as an explanation. 
 
 This is a great field for the immediate future. Those who know 
 most know little enough. Even when it comes to questions of cause and 
 prevention there is need for more information. 
 
 That there is a goiter inheritance has been proven abundantly. That in 
 goitrous districts cretins abound has been proven. Acting on the few known 
 inheritance facts, the Swiss government is greatly reducing the goiters and 
 cretins in the districts where they are working. That water, soil, fright, 
 emotional states are factors is known, but the information is only half in- 
 formation. We need more study of the cause of goiter and cretinism and 
 greater effort by the government to control the ramifications of thyroid 
 problems. 
 
 However, let us bear this in mind: those who are afflicted with having 
 too much thyroid and those who have too little, as well as the slightly goitrous, 
 are entitled to more kindness and patience than they receive. 
 
 Enlargement of Thyroid. — There is goiter and then again there is 
 goiter. There are cases of goiter in which the constitutional symptoms 
 are profound and the only course, if life is to be saved or if the patient 
 is to be spared confirmed invalidism, is prompt operation. 
 
 In another group of cases the disease progresses slowly but inevitably, or 
 nearly so, toward the stage in which the only help is operation. Another 
 group of cases responds well to thyroidectin and similar preparations taken 
 internally. This article does not deal with these groups. 
 
 In a routine examination of 800 people applying for positions in three 
 branches of the civil service in Chicago, in 1914, Dr. E. T. Olsen found goiter 
 present in a surprisingly large percentage of the cases. 
 
 In one series of 449 women 69 were rejected on account of goiter. 
 
THYKOID MALADIES 565 
 
 This was 15.37 per cent of the whole. Analyses of the nativities and ages 
 of these women showed nothing out of the ordinary. It seems probable that 
 somewhere about 15 per cent of all the women of Chicago have enough of 
 a goiter to be somewhat affected thereby. 
 
 In another series of 157 examinations of women there were 32 rejections 
 on account of goiter — 20.38 per cent. In a series of 193 examinations of men 
 there were 13 rejections on account of goiter — 6.72 per cent. 
 
 If you are a Chicago woman there is one chance in seven that you have 
 goiter. If a Chicago man, your chance is one in sixteen. 
 
 From the state of Washington comes a similar report. The probability 
 is that goiter is not especially abundant in either of these regions. 
 
 These surveys have merely revealed conditions that are about average 
 throughout the country. The fact is the thyroid gland is an important organ. 
 Whenever anywhere in the body any organ is put under stress there is a 
 fair chance that the thyroid may enlarge by reason of its efforts to help 
 out in the extra strain. Therefore enlargement of the thyroid is frequently 
 an indication of trouble somewhere else in the body. 
 
 If a woman has pelvic trouble, uterine trouble, or pus tubes or abscess 
 of the broad ligament her thyroid may enlarge. 
 
 I know one physician whose digestion is poor and who has an enlarged 
 thyroid. By eating cautiously he has managed to keep down his thyroid 
 trouble for years. With him his thyroid is a barometer showing the condition 
 of his digestion. 
 
 The Journal of the American Medical Association quotes a Swedish 
 physician, Norregaard, who studied the relation between the thyroid and 
 conditions of the adenoids and tonsils. From a careful study of thirty-five 
 cases he concluded that whenever thyroiditis develops there is a focus of 
 infection somewhere in the body, and the most frequent location is the 
 tonsils. 
 
 Therefore whenever he found a case of thyroid enlargement he first 
 carefully examined the throat. If no source of trouble was found there an 
 examination of all the organs was made. It is only a short distance from 
 the tonsils to the thyroid. Any infection can easily travel the route. 
 
 In some animals there are direct channels from the tonsils to the 
 thyroid. Weglowski carefully examined 153 human cadavers, finding in 50 
 direct routes from the tonsils by which bacteria could have readily traveled 
 to the thyroid. But even if Weglowski had failed to find any small tubes 
 the relation between infection of the tonsils and enlargement of the thyroid 
 would have stood. There are no tubes between the pelvic organs, the ap- 
 pendix, the gall-bladder or the digestive organs and the thyroid. The point 
 is that enlargement of the thyroid is often merely a card which reads: 
 "Trouble here ; look for the cause/' 
 
 Goiter — Endemic. — When the thyroid gland enlarges or gets unduly 
 active, the condition is called goiter. This gland, located in the lower part 
 of the neck, is extremely important. Just enough of its secretion is necessary 
 for health. Too much causes a train of symptoms. 
 
 The number of people in Switzerland with thyroid out of balance — too 
 large or too small — is great. In Aosta a large part of the people had small 
 thyroids. The condition was getting worse as the years went on until the 
 
566 DUCTLESS GLANDS 
 
 inheritance factors were recognized. The marriage of cretins was prohibited, 
 whereupon cretinism began to lessen in Aosta. 
 
 Every now and then a goiterous condition runs riot through a com- 
 munity- The condition becomes epidemic (or endemic). Scientists studying 
 some of these endemics thought the spread was due to water. They said 
 that water from certain types of soil caused it. 
 
 This idea that water causes goiter is widespread. It is extensively be- 
 lieved in this country. In fact, I think most people accept the water theory 
 as a fact. 
 
 Scientists never thought water had anything to do with the ordinary 
 types of goiter. It was only in the goiter endemics, regarding the localities 
 where nearly every woman and many of the men had goiter, that the water 
 was thought to be the cause. 
 
 The Hygienic Institute at Zurich says that water has nothing to do 
 with goiter. In their study the investigators examined 6,000 people. In one 
 town 77 per cent of all the people had goiter. In another, two-thirds of the 
 people were affected. In certain families all the members had the disease. 
 Here were endemic conditions beyond a doubt. 
 
 Examining the source of the water carefully, the experimenters found 
 that it did not come from the rock strata supposed, for some of the original 
 studies had been made in these towns and the whole theory was based 
 on the presumption that the water came from a certain rock formation. 
 
 The next experiment was with rats. Ordinarily rats do not have goiter. 
 Rats caught elsewhere and exposed in the epidemic localities got goiters. It 
 made no difference whether they drank boiled water or water from other 
 sources or water from the local supply, goiter developed just the same. 
 Eats kept in another district but fed on water from a goiter district did 
 not develop goiter. 
 
 It became evident that goiter is slightly catching in a goiter district. 
 But it is not spread by water. Something else in wide use in such a 
 district spreads it. 
 
 What it is is not known. This does not mean that there is danger of 
 spread by water, air, or anything else in a district where goiter is some- 
 what rare, where, say, less than one in one hundred has goiter. 
 
 Battling with Goiter. — When a person has a goiter, he or she should 
 be in good hands, medical or surgical — sometimes one, sometimes the other. 
 Such a person is one who has bulging eyes, enlargement of the thyroid, ir- 
 regular, rapid pulse, muscular tremor, and diarrhea. All of these are 
 symptoms, or at least two or three of them are. 
 
 However, outside of this group are a large number of people who are 
 not much disabled now and hope not to become disabled. They want to know 
 what they can do. 
 
 A while ago I was lunching with an intelligent physician whose thyroid 
 was plainly enlarged. He ate carefully. He told me his trouble had existed 
 for years; that it did not discommode him much. He had noticed that if he 
 were careful of his digestion he had little trouble. By eating small meals, 
 selecting his food with discretion and chewing carefully he kept himself in 
 good shape. Should he be indiscreet he paid the penalty. 
 
 Dr. Hemmeter, a most excellent physician of Baltimore, tells in the 
 
THYROID MALADIES 567 
 
 Journal of the American Medical Association of having controlled three 
 troublesome cases by attending to the digestion. Generally speaking, he keeps 
 his patients, for a while at least, on a meat-free diet. He washes the lower 
 bowel every day with from a pint to ,a quart of a one per cent solution of 
 ichthyol. No one should try the ichthyol without having a physician to 
 keep track. Some patients take sour milk and Bulgarian bacilli. 
 
 After the symptoms had stopped he had the three patients in question 
 keep up cold baths and sleep twelve hours a day, or rather stay in bed 
 twelve hours a day. The colonic flushings were given about once a week. 
 
 The people who have a slight amount of goiter can well see to it that 
 they do not develop chronic constipation. If they can get their bowels in 
 perfect habit they may not need enemas. But rather than allow constipation 
 to continue they should take plain large enemas. 
 
 It would be better still for them to go to their physician or a clinic 
 for a course of medicated enemas. They should look to their diet and their 
 method of eating with especial care. Hemmeter advises plenty of rest. 
 
 In addition, McCarrison would take proper steps to see that the drinking 
 water is not befouled by sewage or human contamination. If the water 
 has been contaminated, boiling it will help. 
 
 McCarrison, though, holds that it is not wholly satisfactory to boil 
 water as a protection against goiter. He believes so thoroughly in intestinal 
 disorders as the cause that he gives his cases courses of thymol somewhat 
 as they treat hookworm people. That part, however, the ordinary person 
 had better leave alone, at least for the present. 
 
 This much is certain: It is not enough to know that one has a goiter. 
 Before anything should be done it is advisable to analyze still further. The 
 diagnosis should include the kind of goiter. Mayo, Plummer, and Wilson 
 have shown plainly that there are different kinds of goiters, and what is 
 required for one kind is quite different from the requirements for another 
 kind. 
 
 Some goiters start out to poison the nerves and protrude the eyes. For 
 these operation is inevitable, and delay may result in the case becoming in- 
 operable. 
 
 In another group of cases the thyroid enlarges because it is necessary 
 that it should do so in order that it may do the work thrown on it. 
 
 Many goiters in women result from disease in the pelvic organs. At- 
 tention to the underlying # condition brings about improvement in the goiter. 
 
 The evidence is good that chronic infections of the nose and throat 
 at times result in enlargement of the thyroid and increase in the amount 
 of thyroid secretion in the blood. Dr. Beebe tells us that in goiter patients 
 between sixteen and twenty-four, from 35 to 49 per cent will give a history of 
 repeated attacks of tonsillitis. 
 
 Then, if a person has goiter he should first find out whether his goiter 
 belongs to the group which results from some diseases elsewhere in the body. 
 
 If it does the search must be to find where the trouble is. In this 
 search the condition of the nose and throat must be investigated. 
 
 If the tonsils are found diseased, it is the opinion of other physicians 
 as well as of Dr. Beebe, they should be removed. 
 
 Effect of Gland Changes. — A child is bom with a large ductless gland 
 
568 
 
 DUCTLESS GLANDS 
 
 called the thymus. This gland remains large during the years of rapid 
 growth. About the time the rate of growth of the young person becomes slower 
 it begins to shrivel. While it is not certain it looks as if the growth impulse 
 in part lies in the thymus gland. 
 
 About puberty there is a second period of rapid growth. The shape of 
 the figure changes, the bones of the face change so as to alter the expression. 
 The body changes are widespread and profound. Simultaneously, there 
 is activity in the ductless portions of the sex glands. The presumption is 
 strong that the structural changes of adolescence are not matters of chance or 
 accident but are the result of glandular activity. 
 
 When the pituitary gland is overactive some of the bones or some parts 
 of some of the bones grow large. When there is a large thyroid gland, the 
 subject is dwarfed, physically and mentally. When most of the thyroid 
 is removed from a young animal, the animal de- BA 
 
 velops legs and bones so changed as to amount to 
 a deformity. On the other hand, when young ani- 
 mals are fed thyroid they grow large and have 
 heavy bones. 
 
 Men and women past forty begin to accumu- 
 late fat — they become obese. An examination of 
 the thyroid made during the same age period shows 
 it is becoming senile. Thyroid, skillfully 
 used, is of service in reducing obesity in cw 
 
 this group of people. Their obesity a 
 be reduced by regulating their food wit 
 out giving thyroid, but the use of thyro 
 permits of greater leeway in dieting. 
 
 When the thyroid is 
 markedly diseased definite 
 intoxication results. The 
 subject is mentally irritable 
 and as the intoxication pro- 
 gresses other symptoms de- 
 velop. When the adrenals 
 are in part destroyed low 
 blood pressure and Addi- 
 son's disease result. When 
 there is not enough of a 
 certain pancreatic secretion 
 diabetes results. 
 
 Knowing these facts 
 physicians lay the founda- 
 tion for much more knowledge of the effects of changes in the secretions of the 
 ductless glands. Here and there in a medical society papers are being read, 
 and research is being recorded. Occasionally an essayist will report a plain 
 matter of fact series of observations on the effect of changes due to altered 
 secretions of the ductless glands. About this report there will be nothing 
 dramatic, no "story." Such a report is no sixteen story building — it is just a 
 brick — but of just such plain, undramatic bricks, tested, tried, and then laid 
 
 Fig. 196. — Thyroid Gland. Subclavian Artery (to arm) 
 and Some of the Branches. Common Carotid 
 Artery (to head and neck). AB, the innominate; Cc, 
 the common carotid; S, the subclavian; BA, the basilar; 
 MMI, the internal mammary; IS, the superior intercost- 
 al; CVP, the deep cervical; TI, the inferior thyroid; CVA, 
 the ascending cervical; CVS, the superficial cervical; TS, 
 the suprascapular; TC, the posterior scapular. 
 
THYKOID MALADIES 569 
 
 one by one, is the sixteen story building constructed. Many observations are 
 needed before our knowledge of the more subtle effects of moderate duct gland 
 changes will be anywhere near satisfactory. 
 
 Enlarged Thyroid (Hands. — "A number of girls have been eagerly 
 watching your articles for anything you might have to say regarding 
 goiter or enlarged glands. Among a club of thirty young ladies, fourteen 
 have these enlarged glands. Three are taking treatment, thus far 
 without much result, and the others would if they had the money to take 
 treatment. 
 
 "Now, then, my own case, which seems to be about the same as some 
 of the others, is as follows: About one year ago I noticed that if I did 
 much long distance telephone talking my jaw would ache and my 
 throat hurt me more or less. Many nights I would go home with a 
 'jaw ache/ 
 
 "I have a slight inclination to double chin, and I have been accustomed 
 to throwing my head back while I sleep at night to overcome, in a measure, 
 this tendency. I have thought there may be a slight possibility that this 
 has something to do with my throat enlarging. 
 
 "During the day my throat does not bother me, but at night, after I 
 take a hot bath before retiring, my throat throbs. Would a hot bath before 
 retiring have a tendency to increase the size of the goiter? 
 
 "Can you tell us what causes these glands to enlarge at the front of 
 the neck? Can you tell us of anything we can do to keep them from in- 
 creasing in size? Is there not some simple remedy or some diet? 
 
 "One of the girls has been so affected by heart trouble, which the 
 doctor says is caused oy goiter, that she has had to quit work and go 
 to bed. 
 
 "Now we have heard that a doctor by the name of W. Thompson Bobo, 
 M. D., a goiter specialist at Battle Creek, has a cure for goiter. Can you 
 tell us anything about his claims? Do you know anything about this treat- 
 ment, and would you recommend it to us as worth trying? 
 
 "We shall eagerly watch the papers for what you have to say. Do give 
 us some advice. This is an important matter to us. — A. L. M." 
 
 Reply. — Some of these girls probably have enlarged glands due to ab- 
 sorption from the gums, tonsils or nose. Such enlargements are well to 
 one side and several inches higher than the thyroid gland. The thyroid 
 is in front and also to the side and reaches from just 'above the breast bone 
 to a point about three inches above it. 
 
 The thyroid gland secretes a most important fluid. When the demand 
 for this fluid is exceedingly great the gland secrets an extra amount, and 
 in consequence it may enlarge. It is a good way from a gland moderately 
 enlarged to do a moderately increased work to the goiter conditions that 
 we need to be disturbed about. 
 
 The enlargement is unsightly and causes some sense of fullness but the 
 effects to be watched closely are due to the gland juice acting on far away 
 organs. They are great nervousness, nervous unrest, nervous instability, 
 rapid, irregular heart action, shallow breathing, diarrhea and protrusion of 
 the eyes. 
 
 I am sure that the majority of the girls in this group are unduly dis- 
 turbed by their thyroid enlargement. The girl who has had trouble so bad 
 that "she has had to quit work and go to bed" probably belongs in the group 
 where the thyroid has got out of relation to its work. 
 
570 
 
 DUCTLESS GLANDS 
 
 Some of these cases get right back on their keels when given some form 
 of antithyroid. Some need to be operated on. Just which belong in each 
 group is a difficult question requiring the best judgment of medical men. 
 However, that is the small group. The larger part of your friends have 
 thyroids slightly enlarged because they have increased work for the thyroid 
 to do. It is pretty well agreed that digestive disorders cause the thyroid to 
 enlarge — where the teeth are bad and the food is badly masticated, when 
 
 the food is of poor 
 quality, when there 
 is a good deal of 
 fermentation, but, 
 above all, when there 
 is constipation. To 
 remedy any of these 
 conditions is to 
 remedy this mild 
 form of goiter. 
 
 The old French 
 writers grouped a 
 lot of causes to- 
 gether and called 
 them causes multi- 
 ples. They referred 
 to such unhygienic 
 conditions of life as 
 defective air space, 
 bad food, bad liv- 
 ing rooms built on 
 damp grounds. 
 
 McCarrison has 
 written a book on 
 the cause of goiter 
 in which he tells the 
 result of years of 
 study. The conclu- 
 sion which he ar- 
 rived at is that 
 water is largely re- 
 sponsible for goiter. 
 The water re- 
 sponsible is not 
 water containing 
 certain mineral in- 
 gredients as was 
 thought formerly. 
 It is polluted water, water that has soaked through soil contaminated by 
 human beings. This means that where the goiter rate of a community is 
 high there is danger of much typhoid. 
 
 Another secondary factor generally recognized is fright or any other 
 form of mental strain. Prolonged mental strain such as worry and over- 
 work at monotonous, grinding, mental labor may be a cause. 
 
 Answering the question in the last paragraph of your letter, Dr. Bobo 
 has been exposed in "Nostrums and Quackery." He is connected with the 
 Peebles epilepsy cure and in close touch with a circle of fakers. 
 
 Fig. 197. — Thyroid Gland ; External Carotid Artery (to 
 the head and neck) and Some of Its Branches. Cc, com- 
 mon carotid; Ce, external carotid; Ci, internal carotid; 
 TSU, superior thyroid ; LS, superior laryngeal and crico- 
 thyroid; HY, hyoid branch of the lingual; S, the sublin- 
 gual; ME, the facial; SMT, the submental; LDI, the infer- 
 ior labial; LDS, coronary of upper lip; SN, the a. of the 
 septum narium; A, the angular; OC, the occipital; AP, the 
 posterior auricular; T PS, the superficial temporal; 1, the 
 tongue; 2, the genioglossus muscle; 3, the hypoglossus; 4, 
 the angle of the lower jaw; 5, the hyoid bone; 6, the thyro- 
 hyoid ligament; 7, the thyroid cartilage; 8, the cricothy- 
 roid membrane; 9, thyroid gland. 
 
 
THYROID MALADIES 571 
 
 Thyroid Gland. — W. P. F. writes: "1. Where is the thyroid gland? 
 2. What are its functions? 3. What are one's symptoms when it is de- 
 ranged? If. What should he done?" 
 
 Reply. — 1. On the front part of the neck just above the collar line. 
 
 2 and 3. It secretes a juice that is poured directly into the blood stream. 
 This secretion has several functions. When it is deficient the child does 
 not grow properly. The man who grew from childhood suffering from such 
 deficiency is small, short limbed, thick skinned, and dull and heavy men- 
 tally. When there is too much secretion the subject is flighty, nervous, 
 and excitable. 
 
 4. Depends on the nature of the derangement. Some cases of goiter 
 yield to rest, control, and medicine; some need to be operated on. All 
 cases of thyroid derangement gain from systematic, scientific medical 
 control — seeing the medical advisor at proper intervals. 
 
 Treatment of Goiter. — B. T. writes: "Will you kindly let me know 
 your opinion of the value of horse or sheep serum in the treatment of 
 goiter? If recommended, what dose should be taken and how long would 
 it take to effect a cure? The patient has the usual symptoms of nervous- 
 ness, instability, slightly bulging eyes, and palpitation of the heart. Can 
 you also tell me of the relationship between goiter and marriage; also 
 insanity ?" 
 
 Reply. — Sheep serum for thyroid, called antithyroidin, has been used 
 with advantage. Better reports come from the use of thyrodectin, the dried 
 blood of an animal from which the thyroid has been removed. Proper 
 attention must be paid to diet and water. 
 
 Take my advice and get good medical counsel and follow it. Do not 
 worry about insanity. 
 
 Davenport says of goiter: "It is clearly inherited, as certainly as epi- 
 lepsy." Not many pedigrees seem, however, to have been studied. 
 
 See Best Surgeon. — C. B. 8. writes: "I wish advice about goiter and 
 curing goiter. I have had it possibly ten or twelve years. I am 25 years 
 old. Do you think it can be cured? If so, what cure would you advise? 
 Does age or length of time one has had it make any difference? I have 
 heard of a woman who says she can cure me in nine treatments. She gives 
 three treatments each month for three months and treats in a certain time 
 of the moon. What is your advice about a doctor of this kind? I know 
 of cases she has cured, but want your advice" 
 
 Reply. — 1. Go to see the best surgeon available and get his advice. 
 
 2. Operation is generally required for cure. 
 
 3. Yes. 
 
 4. Do not waste your chance to get well on that kind of foolishness. 
 
 Enlargement of the thyroid gland, called goiter, calls for skillful han- 
 dling. Many cases are of no especial importance. Other cases are bad at 
 the start, then get better, then slowly proceed into a condition where the 
 wise surgeon will not operate. The condition is then hopeless. 
 
 Thyroid Intoxication Case. — E. W. R. writes: "A woman, now &4 
 years old, developed an exophthalmic goiter five years ago. At first there 
 was violent palpitation of the heart and pain in the chest so severe that 
 morphin and whisky were needed. These spells kept up for four years. 
 A year and a half ago, she went on a farm, and began leading a simpler 
 life. Now the symptoms are less severe, the attacks are rare, and the goiter 
 is nearly gone. Two weeks ago the head got wrong. There is a tendency 
 
5?2 DUCTLESS GLANDS 
 
 to fall over and a constant throbbing in the right ear. The hlood pressure 
 is 200. Is this a forerunner of apoplexy? What is the trouble? Is staying 
 in bed the proper course?" 
 
 Reply. — 1. No. 
 
 2. You have been suffering from thyroid intoxication. Within the last 
 two years you have become partially accustomed to your dose of thyroid. 
 It is possible that your symptoms are due to a temporary increase in 
 thyroid secretion. It is probable you have some condition in your semi- 
 circular canals in your right ear. Your physician should examine care- 
 fully for this condition. 
 
 3. Yes. 
 
 May Not Need Treatment. — Mrs. S. C. E. writes: "Will you kindly 
 tell me what will be helpful to know about goiter? My sister has had one 
 since childhood, but it has never grown large. She is teaching school 
 now, and is nervous. Would a weak back be a cause, effect, or neither, 
 of a goiter? Physicians have told us an operation is the only cure, but 
 our own physician, who has treated her for years, says an operation is not 
 necessary. We are much alarmed about it, especially when considering 
 her nervous condition. We fear such a delicate operation. Can it be cured 
 in any other way?" 
 
 Reply. — If the goiter has been present for many years and has given 
 no symptoms until now it will in all probability require no treatment. 
 Most school teachers work in badly ventilated schoolrooms and they get 
 tired and nervous before June. Having a goiter she would get nervous 
 more easily than a normal person. 
 
 Try the effect of prolonged and thorough rest. If rest does not quiet 
 her she may need an operation. 
 
 Medical and electrical treatment sometimes succeeds. The medical 
 treatment consists in the proper use of iodin and electricity locally and 
 tonics and antithyroid preparations internally. Just how long it is safe 
 to postpone an operation while trying rest and medicine will require the 
 best judgment of your physician. 
 
 Goiter and Children. — A. L. writes: "What, in your opinion, as far as 
 children are concerned, is the danger in two people marrying when each 
 has goiter? Neither was inherited, but both developed. Neither party 
 has ever been incapacitated by it for work, but each is possibly more 
 nervous than the ordinary person. Both persons otherwise may be termed 
 fairly well. Would the child of such a marriage run a greater risk of be- 
 ing a little more nervous than most children? Would the child be more 
 liable to have epilepsy than any other child? Would it run any risk of 
 being defective mentally? Is there any possibility that it could be up to 
 par? Would the danger of childbirth, the woman being 25, be any greater 
 than to anyone else?" 
 
 Eeply. — 1. Yes. 
 2 and 3. No. 
 
 4. Yes, probably would be. 
 
 5. Yes. 
 
 The children of an extremely nervous couple will probably be nervous 
 but if they are trained in the control of nerves they will average up well. 
 
 Regarding Goiter. — Miss N. A. D. writes: "1. Will you please tell me 
 what causes goiter? 2. Some say it is more prevalent in some localities 
 
 
THYROID MALADIES 573 
 
 than in others, and that the drinking water causes it. 3. Does painting the 
 goiter with iodin or something of the kind prevent it increasing in size? 
 If.. Are operations for goiter dangerous, and what kind of goiter and under 
 what conditions should they he operated on?" 
 
 Keply. — 1. Goiter is an enlargement of a gland in the neck called the 
 thyroid. Nobody knows what causes it to enlarge. 
 
 2. It is more prevalent in some localities than in others. Boiling the 
 water as a means of controlling its spread is often recommended. Whether 
 it is of any value I do not think anyone knows. 
 
 3. No. 
 
 4. A careful examination of each case is necessary to determine. 
 
 Graves' Disease. — J. L. T. writes: "Kindly explain what Graves' 
 disease is, its cause, symptoms, and general course. Is it related to heart 
 disease ? Can it be cured?" 
 
 Keply. — Graves' disease is that form of goiter in which the eyes bulge. 
 One of the important symptoms is an irregular and highly nervous heart. 
 My advice to you is to consult the best available physician and abide by 
 his advice. 
 
 When to Remove Goiter. — T. R. S. writes: "Would an operation for 
 goiter be considered advisable if the goiter is not only hereditary but long 
 standing? Should it begin to grow rapidly, would an operation be con- 
 sidered advisable? Have there been any discoveries as to causes and reme- 
 dies for this trouble more recent than the study you gave some months 
 ago?" 
 
 Reply. — 1. Neither heredity nor long standing is an indication in itself 
 for the removal of goiter. Rapid growth is an indication. Goiter should 
 be removed when the general nervousness, heart nervousness, and other 
 constitutional symptoms of thyroid intoxication indicate it. 
 
 2. Much study is being put on goiter. The journals are filled with 
 articles in connection with it. Nothing epoch making has recently ap- 
 peared. 
 
 Operation Often Necessary. — M. B. B. writes: "I am 26 and have a 
 goiter. Is it incurable? I have tried electrical treatments and see no 
 improvement. Would you advise an operation? Are such operations seri- 
 ous? Please tell me what causes a goiter." 
 
 Reply. — Many people are relieved of goiter symptoms due to too much 
 thyroid secretion. Sometimes they get better because they get accustomed 
 to their dose of thyroid secretion; sometimes the gland secretes less; 
 sometimes medical treatment cures. Ofttimes nothing cures except an 
 operation. Which are the cases for operation, when operation should be 
 done, and when it is too late for operation are questions that can only be 
 answered after a careful study of the individual case. Get the best advice 
 available and abide by it. 
 
 Goiters Grow Smaller. — Mrs. E. L. W. writes: "Will you kindly tell me 
 if goiters ever disappear entirely without an operation? I have never used 
 any drugs or treatment of any kind, yet mine seems to be getting 
 smaller. I am just thirty years of age. Do goiters affect the heart in 
 any way?" 
 
574 DUCTLESS GLANDS 
 
 Reply. — 1. Goiters not infrequently cease to be troublesome ; not infre- 
 quently they get materially smaller. The thyroid gland, when enlarged, is 
 called a goiter. This gland is necessary. If it were to disappear entirely 
 grave results would follow. Some thyroid juice is a good thing; too much 
 poisons one. If one becomes accustomed to too much thyroid the goiter 
 ceases to be troublesome. To decide which cases are trending to the worse 
 and which to the better requires the best of judgment. 
 
 2. The goiter heart is one of the most frequent and most troublesome 
 goiter symptoms. 
 
 Goiter. — E. W. writes: "1. Are cases of Graves' disease sometimes 
 found in which the eyes do not bulge? 2. Is a woman with a goiter in 
 more than ordinary danger in childbearing? 3. Is goiter cured by thyroid 
 extract, or is it merely kept under control? 4. In cases of goiter which 
 show a growth on the outside can anything except an operation reduce the 
 enlargement?" 
 
 Reply. — 1. There is goiter without bulging of the eyes more frequently 
 than with it. 
 
 2. Yes. 
 
 3. Goiter is usually harmed by thyroid extract. 
 
 4. Medication will do it sometimes, though not often. 
 
 Goiter Not Contagious. — H. M. D. writes: "Will you kindly say whether 
 there is any chance for one afflicted with goiter to communicate it to 
 another through intimate association? What is the most effective treat- 
 ment one can use to relieve the great suffering one experiences following a 
 severe and general case of sunburn?" 
 
 Reply. — 1. There is none. Sometimes goiter is abundant among peo- 
 ple but the element of contagion is not a factor. 
 
 2. Where the surface is not broken, wash with cold soda water; dry 
 with soft cloth, and dust with talcum powder. To grease with cold cream 
 is pleasant. If the surface is broken, wash with sterilized, normal salt 
 solution; dry thoroughly, and dust with talcum powder, then cover with 
 aseptic gauze. Sterilized vaselin makes a good application to a raw surface. 
 
 Cause and Cure of Goiter. — S. A. writes: "Please give cause and cure 
 for goiter." 
 
 Reply. — The causes of goiter are many: 
 
 1. Inheritance. 
 
 2. Nervous shock. 
 
 3. Worry. 
 
 4. Water. 
 
 5. Soil. 
 
 6. Development out of relation. 
 The cures vary with the cases: 
 
 1. Operation. Most satisfactory and suited to many cases ; unnecessary 
 in some; inadvisable in others. 
 
 2. Iodin preparations. 
 
 3. Milk from animals with small thyroid. 
 
 4. Electricity. 
 
 In every case high-grade medical advice based on adequate observation 
 is essential. 
 
THYROID MALADIES 575 
 
 Treatment for Cretinism. — A. C. A. writes: "Some weeks ago Chicago 
 papers printed an article ahout a man and wife who are cretins and stated 
 that their children were being treated by the city of Chicago. I have a 
 friend in another city whose little girl is small for her age. Her parents 
 took her to Minneapolis for examination, and the doctor there told them 
 she would never grow taller than, possibly, three or four feet. On reading 
 about this family of cretins, I wondered whether this case might be similar 
 and, naturally, would like to bring the matter before my friend, if there 
 is any chance for the child/' 
 
 Reply. — First find out if the child is deficient in thyroid — is a cretin. 
 If she is she should take one of the preparations of thyroid. There are 
 many on the market. 
 
 Thyroid must be used for a long time. It must be intelligently used. 
 In young cretins treatment is fairly satisfactory. 
 
 Life of Cretin. — J. W. D. writes: "About what age do cretins attain? 
 
 What is the maximum age?" 
 
 Reply. — Untreated cretins die young. It is rare for one to reach thirty 
 years of age. 
 
 I haYe neYer seen any statement as to the maximum age. 
 
 Operation Not Dangerous. — Mrs. H. N. S. writes: "I have a small 
 goiter which has been troubling me. In case I decide to have it removed 
 are such operations dangerous? Also are such operations expensive, and 
 how long would I be kept in bed? I am a working woman." 
 
 Reply. — If you are in good condition, and I judge from your letter 
 that you are, the operation is not dangerous. If you have a frank under- 
 standing with your surgeon your bill will be in keeping with your capacity 
 to pay. Such operations cost nothing for those not able to pay. They cost 
 little for those able to pay little; they cost much for those able to pay 
 much. 
 
 Goiter and Medicine. — Mrs. H. P. writes: "Can a goiter be destroyed 
 by medicine?" 
 
 Reply. — The more efficacious of the goiter medicines act by neutraliz- 
 ing the excess of thyroid secretions. In a certain sense they are antitoxins. 
 Therefore they must be continued so long as the excessive secretion of the 
 gland continues. 
 
 In some cases goiter can be kept under control by attention to the diges- 
 tion ; in others by attention to the pelvic organs or by medicine ; other cases 
 require operation. 
 
 Thymus Gland Tablets. — J. S. B. writes: "Have taken thymus gland 
 tablets for rheumatism of the finger joints with some encouragement. 
 Will you please state what these tablets are composed of?" 
 
 Reply. — The thymus gland is a ductless gland located just above the 
 heart. It is quite large at the time of birth ; in fact, it may reach up into 
 the neck. When the young person is about ready to stop growing the 
 gland shrinks. It has much to do with growth. 
 
 Every young animal has a well developed thymus gland. The butcher 
 commonly calls it "the sweetbread in the neck." The tablets are composed 
 of dried thymus gland taken from pigs and calves. 
 
576 
 
 DUCTLESS GLANDS 
 
 THE ADRENAL BODIES 
 
 If one judges by the name of these organs he concludes that they are 
 related to the kidneys. They are located near the kidneys and from 
 this nearness they have drawn their name, adrenal, or their other name, 
 
 suprarenal. Though sit- 
 p HR ting on the kidneys like 
 
 an illy adjusted nightcap, 
 they have no other rela- 
 tion to them. Their 
 work is in no way re- 
 lated to the work of the 
 kidneys. 
 
 The kidneys are the 
 body sewer or an impor- 
 tant part of it. The work 
 of the adrenal has to do 
 with the distribution of 
 the blood to the different 
 parts of the body. As 
 the adrenals are being 
 formed in the body of 
 the unborn child they are 
 placed next to certain 
 nerve cells that have to 
 do with the size of the 
 blood vessels. As develop- 
 ment proceeds the bunch 
 of adrenal tissue and the 
 group of nerve cells grow 
 together to form the 
 adrenal body. 
 
 When in mature life 
 the adrenal cells secrete, 
 a part of the secretion 
 acts on the next door 
 nerve cells and a part of 
 it flows into the blood 
 stream and is carried to 
 nerve cells elsewhere 
 throughout the body. 
 
 Each of the adrenals 
 is about an inch and a 
 quarter by an inch and 
 three-quarters in size and 
 weighs about a dram. Anatomically, the adrenals are not imposing. They 
 are small and inconspicuous. 
 
 Unlike the secretion of the kidneys the secrtion of the adrenals cannot 
 
 Fig. 198. — Adrenal Glands (or Suprarenals). Kidneys, Ab 
 dominal Aorta and Some of Its Branches. Ai, common 
 iliac artery; I, external iliac; H, internal iliac; SM, middle 
 sacral; PHR, inferior phrenic arteries; LD, one of the 
 lumbar arteries; C, the celiac; MES, the superior mesen 
 teric; MEI, the inferior mesenteric; SR, the capsular; R 
 the renal; SPI, the spermatic; HI, the internal hemor- 
 rhoidal. 
 
THE ADRENAL BODIES 577 
 
 be drawn from the living body and made the subject of study. Owing to the 
 difficulty in studying the adrenal secretion it is only in recent years that 
 anything had been known of its effect on the human body. We are just 
 beginning to learn of the discomforts, disabilities and diseases which result 
 when the adrenals go wrong. 
 
 At a meeting of the American Medical Association Dr. Williams of 
 Washington told the section on practice that he no longer recognized neuras- 
 thenia as a disease; that it was a lazy, sloppy diagnosis and that there was 
 always some abnormality somewhere in the body. He said when a physician 
 diagnosed neurasthenia he had used the term "merely as a convenient cloak 
 for failure sufficiently to investigate." 
 
 In his experience, when these cases have been carefully and patiently 
 studied, it has been possible to discover some abnormality in some organ 
 somewhere. In some of them there is organic disease in the more frequently 
 considered organs. After placing these cases under their appropriate heads 
 he finds a large number of ordinarily considered neurasthenics whose trouble 
 is with their adrenal glands. He bases his conclusions upon such experimen- 
 tally proved facts as the following: 
 
 Cannon found that after fright the vein running from the adrenal 
 gland contained too much adrenal secretion. Everyone has noticed that 
 fright causes the skin to pale, the amount of blood in the skin to decrease, 
 and goose flesh to form. These effects are closely related to an increased 
 discharge of adrenal secretion into the blood stream. Crile proved that pro- 
 longed fright caused a continuously excessive secretion of adrenal secretion. 
 
 The ordinary term for prolonged fright is anxiety. Anxiety, worry, 
 and fright cause an oversecretion by this gland, and this oversecretion causes 
 a train of symptoms, some of which are prominent in neurasthenia. 
 
 There are cases of so-called neurasthenia which are purely mental. These 
 divide themselves into insanities and the neurasthenias. The body is influ- 
 enced by the mind. There are cases of so-called neurasthenia in which the 
 mind is under the influence of the body. Among this group are some cases 
 of neurasthenia in which the cause lies in the adrenals. These have the 
 ordinary mental indecisions, worries, anxieties, and fears of the neurasthenic 
 accompanied by low blood pressure. Sometimes the skin bronzes. 
 
 One such man felt that he could not carry responsibility or manage 
 men; he could not come to a decision. Feeling that his usefulness was at 
 an end he feared he was losing his mind and in consequence was greatly 
 depressed. When he was examined the only abnormality found was a low 
 blood pressure. He was told that he was not losing his mind ; that his blood 
 pressure was low because he did not have enough adrenal secretion; that his 
 low blood pressure meant a poorly nourished brain. 
 
 From this came his indecision, his worries, fears and anxieties. Be- 
 cause he took no exercise his muscles became flabby and his flabby, soft 
 muscles made him tire easily, resulting in poor circulation — a vicious circle. 
 His blood pressure was 100. For a man of his years this was quite low. 
 
 Under adrenal tablets, rest, exercise, and diet his blood pressure came 
 up to 114; he became physically fit, quit worrying and got back his old decision 
 and managing ability. 
 
 Another man, fifty-seven years of age, had indecision, weakness, dizziness, 
 
578 DUCTLESS GLANDS 
 
 and throbbing in the abdomen — the usual symptoms of neurasthenia — with a 
 low pressure — 108. The same line of conduct plus adrenal tablets cured him. 
 
 Another, a man of forty-four, had had headaches for six years whenever 
 tired from using his eyes. A dull, aching pain at the end of his spine would 
 often be so severe as to waken him at night. There was nothing the 
 matter with his eyes, and he tired when he was read to as well as when he 
 was reading. His blood pressure was 114. 
 
 Another case, a woman, was low spirited, melancholy, anxious, and 
 mentally depressed. Her pressure was 106. Her skin was pigmented. 
 
 Another, a man of forty, had worried until he was run down so much 
 that he had lost his self-control. He did not want to work ; he fatigued easily ; 
 he had nervous indigestion and insomnia. He was due to marry in three 
 weeks but the prospect horrified him and he wanted to go and hide. His 
 blood pressure was 102. 
 
 Another patient worried all the time. He said: "My mind feels as a 
 shadow only and for two years nothing has seemed real." He had indigestion, 
 flatulence, dizziness and headache. He had a weak, flabby feeling, especially 
 in his arms. His skin was pigmented. His blood pressure was 102. In 
 another case, a woman of 34, the pressure was 86. The skin was pigmented. 
 
 Most persons have a fair knowledge of the symptoms of neurasthenia. 
 From every standpoint, this is for the best. Neurasthenia is sometimes called 
 Americanitis. It is also frequently referred to as "the American disease/' 
 The indications are that it is on the increase. It is inheritable. The 
 children of neurasthenics are somewhat liable to be neurasthenics. 
 
 What is of more importance, neurasthenia, hysteria, insanity and 
 criminality are often found jumbled up in a family strain in such a way as to 
 indicate that these plants grow rather interchangeably out of a common 
 soil — a nervous mental makeup in which there is lacking poise and a proper 
 understanding of one's relation to one's fellow men. 
 
 One writer, albeit only an indifferent authority, goes so far as to propose 
 nation-wide intermarriage between Italians and Americans. The basis of 
 his suggestion is that when the overtense, unromantic American crosses with 
 the underambitious, overromantic Italian there will be progeny in which 
 there will be just enough of tenseness and just enough of romance to make a 
 masterful race, devoid of tendency to neurasthenia. 
 
 This is referred to to show that the inheritance phases are being dis- 
 cussed. It is for the best interest of the individual neurasthenic to have 
 neurasthenia known. 
 
 Three years ago when the neurasthenic wrote me about his symptoms, 
 they were to him very important. To him they always meant organic 
 disease. He was anxious; he worried. He commiserated with himself 
 and he abused anyone who did not appreciate the gravity of his complaints. 
 
 The general tone of the letters from neurasthenics has changed. They 
 still have symptoms; they still worry; they are still anxious but now 
 they frankly acknowledge that they are neurasthenic; that their symptoms 
 do not proceed from that which they dread; that their stomach symptoms 
 do not mean cancer, for instance. At the same time they are unable 
 to throw them off. It is along this line that they search for help. 
 
 To recognize that a group of symptoms means neurasthenia is the first 
 
THE ADKENAL BODIES 579 
 
 step toward cure. The above list of symptoms will be recognized by neuras- 
 thenics. It is for the best interests of neurasthenics that the people know 
 the symptoms of neurasthenia. 
 
 Under the old order neurasthenics were always misunderstood and were 
 commonly neglected. There was a certain period in which the family shared 
 the anxieties of the worried one. In this period the family's commiseration, 
 added to the individual's commiseration for himself, made a combination 
 that was hard on the neurasthenic. It generally landed him in a state of in- 
 validism. 
 
 This period was commonly followed by that in which everybody dis- 
 regarded every complaint of the neurasthenic. Thus he was driven in on him- 
 self all the more. Since nobody would pay any attention to his symptoms 
 he must nurse them the more. Since time had proved that he had some 
 illness of which he had complained and to which no one had listened, he 
 was right in all of his complaints and his heartless associates were wrong. 
 It is best from the standpoint of community life. 
 
 Neurasthenics are not incapacitated for business. Ours, the masterful 
 nation of the last five centuries, is the neurasthenic race. Not all of this 
 is in spite of neurasthenics. Neurasthenics have contributed to progress. 
 They engage in the keen competitions of business. 
 
 It is wise for business competitors to understand the workings of the 
 neurasthenic mind. To the average business man this is more important 
 than to understand the relentless logic of the Eockefeller mind. In literature 
 neurasthenics have been prominent. 
 
 It is for the best from the standpoint of medical men. Physicians have 
 had little patience with neurasthenia. They had been so often misled by the 
 symptoms of neurasthenia they had fallen into the habit of disregarding 
 the neurasthenic wherever they could. Like a hunting dog who, having often 
 investigated promising trails and found that they led to nothing, finally be- 
 came indifferent to all trails, the physician, listening to a story of symptoms 
 and recognizing exaggeration and self-commiseration as earmarks of neuras- 
 thenia, loses interest and worms out as easily as he can. 
 
 The present medical tendency is to dig deeper into these cases. As the 
 result of digging deeper many are found to have a physical basis. Some 
 are found to have early stage Bright's disease or anemia or some other fairly 
 well known disease. Some are found to have trouble with the ductless glands. 
 
 We are just beginning to know about the relations of the ductless glands 
 to health and comfort. In the discussion of Dr. Williams' paper Dr. Starkey 
 said that when a patient suffers from lack of force, inefficiency, lack of decision, 
 easy fatigue, melancholia, the trouble lies with the ductless glands. 
 
 The more important of the ductless glands are the adrenals, the thyroid, 
 the pituitary, the thymus and the sex glands. The secretions of these glands 
 in health are in exact balance. When the balance is lost ill health, discom- 
 fort, or bodily disorder of some sort results. When the disorder takes the 
 bent which forms one of the varieties of neurasthenia extracts of several 
 of these glands should be given. 
 
 He made a therapeutic suggestion which embodies a rather far reaching 
 thought. He said the ordinary commercial preparations of thyroid, adrenal, 
 and so forth, are made from castrated animals. When an animal is unsexed 
 
580 DUCTLESS GLANDS 
 
 the entire structure of that animal is changed. We know of the difference in 
 the texture and flavor of the flesh, of the difference in the mind and spirit of 
 altered, as compared with unaltered, animals. 
 
 "The change from the bull to the ox and from the cock to the capon 
 are conspicuous and familiar examples/' he says. "The change that takes 
 place in their organs of internal secretion is just as marked, so that the 
 chemical composition and the physiological action of glands obtained from 
 spayed animals are very different from those derived from unspayed ones." 
 
 ADRENALIN ^ 
 
 Adrenalin and other preparations made from suprarenal gland have 
 been known to the medical profession for a long time. They have been 
 in general use for more than ten years. The remedy can be procured from 
 any drug store. 
 
 Adrenal substance and extracts of adrenal substance are powerful medi- 
 cines. We strongly advise that they be not promiscuously taken. No one 
 is justified in using adrenal substance until, first, careful consideration has 
 proved his case a proper one, and, second, provision has been made for 
 supervision during its use. 
 
 ADDISON'S DISEASE 
 
 Suprarenal or adrenal extract has long been in use to stop hemorrhage 
 and temporarily decrease local congestions. 
 
 Sixty years ago an English physician, Addison, reported a disease 
 in which the shin turned brown, until a Caucasian became as dark as an 
 Indian or mulatto and in which there was tuberculosis of the adrenal glands. 
 Since that time it has been found that any cause which slowly destroyed the 
 adrenals would cause Addison s disease to develop. For instance, old, neglected 
 peritonitis, appendicitis which has caused extensive adhesions — either of these 
 can cause it if the adrenals happen to be caught in the contracting scars. 
 Nevertheless, much the most frequent cause is infection with tubercle bacilli. 
 
 When tubercle bacilli are swallowed in milk, they may get into the blood 
 and go to any part of the body. However, they usually locate and develop 
 somewhere in the abdomen. Occasionally they locate first in the adrenals or 
 near by whereupon the skin turns brown and Addison's disease is under way. 
 The blood pressure falls to 80 and sometimes 60, the weakness is profound, 
 the blood loses in richness and death finally ensues. The cause of the disease 
 is that the blood does not get as much adrenal secretion as it needs. 
 
 When the adrenals are removed or are rapidly destroyed, the blood 
 pressure also drops, weakness is profound and death ensues, but pigmentation 
 does not develop. This last sign results when the supply of secretion is moder- 
 ately diminished, not entirely stopped. 
 
 The treatment of Addison's disease is the use of some of the forms of 
 adrenal preparations and the care of the symptoms. In a large proportion 
 of the cases no treatment is satisfactory. 
 
 There is great need for study, work and investigation on the curative side 
 of Addison's disease. There is greater need for study of the relation between 
 the secretions of the thyroid, thymus, sexual glands, pituitary, adrenals and 
 
EAYNAUD'S DISEASE 581 
 
 possibly other ductless glands, to learn where they antagonize and where 
 they complement each other* 
 
 There are but few people who develop Addison* s disease and, from the 
 standpoint of this disease, the adrenals are scarcely of interest enough to 
 warrant this space. But a large part of the people are mildly adrenal plus or 
 minus and the greatest need of study is that information may be made avail- 
 able for these. We do not know as much as we should about high and low 
 blood pressure and the relation thereto of the adrenals. 
 
 RAYNAUD'S DISEASE 
 
 This disease at its worst is a kind of dry gangrene, causing the loss 
 of the affected member in a few weeks. A milder and more frequent form of 
 the disease follows about the following course: During a cold spell, an ulcer 
 appears on a finger or toe and, without being exceedingly sore or suppurating, 
 the tissues crumble away until a joint {bone and all) is gone, or an entire 
 finger or toe. 
 
 Some moderately severe cases will consume a winter in developing this 
 far, whereupon the wounds will heal, but the disease will recur when cold 
 weather comes again. Each season will take a finger, toe, ear or nose, 
 as toll. This type of the disease has little or no tendency to destroy 
 life. 
 
 Osier compares the series of phenomena in Raynaud's disease to what 
 takes place when the hand freezes — the skin first flushes, then gets blue, 
 then turns pale, then dead white, stiff and without feeling. This, the stage of 
 local syncope, is due to spasmodic contraction of the blood vessels. 
 
 In order to keep the blood from freezing the vessels are emptied. If 
 this keeps up necrosis or local death ensues. If it is not kept up blood 
 comes back into the veins. The skin becomes livid and mottled. This 
 is the stage of local asphyxia. Soon arterial blood comes in, the hand be- 
 comes livid and swollen, and the fingers throb with pain. This is the stage 
 of active hyperemia. 
 
 These different phenomena but with no freezing to explain them are 
 what happens in Eaynaud's disease. They are logical when the vessels are 
 trying to keep the blood from freezing but when they develop without an 
 adequate temperature reason the mechanism of the body has gone wrong. 
 Eaynaud's results from a continued spasm of the muscles which make up the 
 walls of the small arteries. Why the spasm? No one knows. 
 
 But for every typical case of Kaynaud's disease going on to the loss 
 of joints there are thousands of minor manifestations of the same type but 
 in a mild form. Chilblains, cold feet and even some cases of red nose and en- 
 larged veins in the face are mild manifestations of the same type of dis- 
 order. Perhaps persisting cold feet is also a very mild manifestation. An- 
 other mild disorder somewhat akin is chilblains in which the blood supply 
 oi the feet, having been low, is suddenly increased. 
 
 As the blood comes back some fluid escapes from the vessels and blisters 
 arc formed. Another form noted by Osier is the beefsteak hand — cold, 
 clammy, swollen, chapped, hyperemic hands. Another is the beefsteak cheeks 
 
582 DUCTLESS GLANDS 
 
 of gouty men. Another is seen in the cheeks of full-habited men with red, 
 eyanosed faces and twigs of blood vessels showing here and there. 
 
 These mild manifestations may hot, and usually do not, lead to serious 
 conditions but even the mildest of them are abnormalities. If we could 
 learn the underlying principles of Raynaud's disease we would know the un- 
 derlying principles of less important conditions. If we could control these 
 inconveniencing minor conditions it would help in the solution of the problem 
 of Raynaud's disease. 
 
 Raynaud's Disease. — Mrs. H. B. writes: "What is the cause of 'Ray- 
 naud's disease' and what can be done to cure it?" 
 
 Reply. — Nothing is known as to the cause of this disease. It is usually 
 found in women between ten and thirty years old. It is worse in cold 
 weather. It has some disposition to run in families. Sometimes there 
 seems a relationship between it and gout and sometimes it seems related to 
 goiter. No cure is known. A mild form, showing itself by frequent chil- 
 blains in cold weather, with beefsteak hands, feet and hands which go to 
 sleep and muscle cramps, is closely akin to gout. For this mild form the 
 proper plan is to keep the hands and feet warm and to live so as to avoid 
 gout. 
 
 Symptoms of Raynaud's Disease. — N. E. B. P. writes: "What are the 
 symptoms of Raynaud's disease? I have a constant numb feeling in finger 
 ends of left hand, a dried out, burned feeling of entire hand." 
 
 Reply. — Undue paleness or redness of the ringers and toes. Later, 
 ulcers and sometimes gangrene affect the toes and fingers. Sometimes a 
 toe or finger is destroyed by the disease. It gets worse in cold weather 
 and better in warm weather. In mild cases the fingers and toes chill, pain, 
 and become pale or dusky when the weather is not cold enough to war- 
 rant it. 
 
 Nails Turning Black. — N. 0. C. writes: "Kindly explain why the finger 
 nails turn black. The flesh recedes from the nail, is much inflamed, and 
 at times causes great pain. The nail grows in ridges and seems infected 
 at the root. No pus or dirt under the nail, but at times a dry powder on 
 top of nail. Have been this way over a year, starting with middle fingers, 
 the inflammation often reaching the second joint. The nail becomes very 
 black, turns light, then black again." 
 
 Reply. — Have your physician see if you have Raynaud's disease. 
 
 White Finger Ends. — J. G. K. writes: "What is the cause of dying 
 finger ends? They turn white and stiff when cold. Is there any effective 
 treatment?" 
 
 Reply. — I judge you have Raynaud's disease. If so, the condition is 
 not to be treated lightly. Put yourself in the hands of a physician. 
 
CHAPTEE XXXII 
 
 The Spleen 
 
 Everyone knows the location of his liver. The spleen is placed in the 
 corresponding position on the left side of the body. Like the liver, it is tucked 
 away just below the diaphragm under the arch of the ribs and in front of the 
 kidney. Being much smaller than the liver, it is lodged up under the ribs so 
 that it cannot be felt at the rib edge, but when it is enlarged enough to 
 
 become somewhere near the liver's size 
 it can be felt on the left side, just as 
 the liver can be felt on the right side. 
 I venture to say most people do 
 not know that they have spleens. The 
 spleen does not hold the center of the 
 stage except when things are going 
 wrong. In long continued malaria the 
 spleen, called now an ague cake, large 
 and heavy, is felt as a dragging mass 
 in the left side of the abdomen. In 
 leukemia it is so radically changed that 
 any observer can feel it as a hard, tumor- 
 like mass. 
 
 The spleen is a blood gland. In a 
 certain sense it is the only blood gland. 
 The lung is one kind of blood gland. 
 The black, venous blood flows in the 
 arteries to the lungs and there meets the 
 air from which it picks up oxygen and 
 into which it pours out smoke or what corresponds to smoke. In that it 
 changes the blood it is a blood gland. 
 
 In a certain sense the kidney is a blood gland. Into it the blood, charged 
 with waste, is carried by the arteries. The kidney cells remove urea and other 
 waste materials and discharge them down the waste duct, and the purified 
 blood flows in the veins back into the general circulation. 
 
 The lungs have ducts, the bronchi, through which waste discharges. The 
 kidneys have ducts through which waste discharges. The spleen has no ducts. 
 Its cells act on the blood in the vessels, change it in some way or other, and 
 the changed blood flows on through the vessels. 
 
 It is easy to catch the air as it flows from the lungs and analyze it, and 
 in that way get an idea as to what is the work of the lungs. It is easy to 
 analyze urine and judge of the work of the kidneys. It is not impossible, 
 to drain the gall-bladder, gather the bile, analyze it, and get an idea of the 
 work of the liver. 
 
 583 . 
 
 Fig. 199. — Diagram Showing Division of 
 Stomach into Two Physiological 
 Parts. 
 
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THE SPLEEN 585 
 
 There is no spleen secretion to analyze and getting a line on the work of 
 the spleen has been hard. 
 
 The blood vessels to the spleen are large for so small an organ. They 
 divide and redivide until the thick walled arteries have delivered their blood 
 into their thin walled branches, called arterioles. From these the blood flows 
 into thin walled tubes called capillaries, and from these right among the spleen 
 cells themselves. 
 
 The blood, after it gets among the tissues of the spleen, is in great lakes 
 in which are islands of spleen cells. In these lakes the blood no longer rushes 
 forward. It comes into the spleen tearing away under torrential speed. It 
 begins to slow up soon after it gets in. In the capillaries it flows gently. 
 
 In the lakes it tides back and forth like water in a lake, gradually travel- 
 ing from where it enters to where it flows out, but without any inlet to outlet 
 current that anybody can find. 
 
 The water flows into Lake Michigan from the mouth of the St. Joseph. 
 Some day that same water will flow out through the "Soo," but if one observed 
 the direction of the flow on any given day he would be quickly liable to 
 find it towards the mouth of the St. Joe Eiver. 
 
 This lake effect gives the spleen cells a good chance to act on the blood. 
 As the blood passes through the lungs it is always moving from the arteries 
 to the veins. As it travels through the kidneys it keeps on the move. Yet the 
 effect of these organs on the blood is important. 
 
 How important then is the work of the spleen ? What is that work ? We 
 know a part of the answer, but probably only a part. 
 
 In those diseases where germs circulate in the blood, the spleen enlarges. 
 In anthrax, about the first bacterial disease of which we knew the bacterial 
 cause, the bacteria gets into the blood, and in consequence the spleen enlarges. 
 In fact, one of the names for anthrax is splenic fever, while the Germans 
 call it Milzbrand, or spleen disorder. 
 
 The large rodlike bacillus is carried by the blood to the spleen, where the 
 spleen cells get to work trying to destroy them. As the work required is 
 prodigious, the spleen cells rapidly multiply. The spleen would get quite 
 large in anthrax if the patient lived long enough, but anthrax is rapidly fatal. 
 
 In typhoid fever the typhoid bacillus circulates in the blood. The spleen 
 rallies to the rescue. The extra work calls for extra cells. The spleen enlarges 
 in typhoid. It often becomes large enough to be felt below the border of 
 the ribs. 
 
 In pneumonia the coccus gets into the blood. It circulates everywhere. 
 At once the spleen knuckles down to work. Before the work is over the 
 swollen, tender spleen can be felt at the border of the ribs. 
 
 In syphilis the spirochetes get into the blood. They circulate widely. 
 There is fever and a skin rash. The spleen gets to work. It swells. Within 
 a few weeks the secondaries have passed. The spirochetes are no longer in the 
 blood ; they are out in the tissues. The spleen is not under strain ; it goes 
 back to normal size. After that, as long as the spirochetes keep out of the 
 blood, the spleen keeps down ; whenever they get in the spleen enlarges. 
 
 In septicemia and pyemia, or blood poisoning, the pus cocci are circulating 
 in the blood and the spleen increases rapidly in size. 
 
 This evidence is enough to convince us that one of the functions of the 
 
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 586 
 
THE SPLEEN" 587 
 
 •pleen is to remove from the blood the bacteria that get in it. As long as 
 the number is small the spleen removes and destroys them and gives no sign 
 to indicate that it is on earth. 
 
 In olden times, when everything about the body was speculative, it was 
 claimed that the spleen was the seat of ill humor. In consequence, the term 
 spleen was used as synonymous with anger. We spoke of ill tempered men 
 as "having the spleen" or being "splenetic." How it came about one can 
 scarcely understand, since the origin is so free from ways of speaking. 
 
 There are several conditions that cause the spleen slowly to enlarge and 
 to remain large for a long time. In chronic malaria the abdomen enlarges 
 and one can feel a large, firm spleen pushing from under the ribs. This is the 
 fever or ague cake. 
 
 The malarial parasite passes through two forms. In one form the organ- 
 ism causes regular, periodic chills and fever. In this stage it is easily killed by 
 quinin. In this stage the spleen is also busy killing the parasite, but it is 
 not exceedingly adept at the job, and in consequence this organ swells less in 
 three weeks of malaria than it does in three weeks of typhoid, or in ten days 
 of pneumonia. 
 
 The malarial parasite, after about sixteen days, begins turning to the 
 sexual form. In this stage chills and fever are irregular. The parasite is not 
 so easily killed by quinin. The spleen does the best it can to rid the body of the 
 parasites. In consequence it enlarges, though slowly. 
 
 Whenever a person has ague cake, two things may be taken as certain. 
 The first is that the malarial parasites in that man's blood are in just exactly 
 the right stage to infect mosquitoes. The second is that it will take consid- 
 erable time to rid him of malaria, for the parasites in that stage are not easily 
 killed. 
 
 If a community cannot afford to do all the things necessary to rid it of 
 malaria it can cut the disease in half or decrease it even more than that by 
 doing one thing — providing care until completely cured for every person having 
 an ague cake. 
 
 In leukemia there is a great enlargement of the spleen. The large, firm, 
 notched tumor can be easily felt. We know little about the cause of leukemia. 
 We know that it is a slow disease; that at times the forces defending the 
 body are able to hold the invaders at a standstill for years; that the cause, 
 whatever it may be, is combated by the one-nuclear, white blood cells, for 
 these are found present in great excess ; that the multi-nuclear white cells, the 
 best fighters of the blood cells, are of no service in the fight, and that the 
 quality of the blood is lowered until it is exceedingly watery. 
 
 This group of facts makes it plain that leukemia is due to a mild infection 
 with some parasite; that the parasite is a blood parasite, though it may have 
 its principal holdout in the spleen, as does chronic malaria. Probably the 
 parasite is not a coccus, but is more nearly like the malarial parasite or the 
 syphilis parasite. Some day somehody will identify this parasite and then 
 the research to find a cure will start on a scientific basis. 
 
 The spleen gets large in ordinary consumption, because the blood is 
 poisoned for months by the large number of germs that absorb from the 
 cavities* in the lung ; in suppurative pleurisy from the same cause ; in inherited 
 syphilis because the spirochetes are in and out of the blood. 
 
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 588 
 
THE SPLEEN 589 
 
 It may occur to some readers that the spleen should be removed when 
 it gets in the way. In ague cake, in leukemia, and in a few other conditions 
 the great, heavy organ is as much in the way in the abdomen as any large 
 abdominal tumor would be. Surgeons remove these other tumors, why not the 
 heavy spleens? 
 
 The answer is this : Usually the spleen is large because it has extra work 
 to do. If the number of germs to be removed is small it can be done by the 
 liver or some other organ, in which event the spleen could be removed without 
 harm. But when the spleen is big because it has big work to do, it would be 
 most unwise to remove it. Therefore, the surgeons do not remove ague cakes 
 or leukemic spleens 
 
CHAPTER XXXIII 
 
 Heart Disease 
 
 In this country school inspectors are not allowed to remove the cloth- 
 ing in examining school children. Therefore in order to learn how much 
 heart disease there is among school children and what effect such disease 
 has on their health it is necessary to go to reports from the old country. 
 
 The Medical Officer for May, 1911, has an interesting study of heart 
 disease among school children of a small town in Scotland. Of 2,380 chil- 
 dren examined, 131 had leaking heart valves and 55 had nervous hearts. 
 
 Those having organic heart disease — leak- 
 ing valves — on an average were 55 per 
 cent below height, 52 per cent below 
 average weight, and increased in weight 
 at a rate which was 60 per cent below the 
 average. 
 
 A crippled heart valve causing a leak, 
 ordinarily called heart disease, results 
 from bacterial destruction. Rheumatism 
 is that bacterial disease which is the usual 
 cause of heart disease, though in scarlet 
 fever, pneumonia, diphtheria, and even in 
 hard colds, the needed germs can enter 
 the blood and become attached to the 
 valves. 
 
 If there were no heart disease rheu- 
 matism would not amount to much. If 
 there were no rheumatism, life insurance 
 would be 10 per cent cheaper, for heart 
 disease would not amount to much. 
 
 Engineers know it to be good econ- 
 omy to put in a 1,000 horse power boiler 
 for a 500 horse power plant. They 
 learned that by experience. Had they 
 asked what the human heart had to say 
 about it they would have had an answer. The human heart does its work 
 with three-quarters of its horse power held in reserve. When rheumatism 
 has crippled a valve the heart compensates by using a little of the reserve 
 horse power. 
 
 Ordinarily we say a man has heart disease when his compensation fails. 
 It would be truer to say he has a failing heart compensation, the result 
 of heart disease. The real heart disease was in existence when during 
 rheumatism his joints creaked and, over the heart a soft, blowing mur- 
 
 590 
 
 Fig. 203. — Heart and the Great 
 Vessels which Lead into and 
 out from the heart. coronary 
 Arteries which Supply the Head 
 Muscles with Blood. The left 
 ventricle makes up the apex. The 
 right ventricle is not so prominent. 
 
THROBBING AND BEATING 
 
 591 
 
 mur was heard. When his acute disease subsided his rheumatic joint was 
 a little stiff and his heart valve leaked. In a certain sense he had heart 
 disease at that stage, though he would have resented being told so, for he 
 felt equal to anything. Twenty — perhaps forty — years later his heart muscle 
 lost some of its tone, compensation failed and he finds out a fact that had 
 been a fact since his childhood — he has heart disease. 
 
 THROBBING AND BEATING 
 
 As the heart beats the force of the contraction runs instantly down 
 the arteries and loses itself in the capillaries. The blood runs in the 
 same direction but it runs slowly as compared with the force that we call 
 the pulse. We see the same 
 thing where a pump is send- 
 ing water through an iron 
 tube. When we watch the end 
 of the pipe we notice that at 
 the instant the piston strikes, 
 the water spurts. The water 
 took several minutes to flow 
 from the pump to the nozzle 
 but the spurt arrived in a 
 fraction of a second. 
 
 In the case of an iron 
 pipe the throb is just as plain 
 a few hundred feet away as it 
 is at the pump. In the pulse 
 the throb disappears in the 
 capillaries — in no case more 
 than six feet from the pump, 
 the heart. The water in the 
 iron pipe had a wall in which 
 there was no give and in con- 
 sequence all the forces of the 
 piston carried on the water 
 stream. 
 
 In the arteries the blood 
 vessels have walls nearly as 
 elastic as rubber. Some part 
 of the force of the heart is 
 used in stretching the vessel. 
 
 After a flow of a few feet the blood moves smoothly and evenly and without any 
 j erhs or spurts. The blood in the capillaries and veins Hows smoothly and 
 evenly — there is no pulse. That is the way when things are right. 
 
 In old people the arterial walls are stiffened. Some of the rubber ig 
 gone. Their vessels are more like iron pipe in that they have not much 
 give. The larger blood vessels are generally placed so that they can swell 
 without pressing on anything. The smaller blood vessels are not infrequently 
 
 Fig. 204. — Diagrammatic Section of Heart Showing 
 Cavities and Vessels. LV, Left Ventricle; LA, 
 Left Auricle; PV, Pulmonary Veins; MV, Mitral 
 Valves; a, Aortic Valves; Aa, Aorta; RV, Right Ven- 
 tricle; SRA, Right Auricle; SVC, Superior Vena Ca- 
 va (vein carrying blood from head, neck and arms). 
 IVC, Inferior VenaJ Cava (vein carrying blood from 
 trunk and legs) ; TV, Tricuspid Valves; Pa, Pulmo- 
 nary Arteries. 
 
592 HEART DISEASE 
 
 packed in tighter. In an old person the stiff arteries continue the pulse im- 
 pulse into some of these smaller vessels. Here the pulsing presses on delicate 
 nerves. 
 
 Old people not infrequently complain of thumping in the ears and 
 disagreeable pulse beats elsewhere throughout the body. It causes nothing 
 more than annoyance and is not worthy of the worry that it usually occasions. 
 
 When a limb is swollen and sore the pain sometimes comes in throbs. 
 The pulse beats can be felt and they hurt. The tissues are filled with an 
 excess of fluid, the skin is stretched tight; as the pulse beats the small 
 nerves cannot roll out of the way — they get pinched and pain results. 
 Again, the inflammation throws the muscles of the small vessels out of 
 service, the vessels dilate their walls and cannot give further. They are 
 somewhat similar in physics to the iron wall pipe, and the pulse beat, instead 
 of stopping where it should, is carried on into the smallest blood vessels. 
 
 If a man has a sore foot and would be rid of the throbbing he can 
 usually succeed by raising it. If the foot vessels can be rid of gravity 
 they come near enough handling the situation to stop the throbbing. 
 
 In no part of the body is throbbing so much in evidence as in the teeth. 
 Nowhere else do blood vessels and nerves pass through such narrow quarters, 
 such canons between solid, bony walls. 
 
 Throbbing pains are then the result of mechanical conditions. Some of 
 these can be changed and the condition remedied^ some must be endured. 
 
 THE HEART AND EXERCISE 
 
 Should a man be afraid to exercise because of his heart? How should 
 a well man decide this question? How should a man with a nervous heart 
 decide it? How should a man with disabled heart valves decide it? 
 
 To some it would seem silly to ask whether well men can harm 
 their hearts. Yet a good deal has been written about acute dilatation of the 
 heart and some office men with very soft muscles are afraid to exercise. 
 
 Occasionally there is a report of the results of close, careful examina- 
 tion of a group of athletes who have just finished a marathon or similar 
 contest which states that dilatation of the heart has been the rule. 
 
 As to persons with sick hearts the Schotts of Nauheim and those of 
 their school have written forcibly and often of the great danger of dilata- 
 tion of sick hearts from what they hold to be overexercise. 
 
 The heart is a bag. Or, rather, it is two bags, for there is one bag, 
 the right, to get blood to the lungs, and another, the left, to get it to the 
 rest of the body. The wall of this bag is elastic. It is composed of muscle 
 which expands and contracts alternately. 
 
 The blood returning from the veins pours into this bag. This blood 
 is under pressure. It balloons the bag. The muscle of the wall responds by 
 contracting. It collapses the bag driving all of the blood into the arteries. 
 There is, therefore, a constant opposition between the ballooning force of 
 the blood in the heart and the collapsing force of the heart muscle. 
 
 In the period extending from heartbeat to heartbeat there is a time in 
 which the inflowing blood is ballooning the heart and another time in which 
 
THE HEAET AXD EXERCISE 
 
 593 
 
 the muscle is collapsing the bag. In this antagonism of forces things are 
 going well if the muscle force is easily holding its superiority over the bal- 
 looning force. Other tilings being equal the good heart is the one which 
 does not balloon out and dilate unduly. 
 
 Dr. Williamson, assisted by Drs. Hartung, Moore and Mosser, has 
 attempted an answer to the 
 questions asked above by ac- 
 curately measuring with x-ray 
 apparatus the hearts of a large 
 number of persons. Some 
 were healthy young men with 
 sound hearts. Some had heart 
 disease, but compensation was 
 fully established. Some had 
 no heart diseases but were af- 
 flicted with other diseases the 
 nature of which would lessen 
 the tone of the heart muscle. 
 Others had heart disease with 
 a failure of compensation. 
 
 The hearts of these per- 
 sons were measured. They 
 then climbed stairs until their 
 pulsebeat was around 160 and 
 the beating was rapid and 
 "panty." 
 
 The hearts of the well peo- 
 ple were less ballooned after 
 this violent exercise than be- 
 fore. The answer for that 
 group is that exercise is good 
 for the heart immediately and 
 ultimately. 
 
 In the case of the sick per- 
 sons with good compensation 
 one-half of the hearts ballooned less than before the exercise. In the case of 
 the sick persons with poor compensation nearly one-half ballooned less after 
 as compared with before the exercise. This violent exercise was of momentary 
 benefit even in heart cases. 
 
 The answer then to the last question is that persons with sick hearts 
 under proper direction can exercise with immediate benefit and also with 
 ultimate good. Finally, people with nervous hearts need exercise above all 
 else. 
 
 Valvular Trouble Symptoms. — E. K. A. writes: "What is a leaking 
 heart valve f How does it affect a person? Does it cause the nose to 
 bleed? What are the symptoms?" 
 
 Fig. 205. — Sketch Showing Approximate Location 
 of Gall Bladder (gb), Appendix (a), Navel (N), 
 Crest of Ilium — hip bone — (H), and Rib Bor- 
 der (R). 
 
 Reply. — A heart valve is like a pump valve. When the blood is going 
 in the right direction it gets out of the way. When the blood starts in the 
 wrong direction the valve gets in the way, closes the opening, and stops 
 
594 HEAET DISEASE 
 
 the backward flow. If the valve is shriveled as the result of disease or is 
 not large enough to stop the backward flow, it leaks. 
 
 If the heart muscle works hard enough to repump the leakage there 
 are no symptoms. A physician listening to the heart will detect a blowing 
 sound which he knows means a leaking valve. 
 
 When the heart muscle has lost some of its power and can no longer 
 repump the leakage then symptoms appear. 
 
 The more frequent symptoms are swelling of the feet, short breath and 
 palpitation. There may be nosebleed. 
 
 Care with Heart Murmur. — J. W. writes: "A gentleman friend, of 
 mine, 26 years old, is troubled with a soreness in the left side which has 
 been described by a physician as a 'heart murmur.' He has been in the 
 habit of taking a cool bath every morning and evening. Don't you think 
 this too often, and that the shock to the heart is too great? Wouldn't just 
 the evening bath be sufficient?" 
 
 Eeply. — A man with a heart murmur must be extra careful to keep 
 up his general muscle tone. If he gets a good reaction after a cold bath 
 his muscle tone will be benefited. If not he will be harmed. If he can 
 take one he can take two. 
 
 See Heart Specialist. — "Thankful" writes: "Would you kindly tell me 
 if there is any hope in leakage of the heart for a man of 1+6? He is a 
 tailor. Once in a while he has to lift about 300 pounds of goods. Does 
 smoking hurt him? Would you suggest something for him?" 
 
 Reply. — If you have an injured valve and that is the reason of the leak 
 you cannot hope to restore the valve to what it was. But you can hope 
 to live reasonably comfortably and be able to work for many years, pos- 
 sibly for as many years as is the lot of the average man of 46. 
 
 To do this you must so regulate your life as to keep your muscles in 
 good tone and you must always be careful not to overstrain your heart. 
 
 In lifting 300 pounds of goods, divide it into "takes" that do not make 
 you pant. 
 
 You should stop smoking. 
 
 Ask your physician to go with, you to a heart specialist. Have them 
 together lay out a plan for you — how much work, what kind of work, how 
 much exercise, what kind of exercise and similar advice in detail. Then 
 follow directions. 
 
 Nervous Heart. — J. C. W. writes: "1. What is a nervous heart? 
 2. What are the symptoms? 3. What are the causes of nervous heart? 
 If. How may the condition called 'nervous heart' be corrected or cured? 
 5. What are the consequences of neglecting it?" 
 
 Reply. — 1. A heart that is easily made to beat too fast, or too slowly, or 
 irregularly in speed, or too hard, or too feebly, or irregularly in force, or 
 to skip. 
 
 2. Variation in speed, or force, or rhythm without adequate cause; 
 rapid, irregular pulse, pounding heart beat, or skipping pulse are 
 symptoms. 
 
 3. Tobacco, excesses of various kinds, general nervousness. 
 
 4. Remove the cause — e. g., stop tobacco. Practice simple, plain, 
 hygienic, sane living through nervous poise. 
 
 5. A nervous heart may and does frequently nourish itself poorly and 
 
THE HEART AND EXERCISE 595 
 
 in consequence the heart muscle loses power. Irregular heart action may 
 contribute to angina pectoris. Generally speaking, a nervous heart is not 
 so serious a matter as the affected person thinks. 
 
 Nervous Heart Evidence. — J. W. writes: "Please give the symptoms 
 of a nervous heart and the best remedy for it. Is it dangerous?" 
 
 Reply. — A nervous heart is one that under any form of excitement or 
 under the strain of physical exertion beats very rapidly or irregularly. 
 We expect the heart to beat faster when one exerts himself but if the 
 increase is much greater than that of the average person the heart is 
 nervous. 
 
 The way to find out is to feel the pulse. 
 
 The most frequent form of nervous heart is the tobacco heart. That 
 is seldom dangerous, but is annoying. 
 
 The remedy is to stop the use of whatever is causing the nervous 
 heart if it is some drug like tobacco or coffee. 
 
 The heart is frequently nervous when the thyroid gland is enlarged or 
 overactive. Finally, remember that watching the pulse can cause it to 
 beat fast and sometimes can cause it to become irregular. 
 
 Nervous Heart Not Serious. — E. G. N. writes : "If consistent will you 
 kindly advise me as soon as possible whether or not a 'nervous heart' is a 
 serious condition; or will lead to serious conditions if neglected?" 
 
 Reply. — A person with a nervous heart usually thinks it more serious 
 than it is. Nothing is more alarming to a man than to feel his heart 
 cutting up. Upon regular beating of the heart depends not only general 
 nutrition but the nutrition of the heart muscle itself. Therefore a 
 nervous heart in time results in some organic trouble — in the main, flabby 
 heart muscle. If the nervous heart results from tobacco habit or any 
 other removable cause, no man is justified in not removing it. 
 
 Heart Trouble. — A. B. B. writes: "Would you advise a heart stimu- 
 lant in the case of a woman 88 years of age, married and the mother of 
 two children almost grown? She is seldom sick, and never complains, but 
 her heart bothers her. It beats hard, often missing a beat, and her pulse 
 beats often 100 and seldom less than 85. She is not a big eater, but her 
 heart is always worse after meals. I have had her examined by several 
 doctors, who say she has no leakage." 
 
 Reply. — Do not give her a heart stimulant. Her heart is now over- 
 stimulated. Evidently her heart is nervous from some cause located else- 
 where in her body. It may be that her thyroid is secreting too freely. It 
 may be her stomach is the seat of trouble. It may be purely mental. Of 
 itself the condition is of little consequence. If it is the result of too much 
 thyroid, that should be looked after. If of the stomach trouble that should 
 be looked after. 
 
 Heart and Altitude. — Constant Reader writes: "What effect does the 
 high altitude of the West have on one who has heart trouble? Would it 
 be safe and beneficial for one 35 years of age who has heart trouble, is 
 under weight, and whose general health needs building up to live at an 
 altitude of 1^,000 feet or so in New Mexico or Colorado? Which would be 
 better, the mountainous regions of the South or the southern part of New 
 Mexico for one in such condition?" 
 
696 
 
 HEART DISEASE 
 
 Reply. — 1. Generally speaking, an altitude of 4,000 feet has no effect 
 on the heart. There are some exceptions. 2. Whichever makes you happier. 
 
 Find Cause. — A. H. F. writes: "Will you kindly state what it meant 
 ~by a tremor of the heart? Can anything be done to cure it?" 
 
 Reply. — I judge that by tremor you mean that you have palpitation 
 of the heart at times. If so, you should find the cause and correct it if you 
 can. It may indicate a condition of great gravity, and it may mean some- 
 
 HEAD""> UPPER 
 EXTQEM. 
 
 CYANOSIS OF FACE 
 
 Cl UBBED FINGERS 
 
 SYSTOLIC JUGULAR 
 
 PULSE, 
 
 L UA/GS. 
 
 COUGH. 
 
 DYSPNOEA. 
 
 FREQUENT BRONCHITIS* 
 
 OEDEMA. 
 
 HYDRO THORAX. 
 
 HAEMOPTYSIS. 
 
 BROWN INDUR, 
 
 ATHEROMATOUS 
 
 VESSELS. 
 
 CEREBRAL ANAEMIA. 
 
 VERTIGO,, 
 EAINTNESS, 
 
 a" 
 S YNCOPE. 
 
 VEOGflS. 
 
 OEDEMA, LOINER 
 EXTREMITIES. 
 
 INTESTINAL CATARRH, 
 OBSTINATE DIARRHOEA. 
 
 OR r^~ 
 
 CONSTIPATION^ 
 ASCITES, 
 
 LIAC ARTS* 
 
 Fig. 206. — Scheme Showing Circulation of the Blood. Systemic circulation: arteries 
 shown on the right, veins on the left. Pulmonary circulation arteries shown on left, veins 
 on the right. In brackets are stated the effects of certain disturbances of circulation. 
 Examples: Obstruction of return of blood from legs results in edema of lower extremities 
 (lower left bracket). Obstruction to return of blood through innominate vein results in 
 cyanosis of face, clubbed fingers, pulse in jugular veins (upper left bracket). Insufficient 
 force in carotid artery results in vertigo, faintness, syncope (upper right bracket). 
 
THE HEART AND EXERCISE 
 
 597 
 
 tHng that can be easily remedied. It may be caused by smoking, over- 
 eating, indigestion, constipation, high arterial pressure, lime plates in the 
 arteries, a weakening 
 heart muscle, a diseased 
 valve, etc. You will note 
 that most of these causes 
 can be remedied. 
 
 Chronic Myocarditis — 
 F. J. writes: "Will you 
 describe the symptoms of 
 chronic myocarditis, cure 
 if any, and effect of hard 
 work on one suffering 
 from it? Advise what 
 precaution to take, and if 
 a complete rest from 
 mental or physical strain 
 will help." 
 
 Reply. — In chronic 
 myocarditis there may be 
 very few symptoms. A 
 weak, rapid pulse, a weak 
 apex sound and a low 
 blood pressure are fairly . 
 good signs. But do not 
 put thought on the diag- 
 nosis. A diagnosis re- 
 quires good diagnostic 
 ability. Have an exam- 
 ination by a capable diag- 
 nostician and accept his 
 opinion. One with 
 chronic myocarditis 
 should devote his care 
 and control to efforts to 
 make his disabled organ 
 equal to the tasks im- 
 posed. Temperance in 
 work and worry, in eat- 
 ing and drinking is the 
 proper plan. 
 
 Nothing Out of the 
 Way. -B. F. M. writes : 
 "I hear sounds with 
 heartbeats, though not 
 constantly. I have con- 
 sulted physicians with no 
 results. I am perfectly 
 well at 65. The sound is 
 sometimes a whir, a chug, 
 or a peep, and more trou- 
 blesome at night/' 
 
 Fig. 207. — Femoral Artery and Its Branches. 
 CFI, common femoral ; ESF, superficial epigastric; 
 CIS, superficial circumflex iliac ; PUE, external pudic; 
 PRF, deep femoral; CFL, external circumflex of 
 thigh; PF 1 , first perforating a. of the thigh; PF 2 , 
 second perforating a.; PF 3 , third perforating a.; AGS, 
 arteria anastomotica magna; SF, superficial femoral. 
 
598 
 
 HEART DISEASE 
 
 CUI 
 
 Reply. — In certain positions it is easy- 
 enough for one to hear his heartbeats. To 
 him they may sound like a whir or a chug 
 or a peep according to how he happens to 
 hear them. A heart murmur loud enough 
 for you to hear could not escape an exam- 
 ining physician. You can therefore feel 
 certain that what you heard were the nor- 
 mal heart sounds. 
 
 Have Your Heart Examined.*— A. C. 
 
 writes : "In a man of 73, in apparent good 
 health, whose normal pulse had been 60 per 
 minute, what causes it to drop to 50 and 
 55, with sometimes an intermittent pulse?" 
 Reply. — It may not be of any signifi- 
 cance. It may mean some lime plates in the 
 arteries. You had better have your heart 
 examined and your blood pressure taken. 
 
 Irregular Beat of Heart. — D. A. writes: 
 "1. I was examined recently by a physician 
 who told me I was in good condition. He 
 said my heart had a catch in it, but he did 
 not consider this of any consequence. 
 Would you consider this a disease of the 
 heart? If so, can it be cured or remedied? 
 2. Will tobacco contribute to this if the 
 smoke is not inhaled? 3. Could indigestion 
 cause this irregularity of the heart?" 
 
 Reply. — 1. I suppose by "catch" you 
 mean your heart interrupts or skips a beat 
 occasionally. Skipping a beat may result 
 from disease in the heart. It usually re- 
 sults from causes outside the heart. It can 
 usually be cured. 2. Yes. 3. Yes; a man 
 with a heart that skips should find out 
 what he is doing wrongly (e. g., worrying, 
 smoking, or digesting poorly) and change it. 
 
 Has Years to Live.— E. L. writes: 
 "What are the possibilities of living for a 
 man of JfO with a mitral lesion? Is it pos- 
 sible for a man so afflicted to live to 60 or 
 70? Does such a condition have any 
 marked symptoms, such as swelling of 
 limbs, nosebleed, or fainting spells?" 
 
 Fig. 210. — Brachial Artery (arm) and Its 
 mvp Branches. B, brachial; R, radial; U, ulnar; 
 
 CLS, arteria deltoidea; CLI, profunda radial; 
 
 PB, superior profunda; CM, arteria collateralia 
 media; CUI, anastomotic a. of arm; RR, anterior radial recurrent; RV, anterior ulnar 
 recurrent; ICO, common interosseous; I A, anterior interosseous; IP, posterior inter- 
 osseous; IR, posterior interosseous recurrent; IAV, arteria interossea anterior volaris; 
 IAD, arteria interossea anterior dorsalis; M, median; CVR, anterior radiocarpal; CVU, 
 anterior ulnocarpal; CDR, posterior radiocarpal; MDU, posterior ulnocarpal; MVS, 
 superficial volar; MVP, ulnar portion of deep palmar arch; DC, first palmar digital. 
 
 SKI 
 
 DC 
 
 flfll/O /Wl/S 
 
THE HEAET AND EXERCISE 599 
 
 Reply. — 1. If lie is wise, has good muscles and has a good compensa- 
 tion he is nearly as likely to reach 70 as the average person of 40. 
 
 2. When there is a break in compensation these symptoms appear. A 
 break in compensation means that the heart muscle is straining to do the 
 extra work and not succeeding well. To avoid this keep fit, especially 
 keep your muscle tone good, live hygienically and do not overdo. 
 
 Heart Trouble. — B. L. R. writes: "I am engaged to a young lady who 
 has heart trouble and has had several attacks of inflammatory rheumatism 
 during the last ten years, the last being three years ago. Her physical 
 development is perfect, height about 5 feet 6 inches and weight about lJfi. 
 
 "I am over 6 feet tall, weigh 180, have never been sick, and free from 
 anything of a contagious nature. My fiancee feels well, although she has 
 shortness of breath on going upstairs rapidly. Do you think it safe for us 
 to marry? I know she is not able to do much work, hut I am in position 
 to let her have all of the help she needs. I also realize that she will need 
 better care than many men give their wives/' 
 
 Reply. — Her heart disease is evidently the result of rheumatism; her 
 rheumatism the result of a bacterial infection. She did not inherit either 
 nor can she transmit either. The question, then, is limited to how long 
 her heart will be able to do the extra work which its leaking valves throw 
 on it. If you are in a position to make her married life easier than her 
 single life has been her compensation will be maintained longer married 
 than single; otherwise not. Judgment as to permanence of her heart com- 
 pensation must be based on (a) amount of damage to the heart valve, (b) 
 state of heart muscle tone, (c) state of general muscle tone, (d) whether or 
 not rheumatism germs are continuing to find entrance to the blood, joints, 
 and heart. The opinion of those who have seen her, examined her, and 
 know her is much better than mine or that of any other stranger. 
 
 Probably Angina Pectoris. — M. A. L. writes: "What is the cause of 
 pain in the chest, beginning at the oreast bone and passing into the collar 
 bones and shoulders? The pain seems to be in the bones rather than inside 
 the chest walls, and is intense for a few minutes, then passes away." 
 
 Reply. — My guess is that this is angina pectoris. The pain of the con- 
 dition does not start in the breast bone. It starts behind the bone and 
 shoots into the arm. See your physician about it. 
 
 Don't Try "Remedy." — B. F. M. writes: "For the last few years I have 
 had a leaky valve which I acquired through rheumatism. It is in the artery 
 going out of the heart to the body (the aorta). 
 
 "According to an article recently printed, it is claimed that a treatment 
 of hammering on the seventh cervical vertebra will contract the aorta. 
 
 "Will such treatment by a physician do any good to the leaky valve, as 
 it is claimed it will contract the artery f 
 
 Reply. — It will do absolutely no good. The aorta is made up of dense 
 fibrous tissue like gristle and some elastic tissue like rubber. It contains 
 no muscle. It cannot contract and dilate as do small arteries. It cannot 
 be stimulated to contract. Its limited power to change size is similar to 
 that of a rubber tube. Therefore pounding on a vertebra is foolishness. 
 When people study and know more about such things it will no longer be 
 possible to make foolish claims for treatments and get away with it. A 
 
6,00 HEAET DISEASE 
 
 leaking aorta can be made to do satisfactory work if the heart muscles are 
 kept strong enough to do the extra work thrown on them by the leak. In 
 building up the general muscles the heart muscle will be built up. 
 
 Heart Trouble in Son. — J. S. C. writes: "What can I do that will he 
 test for my son? He is 16 years old and has a touch of heart trouble. He 
 has had it for five years and it is now worse and more dreaded by him than 
 ever. He weighs 95 pounds and is 5 feet 1 inch in height." 
 
 Keply. — The first thing for him to do is to quit dreading it. Dread 
 will make it twice as bad. It should be no trouble for a 16 year old boy to 
 keep his heart equal to its work. A fair percentage of 10 year old boys 
 have heart leaks but the heart muscle is so strong during those years that no 
 symptoms result. The symptoms come when the adults begin to let their 
 muscles get flabby. Your boy should be watched over by a good physician. 
 Under his direction the boy should exercise enough to build up his mus- 
 cles. As he gets stronger he should exercise more. His heart muscle will 
 get strong as his other muscles get strong. Let him forget his heart and 
 watch his calf, his thigh and his biceps. 
 
 Quick Heart. — W. A. D. writes: "The insurance examiners say I have 
 a nervous heart. It beats 80 standing, 6Jf lying down, and 96 after walking 
 upstairs, and misses a beat now and then. I am 1+3, general health good, 
 sleep and eat well, and am gaining flesh, although weight is somewhat below 
 normal — 1^5 pounds, 5 feet 8 inches tall. I work hard mentally and get 
 tired easily. Can a man over JfO do more than conserve his nervous energy? 
 How can he increase it?" 
 
 Reply. — A heart which is sixteen beats faster when standing than when 
 lying down, which increases another sixteen on walking upstairs, and which 
 skips a beat occasionally may or may not be structurally sound. Have your 
 physician find out if the valves are sound and the muscle not degenerated. 
 If everything is organically all right cut out tobacco and all other bad 
 habits, take some muscle exercise and get yourself in hand. 
 
 Doctor Should Superintend. — B. T. W. writes: "I am a man 53 years 
 old. I weigh 180 pounds, am 5 feet 10 inches in height. I was recently 
 examined for life insurance and was refused, I have since learned, on the 
 following account: 'High blood pressure and slight murmuring of the 
 heart.' Can you suggest what exercise and diet to follow to remedy these 
 defects as much as possible?" 
 
 Keply. — If your blood pressure and heart condition was bad enough to 
 cause your rejection by the life insurance company you had better have 
 your physician superintend your efforts. The general principle of such 
 efforts should be as follows: 
 
 A — When a heart valve leaks the heart muscle is called upon to do 
 extra work. If the heart muscle is in good tone it does the extra work 
 and there are no symptoms from the leaky valve. If the muscle tone is 
 lost we say compensation is broken and we expect symptoms to ensue. 
 The plan of treatment then is to build up muscle tone. This is done by 
 carefully graduated general muscle exercise. To be right the exercise 
 must almost reach the point of making the heart beat fast and hard but 
 must not quite do so. You must work almost to the point of tire but not 
 quite. You must persist. 
 
THE HEART AND EXEECISE 
 
 601 
 
 Fig. 209. — Veins, 
 Showing (A) 
 Valves Open 
 when Blood is 
 Flowing; (B) 
 Closed When 
 Blood Starts to 
 Flow in Wrong 
 Direction. 
 
 B — When the blood pressure gets high the elastic tissue of the blood 
 vessel walls has been worn out and been replaced by inelastic tissue. It 
 is therefore late to begin. The best you can do is to eat fruit enough to 
 keep your bowels regular and to live abstemiously. No tobacco, no alcohol, 
 no heavy meals; in fact, light meals consisting largely of cheese, milk, 
 buttermilk, bread and fruit are advised. 
 
 Have Heart Examined. — A. B. C. writes: "I am a man 35 years of age, 
 and up to six months ago drank almost every day regularly. I stopped 
 drinking suddenly; just made up my mind to stop for 
 ever, and did. Shortly after doing so I would become 
 nervous at the least provocation and my digestion has 
 been bad off and on of late. Almost constantly for the 
 last few months my heart has bothered me greatly by 
 its thumping at night, when I lie down in bed to sleep. 
 Sometimes it thumps so fast that I imagine it will 
 jump out of my mouth, and then it will get so slow 
 that I am in dread it will stop. Most of the time my 
 pulse is 60 to 66, when calm, and under any excitement 
 it jumps away up to 100. I sometimes get so dizzy that 
 I imagine I am going to drop dead. I wish you would 
 tell me what you think is the matter and advise me 
 what to do, as I am becoming a wreck worrying about 
 myself. Is a pulse of, say, below 72 a sign of a weak 
 heart or a bad one? Is 60 to 66 too slow for mef The 
 beat is a light one, but seems regular/' 
 
 Reply. — The condition described is much more sug- 
 gestive of tobacco poisoning than of alcohol poisoning, 
 and you do not tell your tobacco habits. A pulse beat below 72 is not a sign 
 of a weak heart or a bad one. Have a physician examine you to find out if 
 you have a heart leak. If you have not but have a nervous heart instead 
 he will tell you how to end that. He will start by telling you to quit wor- 
 rying, to quit watching your heart and counting your pulse. 
 
 Blood Pressure in Hardening of Arteries. — C. G. R. writes : "Can there 
 be high blood pressure without hardening of the arteries? What is the 
 average blood pressure? What would blood pressure of 150 indicate?" 
 
 Reply. — 1. The pressure rises temporarily from many causes. If it 
 persistently remains high it means hardened arteries. 
 
 2. Varies with age. In childhood, under 100; in early adult life, 120 
 to 130; after 50, 150 to 160. 
 
 3. Hardening of the arteries in anyone under 50. 
 
 Prevention of Hardening of Arteries. — M. writes: "What is the treat- 
 ment proposed by a Russian scientist to prevent premature arterial harden- 
 ing? What can be done to reduce blood pressure?" 
 
 Reply. — 1. The Metchnikoff plan is to prevent the growth of putrefac- 
 tive bacteria in the large intestine by infecting the contents thereof with 
 an acid secreting bacillus. He makes use of a certain lactic bacillus which 
 makes a great deal of acid and is not killed thereby. This bacillus can 
 stand acid four times as strong as ordinary lactic bacilli. To help out, 
 this bacillus should be given with much sugar. The treatment is not get- 
 ting a fair trial, since many of the commercial preparations are composed of 
 germs easily killed by acid. 
 
602 HEAET DISEASE 
 
 2. Not much can be done. The horse is out; what good to lock the 
 stable door? Eat lightly, live temperately, and avoid constipation. 
 
 Tissue Change in Hardening of Arteries. — C. J. D. writes: "What 
 causes hardening of the arteries? Is it curable? By what general meth- 
 ods, baths , or medicine? How is this trouble prevented?" 
 
 Eeply. — The tissues of young people are exceedingly elastic. The more 
 elastic fibers of the tissues wear out more rapidly than other tissues. As 
 they wear they are replaced by a harder, less elastic tissue, called fibrous 
 tissue. It happens that the change from elastic to fibrous tissue in the 
 arteries can be measured in a rough way by measuring the blood pressure. 
 There is no satisfactory way to measure senility in the other tissues. 
 
 When a man's blood pressure indicates that his arteries are old as 
 measured by wear his other tissues are also worn, though it cannot be 
 proved. 
 
 The papers tell us of cures by radium. Maybe so, but I doubt it. To 
 change one's method of living is more rational. While cures have a small 
 field the field of prevention is large. 
 
 The method? Eight living; temperance in eating, drinking, working, 
 worrying; avoiding infections and subinfections, especially avoiding rheu- 
 matism and gout. 
 
 Cause of Hardening of Arteries. — W. H. S. writes: "1. What causes 
 hardening of arteries and high blood pressure in a middle-aged man? 2. 
 What can be done for a person who is said to be neurasthenic?" 
 
 Eeply. — 1. Overeating, drinking stimulants, constipation, a tobacco 
 heart, Bright's disease. There are other causes but these five are the most 
 important. 
 
 2. Exercise in the open air, a natural life, taking an interest in others, 
 optimism. Many mild cases cure themselves by reading books on nerves. 
 In these they learn that "there are others," that their experiences are no 
 worse than thousands of others have had, that the condition in the main 
 is due to bad mental inheritance or bad mental training or both, and that 
 it yields to patient efforts at nerve control. 
 
 Water in Hardening of Arteries. — A. F. writes: "I am a woman, near- 
 ing 60. Have hardening of arteries, and b. p. much above normal. What 
 effect would hard water {very hard) have upon me, in my condition? 
 Would boiling the water, and pouring off for use after the white deposit 
 settles, make it less injurious?" 
 
 Eeply. — Hard water will not harm you. Boiling it will make no dif- 
 ference so far as your arteries are concerned. Back of the existing condi- 
 tion in your arteries lies the cause. You used up the strength and elas- 
 ticity of your arterial walls when you were young. As long as Nature 
 could she repaired the wear with the best materials, elastic and fibrous 
 tissues. 
 
 Now she must stop it with the best available material and this is lowly 
 organized tissue and lime salts. 
 
 The lime salts are not to blame. In fact, were they not available the 
 wall would give worse than it does. 
 
 An excess of salts taken in as hard water is passed right out by the 
 kidneys and bowels. The mineral may hurt these organs a little but it 
 will not harm the arterial walls or the tissues generally. 
 
THE HEART AND EXEECISE 603 
 
 Premature Hardening of the Arteries. — J. W. writes: "1. In the case 
 of an individual about J+0 suffering from premature hardening of the ar- 
 teries, not in any marked degree, but where the hardening is perhaps ten 
 years in advance of his years, can it be arrested? 2. Would or does this 
 condition necessarily lead to or cause bodily discomfort, disability to per- 
 form manual labor, illness, or shortening of life? 3. Are fat, well nour- 
 ished people usually those whose arteries are in prime condition? .4. 
 What is considered the normal blood pressure?" 
 
 Reply. — 1. Yes, by eating in moderation, living temperately and hy- 
 gienically. 
 
 2. No, as to all except the last and even that can be avoided. 
 
 3. No. Fat people usually have pressure a little higher than normal. 
 
 4. 110 to 140, but what is normal at one age is high at another. It is 
 lowest in infancy, rapidly heightens during childhood and adolescence, 
 then slowly until 70 to 80, after which it may be somewhat lower. The 
 force of the heart beat is a contributory factor and that goes off a little 
 in old age. 
 
 Simple Life Only Avails. — Southerner writes: "Will you please tell 
 me what causes arteriosclerosis and what, in your opinion, is a sensible 
 treatment? My husband has been told by a physician that he is suffering 
 from it. He complains of nothing, save of a tingling in the tips of the 
 fingers of his left hand, and all the left arm is almost continually in the 
 condition popularly described as 'asleep.' What would you advise and also 
 what is the span of life after a case of arteriosclerosis reaches the condi- 
 tion of being well defined? My husband is 52 years of age, weighs 180, 
 and is intensely nervous. I have been much given over to the idea of 
 calomel, and you have turned me from this faith/' 
 
 Reply. — 1. Arteriosclerosis is due to the wear and tear of life. The 
 processes of senility begin in a baby at birth. The child ages most rapidly. 
 Senility progresses much more slowly in middle life but its effects are 
 more generally recognized. At no other period does one age so slowly as 
 in old age. 
 
 The process is one of wear. Wear is greatest when the wheels are turn- 
 ing fastest. Worry, whisky, and improper eating increase the wear. The 
 other tissues wear as do the artery walls, but in the artery walls scar tissue 
 grows to take the place of the worn muscle. 
 
 A way to measure the vessel wall change mathematically has been 
 found. That is why we hear so much about high blood pressure and 
 arteriosclerosis. 
 
 Arteriosclerosis having been diagnosed, follow the simple life. Noth- 
 ing else avails. Of course, the time to have locked the stable was before 
 the horse escaped. 
 
 2. People who live in a warm climate and eat heavily have swollen 
 livers. Calomel purges them and makes them more comfortable. So would 
 any other purge. But why go on swelling one's liver and purging to get it 
 down again? Is there sense in that? 
 
 Treatment of Hardening of the Arteries. — C. T. O. writes : "1. Is olive 
 oil beneficial in cases of hardening of the arteries? 2. Will massage relieve 
 pain in such cases? 3. Is there any remedy for enlarged liver? 4. What 
 will prevent accumulation of gas in the stomach?" 
 
604 HEAET DISEASE 
 
 Eeply. — 1. No. 
 
 2. Massage will help many kinds of pain. 
 
 3. Depends on what causes the enlargement. The enlargement of the 
 liver which comes in summer can be cured by eating less. 
 
 4. Gas is not formed in the stomach in any considerable amount. Much 
 gas is swallowed. Slower eating limits this. Belching, if that is what you 
 mean, nine times out of ten is a sign of nervousness and is to be so treated. 
 
 Symptoms of Hardening of Arteries. — Florida writes: "Please state 
 what some of the symptoms are of hardening of the arteries." 
 
 Keply. — High blood pressure, large quantity of urine, enlarged heart, 
 dizziness, vertigo. 
 
CHAPTER XXXIV 
 
 Blood Pressure 
 
 HIGH 
 
 PRESSURE 
 
 : i 
 
 L INE 5\ i 
 
 VENTRICULAR SYSTOLE 
 
 /IRTERIES 
 
 [curved double lines : 
 represent the dis - 
 tcntion and length- 
 ening or the . 
 
 arteries) 
 
 BLOOD PRESSURE RECORDS 
 
 We begin to get old when we begin to live. When we are young we 
 get old rapidly. When we are old we get old slowly. The tissues of a baby 
 age rapidly. The tissues of 
 a man of seventy age slowly. 
 A baby is a great energy 
 waster. He has a surplus 
 of energy and he spends it 
 like a drunken sailor. An 
 old man makes his efforts 
 count. 
 
 Repair never leaves the 
 cell quite as it was before 
 the waste. Some vitality is 
 gone even when everything 
 ' seems absolutely normal. 
 After a few decades the dif- 
 ference between the cells as 
 they are and as they were at 
 the beginning becomes rec- 
 ognizable by certain tests. 
 The only test that is reduci- 
 ble to a mathematical basis 
 is blood pressure. 
 
 Blood pressure is a test 
 of two tissues only — the 
 blood vessel wall and the 
 heart muscle. Therefore, it 
 is only a partial test but at 
 that it is a better test than 
 the years lived. 
 
 The insurance compan- 
 ies pay out most of their 
 money for wear and tear 
 diseases. The most promis- 
 ing way of lessening the 
 wear and tear diseases is by 
 
 changing some of the popular customs. To this end the life insurance com- 
 panies spend money on efforts for public education. 
 
 605 
 
 /IRTERIOL 
 
 oKrras 3 ®!!® 
 
 iYiTEM 
 
 ttAim 
 
 Tiyn§is. 
 
 RESISTANCE 
 
 (triction in 
 capillaries, 
 
 MAINLY.) 
 
 VEINS 
 
 !L©W 
 
 (D 
 
 Fig. 210. — Diagram Explanatory of Arterial. Ten- 
 sion. 
 
606 
 
 BLOOD PKESSUKE 
 
 The Northwestern Life has been studying blood pressure. It has 
 observations on about 3,000 people, some of whom had been insured five years. 
 The average blood pressure of those who passed was 143. The 525 with 
 highest blood pressure among those passed had an average of 153. Seven 
 
 hundred and twenty- 
 three persons rejected 
 had an average pressure 
 of 171. 
 
 In another group 
 of cases the average 
 blood pressure of those 
 under 40 accepted was 
 125. The average of 
 accepted risks at 40 to 
 44 had an average pres- 
 sure of 128; 45 to 49, 
 130; 50 to 54, 132; 55 
 to 60, 134. 
 
 When a life insur- 
 ance company insures a 
 man it counts upon his 
 living out a certain ex- 
 pectancy. The actual 
 death rate among a 
 group of insured who had a blood pressure of 143 was but 47 per cent of 
 the expected death rate. In the group with a pressure of 150 and over, the 
 death rate was 70 per cent of the expectancy. Of those rejected and having 
 a pressure of 171, the death rate was 153 per cent of the expectancy. Those 
 having a high pressure, 171, and some organic disease had a rate of 161 per 
 cent of the expectancy. 
 
 The causes of death in the high blood pressure cases were apoplexy, 13; 
 Bright 's disease, 10; heart disease, 8; arteriosclerosis, 6; remainder, scat- 
 tering. In the cases in which the blood pressure averaged 152, apoplexy and 
 heart disease led but the lead was not so great. 
 
 Fig. 211. — Method of Taking Blood Pressure. 
 
 PROTECTING THE BLOOD 
 
 The blood runs from the heart through the arteries to the capillaries 
 and then back through the veins to the heart. The blood is always inside a 
 closed tube. When the structure of man was planned it was seen at once 
 that the important fluid — the blood — must be protected against infection. 
 On the other hand, it was seen to be necessary, in order that the tissues be 
 nourished, that the liquids ooze out of the vessels so that the cells of the body 
 might soak in them. Therefore the small blood stream was so arranged that 
 food could easily soak out but that harmful things could not soak in. 
 
 Now, whenever any arrangement for soaking out is provided an ar- 
 rangement for soaking in must also be provided; else presently everything 
 will be out and nothing will be in. 
 
PROTECTING THE BLOOD 
 
 607 
 
 The arrangement provided was that whatever had got out could get 
 back in again by flowing into certain spaces and then flowing along certain 
 tubes and through certain filters and finally back into the blood stream. 
 
 This especial arrangement for getting the tissue juices back into the blood 
 stream is known as the lymphatic system. It is an adjunct to the blood system 
 especially provided to make it safe for the blood fluids to do their work. 
 
 A properly arranged lymphatic system must have open mouths. It must 
 be easy for anything to get in. Therefore the lymph vessels start as open 
 
 Fig. 212. — The band B is fastened around the arm; air is pumped by the bulb C through the 
 tube D until the inflated band B pressing the artery against the bone stops the pulse at the 
 wrist. The air pressure in B and D is registered on the column of mercury A. 
 
 mouthed tubes lying everywhere around the cells and any liquid or solid 
 that gets under the skin or through the mucous membrane can get at once 
 into a lymph vessel. 
 
 Disaster, however, would wait around every corner unless a way was 
 provided to filter the lymph and thus keep dangerous substances out of 
 the blood. These filters are called lymph glands. It is impossible for the 
 lymph to get into the blood until it has gone through several of these lymph 
 glands. 
 
 The little kernels that appear here and there under the skin are lymph 
 glands. So long as their work is not too great they are small, in fact usually 
 too small to he felt. 
 
 When they grow large enough to be felt it means something. It means 
 that they are being called upon to do an excessive amount of work and they 
 are striving hard to do it. 
 
 If they get tender and painful it means that the job is more than they 
 can stand up under. The gland is straining out the germs and saving the 
 blood stream from pollution but the poison is proving too much for the filter. 
 
 A swollen, tender, inflamed gland is in a bad condition but it is better 
 that the gland should suppurate than that the blood stream should be polluted. 
 
608 BLOOD PRESSURE 
 
 Blood Pressure. — Mrs. S. G. writes: "1. Will you kindly state whether 
 150 m. m. is normal hlood pressure for a man of 59 years'? He is slightly 
 pigeon breasted, and has had a hard winter cough — bronchitis — since child- 
 hood. He gets red in the face and neck at times, with no great throbbing 
 of arteries. The physician calls it a vasomotor disturbance. 2. What is 
 meant by 'vasomotor disturbance'? 8. After an operation for chronic 
 appendicitis the colitis ceased, and last summer there was no recurrence of 
 the trouble. He has been using a good deal of buttermilk {creamery). 
 Can the ordinary lactic acid germ have given him relief? Jf. How much 
 credence should be given to the theory that buttermilk will stop putrefac- 
 tion in the bowels and prevent arteriosclerosis? 5. Can vaccinating for 
 'colds' do any good? 6. Kindly tell those who cannot go to bed how to 
 stop a cold." 
 
 Reply. — 1. It is a little too high. 
 
 2. Blushing is a vasomotor disturbance. A vasomotor disturbance is 
 a lack of proper automatic control over the size of the smaller blood 
 vessels. 
 
 3. My guess is that his intestines were irritable from the appendicitis; 
 therefore that the operation cured the intestinal trouble indirectly. 
 
 4. A little, not much. 
 
 5. Yes. 
 
 6. A purge, light diet, and a few doses of aspirin. 
 
 High Blood Pressure. — L. H. writes: "1. Would a blood pressure of 
 200 and over — at times 230 — be dangerous for one of Jf9 years who has a 
 nervous heart, but otherwise is in good health? 2. What is apt to be the 
 result from such a condition? 3. How high can the blood pressure run 
 without causing paralysis at 50 or 60 years?" 
 
 Reply. — 1. Blood pressure of 230 at forty-nine is about the limit. It 
 indicates a bad condition. 
 
 2. Bright's disease, apoplexy, the tissue changes of arteriosclerosis. 
 
 3. The pressure does not cause paralysis. A high pressure may accom- 
 pany brittle arteries and one of these may break, causing paralysis. You 
 had better quit smoking, eat less, change your habits, and get your pressure 
 down. 
 
 Temperate Living Urged. — Mrs. I. S. K. writes: "A friend of mine 
 suffers from too high blood pressure and hardening of the arteries. Her 
 age is 65 years. Has been taking nitroglycerin tablets for six months 
 four times daily, but so far has derived no benefit. Would you advise 
 to continue the use or is there anything you could suggest?" 
 
 Reply. — Many people use nitroglycerin. I do not think it does any 
 good. Prevent constipation. Eat, drink, and in all other ways live tem- 
 perately. 
 
 No Great Danger. — W. A. writes: "Is a blood pressure of 170 to be 
 considered dangerous for a woman of 65, living under conditions almost 
 ideally sanitary and hygienic?" 
 
 Reply. — 170 is high for that age. That does not mean you are in great 
 danger. 
 
 The Northwestern Life has found that the death rate among people 
 with a blood pressure of 170 is 138 as compared with a normal for that 
 
PROTECTING THE BLOOD 609 
 
 age of 100. In other words, you are in no great danger but your life ex- 
 pectancy is somewhat lower than normal for your age. 
 
 Altitude Effect Exaggerated. — E. W. S. writes: "What precautions 
 should a person take who is going to Colorado or some other point in the 
 west of a high altitude, and who has 'leakage of the heart/ or valvular 
 trouble of the heart? Is there any relation between 'leakage of the heart' 
 and inflammatory rheumatism? Could one be said to be the cause or fore- 
 runner of the other; if so, which? What are the first symptoms of dia- 
 betes? What would you say was the cause of one requiring a great deal 
 of drink (nothing stronger than water) especially in the evening after 
 dinner?" 
 
 Reply. — 1. Let him be careful about exercising. After a few weeks he 
 will find that he has adjusted himself to the new atmospheric pressure. 
 The effect of altitude on the heart is greatly exaggerated in the public 
 mind. 
 
 2. Yes, inflammatory rheumatism is the cause or forerunner of much of 
 the heart disease. 
 
 3. Generally an increased amount of urine and increased thirst. Some- 
 times a crop of boils or a carbuncle first calls attention to the existence of 
 diabetes. 
 
 4. May be due to an overfull meal or to inactivity after eating. It is a 
 good idea to drink a good deal of water after a full meal. 
 
 On High Blood Pressure. — M. J. B. writes: "Will you please tell me 
 what is the cause of high pressure of the blood and are there any serious 
 results from too high pressure? What should the treatment be?" 
 
 Reply. — A high blood pressure means that (1) the heart is beating too 
 strongly; (2) the blood vessels walls are thickened and inelastic; (3) 
 the person is obese; or any two or all of these combined. Of these 
 much the most important is the second. Naturally the blood vessels are 
 large enough and smooth enough for the blood to flow through with very 
 little friction. They are elastic enough to stretch like a rubber tube every 
 time the heart beats. As age comes on the elasticity diminishes, the walls 
 thicken, and the inside width of the tube gets less. In consequence the 
 blood in the tubes is under too much pressure. High blood pressure is 
 of importance, more because it is an indicator of senile changes in the 
 tissues rather than on account of itself. For instance, it usually goes hand 
 in hand with chronic Bright's disease — senile kidneys. About all that can 
 be done is to live "slimmer." 
 
 Treatment of High Blood Pressure. — L. C. R. writes : "I have what they 
 call hardening of the arteries. About one year ago I was working in my 
 yard and it was awfully hot. I got dizzy and fell and since then my right 
 leg has been numb and I have dizziness when I walk. I am a man of 6Jf 
 years old and my blood pressure at the present time is 172. Can you sug- 
 gest where I could go or what is best for me to do?" 
 
 Reply. — People generally start to work on high blood pressure about 
 twenty years too late. Eat lightly, eat simply, chew your food well, drink 
 plenty of water, attend to your bowels, exercise moderately, keep happy, 
 do not worry and you will be doing all you can do for high blood pressure. 
 
 Blood Pressure at Forty. — A. M. writes: "The writer, age Ifi, recently 
 applied for life insurance, and, though the application was granted, the 
 
610 BLOOD PRESSURE 
 
 examining physician expressed dissatisfaction with the blood pressure, say- 
 ing it was 138, or within two degrees of 'the limit' for that age. Will you 
 kindly say (1) how serious this record should be thought to be? (2) 
 Whether medical advice should be sought? (3) Whether one may hope to 
 reduce such a record of blood pressure, or only to prevent it increasing too 
 rapidly? The writer s health is good, and he is commonly thought to be 
 much younger than he is, but he has congenitally poor circulation, being 
 troubled with hot head, cold extremities, etc." 
 
 Reply. — 1. For 40 years of age 138 is high. In the sense of immediate 
 danger the condition is not serious. If one maps out a plan of proper living 
 and follows it the condition may never be serious. I know a man whose 
 blood pressure was found high twelve years ago. He was frightened and 
 agitated about it for a while. Since then his first wife has died; he mar- 
 ried a second time and that wife died. He married a third time and that 
 wife is living. 
 
 2. Yes. 
 
 3. A sensible hygienic life may result in some lowering. It will surely 
 result in a lower rate of increase. 
 
 High Blood Pressure Symptoms. — J. B. W. -writes: "Will you please 
 state the cause of a high blood pressure, and also what are the symptoms?" 
 
 Reply. — A high blood pressure means that the elastic fibers of the walls 
 of the blood vessels have been worn out and replaced by inelastic fibers. The 
 cause is "wear and tear." "Wear and tear" may result from syphilis, lead 
 poisoning, alcoholic addiction, overeating, overworking, worrying, and con- 
 stipation. The symptoms are many. In a given case any symptom may 
 be absent. There is an instrument for measuring pressure. Symptoms 
 which suggest the need of this examination are dizziness, cold extremities, 
 albumin in the urine, irritable heart. 
 
 Blood Pressure at 23. — A. R. writes: "1. What is the normal blood 
 pressure of an unmarried woman, 23 years old? 2. In a person who is 
 anemic, what does a blood pressure higher than normal indicate? 3. What 
 would it indicate should the blood pressure be lower than normal?" 
 
 Reply.— 1. About 105 to 110. 
 
 2. If the person concerned is the woman referred to in the first ques- 
 tion I doubt if her blood pressure would go above normal for long. 
 
 3. Probably a weak, flabby muscle and general lack of tone. 
 
 Leave the Bed. — C. B. A. writes: "Kindly give me your opinion of a 
 case of high blood pressure. Can it be cured, and how? Is there danger to 
 a woman of about lfl years, who has had good health, as a rule, and looks 
 well? The weight is about 150 and the height about 5 feet 7 inches. The 
 patient has been in bed three months on a strict sweet milk diet. Should 
 there be a diet, and of what, after giving up the milk diet? Is the condition 
 critical at this time or later? Is traveling safe?" 
 
 Reply. — High blood pressure indicates long continued wear. The wear 
 may be from overwork, or worry, lead poisoning, venereal diseases, stimu- 
 lants or tobacco. Unless there is some special occasion for it there is.no 
 sense in going to bed for high blood pressure. A "one hoss shay" may be 
 somewhat creaky but why have it if you do not use it? Get out of bed, 
 go about your affairs, change whatever in your habits should be changed 
 and you will do about all you can do for high blood pressure. 
 
PROTECTING THE BLOOD 611 
 
 Milk, eggs and meat should not make up any considerable part of your 
 diet. Eat lightly. You have been a sinner for forty years. You are now 
 trying to escape your sins by being good and, as usually happens, you are 
 too good. 
 
 Hemophilia. — J. E. R. writes: "Please tell me why the daughters of 
 bleeders should not have children. Where can I procure agar and what is 
 a dose? Is there danger of its becoming impacted in the bowel f 
 
 Reply. — 1. The sons of the daughters and sisters of bleeders are apt to 
 be bleeders. Hemophilia [tendency to bleed] is inherited. It is an in- 
 heritance limited by sex. While only men have it it is transmitted only by 
 women. 
 
 2. Your druggist can get it for you. You may eat a handful a day if 
 you wish. 
 
 Nosebleed. — G. A. C. writes: "I am troubled with nosebleed a great 
 deal. My left nostril has bothered me the most. The secretions form a clot 
 at the upper end of the nostril and it is necessary to remove it 
 upon getting out of bed. The clot is about one-quarter of an inch across 
 and quite thick. When I remove it the nostril always bleeds. It is 
 very easily stopped by snuffing a little cold water up the nostril. Lately 
 the right nostril has taken to bleeding, but it is hardly ever stopped up, 
 and it is very hard to get it stopped. The right nostril bleeds very 
 freely and the left very slowly. I find it necessary to pack the left 
 nostril with cotton, sometimes two or three times. The blood seems to be 
 of a good bright color. It bleeds at all hours — just starts itself. I am a 
 locomotive engineer, and work nights. Have for years smoked a great deal, 
 and drink lots of coffee. I do not use intoxicants." 
 
 Reply. — If the cause of the bleeding is of a local nature then local 
 treatment is all that is necessary. Such treatment consists in cleansing the 
 nose thoroughly at night with a solution of warm salt water in the propor- 
 tion of one teaspoonful of salt to one quart of water followed by a free 
 application of boracic acid and lanolin. 
 
 The nose should not be blown hard at any time and picking is positively 
 forbidden. Where crusts of scales form and it is desired to dislodge and 
 remove them do this by first softening with warm water, vaselin or oil. 
 
 When nose bleeding persists it is usually advisable to have a physician 
 or nose specialist if one is available. 
 
CHAPTEE XXXV 
 
 Apoplexy 
 
 APOPLEXY IS CEREBRAL HEMORRHAGE 
 
 Apoplexy stands near the top as a cause of death in old people. It gen- 
 erally disables for several years before it produces death; therefore, it stands 
 near the top as a cause of disablement. After the blood vessel breaks and the 
 blood pours into the brain, there is about a week in which the patient runs 
 fever and is worse than immediately after the stroke. Then the paralysis 
 of the tongue, face, arm, and leg slowly gets better. 
 
 The improvement is exceedingly slow, because a new set of nerve cells and 
 fibers must be trained to do the work formerly done by those destroyed by the 
 hemorrhage. 
 
 There are two phases of the subject worthy of some thought. The first 
 is that there is usually a history of vertigo and nausea for a few hours preced- 
 ing the attack. 
 
 Apoplexy runs in families. Therefore, if a man is of an apoplectic fam- 
 ily and has arrived at the apoplectic age, he will be wise to watch his digestion 
 closely, to live carefully, especially avoiding intemperance in eating and 
 drinking, and, if he finds himself giddy and a little nauseated, to take a dose 
 of saline water without delay. 
 
 The second point is this : After the fever stage has been passed a man 
 can do a great deal to improve his condition. Eegular massage to keep up the 
 tone of his muscles will be of great service. When a man is learning to walk 
 again he can be helped by experts in the training of his nerve cells and fibers 
 to the new duties. 
 
 Careful watching will prevent the development of cystitis and Bright's 
 disease, so destructive to the life of people of this group. 
 
 Apoplexy produces paralysis — but it is not a nerve or brain disease. It 
 is the result of disease of the blood vessels in the brain. In the evolution 
 of apoplexy the order of events is as follows: Eheumatism, gout, venereal 
 disease, alcohol, lead poisoning, resulting in weakened patches in the brain 
 arteries; a brittle area in a brain artery breaking under strain; outpoured 
 blood tearing brain substance to pieces; paralysis from injured brain tissue. 
 
 The effective prevention of apoplexy lies in shielding the arterial walls 
 from infection and mild poisons during the earlier years of life. Therefore 
 the apoplectic looking for the cause of his condition must have his mind run 
 back to the social history of his childhood, youth, and early manhood. 
 
 The usual story told by one who has had a stroke is as follows: For 
 several days he had been feeling tense, with some tendency to vertigo, and 
 possibly a little nausea. The blood in his vessels and the tissues under his skin 
 
 612 
 
CAUSE OF APOPLEXY 613 
 
 were under about as much pressure as they could withstand. There came a 
 little change in position, a stooping, a little extra exertion, a vomiting spell, 
 and — the weak place snapped. 
 
 If those having brittle arteries would recognize these tension warnings 
 and take a laxative, eat lightly, and keep quiet until the vertigo and "bilious- 
 ness" had passed, they would prevent the break — at least many would. 
 
 It takes nothing from the force of the first statement to say that a man 
 who has lived wrongly and finds himself with brittle arteries can still be fairly 
 successful in warding off apoplexy by temperance in emotion, excitement, 
 work, straining, eating, and drinking. Nor does it make any difference that 
 a tendency to gout and rheumatism runs in families; that some men are of 
 apoplectic strain and others not. The man of a consumptive strain can afford 
 to take chances by gormandizing; the man of a gouty or rheumatic strain 
 cannot. 
 
 CAUSE OF APOPLEXY 
 
 The blood vessels of young people are very elastic. Their walls are 
 largely composed of tissue having the quality of rubber. Such vessels do not 
 break easily. 
 
 The wear and tear of life consumes this elastic tissue and causes it to be 
 replaced by inelastic tissue. The "give" is lost, but the result is not a 
 tendency to break. The worn man tires easily, is short winded, does not re- 
 cuperate easily, has less than the normal reserve strength; but he does not 
 have apoplexy. 
 
 The deacon's one hoss shay was as good in one place as in another. When 
 it broke, it went all to pieces. 
 
 The man subject to apoplexy is not like the deacon's one hoss shay; he is 
 bad in spots. 
 
 In his blood vessels are islands in which the live tissue of the vessel wall 
 has been destroyed and removed and replaced by lime stones, called lime plates. 
 Around the edge of these plates is an "easily broken" zone. 
 
 "Miscondition," the doctors call atheroma. Whenever in a man with 
 atheroma the blood pressure exceeds the breaking point in these weak areas, 
 a break occurs. If the break is in a brain blood vessel the result is apoplexy. 
 Sneezing sometimes acts as a cause. A sudden jump in pressure and the 
 vessel breaks. Straining from any cause is liable to produce the same effect. 
 
 However, apoplexy induced by coughing, sneezing, stooping, violent emo- 
 tion, and so forth is the exception. The blood vessels are well protected from 
 outside influences. 
 
 The rule is that the stroke comes in times of physical and mental calm. 
 Usually there is a history of several days of slight disturbance of digestion 
 and slight vertigo preceding the stroke. 
 
 Many who know their family tendency to apoplexy accept these signs as 
 premonition and take a purgative. Some stop eating as a precautionary 
 measure. These are proper procedures. 
 
 The trouble is not with the digestion primarily. Observations on blood 
 pressure have shown that there is a progressive rise in blood pressure. The 
 indigestion and vertigo are the direct effects of the high pressure. 
 
614 APOPLEXY 
 
 To take a laxative and refrain temporarily from eating is both right and 
 wrong. 
 
 It is right in that it gives temporary relief. It is wrong in that it em- 
 phasizes the digestion unduly. The moderation in eating for a day or two 
 will probably be followed by systematic overeating. 
 
 WARNINGS AND PREVENTION OF APOPLEXY 
 
 What can a man who belongs to an apoplectic family do to prevent a 
 stroke ? 
 
 What can a man who has had one stroke do to prevent a second? 
 
 As a man who belongs to an apoplectic family approaches the apoplexy 
 age, he should have his blood pressure taken once a year. If he finds that 
 his blood pressure is more than 20 per cent above the normal for his age, he 
 should map out his life in accordance with the facts. Thereafter he should 
 go to a physician for a physical examination, including a blood pressure test, 
 at least twice a year. 
 
 If the pressure warrants it, he should purchase a blood pressure apparatus 
 and take his pressure at periodic intervals. A pressure apparatus is inex- 
 pensive. It is not difficult to use. No great technical skill is needed. A man 
 of fair intelligence can learn to use it in two lessons. 
 
 Apoplexy is preceded by two warning signs. One of these is dizziness; 
 the other is rise in blood pressure. Ability to use a blood pressure apparatus 
 makes the second of these warning symptoms available. 
 
 An apoplexy warning having been recognized, the indications are clear. A 
 saline purge should be taken at once. This should be followed by a dose of oil 
 or calomel. The reason for reversing the usual order is that quick action is 
 needed, and salines act quickly. A person with whom a saline does not act 
 quickly should take an enema. 
 
 The diet should be very light for several days. The digestive organs 
 should be given a partial rest. The system should have an opportunity to use 
 up some of the excess nourishment stored up in the liver and elsewhere. 
 
 No tobacco should be used. Tobacco raises blood pressure. Even heavy 
 tobacco users should "lay off the weed" until the vertigo period has passed. 
 
 FORMS OF PSEUDO-APOPLEXY 
 
 A number of years ago Weir Mitchell wrote about nocturnal hemiplegia. 
 This disease is not apoplexy, but those who have it are usually much afraid 
 of apoplexy. The patient wakes up at night to find that one leg and one 
 arm or both legs are numb and cannot be moved. After a few minutes of 
 rubbing, the symptoms pass away. 
 
 To prevent the attacks from coming back two things must be done : Take 
 a purge and afterwards carefully regulate the diet, especially the evening 
 meal. The amount of coffee and tobacco should be lessened. The second is to 
 get a better bed. If the mattress has been hard, get a softer one. If an 
 exceedingly soft mattress was used, get a harder one. Certain nerves have 
 
FORMS OF PSEUDO-APOPLEXY 615 
 
 gone to sleep because of pressure. This, however, is much more liable to 
 happen in one who has been eating improperly. 
 
 Another condition which frightens people who are dreading apoplexy 
 is night cramps in the calves. Night cramps are not related to apoplexy. 
 They are not forerunners of apoplexy. 
 
 One who has night cramps should regulate his diet. Especially should he 
 cut down on tobacco and coffee. He should also change his mattress so that 
 he will not suffer from pressure. Night cramps are the result of lowered 
 blood supply to the cramping muscles. 
 
 Not Apoplexy Sign. — M . H. W. writes : "What should one do to avoid 
 cerebral hemorrhage? I have had an ache at the base of my brain for 
 some time. When I turn my head suddenly it causes pain there. I 
 understand the symptoms are those that -precede cerebral hemorrhage, and, 
 if possible, I wish to avoid having it." 
 
 Reply. — To avoid cerebral hemorrhage, keep the bowels open well, eat 
 lightly, refrain from vomiting, or any other physical act or any emotion 
 which increases blood pressure in the arteries of the brain. These precau- 
 tions are for those whose arteries are brittle, and liable to break under 
 strain. Pain at the base of the head increased by suddenly turning the 
 head is not a sign of threatened apoplexy. It bears no particular relation 
 to apoplexy. 
 
 Due to Apoplexy. — 8. R. T. writes: "1. What is paralysis? 2. What 
 causes it? 3. Can it be prevented? k- Is it hereditary? 5. Can a man 
 survive four strokes? I am troubled with dull pains in my lower limbs, 
 numbness in my hands and feet, cold shin, dizziness at times, especially 
 when stooping, dull pain at times in bach of neck." 
 
 Reply. — 1. I judge from question 5 that you have in mind the most 
 frequent kind of paralysis — that which is due to apoplexy. In apoplexy a 
 blood vessel in the brain breaks and blood flows out — a clot forms. This 
 hemorrhage destroys certain nerve centers. The nerve centers usually 
 destroyed are those of motion for a hand and leg. These limbs immediately 
 become paralyzed and remain so until they come under the partial control 
 of other nerve centers. 
 
 2. The arteries are made brittle by contagion in childhood, or rheu- 
 matism, or venereal disease, or lead poisoning, or overeating. They break 
 from high pressure. 
 
 3. Yes, by preventing the cause. To prevent it, care must start in 
 childhood. 
 
 4. In a certain sense — yes. There are "apoplexy'' families. These are 
 families in which members like to live high or have a tendency to heart 
 disease, Bright's disease, or sclerosis. 
 
 5. Yes, he can, for there is no magic in numbers. But when a man's 
 arteries have broken four times, the inference is that they are about worn 
 out. Numbness and pains in the legs do not mean impending apoplexy. 
 
 Meat and Apoplexy. — J. E. B. writes: "Does the eating of beef, pork, 
 or mutton induce paralysis? Should one eat much after Ifi years of age? 
 Why are the sanitaria eliminating the use of meat with the paralytics?" 
 
 Reply. — Eating large quantities of pork, mutton, or beef has some 
 tendency to produce apoplexy. Apoplexy follows a break in one of the 
 
616 BLOOD PRESSURE 
 
 arteries of the brain. The arterial wall does not break until it is first 
 diseased. 
 
 The most important cause of disease in the arterial wall is syphilis. I 
 should say that lead poisoning is second. Alcohol and tobacco operate 
 somewhat in injuring the wall and somewhat by increasing the blood 
 pressure. A high protein diet is a factor and a prominent one. That 
 means habitually eating heavily of meats. Habitual overeating of foods 
 in general also causes it. Dr. Wedekind holds that eating foods that con- 
 tain too much sodium chlorid (common salt) and other salts and drinking 
 hard waters is another cause. 
 
 I have the impression that you are going off on a tangent. Excessive 
 meat eating is an important cause, but you may exaggerate its importance. 
 
 
CHAPTER XXXVI 
 
 Bright's Disease 
 
 A hundred years ago an English physician, Dr. Bright, discovered that 
 albumin was present in the urine of certain patients who had dropsy. He 
 came to the conclusion that the cause of dropsy was an inflammation of the 
 kidneys which caused albumin in the urine. The disease came to be known as 
 Bright's disease. Since that time every form 
 of inflammation of the kidney has been loosely 
 called by that name. In some of these inflam- 
 mations there is a high percentage of albumin 
 in the urine ; in some there is none at all. 
 
 Ordinarily men judge of their condition 
 by symptoms. If they have aches or pains or 
 fever or cough or difficult breathing they think 
 they are sick. If they have none of these they 
 think they are well. When Bright wrote about 
 the disease which bears his name he had in 
 mind the people who had the symptom dropsy. 
 But when the name came to be applied to all 
 forms of inflammation of the kidney it was 
 found that in some of them there were no symp- 
 toms except albumin in the urine, and people 
 generally never thought of that as a symptom. 
 
 In no other disease is the unreliability of 
 symptoms as a guide better shown than in 
 Bright's. Most of the people who have Bright' s 
 disease have none of the ordinary symptoms 
 which cause us to think ourselves sick.' To this 
 statement another should be added. There is 
 no way to be on guard against Bright's disease 
 except to have the urine examined once or twice 
 a year. 
 
 When people began to hear about Bright' s 
 disease most of them learned of it as a disease 
 
 which steadily grew worse and invariably caused death. There is variety in 
 Bright' s disease. There are varieties in which there are few symptoms and, 
 especially worth noting, in which there is little tendency toward a fatal ter- 
 mination. 
 
 The object of this article is to teach people that when one case called 
 
 617 
 
 Fig. 213. — Method of Collect- 
 ing a Sample of Urine from 
 a Male Baby. 
 
618 
 
 BRIGHT'S DISEASE 
 
 Bright's disease does not act like some other case the doctor has not made a 
 mistake in diagnosis. The diseases are different, though they go by the same 
 name. 
 
 With it there goes another lesson. There are no kidney cures. The so- 
 called "cures" have no power to cure inflamed kidney tubes. 
 
 Then why do people buy and take medicines of this sort? Often it is 
 because they have heard of some case which had Bright's disease, or thought 
 he had it or was told he had it, and took one of them and got better. 
 
 While there are no patent medicines or domestic roots and teas which 
 cure Bright's, there is no other disease in which carefully regulated 
 living accomplishes so much. Most cases of Bright's get well. Many go 
 through life fairly efficient and fairly safe. In a proper sense Bright's disease 
 is a curable disease. The cure is early diagnosis, followed by right living. 
 
 WARNING OF BRIGHT'S 
 
 The Human Factor informs us that in 1914 100,000 people died of 
 Bright's disease in the United States; that the death rate from this disease is 
 increasing rapidly, 72 per cent in the last twenty years and 23 per cent in 
 
 the last ten. The greatest rate of increase noted was 106 
 
 per cent in Richmond; the 
 
 smallest, 16 per cent in San 
 
 Francisco. Some increases in 
 
 percentages were: Boston, 22; 
 
 Chicago, 47; Memphis, 50; 
 
 Denver, 36. 
 
 Human Factor says that 
 
 60,000 of these 100,000 lives 
 
 could have been prolonged sev- 
 eral years, and many thousands 
 
 could have been saved had the 
 
 disease been discovered in its 
 
 early stages. 
 
 The increase for a state 
 
 was highest in New York, 132, 
 
 and lowest in Montana, 52. 
 
 This refers to the registration 
 
 area. The states not in the 
 
 registration area have no way 
 
 of knowing what is happening 
 The Tcidney is an exceedingly vulnerable organ, 
 hind is nearly certain to cause some Bright's disease. This is especially 
 true of pneumonia, scarlet fever, diphtheria, and rheumatism. In addition, 
 overeating, overdrinking, and overworking put the kidneys under great 
 strain. 
 
 Whatever the nature of the overload, the organ carries it as best it can. 
 When the strain is too great and the kidney gives down under it there is no 
 pain, no ache, no complaint of any character. Albumin and casts appear in 
 
 Fig. 214. — Test 
 Tube Used in 
 Testing Urine 
 for Sugar and 
 Albumin. 
 
 Fig. 215. — Half a Kidney 
 Showing Suprarenal 
 (or adrenal) Kidney 
 Structure, Pelvis of 
 Kidney and Ureter. 
 
 to their people. 
 Severe illness of any 
 
ACUTE BKIGHT'S DISEASE 
 
 619 
 
 the urine, but a laboratory examination is required to snow it. Swelling of 
 the feet, puffiness under the eyes, short wind — these speak for the kidneys, but 
 the disease has progressed far before they show themselves. The kidneys do 
 not complain. 
 
 To warn their people in time one life insurance company will make an 
 examination of the urine once a year for any person who has been insured 
 with it three years. If the party insured is in one of the company's central 
 points a physical examination also will be made. 
 
 This type of service was begun by another company a year or two ago. 
 It is spreading. Other companies are adopting it. A life extension institute 
 has been organized to make the same sort of service available for any life in- 
 surance company or any organization desiring it. Treatment is not the object 
 of this service. Its object is to discover organic diseases in their beginning 
 stage. 
 
 The man who thus discovers that he has an organic disease in its early 
 stage may be able so to change his habits as to cure his disease. In the great 
 majority of cases he can prolong his life five years or more by changing to a 
 thoroughly hygienic method of living. Medical service can promise much 
 when the trouble is just unfolding. 
 
 The insurance companies feel that people past middle life are neglected. 
 Health departments have not been mucli interested in the welfare of this 
 group. The work inaugurated by the companies for their policy holders will 
 eventually be furnished by health departments to all the people. 
 
 ACUTE BRIGHT 'S DISEASE 
 
 Acute Bright' 's disease frequently results from an infection. The effect 
 elsewhere in the body may be slight, yet the poison may set up an inflamma- 
 tion of the Tcidneys. On the 
 other hand, the infection may 
 be profound in its effect on 
 other parts of the body, yet the 
 kidneys may escape. 
 
 While any type of infec- 
 tion may cause acute Bright's 
 disease, some are much more 
 prone to do so than others. 
 Scarlet fever and pneumonia 
 infections are trying on the 
 kidneys; common colds and 
 typhoid fever are not. Acute 
 rheumatism, though it is ac- 
 companied by highly acid, 
 highly colored, and greatly con- 
 centrated urine, is not likely FlQ - 216.— Bed Grapple. 
 to set up an acute Bright's. 
 
 Occasionally an acute Bright* s disease is spoken of as being apoplecti- 
 form, meaning a person previously well is suddenly and violently stricken by 
 
620 
 
 BRIGHT'S DISEASE 
 
 unconsciousness or convulsions, or both, as the result of an acute developed 
 Bright's. That way of oncoming is exceptional. The usual method is subtle : 
 A child sick with scarlet fever is not doing so well as it should; it is difficult 
 to see just what is the trouble; a chemical and microscopic examination of 
 the urine shows albumin, casts and probably blood present. 
 
 The teaching of all this is that in any condition which throws a strain 
 upon the kidneys the urine should be examined as a matter of routine. It 
 should be done as systematically as taking temperature, counting of the 
 pulse, or looking at the tongue now is. 
 
 I do not mean that it should be done several times a day. The frequency 
 should be determined by the disease and by the other indications — in scarlet 
 fever and pneumonia every day, in typhoid once a week, in tuberculosis (and 
 pregnancy) once a month. 
 
 It should be done for the same reason that a trackwalker walks a rail- 
 road track or a man comes around and taps the car wheels at every division 
 point. In cold weather the greater the need that the trackwalker watch 
 closely for broken rails, the greater the need that the wheel tapper listen well 
 for cracked wheels. The wheel tapper usually finds the wheels all right, and 
 not every broken rail causes an accident. These results are arguments for 
 and not against track inspection and wheel tapping. 
 
 INFECTION OF THE KIDNEYS 
 
 The kidneys are loosely connected with the tissues which surround them. 
 In consequence infection of the spine (Pott's disease), or of the muscles 
 
 (psoas abscess), or the peritoneum (peri- 
 tonitis) — all near-by structures — seldom 
 spreads directly to the kidneys. Around 
 each kidney is a tense, almost impene- 
 trable capsule which shields it from the in- 
 fections of its neighbors. 
 
 Infection can travel to the kidney by 
 the blood stream and up the ureters from 
 the bladder. The most frequently infect- 
 ing organism is the colon bacillus, the or- 
 ganism which, so long as it stays in the 
 large intestine, is nearly harmless. An- 
 other one frequently found is the proteus, 
 a germ which of itself is quite harmless 
 but which ferments the urine and manu- 
 factures a lot of ammonia which irritates 
 and harms the kidney. 
 
 Another important group is the 
 ordinary pus cocci, which may have 
 traveled to the kidney in the blood, 
 but which usually have traveled from the 
 bladder, in cases of cystitis, up to the kidney. Another of some importance is 
 the tubercle bacillus. The Phipps Institute found Bright's disease frequently 
 
 Fig. 217. A Human Kidney a Little 
 More Than One Half Natural 
 Size in an Adult. 
 
CHRONIC BRIGHT'S DISEASE 621 
 
 present in the later stages of consumption, but that is a different matter from 
 infection of the kidney with tubercle bacilli. Tuberculosis of the kidney is 
 usually unassociated with consumption. 
 
 Gonococcus infection rarely travels to the kidney. Sometimes it does, but 
 in most infections of the kidney, following a gonococcal infection elsewhere, 
 complicating bacteria are responsible. 
 
 Whether or not a person is to get an infection of his kidney depends 
 largely on himself, and that is the reason for this article. A large group 
 of the cases is due to the use of dirty catheters and other dirty instruments — 
 not dirty in the sense that a garbage can is dirty, but laden with enough 
 bacterial life to infect the bladder or the urine in the bladder, whence the 
 infection travels to the kidney. Especially are men with enlarged prostates 
 liable to forget at times 
 the necessary precau- 
 tions during the years 
 
 of continuance of the 
 condition. Eternal vigi- 
 lance is difficult when 
 the need is drawn out Fig. 218.— Head Coil. 
 
 for ten to thirty years. 
 
 Osier's " System" says : "It is advisable to give plenty of water in severe 
 febrile diseases, in pregnancy, and in the latter case to insist upon a certain 
 amount of rest in the prone position, and in addition to this, as in all other 
 conditions, to build up the patient's general health, avoiding above all things 
 constipation. ... It is therefore important to avoid all irritating drugs, to 
 use the greatest care in the use of instruments, to avoid introducing infection 
 or producing trauma, to treat with care and promptness all cases of cystitis and 
 gonorrhea, to remove if possible all causes of stasis, such as strictures, prostatic 
 enlargements, and stone ; ... to use large quantities of water." 
 
 The quack medicines so widely advertised and so widely used for a certain 
 infection can be classified as irritating drugs, such as copaiba, cubebs, sandal- 
 wood, and turpentine. 
 
 CHRONIC BRIGHT S DISEASE 
 
 The man who has gouty kidneys suffers no pain and does not feel very 
 different from the ordinary man. He is a little short winded, but to him that 
 does not mean much, because most of those who have it are old enough to be 
 slowing up. It follows that the condition is frequently discovered by accident 
 — a urine examination for life insurance, for an operation, or for some pur- 
 pose and, presto ! albumin and casts are found. A few years ago a famous 
 teacher in Tulane, demonstrating to his class, discovered that he had ad- 
 vanced and advancing Bright's disease. 
 
 " Bright' s disease of the kidneys" is 'about as indefinitely used as "catarrh 
 of the head." It includes an acute inflammation of the kidney due to an acute 
 infection of the kidney, which, like a pneumonia infection, runs a short, sharp 
 course and terminates in death or in recovery. A progressive form is one in 
 which there is much dropsy, while the chronic, or gouty, form, which causes 
 
622 
 
 BKIGHT'S DISEASE 
 
 few symptoms, but does not improve, has little tendency to kill. Where it 
 causes death, it makes a fatal disease out of an otherwise mild infection, such 
 as colds, bronchitis, pneumonia, typhoid fever. It is insidious. It is the pun- 
 ishment for years of wrong living. It shows full meals, nutrition out of bal- 
 ance, constipation, lead poisoning, venereal disease; bad colds, pneumonias, 
 contagious diseases. Neglect before fifty means Bright' s disease afterward. 
 
 A great many people are interested in how to live with Bright' s disease, 
 for it is a condition, not a disease. 
 
 Osier, writing of some cases of chronic Bright's disease of which he had 
 
 Fig. 219. — Cold Water Coil Applied to Abdomen. 
 
 known as living twenty years with the condition, sums it up by saying that 
 the man with chronic Bright' s disease is no longer No. 999 drawing the Em- 
 pire State Express, but is a dinky switch engine. If he will allow the Bright's 
 disease to teach him temperance it will be an advantage and not a disad- 
 vantage. 
 
 The man who keeps his shin warm, eats temperately , avoids excesses, 
 avoids colds and other infections, will live to a comfortable old age in spite of 
 his crippled kidneys. 
 
 Some day it will be the custom for men who think themselves well to have 
 a complete examination at stated intervals — to take stock— and then govern 
 their lives in accordance with the findings. This means efficiency as well as 
 security. Efficiency and security are the watchwords of the health movement. 
 
CHRONIC BKIGHTS DISEASE WITH MUCH ALBUMIN 623 
 
 CHRONIC BRIGHT'S DISEASE WITH MUCH ALBUMIN 
 
 There is a form of Bright' s disease characterized by much albumin, many 
 casts in the urine, and by a marked dropsy. The dropsy in Bright's disease 
 usually shows itself by puffiness under the eyes. This puffiness comes on before 
 swelling of the feet appears. From the loose tissues under the eyes the water 
 logging process extends, first involving other loose tissues and finally becoming 
 universal. 
 
 Frequently this kind of Bright's disease goes hand in hand with related 
 changes in the heart 
 and liver. The heart 
 muscle becomes weak 
 and flabby and the 
 liver swollen and pale. 
 This group of moder- 
 ately progressive cases 
 acts as if some fairly 
 active cause were car- 
 ried around the body 
 by the blood, poisoning 
 all of the delicate tis- 
 sues with which it 
 came in contact and 
 slowly destroying some 
 of the most necessary 
 of the body tissues. 
 
 Many causes oper- 
 ate to bring about this 
 disease. Drink is one 
 of them; others are 
 lead and mercury pois- 
 oning and the differ- 
 ent varieties of vene- 
 real disease. Bakers, 
 butchers, and icemen 
 have more than their 
 share of it, because 
 they work in damp 
 places, some of which 
 
 are too hot and some too cold. Underground and cellar workers of every 
 sort get more than their share. But the most important cause is consump- 
 tion. About one-fourth of all the cases occur in connection with consump- 
 tion. 
 
 Within the last few years it has been the custom to restrict the amount 
 of salt given patients with this form of Bright's disease. 
 
 A few years ago Fischer wrote an interesting book on the reasons why 
 water sometimes soaks into the tissues in too great quantity. In other words, 
 why dropsy occurs. His conclusion was that in such cases there was too much 
 
 Fig. 
 
 220 — Arrangements for Prolonged Bath. 
 used in sunstroke, fevers and alcoholism. 
 
 To be 
 
624 BEIGHT'S DISEASE 
 
 acid waste or ash in the tissues; that the tissues, instead of burning com- 
 pletely, as they should, made slag or something corresponding thereto, and if 
 there were plenty of oxygen this was not so liable to happen. 
 
 One of the practical applications of this discovery of Fischer's is that we 
 decrease the amount of swelling in the milder conditions of dropsy if we give 
 the patient plenty of fresh air. This is why these patients do so much better 
 in the open air than in tightly closed, badly ventilated hospital wards — those 
 of the old type. For the same reason in part these patients do better when 
 they go South for the winter, assuming that they stay out of doors when they 
 get there. 
 
 Another practical suggestion is that, by the use of a solution of salt and 
 soda, the edema can be materially reduced. However, this last is not of much 
 importance since it strikes at the effect rather than the cause. 
 
 We do not know how to strike at the cause after the disease is estab- 
 lished. About all we can do is to protect and shelter the vital forces, keeping 
 the patient as comfortable as possible, meanwhile hoping that this particular 
 case may be one of those relatively few when nature seems to be able to arrest 
 the progress of the disease. 
 
 VERY SLOW BRIGHT 'S DISEASE 
 
 Brault speaks of this form of Bright's disease as nephritis from slow 
 poisoning. It is the kind that develops in people at and after middle life. 
 That form causes but little dropsy. There may be some puffiness around the 
 eyes and, later, a little swelling of the feet, but there is seldom much dropsy. 
 The urine is pale in color, copious in quantity, low in gravity, contains but a 
 trace of albumin and only a few casts. Sometimes there will be long intervals 
 during which there is no albumin and no casts. 
 
 It is caused by gout, alcohol, overwork, worry, overeating, lead poisoning, 
 and venereal disease. It is the disease of the bon vivant. Usually the cause 
 is some mild poison scarcely detectable as a poison, some chemical substance 
 which wears just a little more than the average but which just keeps on wear- 
 ing until a condition is brought about at fifty which would be about normal 
 at eighty. 
 
 Water falling drop by drop on a stone will wear a hole, yet if one were to 
 judge from the force of the fall of any one drop, he would say so insignificant 
 a force could never channel through solid rock. But mild irritations, long 
 continued, bring senility a few decades before it is due. 
 
 Another group of cases stands for the scars of acute infections, especially 
 in childhood — such infections as scarlet fever, diphtheria, and pneumonia. At 
 the time of the original illness kidney cells were destroyed and scar tissue 
 started to grow. This scar tissue did no particular harm until, having grown 
 old and firm, it contracted and thus puckered and squeezed the kidney sub- 
 stance. 
 
 Several years ago Osier wrote an article on "The Advantage of a Few 
 Casts and a Little Albumin." A Canadian statesman who had been pro- 
 nounced incurably sick with Bright's lived a useful life, though a very tern- 
 
KIDNEY OF PKEGNANCY 625 
 
 perate one, for twenty years after Osier pronounced his sentence. Several 
 other cases were cited. 
 
 A man in good health whose tissues have the spring of youth can overeat 
 or overdrink or work in lead and not feel the effect for a long time, possibly 
 never. There is about it a certain element of gamble. A man with a chronic 
 Bright's must behave himself. He has no option. For him to play the game 
 is about the same thing as sitting in where the other fellow has the cards 
 marked. There isn't even a gambler's chance. 
 
 KIDNEY OF PREGNANCY 
 
 Women with Bright's disease are liable to become pregnant. The progress 
 of the changes in the kidney when Bright's disease was present before preg- 
 nancy occurred is different from that when the kidneys were in good condition 
 at the beginning of pregnancy. 
 
 Pregnancy occurring in a woman with a preexisting Bright's disease is to 
 be watched more closely than where the kidneys were normal to begin with. 
 But, watched closely, there is an excellent chance that the woman can be car- 
 ried through without accident. Of course, albumin and casts in the urine of 
 a woman with a preexisting Bright's disease does not indicate that she is being 
 harmed by her pregnancy, as does this sign when Bright's disease was not 
 present to begin with. When the pregnancy has caused the albuminuria, it 
 means that the task on the kidneys is too great. If the albuminuria existed 
 first, the kidneys may be standing the strain without trouble. 
 
 Every woman should have a urinalysis made soon after pregnancy is de- 
 termined to discover whether she has Bright's disease or not. At that early 
 stage one can be certain that sound kidneys are equal to the extra burden of the 
 pregnancy. If albumin and casts be found and further examination confirm 
 the existence of a Bright's disease, during the rest of the pregnancy the woman 
 must be watched closely for evidence that her kidneys are not failing to do 
 their work, and everything possible must be done to lighten the kidney load. 
 
 Women who start out with good kidneys not infrequently develop what is 
 known as the kidney of pregnancy. Some writers think the great change from 
 the usual routine in the machinery within the abdomen causes bacteria to be 
 absorbed from the intestines and that these, being excreted by the kidneys, 
 cause the kidney of pregnancy. Some think the pressure of the heavy uterus, 
 supplemented by the weight of the child, is responsible for the kidney con- 
 dition. 
 
 The great Virchow, the father of pathology, brought prominently forward 
 the theory generally accepted now. It was that pregnancy put a fearful strain 
 on the kidneys of the mother. There is the waste of the baby — and rapid 
 growth means much waste — the waste of the rapid pregnancy changes in the 
 mother and the usual daily waste — all to be got rid of, and much of it by 
 the kidneys. This theory is that the toxins overload the organs and the kidney 
 of pregnancy develops. 
 
 Usually the first suggestion that the condition is present comes in the 
 shape of a laboratory report. Albumin and casts have been found where no 
 particular symptoms suggested things were not going right. Sometimes head- 
 
626 BBIGHT'S DISEASE 
 
 ache, dizziness, sleeplessness suggests that something is wrong, and urinalysis 
 shows what the trouble is. Sometimes there is but little albumin and casts are 
 quite abundant — so abundant that they will not be overlooked by even the 
 most superficial examination. In fact, many families provide themselves with 
 a test tube and some nitric acid and do their own routine testing. 
 
 ALBUMINURIA IN PREGNANCY 
 
 When albumin is discovered in the urine during pregnancy the woman 
 must be watched closely. In the first place an effort should be made to decide 
 whether the kidneys were sound when the pregnancy began. The history, the 
 condition of the heart and blood vessels, and the presence or absence of changes 
 in the retina will usually settle this question. 
 
 If it be found that Bright's disease preceded the pregnancy, then one must 
 judge of the ability of the diseased organ to withstand the strain. The evi- 
 dence of albumin in the urine does not mean that the kidney is not standing 
 up. If it be found that the albuminuria has developed after the pregnancy, 
 then its presence means that the kidneys are not wholly up to the demand, and 
 the question then to decide is whether they can be nursed along. 
 
 This question cannot be decided at once. It must be held open and close 
 watch be kept on the quantity of urine, the amount of albumin, casts and blood, 
 and the evidence of intoxication in the patient — headache, dizziness, sleepless- 
 ness, and dimness of vision. The degree of dropsy must be closely watched. 
 If the mother can escape convulsions the chance, that both she and her baby 
 will escape is great. If she gets convulsions the mother will recover three 
 times out of four, but the baby will not fare so well. 
 
 The later kidney effects do not seem to be especially bad. If the woman 
 recovers there does not seem to be the same trail of chronic Bright' s disease 
 that we get after scarlet fever and rheumatism. 
 
 The preventive treatment is much a matter of being on guard — watching 
 for a little puffiness of the eyes or feet, a little albumin or casts, headache, rest- 
 lessness. 
 
 Dr. Herrick says, in Osier's "System," "The prejudice of even the civilized 
 woman against ordinary cleanliness of the skin because of fear of catching 
 cold, her aversion to exercise, particularly in the later months of pregnancy, 
 and especially in the open air, the frequent obstinate constipation, the faulty 
 performance of function on the part of the stomach, sluggish action of the 
 kidneys — these are some of the explanations offered for the accumulation of 
 an undue amount of toxic material in the blood of the pregnant woman, which 
 substance may harm the delicate renal parenchyma." 
 
 The items embodied in the above collection suggest measures for the pre- 
 ventive treatment of the kidney of pregnancy. Of greatest importance is the 
 prevention of constipation. It is a little too much to ask the kidneys, already 
 doing work for mother and child, to take up the work of the bowels in ad- 
 dition. 
 
 
BKIGHT'S AND DIABETES 627 
 
 TO TEST URINE FOR BRIGHT 'S DISEASE 
 
 There are needed : 
 
 A test tube, 
 
 An alcohol lamp, • 
 
 Some strong nitric acid (white), 
 A medicine dropper. 
 
 About a half-inch of nitric acid is placed in a test tube. The acid is gently 
 warmed over the lamp. It must not be boiled. With the medicine dropper 
 a half -inch of urine is carefully run on top of the warm acid. If a white band 
 forms at the junction line of the two fluids, albumin is present. If albumin 
 is found its presence should be verified by a laboratory. 
 
 This test does not show casts. Albumin may be present from some cause 
 other than Bright's disease. Bright's disease may be present where there is 
 no albumin in the urine. These are the exceptions. The rule is that albumin 
 in the urine means Bright's disease. 
 
 BRIGHT'S AND DIABETES 
 
 Most chautauquas give personal and public hygiene a place on their pro- 
 grams. Many arrange for a daily talk on some phase of personal hygiene, 
 since personal hygiene is of interest to so large a group of people. Becently, 
 I attended one of these chautauqua talks on personal hygiene. The subject 
 announced was "Diet in Belation to Disease." When the bell rang the audi- 
 ence gathered from all parts of the grounds. It was a late afternoon hour 
 and the proportion of women to men was about four to one. More than half 
 the audience had notebooks, and they used them. 
 
 When the lecture was finished, questions were fired at the lecturer from 
 all parts of the hall. The questions showed that the audience had a fair 
 grasp of the subject. The speaker had been trained in a low protein school 
 and her teaching was based upon the theories which prevail there. Neverthe- 
 less her first subject was the tea and toast meal of the unmarried woman. 
 
 She told of calories ; what a calory is ; how many calories the body needs, 
 and how toast fails to supply fully the need, while tea is used to whip the 
 underfed, fatigued cells to do their work. 
 
 However, the theme on which the lecturer especially dwelt was overeating. 
 She emphasized the folly of taking more calories than the machine needs. Not 
 only is it wasteful, but in time it brings about obesity, Bright's disease and 
 diabetes. 
 
 She told her audience of the insidious onset of both Bright's disease and 
 diabetes. Neither had a single outstanding symptom, one capable of halting a 
 careless person. But each had a symptom capable of arresting the attention 
 of a careful person. The symptom of Bright's was albumin in the urine; of 
 diabetes, sugar. 
 
 The lecturer advised her hearers to make the simple tests required at 
 
628 BRIGHT'S DISEASE 
 
 least twice a year. The only equipment needed is an alcohol lamp, a test tube, 
 a little nitric acid and a little Haines' solution. 
 
 To test for albumin an inch of urine is placed in the test tube, and 
 brought to a boil. If the urine becomes cloudy on boiling, three drops of 
 nitric acid is added. If the cloudy urine remains cloudy, it is due to albumin, 
 and Bright's disease is present. 
 
 To test for sugar, an inch of Haines' solution is placed in the test tube 
 and brought to a boil. Then ten drops of urine are added. If the deep blue 
 solution changes to a muddy yellow or reddish yellow, sugar is present, and 
 the patient has diabetes. If either test indicates anything wrong, the person 
 should seek medical advice. 
 
 KIDNEY CURES 
 
 The kidney cures have been popular frauds for years. The reason these 
 compounds have sold is because they have traded on a popular belief. Our 
 forefathers grew up on the idea that certain drugs were "good for the kid- 
 neys." They thought asparagus and onions were good for the kidneys because 
 of the odor of the urine after these vegetables had been eaten. They thought 
 gin and juniper berries were good because of the large quantity of clear urine 
 after one had tanked up on gin. Niter and sweet spirits of niter are other 
 compounds that have had reputations as "good for the kidneys." 
 
 Along came the patent medicine man and he traded on these old-fashioned 
 notions. He called his medicine kidney cure and kidney medicine. He usu- 
 ally advertised that his medicine contained juniper berries, asparagus, and 
 other "yarbs" of repute. 
 
 Probably the medicine did contain them. There must be some flavor, 
 and these different roots and herbs are as cheap as anything. Gin is as good 
 a solvent as other forms of alcohol, and the cost is not prohibitive. There- 
 fore, why not make use of the advertising values of these traditional kidney 
 remedies ? 
 
 Now, what are the facts? Much the best kidney stimulant is water, just 
 plain tap water. The amount of urine can be increased by digitalis, or niter, or 
 gin, but it can be increased more and in a better way by talcing a few extra 
 glasses of plain water. 
 
 If one should drink gin and stimulate the kidneys to take an excess of 
 water from the blood, he would be worse off therefrom until he had filled up 
 the deficiency of blood by drinking water. 
 
 Another excellent way to stimulate the kidneys is to permit the skin to 
 get cold. If a man has any reason to feel that his kidneys should secrete more 
 freely, he does not need to take a tablespoonful of kidney cure. Let him walk 
 out of the office without his overcoat on any cold day; let him stroll a few 
 blocks leisurely or stand on a corner until he gets chilled through. This 
 "medicine" he will find much more effective than kidney medicine taken from 
 a spoon. 
 
 Of these two suggestions, the first is much to be preferred. The sug- 
 gestions are offered those who take kidney medicine for "pain in the back," 
 "heavy feelings" or "scant kidney secretion." 
 
 If a person has any form of Bright's disease, it is because of some error in 
 
BRIGHT'S DISEASE TREATMENT 629 
 
 his way of living, or because somewhere his machine is slipping a cog. Most 
 cases of Bright's disease get well, at least for a time. Of those that are not 
 recovered from, most are of such a nature that they can be lived with for 
 years. 
 
 A sensible person can usually round out a full life in spite of Bright's 
 disease. The only cases of Bright's that are cured by these remedies are those 
 that were cured in spite of the remedies. 
 
 The treatment of Bright's that gets results is right living under intelligent 
 medical control. 
 
 BRIGHT'S DISEASE TREATMENT 
 
 Some time ago we published (in the Chicago Tribune) a letter from J. E. 
 Hardy in which he said that he had cured himself of Bright's disease. Many 
 wrote asking for Mr. Hardy's address. We adhered to our rule and declined 
 to give this information. However, we wrote to Mr. Hardy, requesting him 
 to write out his method, that we might publish it for the benefit of many who 
 had written. We have been compelled to abridge his letter. 
 
 He writes, however, that he is willing to answer letters and submits his 
 address. Letters sent to him must include stamped envelope; otherwise the 
 burden would be unreasonable. Mr. Hardy resides at Victor, Colorado. 
 
 Many cases of Bright's disease get well ; others live to a ripe old age. We 
 are always liable to fall into errors when we draw conclusions as to all man- 
 kind from one experience with one man. Mr. Hardy's temperance and right 
 living are right. With some of his food ideas I cannot agree. 
 
 J. E. Hardy writes : "About twenty years ago I was informed by a phy- 
 sician who has since died of Bright's disease that I had that much dreaded 
 malady and that I had only six months to live. There is no doubt that this 
 diagnosis was correct because I had it confirmed by several physicians. The fact 
 that I am alive and enjoying life, although I am past 54 years of age, speaks 
 volumes for the methods I have used. 
 
 "Dear reader, this article will mean little to you if you are unwilling to 
 deny yourself. If you are determined to eat and drink various articles just 
 because you enjoy their taste and you do eat these articles just to gratify your 
 appetite, although you know they are injurious, then these suggestions are of 
 little worth to you. Your health and future happiness depend on what you 
 eat and drink and what you do not eat and drink, together with your manner 
 of living. 
 
 "Do not drink milk, cream, tea, coffee, cocoa, chocolate, beer, whisky, wine, 
 hard cider, soda water, mineral water, or any fancy drink sold at a drug store 
 or over a bar. Avoid all hard waters and waters impregnated with minerals 
 and alkalis. Drink nothing but soft water. Eat all kinds of grains, such as 
 wheat, oats (oatmeal), corn (cornmeal mush, corn bread), rice, barley, rye, 
 flaxseed, boiled whole wheat, whole wheat mush, parched whole wheat mixed 
 with flaxseed and ground. Whole wheat bread should be eaten at every meal. 
 Whole wheat can be purchased at all seed stores and at most of the feed 
 stores. 
 
 "You can make your own whole wheat meal or flour by grinding whole 
 wheat in your coffee mill, after having thoroughly washed the wheat and 
 
630 BEIGHT'S DISEASE 
 
 letting it dry. This whole wheat meal makes excellent gems or bread. When 
 prepared like oatmeal mush it makes an excellent and inexpensive breakfast 
 food and is beneficial to those who are troubled with constipation. 
 
 "Take equal parts of whole wheat and flaxseed. Parch this combination 
 in a pan on the stove. When slightly parched grind in a coffee mill. Eat 
 freely at your regular meals and you will have no more trouble with con- 
 stipation. 
 
 "Eat potatoes and all legumes, viz., beans, peas, lentils. Avoid canned 
 beans; Mexican beans are preferable. Eat apples freely, uncooked principally. 
 Eat figs if they agree with you. Nuts are permissible, provided they do not 
 produce constipation. 
 
 "Avoid all forms of animal foods, such as milk, butter, eggs, grease, 
 oysters, meats, fats, glands, thymus, liver, sausage, cheese, gelatin, fish, calves' 
 foot jelly, and similar dishes. 
 
 "By avoiding the following articles of food, which contain oxalic acid, you 
 will escape uremic poisoning and those sick spells: Spinach, sorrel, lettuce, 
 rhubarb, cabbage, turnips, olives, gooseberries, currants, plums, strawberries, 
 raspberries, grapes, cranberries, apricots, peaches, horseradish, olive oil. 
 Avoid sugar and all sweets. If you must have some sweets experiment with 
 pure maple syrup or saccharin as a substitute for sugar. Bananas should be 
 avoided by most persons. 
 
 "Avoid the use of pepper, salt, mustard, pickles, essential oils, spices, 
 ice cream, flavoring extracts, catsup, and all condiments ; also all rich and indi- 
 gestible pastries and cake. Avoid the use of tobacco in every form. 
 
 "'Drink a glass of lemonade once or twice a week. When the kidneys are 
 sluggish, drink corn water, which is made by boiling one cupful of common 
 field corn in two or three quarts of water for five or six hours. 
 
 "An absolute fast for one, two, or three days will correct these sick spells 
 by giving nature a chance to throw off the accumulated poison in the system. 
 
 "Eat three regular meals per day. Do not overeat. Eat at the same 
 hour every day. Do not eat between meals. Do not eat late suppers. Eat 
 slowly and masticate your food thoroughly. Do not drink more water than 
 your natural thirst demands. 
 
 "Keep the pores of your skin open by frequent baths, say two per week. 
 One of these should be a hot steam bath, if possible. Bathe your feet fre- 
 quently. 
 
 "Sleep with your bedroom windows open every night during the year. 
 
 "Keep your living rooms well supplied with fresh air. 
 
 "Take plenty of outdoor exercise. Walk several miles each day. Com- 
 mence your walking exercise gradually. 
 
 "If you are dropsical I suggest that you live in a high, dry climate. 
 
 "One who lives on milk and vegetables is not living on a strict vegetarian 
 diet. I cut out milk many years ago. 
 
 "Eice as an article of diet cannot be too highly recommended. Boiled rice 
 is easily digested, and as it contains less alkaline salt than any other food, it 
 does not overtax the kidneys. Be careful to use the unpolished rice, because 
 the polished rice is coated with paraffin and talc, and, like white flour, has 
 been robbed of its most health giving and nourishing qualities. 
 
 "You may think this treatment is a strenuous dose. Well, possibly it. is 
 
BRIGHT'S DISEASE TREATMENT 631 
 
 somewhat heroic, but remember you are playing for big stakes — life, health, 
 and happiness. Is it not worth while? Give it a trial." 
 
 Water and Bright's. — L. C. R. writes: "You have written a series of 
 articles on the spring waters in this country. I would like to know whether 
 you could tell me what is the best water for Bright's disease." 
 
 Reply. — People with milder forms of Bright's disease generally get help 
 from the free use of waters containing very little mineral matter, such 
 as Chippewa, Poland, Waukesha, and Mountain Valley. People with the 
 acute forms of Bright's disease are sometimes helped by the bitter purgative 
 mineral waters. 
 
 No water is a specific for Bright's disease or any other disease. The 
 composition of the water is of minor importance as compared with the 
 method of use of the water. We have better waters than those of the 
 famous cures of Europe. Our hope of developing cures equal to those of 
 Europe lies in the possibility that we shall learn that it is the method of 
 use and not the chemical constitution of a mineral water which counts. 
 
 Bright's Disease Diets. — C. R. writes: "Will you kindly let me know 
 what to eat? I have Bright's disease. Will Hot Springs, Arkansas, 
 cure me?" 
 
 Reply. — I wish I could answer your question in detail and not mislead 
 you a bit. I am afraid to try. 
 
 Bright's disease is of several varieties, and the diet good for one is not 
 good for another. If you have acute Bright's disease you should go on a 
 very limited diet. The skim milk cure has helped some. If you have a 
 form of chronic Bright's you must eat more in order to nourish your body, 
 but still you must eat much less than does the average well man. Yon 
 Noorden has a valuable little book on diet in Bright's disease. Suppose 
 you get that. 
 
 No spring water will cure you. The waters of some springs are of great 
 service in the treatment of certain forms of Bright's, particularly the cases 
 that have a good deal of albumin in the urine. Mountain Valley and 
 Potash- Alum Springs, near Hot Springs, are good. 
 
 Bright's Disease Ration. — 8. I. K. writes: "What diet should one take 
 who has albumin, a symptom of Bright's disease? What is the best section 
 of the country for one having Bright's disease, or endangered with the 
 malady, to live in? Is it harmful for one having this disease to work 
 indoors?" 
 
 Reply. — 1. Eat what you please, but not so much as you please. Cut in 
 half the amount of meat in your daily ration. Reduce the quantity of 
 food other than meats one-third. Take no whisky nor beer. Be temperate 
 in all things. Avoid getting wet or cold. Avoid infections of every kind. 
 
 2. A warm, even climate, such as southern Florida, California, the 
 Gulf coast. 
 
 3. Not especially. 
 
 Interstitial Nephritis. — L. C. M. writes: "1. What is interstitial 
 nephritis? 2. Does blood pressure above normal and arteriosclerosis usually 
 accompany this disease? 3. Is it slow or rapid in developing? Jf. Is 
 apoplexy liable to occur from this disease if arteriosclerosis is present also? 
 5. What are usually the last stages?" 
 
632 BRIGHT'S DISEASE 
 
 Reply. — 1. The slowest form of Bright's disease. It is a mild, chroni« 
 inflammation of the kidneys. 
 
 2. Yes. 
 
 3. It develops very slowly. While it is incurable, ofttimes it is without 
 symptoms. Sometimes the symptoms are very mild. Often people with 
 this disease live long and comfortable lives. 
 
 4. Apoplexy in people with high blood pressure and chronic Bright's 
 disease is rather frequent. 
 
 5. Death is generally brought about by some intercurrent, acute disease, 
 such as pneumonia or acute Bright's disease. The symptoms in that event 
 would be those of the intercurrent disease. Death frequently is from 
 uremic coma. Sometimes it comes with the symptoms of an advanced 
 arteriosclerosis. 
 
 To Avoid Uremia. — E. L. L. writes: "What foods should be avoided 
 if there is a tendency to uremia?" 
 
 Reply. — Overeating is much more important than anything else. A 
 low protein diet is advised, one consisting largely of milk, buttermilk, 
 cheese, fruits, and vegetables. The amount of meat and bread in a low 
 protein diet is not over half that usually taken. 
 
 Symptoms of Bright's Disease. — M. E. S. writes: "What are the symp- 
 toms of Bright's disease? Is there a swelling of the kidneys, face, and 
 eyes? Also the feet? Is there a certain diet for it? The person in ques- 
 tion is only 18 years of age. For a time she seemed to be doing very well, 
 but is now in a very serious condition. Probably it is not Bright's disease, 
 but that is what we think it is. A doctor at one time said it was kidney 
 trouble." 
 
 Reply. — Examination of the urine shows the presence of albumin and 
 casts. This is the best sign. Pumness around the eyes is often due to some 
 other cause. At the same time it is one sign of Bright's disease. The 
 same is true of swelling of the feet. 
 
 Most cases of Bright's disease respond to change in living habits. 
 In fact, right living is the only treatment needed in a fair proportion of 
 the cases of Bright's. 
 
 Dieting is an important feature of right living. The first essential of 
 dieting for Bright's disease is never to overeat. The second is to eat 
 simple foods. The third is to decrease materially one's consumption of 
 savory meats — juicy steaks. The fourth is to cut the amount of protein 
 eaten about in half. 
 
 Try Dieting and Exercise. — H. E. B. writes: "What causes the albumin 
 to go into the urine? Is it a sure sign of Bright's? What articles of food 
 should be excluded? What is the best medicine to take? When the blood 
 is poor from malaria and taking quinin, what is the best thing to take?" 
 
 Reply. — 1. The albumin is held in the blood by the kidney cells when 
 they are normal. When they are diseased some of the blood albumin passes 
 through the diseased cells into the urine. 
 
 2. No; it is, however, reasonably sure, and that is about' as much as 
 we can say of anything. Sometimes albumin is present when there is no 
 Bright's, and sometimes Bright's is present when there is no albumin. 
 
 3. In chronic Bright's disease, be sure to eat enough nutritious food, 
 but be sure not to eat too much. In acute Bright's eat lightly of meats 
 
BRIGHT'S DISEASE TREATMENT 633 
 
 for, say, a month. Don't stop eating meat entirely in acute Bright's, and 
 certainly not in chronic Bright's. 
 
 4. Instead of relying on medicine, have your physician outline a plan 
 of eating, exercise, and personal hygiene, and follow it. If you put your 
 dependence on kidney cures, you for the scrap heap. 
 
 5. Iron tonic, good food, and exercise in the open air. 
 
 Loss of One Kidney. — H. J. C. writes as follows: "1, My brother, a boy 
 of 18, has had one of his kidneys removed by a recent operation. Does this 
 lessen the chance of his ever becoming strong and robust again? 
 
 "2. A. C, aged 37, has for years been annoyed by a cough which comes 
 on suddenly if he should sit in a draft or at an open window, or even out 
 of doors at night, regardless of how warm the weather. During the winter 
 months bedroom windows cannot be left open at night or he will cough 
 most of the night. It is only at these stated times, however, that said 
 cough puts in an appearance. From this information what would you say 
 it was caused by? 
 
 "3. What is glycerin made of? Have been using it on hands and lips 
 at night, and have been told it is drying. Would it hurt a person if he 
 took any quantity of it?" 
 
 Reply. — 1. If the remaining kidney is sound, he should get as strong 
 as the next man. A normal man has a great excess of kidney capacity. 
 One healthy kidney is more than ample. 
 
 2. A. C. coughs when, by reason of chilling of his skin, his outside 
 blood pressure is lowered and his internal blood pressure is increased. If he 
 will use more cover on his bed and wear more clothes when exposed to 
 chilling, he will not have the coughing spells. In some way or other, the 
 increased internal pressure on the skin reflexes irritate his bronchial tubes. 
 In some cases it is thought the irritation comes from enlarged bronchial 
 lymph glands which swell when the skin is chilled. 
 
 3. I think usually from alcohol. It dries. By itself it is not good to 
 take nor to put on the hands. In Arizona it is wise to grease the skin fre- 
 quently with a grease gum mixture to which some but not much glycerin 
 can be advantageously added. 
 
 Tubercular Kidneys. — L. A. T. writes: "1. What is the cause of tuber- 
 cular kidneys? 2. Would 'dope' produce a condition leading to this con- 
 dition or an appearance of this condition?" 
 
 Reply. — 1. Tubercle bacilli cause tuberculosis in the kidneys as else- 
 where. Sometimes the bacilli get into the blood and are carried in that 
 way to the kidneys. In this condition the tuberculosis is not limited to the 
 kidneys, but is everywhere throughout the body. Sometimes the bacilli are 
 carried to the lining of the kidney by the lymphatic tubes. In this variety 
 of tubercular kidney no other organ is involved except those of the urinary 
 tract. Ofttimes the disease involves but one kidney, the other being 
 healthy. 
 
 2. I should say no to each half of this question. 
 
 Case Is Incurable. — New Subscriber writes: "I have a friend, J+6 years 
 old, weighing 200 pounds. He has a good appetite, can eat anything cooked 
 for him. He has suffered from Bright's disease for seven or eight years. 
 His doctor ordered him to take Epsom salts or cream of tartar every fore- 
 noon. He got tired of it and can't take it any more. He is constipated 
 
634 BRIGHT'S DISEASE 
 
 all the time and has pain in the head and frequently in the back of his 
 neck. He is restless at night and finds it hard to get his breath at times. 
 He is always dull and sleepy. Would you tell me if his case is incurable, 
 or what would you suggest?" 
 
 Reply. — If his Bright's disease has lasted seven or eight years, he is 
 incurable. At the same time by intelligent care and watchfulness you may 
 succeed in keeping him alive and fairly comfortable for several years. 
 The symptoms stated in your letter do not indicate that he is doing well 
 now. You must keep his bowels and skin working well. As he can no 
 longer take what he has been taking, use something more simple. Find 
 something the effect of which he will like. 
 
 Danger in Overeating. — A. B. S. writes: "I weigh 220 pounds and am 
 about 5 feet 8 inches in height. At times I feel dumpish, am heavy eater, 
 and work inside, drink some and smoke. At times I think I am troubled 
 with liver, then again I think it might be Bright's disease; have large puffs 
 under my eyes at times. What do they indicate ?" 
 
 Reply. — Puffs under the eyes may mean Bright's disease. Urinalysis 
 repeated in case the first is negative will tell you. A heavy eater who works 
 inside is certain to overtax his liver or his kidneys or both sooner or later. 
 Why not reform now ? 
 
 Use of the Kidneys. — Constant Reader asks: "Why was the elaborate 
 pumping machinery (the kidneys) put in the body, when, seemingly, all 
 possible fluid is needed for flushing the colon?" 
 
 Reply. — If all of the water separated from the blood by the kidneys 
 was excreted into the colon conditions would be intolerable. The average 
 man would be better off if he had a few ounces of additional water in his 
 colon, but the pints excreted by the kidney would overdo things. The 
 human machine, as nature makes it, is a very good article. That it goes 
 wrong when man tampers with the works does not argue that it should 
 have been made different. 
 
 Stone in the Kidney. — N. L. G. writes: "Can stone in the kidney be 
 cured? My doctor tells me I have one, and suggests an operation. To 
 avoid this, what would you advise?" 
 
 Reply. — Stone in the kidney cannot be cured, in the sense of removal 
 of the stone, in any way except by surgical operation. Sometimes the 
 symptoms disappear because the stone settles down quietly in a pouch or 
 because an infection which accompanied the stone subsided. But the stone 
 is there just the same. Follow your physician's advice. 
 
 Gravel in the Urine. — M. A. C. writes: "1. What is the cause of gravel 
 in the urine in a young woman 27 years old? She also has severe head- 
 aches by spells. 2. Is the gall-bladder working all right? She has to take 
 pills all the time to move the bowels. 3. What kind of diet should she 
 follow to help her? She has pain in the bladder for quite a while now." 
 
 Reply. — 1. Gravel in the urine is precipitated urates. After normal 
 urine has stood for a while in the cold it precipitates urates. Some call 
 this gravel. This phenomenon indicates nothing. When urates precipi- 
 tate while the urine is in the kidney or the bladder the condition is called 
 gravel. That is of consequence. If that is the condition drink more water 
 
BRIGHT'S DISEASE TREATMENT 635 
 
 — several times as much as you now drink — and go to your physician for 
 counsel. 
 
 2. You do not give any symptoms referring to your gall-bladder. 
 
 3. Eat an abundance of fruit and vegetables. Eat bran bread. Drink 
 plenty of water. Exercise in the open air. 
 
 Salt and Bright's Disease. — P. writes: "An article by an M. D. in a 
 
 recent issue of The Cooking Club on the salt eating habit stated that the 
 use of salt in the human system is deleterious, producing diabetes, Bright's 
 disease, and heart troubles. He protested against its use in cooking. Is 
 there any considerable school opposed to the use of salt? What is your 
 own view of meat eating, as opposed to a strictly vegetarian diet?" 
 
 Reply. — I do not think there is any considerable school opposed to the 
 use of salt. In Bright's disease it is best to decrease the amount of salt 
 taken with the food. Many physicians think so. My opinion is that a 
 moderate amount of salt is a necessity. I believe in a mixed diet — one 
 containing meat, bread, vegetables, and fruit. However, adults doing 
 mental work require little meat. In summer little meat is required. 
 
 Concerning Floating Kidney. — Subscriber writes: "Will you kindly 
 answer the following: 1. What causes floating kidney in child of Ik, not 
 adolescent? 2. Will this interfere in any way with periods? 3. Can float- 
 ing kidney cause intense pain in kidney region, nausea, weakness? If.. Is 
 it advisable to use X-ray to determine cause of pain, if it is felt that the 
 kidney is not causing all trouble? 5. Is not use of X-ray a bad idea? I 
 know, of course, it has value, but are not the effects on the individual 
 deleterious? Have heard prominent physician decry use of it and wish 
 to know. 6. Is gymnastic dancing advisable for one who has had two 
 severe attacks of appendicitis?" 
 
 Reply. — 1. Probably she was born that way. The tissue that holds the 
 kidney against the back sometimes is so arranged as to permit that organ 
 to move about. Movable kidney may be due to accident, to pressure from 
 a corset, or to loss of flesh. 
 
 2. No. 
 
 3. Yes. The displaced organ sometimes kinks the ureter, causing pain. 
 
 4. I don't think X-rays will give you any information. Physical exam- 
 ination and urinalysis ought to be satisfactory. If not, a catheter can be 
 passed up the ureter to the kidney. It is possible that X-ray of the ureters 
 with the catheters in them might help. 
 
 5. There are no bad effects unless there is a burn. Burns are exceed- 
 ingly rare now. 
 
 6. Yes. 
 
 Osier on Floating Kidney. — G. W. writes: "My daughter has been 
 troubled with a floating kidney. Will you kindly advise whether an opera- 
 tion is necessary, and, if so, whether it is dangerous?" 
 
 Reply. — Sometimes floating kidney calls for an operation. The opera- 
 tion consists in fastening it to the back. Ninety-nine times out of one hun- 
 dred it calls for nothing. Osier says people with floating kidney should 
 never be told about it, since they thereupon commence having aches and 
 pains, imaginary in character. 
 
 Dropsy. — A. B. Z. writes: "1. What is the cause of dropsy? 2. Is 
 there a permanent cure when a young person has had an attack where feet, 
 
636 BRIGHT'S DISEASE 
 
 hands, and face were swollen? 3. Should a person marry who has had an 
 attach of dropsy? J/.. Does it run in a family and can children inherit it?" 
 
 Reply. — 1. Dropsy may be due to any one of several causes, the most 
 important being kidney disease, heart disease, and liver disease. 
 
 2. Probably, in the case suggested, the cause was kidney disease. Many 
 such conditions pass away and there are no symptoms for years, sometimes 
 never. The dropsy is a detail. The answer must depend on the condition 
 of the kidneys. 
 
 3. If the kidneys get in good condition, yes. However, the person af- 
 fected should be frank with the intended. 
 
 4. No. 
 
 Kidney "Dopes." — K. M. S. writes: "I have been talcing kidney dopes 
 for several years, with no good results. I always have a full feeling in the 
 top of my head and a ringing sensation in my ears for several hours every 
 evening, also my hair persists in falling out steadily. I am not lazy, but I 
 find it so hard to take the least interest in anything." 
 
 Reply. — Kidney dopes cannot possibly help you. If you have kidney 
 disease, regulation of your life will help you, but kidney medicine certainly 
 will not. You may have kidney disease. Find out through urinalysis. 
 You may have profound anemia. Find out by blood examination. 
 
 Blight's and Diabetes. — A. L. N. writes: "You state a warm climate, 
 as in Tucson, San Antonio, and El Paso, is excellent for Bright's disease. 
 Several specialists in this country claim there is no such thing as Bright's 
 disease; that sugar sickness, called diabetes, is not a kidney disease. There 
 must be some mistake. Diabetes, called sugar sickness, is certainly a kid- 
 ney disease; it is not a stomach, liver, gall, or an intestinal malady. Dia- 
 betes at a certain age is fatal, no matter what climate or what remedies are 
 used; but after a certain age patients keeping a prescribed diet can live an 
 unlimited time. A few years ago a friend of mine suffering from diabetes 
 visited Europe, consulting Professor Erd in Germany, a prominent spe- 
 cialist, who, after making an examination and telling him no medicine 
 would be given, gave him a printed book informing him about his diet — 
 what to eat and drink, and what not to eat and drink. In parting the pro- 
 fessor told him that the cause of diabetes was unknown and that there is 
 no cure for it. My wife had diabetes for about twenty-five years and lived 
 strictly as to her diet, staying for many years at Waukesha drinking the 
 water. She died here at 73. Still, a good deal depends upon the constitu- 
 tion and good care patients receive." 
 
 Reply. — The term "Bright's disease" is used loosely to designate inflam- 
 mation of the kidneys. There are several different kinds of Bright's dis- 
 ease, due to several different causes. They vary greatly in their symptoms 
 and in the rapidity of their progress. 
 
 Diabetes is a disease in which there is sugar in the urine. It may be 
 due to brain or nerve disease, to disease of the pancreas, or to the eating of 
 more starches than the body can burn up. 
 
 It is not a kidney disease. The kidneys are simply doing the best they 
 can to rid the body of sugar. Sometimes the hard work causes the kidneys 
 to break down under the strain, but that is secondary. 
 
 The disease is usually rapidly fatal in the young. In the old it is very 
 mild. From the philosophical standpoint, it is about on a plane with 
 obesity and is not much more serious. 
 
CHAPTEE XXXVII 
 
 Digestion 
 
 IMPORTANCE OF CHEWING FOOD 
 
 Digestion begins in the mouth. It is essential to know that when 
 the food has been retained in the month long enough to become thoroughly 
 incorporated with the mouth juices an important part of digestion has 
 already taken place. When the food is well chewed it becomes well mixed 
 with the saliva and other mouth juices and this is one of the reasons why 
 complete mastication of the food is necessary. 
 
 Starch, for instance, is converted into sugar by 
 the action of the saliva and this is one of the steps 
 of digestion. If food be thrust into the stomach 
 without being emulsified by chewing and the starchy 
 substances of the diet converted into sugar before 
 being swallowed the stomach is compelled to take on 
 a duty for which it was not intended. 
 
 That the stomach can and does take on and 
 perform the functions of the teeth and the mouth 
 for years without complaint does not refute the ar- 
 gument in favor of chewing. It only indicates that 
 the stomach is an organ of wonderful power and 
 adaptability. It can and will for a time in addition 
 to its other duties perform the function of the teeth 
 and the mouth; but at last it gives out and the 
 owner finds himself a victim of one of the forms of 
 indigestion. 
 
 There are other reasons why thorough mastica- 
 tion is necessary. The longer the food is retained in the mouth and the 
 longer it is chewed the more chance the taste nerves have to come in contact 
 with it ; and when the palate is satiated the appetite is appeased and the desire 
 for food is gone. The same mouthful of food retained in the mouth sixty 
 seconds will go nearly as far toward satisfying the taste nerves as two mouth- 
 ful s retained in the mouth thirty seconds each. 
 
 Hence it follows that thorough mastication of food is a preventive of 
 overeating and it may be said that overeating is one of the dietary sins of 
 the age. 
 
 The savory taste of food in addition to the motion of the jaws and 
 cheeks facilitates the flow of saliva. It is necessary that the mouth juices 
 be incorporated with the food while it is still in the mouth. 
 
 All chewing of gum or other substances between meals creates an undue 
 
 637 
 
 Fig. 221. — Section of a 
 Tooth Showing En- 
 amel, Dentin and 
 Pulp. 
 
638 
 
 DIGESTION 
 
 flow of saliva at a time when the salivary glands should be at rest. The 
 result is a shortage of that necessary fluid when the next meal time arrives. 
 
 PROCESS OF DIGESTION 
 
 A man from whom the entire stomach has been removed can digest 
 lean meat. The digestive and assimilative apparatus can convert lean meat 
 into sugar. It can convert lean meat into fax. But muscle cannot be made 
 from sugar and starch foods or from fatty food. 
 
 When proteids whether from animal or vegetable sources are eaten 
 digestion begins in the stomach. The mouth breaks the food up and the 
 
 saliva moistens it ; but it is not 
 until the gastric juice strikes 
 it that digestion begins. 
 
 The stomach is powerful 
 as a mechanical mixer. Its 
 juice converts proteids into 
 acid albumin or syntonin, then 
 into proteose; then some of it 
 is changed to peptone. Then 
 the mixture of syntonin, pro- 
 teose and peptone is passed 
 into the small intestine. The 
 pancreatic juice changes the 
 syntonin and proteose to pep- 
 tones. This action is so power- 
 ful that it has been found that 
 the pancreas can wholly take 
 the place and digest lean meat 
 in a person who has no stomach. 
 We have known for a long time that the stomach was not so important 
 as it was thought to be in olden times. Its most important function is its 
 gizzard function — its work as a mixing machine. Most people who think 
 they have dyspepsia and stomach trouble have something else. 
 
 The intestinal juice converts the peptones into amino acids. Now the 
 work of digestion of albumin has been completed. The next step is absorp- 
 tion. 
 
 The amino acids are absorbed from the intestines and pass into the 
 blood bound for the liver. They are carried from the liver to the different 
 portions of the body. 
 
 The different cells of the body in need of material for repair pick up 
 what amino acid they need and use it to replace the tissue that has been 
 worn out. 
 
 The worn out tissue is changed into an amino body whereupon it dis- 
 solves, enters the blood stream, travels to the liver and from there to the 
 organs of excretion, principally the kidneys. 
 
 On the way it is converted first into ammonia and then into urea. The 
 conversion occurs in the blood and somewhat in the body cells. The con- 
 
 Fig. 222. — The Three Salivary Glands. 
 
DIGESTIVE TEOUBLES 
 
 639 
 
 The filtration of the 
 
 version of the ammonia into urea occurs in the liver, 
 urea from the blood occurs in the kidney. 
 
 This is what happens in the body 
 of the cell. Every cell has a nucleus 
 — the small directing head for the cell 
 body. When the aminoacids replace 
 the waste in the nucleus ferments con- 
 vert the waste through several steps 
 to form uric acid. 
 
 This uric acid is carried by the 
 blood to the muscles, the liver and 
 the kidneys. A good part of it is 
 burned up, destroyed by the muscles 
 and the liver. 
 
 The part not destroyed by these 
 structures reaches the kidneys which 
 filter it out of the blood. In the urine 
 it may exist as uric acid or urates or 
 substances closely related to uric acid. 
 
 DIGESTIVE TROUBLES 
 
 If one is afflicted with pain in Fig. 223. — The Jaws and the Teeth. 
 
 the Stomach, distention, belching or 1, 2 incisors; 3, canines; 4 5, bicuspids; 
 
 -,. , & 6, 7, 8, molars; a, vein; 0, artery; c, nerve; 
 
 gas, colicky pains, SOUr stomach, SO- d, vein, artery, and nerve. 
 
 called heartburn, or like maladies, 
 
 the cause is usually some form of indigestion and is due to improper feeding. 
 Few of these symptoms occur in the underfed but all of them may occur 
 
 in those who are overfed. Too much 
 food for one person may not be too 
 much for some other person, as diges- 
 tion is wholly an individual affair. It 
 naturally follows that a food that has 
 helped or harmed one individual may 
 not so affect his neighbor. 
 
 It is irrational to be careless in 
 eating or to eat too much and then 
 to take medicine or spirits to aid diges- 
 tion. If a food cannot be digested 
 without artificial aid it should not be 
 eaten at all, or if eaten the quantity 
 should be small enough to be within 
 the digestive power of the diner. 
 
 Some persons have lived to old age 
 without any appreciable illness from 
 
 indigestion; but they were persons of equable temperament, were robust to 
 
 start with and practiced few indiscretions in eating or otherwise. 
 
 Such instances are extremely rare, for most persons have more or less 
 
 Fig. 224. — Baby Teeth, Except the Six- 
 Year Molars. The six-year molars be- 
 long to the permanent teeth 
 
640 DIGESTION 
 
 trouble some time in their lives and very many have digestive troubles 
 all their lives. Many ailments have their origin in faulty nutrition. Indeed, 
 physicians know that most of those who consult them have no organic disease 
 but suffer from the evil effects of errors of diet, overwork or bad habits 
 of life. 
 
 Different kinds of food produce different kinds of trouble but the first 
 requisite bearing upon relief is to reduce the total quantity of food taken 
 while the trouble lasts and to endeavor to determine the kind of food and the 
 quantity that can be best borne with freedom from discomfort. 
 
 Those suffering from a feeling of distention and the eructation of 
 gas may have excessive fermentation in the digestive process. As sugar is the 
 chief factor in fermentation it should be discarded or the quantity greatly 
 reduced. As bread, potatoes and beans are rich in starch and the mouth 
 and stomach juices convert starch into sugar they should be eaten sparingly. 
 But most of the gas belched has been swallowed as air. 
 
 EXERCISE AND THE STOMACH 
 
 The stomach muscles move in waves somewhat similar to those of the 
 heart muscle. When the muscle is contracted down we call the stage systole. 
 When the muscle is relaxed the stage is called diastole. Exactly these same 
 terms are used for the movement of heart muscle. The muscular contraction 
 starts when the food enters the part of the stomach called the cardiac end 
 and moves toward the end where the food leaves the stomach called the 
 pyloric end. 
 
 Each muscular contraction is called a cycle. A cycle takes three seconds. 
 In other words we might say that the stomach beats twenty times a minute. 
 The heart beats about four times as fast. 
 
 Sometimes a wave travels from one end of the stomach to the other. 
 More frequently it travels a quarter way, then breaks, then starts up, travels 
 another quarter, then breaks and so on until it gets to the emptying 
 end. 
 
 Now, during all of this churning chemical action is taking place. The 
 point is that the churning is more important than the chemical action. 
 When the mixed food has been pushed into the first part of the small intestine 
 the chemical work can and does keep up but if the churning has not accom- 
 plished its part of the work it will not be done. As a large part of the 
 chemical work of the stomach is done outside of the stomach the muscular 
 work must be done in the stomach and by the stomach. 
 
 These few facts lay the foundation for some highly important practical 
 conclusions. The diagnosis of cancer of the stomach is difficult. Operations 
 based on the old symptoms such as tumors, hemorrhage, rapid emaciation 
 and chemical tests do no good. A test suggested by Abderhalden is being 
 tried out. It may prove able to demonstrate cancer of the stomach in the 
 early stages. Let us hope. 
 
 X-ray examination of the bismuth-lined stomach shows cancer at an earlier 
 stage than did the old methods. 
 
 The second is this: When the digestion is poor the most important 
 
DIETING FOR FERMENTATION 
 
 641 
 
 j Salivary glana\ 
 
 thing to do is to build up the stomach's muscle. When one builds up his 
 general muscular tone he builds up his heart muscle tone and his stomach 
 muscle tone. 
 
 Exercise in the open air well planned and persistently carried out is 
 better for dyspepsia than pepsin or soda or 
 tablets or several of these combined. 
 
 In one of Dr. Cole's articles on the radio- 
 graphic examination of the stomach he says: 
 
 "The gastric cycle is governed somewhat 
 by respiration through the vagus, which sup- 
 plies impulse both to the diaphragm and to the 
 stomach. This suggests a method by which 
 gastric peristalsis may be stimulated." 
 
 An extremely important nerve called the 
 pneumogastric or vagus runs down the neck 
 into the chest to the abdomen. It stimulates 
 the lungs to do their work and the stomach to 
 do its work. The stomach, lungs and heart 
 being hooked on the same wire, what affects 
 one may have some effect on the others. 
 
 The exercise that causes one to breathe 
 well stimulates the stomach to work well. Per- 
 haps the old fellows who sniffed snuff were 
 wiser than those who took pepsin. 
 
 To give the statements "punch" let us 
 summarize as follows: 
 
 1. The most important work of the stom- 
 ach is that done by its muscle. 
 
 2. Muscle exercise which builds up the 
 general muscle system prevents and cures dys- 
 pepsia by improving the tone of the stomach 
 muscle. 
 
 3. Since the same nerve which supplies the stomach muscle supplies 
 the heart and lungs anything which stimulates breathing and heart function 
 stimulates the stomach. 
 
 4. An X-ray study of the stomach movements is about the best method 
 for diagnosing early stage stomach cancer now known. 
 
 Agm* 
 
 Jpfiefl<f/x. 
 
 Fig. 225. — Diagram Illustrat- 
 ing Digestive Organs. 
 
 DIETING FOR FERMENTATION 
 
 Many people complain of intestinal fermentation. Dr. Ashford of 
 Porto Rico gives three methods of dieting to overcome this trouble. 
 
 1. Stop all food except milk for a period of forty days. Take eight 
 ounces of milk every two hours for four days. Nine feedings a day should 
 be taken. The milk should be consumed cold. It should be slowly sucked 
 through a straw. A half tube of Bulgarian lactic bacillus from a good 
 manufacturer should be added to each feeding just before taking. On the 
 fifth day and for three days thereafter take nine ounces at a feeding. On 
 
642 DIGESTION 
 
 the ninth day take ten ounces. Increase the feeding one ounce every 
 fourth day until thirteen ounces constitute the size of the meal. When 
 thirteen ounces as a portion has been taken for four days reduce the dose 
 of milk to twelve ounces nine times a day and add one banana a day. 
 After four days of this reduce the dose of milk to eleven ounces nine times a 
 day and eat two bananas a day. From this point on gradually decrease 
 the milk, indulging instead in eggs, fruits, and vegetables. Avoid potatoes, 
 beans, apples and underripe fruit. 
 
 2. Stop all the usual foods for one week. Take two pounds of chopped or 
 roasted meat a day. Divide it into six feedings. The meals are to be taken 
 at three hour intervals. Few people can stand this diet for more than a 
 week. After the expiration of the week reduce the amount of meat and add 
 vegetables, fruit and eggs. 
 
 3. Take a simple fruit diet in which bananas form the principal in- 
 
 Fig. 226. — The Pancreas, Partly Cut Away, so as to Show the Duct which Collects the 
 Pancreatic Juice and Empties it into the Duodenum. 
 
 gredient. The fruits must be fully ripe. Apples and fruit containing a good 
 deal of starch should be avoided. 
 
 Dr. Ashford's advice relates particularly to intestinal fermentation in 
 a form of tropical disease called sprue. This disease, he thinks, is due to 
 a yeast-like body belonging to the monilia. Monilia is liable to grow in 
 yeast as a contamination. When bread is made with yeast containing monilia 
 the mold may not be killed by the heat. Ashford thinks that this mold 
 carried into the intestines by bread is the cause of sprue. 
 
 By withdrawing bread, potatoes, sugars and sweets wholly from the 
 diet for from one to six weeks he starves out the molds in the digestive tract. 
 Of course care must be taken with bread and potatoes thereafter, else the 
 disease will return. 
 
 People in this country are not interested in sprue but thousands of 
 them are interested in intestinal fermentation. The custom is to take char- 
 coal or soda every day and a purge about every so often. 
 
 The plan above outlined should help these cases. They will not stay 
 cured if they go back to a diet rich in bread, beer, potatoes, apples, pastries, 
 cakes and desserts. 
 
 SUGAR EATING 
 
 Dr. Kuhnert offers some suggestions to the German people for im- 
 proving their chances in the Great War. He advises them to cut their acreage 
 
SUGAK EATING 643 
 
 of beets in half. The land released from beets is to be devoted to grain. Before 
 the war the German law required that the flour mills grind 70 per cent of the 
 wheat berry into the flour. At present the requirement is that 82 per cent 
 shall go into flour. This requirement prevents waste and, what is more 
 important, it increases the protein and the mineral matter in the flour. 
 
 Dr. Kuhnert advises that all of the berry go into the flour, that none 
 of the bran be discarded. 
 
 Now for a most subtle suggestion. He advises that the Germans export 
 as much beet sugar to England as possible. The Chicago Medical Recorder 
 quotes him as saying that by fairly flooding the English people with sugar 
 their vitality would be lessened, the plain inference being that they would 
 thus become less powerful opponents of the Germans. 
 
 The basis of this novel proposal is as follows : Sugar is absorbed by the 
 digestive apparatus without having to be changed. It is burned quickly 
 into energy and heat. People in need of a great deal of heat and energy 
 can get it by eating sugars and sweets. Men exposed to great cold, children 
 playing very hard and men leading very active lives can get what they need 
 of attractive flavors in convenient form and in a generally satisfactory way 
 by using chocolate, candies, sugars and sweets. 
 
 However, let us not forget that alcohol in moderate doses furnishes heat 
 and energy quickly and effectively. Yet the disadvantages of alcohol far 
 outweigh its advantages. Sugar has not the poisonous effects of alcohol but 
 it has some of its other disadvantages. It is a one-sided diet. It satiates 
 the appetite without furnishing the proteins and the minerals needed for a 
 good physical development. People who eat much sugar are fat and flabby. 
 
 The eating of sugar requires no work by the digestive organs. There- 
 fore, the digestive organs of heavy sugar eaters are apt to balk at digesting 
 meat, bread and vegetables. Sugar eaters generally have no particular appe- 
 tite for heavier, coarser foods. 
 
 Dr. Beck says that sugar eating children get very hungry, are quickly 
 satisfied with a little food and in a short while are very hungry again. 
 
 Finally, sugar eaters develop a lot of lactic acid in their tissues. To 
 neutralize this lime is absorbed from other tissues. In consequence sugar 
 eaters have poor teeth. Sometimes in the case of children they develop 
 rickets — they are fat but soft. 
 
 Dr. Kuhnert would give the German soldiers sugars, chocolates and 
 sweets whenever they are very tired or very cold. But for a steady ration — no. 
 On the other hand, he would advise flooding England with German beet 
 sugar with a view to promoting its daily use by the British soldier and by 
 the people at home. 
 
 Indigestion the Cause. — H. W. ivrites that he has an irregular pulse, 
 especially at night. Physicians have failed to find any organic heart dis- 
 ease. He takes strychnin tablets or digitalis as a stimulant frequently. He 
 wishes to know if an irregular pidse is dangerous and if the talcing of 
 strychnin and digitalis is harmful. He takes a half teaspoonful of car- 
 bonate of soda each evening and has done so for two years, and wishes to 
 know if this is doing harm. 
 
 Reply. — Functional heart trouble resulting in an irregular pulse sug- 
 gests the need of proper medical care. The heart can be as much a source 
 
644 
 
 DIGESTION 
 
 of danger by reason of disturbance of its nervous mechanism as it can be 
 
 from leaky valves. 
 
 It appears that H. W. has indigestion which he patches up with soda; 
 
 that the indigestion causes a 
 disturbance of the heart on its 
 nerve side and this he patches 
 up with digitalis. 
 
 No man is justified in con- 
 tinuing the use of a half tea- 
 spoonful of soda for two years. 
 He should change his eating 
 habits and get at the reason 
 for his stomach disturbance 
 rather than use soda. His use 
 of digitalis is also to be con- 
 demned. 
 
 Nerves of Taste.— A. T. D. 
 
 writes: "1. Why does the tem- 
 perature of any article taken 
 into the mouth affect the sense 
 of taste? 2. Will not the taste 
 discover where the chemist will 
 fail? 3. Is it not possible to get 
 an infection through eating or 
 drinking something that is very 
 cold, and if taken at a warmer 
 temperature are not the chances 
 minimized by the sense of taste 
 in discovering the infection? 
 Jf. What is the construction of 
 the tongue and palate?" 
 
 Eeply. — 1. The endings of 
 the nerves of taste are delicate. 
 If a substance is hot or cold 
 the temperature will numb the 
 nerve endings. If the tempera- 
 ture is within the limit of this 
 numbing effect of temperature 
 will be on the substance tasted. 
 Most substances dissolve better 
 in warm water. Taste will be 
 more acute if the solution is a 
 little warm. If the substance 
 gives off an aroma when warm 
 the nerves of smell aid the 
 nerves of taste. 
 
 2. No. I think without exception for each substance there is a chem- 
 ical test more reliable and more trustworthy than a taste test. 
 
 3. No. Taste is of no service in guarding against poisoning. For in- 
 stance, many food poisons do not change the taste of the food in which 
 they have developed. 
 
 4. Taste lies in the tongue. The palate has no taste nerves. The taste 
 
 a, esopha- 
 d, pylorus; 
 
 Fig. 227. — Digestive Apparatus. 
 gus; b, stomach; c, cardiae orifice 
 e, small intestine;/, biliary duct and gall-blad- 
 der; g, pancreatic duct; h, i, j, k, large intes- 
 tine; h, ascending colon; i, transverse colon; j, 
 descending colon; k, rectum. At junction of e 
 and h is ileocecal valve, below which is vermi- 
 form appendix. 
 
SUGAR EATING 645 
 
 nerves end in delicate bulbs. These little bulbs contain nerve endings 
 sensitized so as to be irritated by substances in solution having tastes. 
 These nerve endings are not capable of appreciating slight changes in 
 temperature or touch and they are not capable of registering pain. 
 
 Eat Bulkier Food. — C. K. twites: "What can a woman of 75 do whose 
 head is one mass of acute neuralgia, who works mure than she ought to, 
 and patches more quilts than is necessary, hut cannot be made to shake off 
 work habit? Ordinary relief, as she understands it, does not suffice. What 
 about the sand cure? Will one-half a teaspoonful a day of sterilized sand 
 be beneficial to the average person? How and upon what organs does it 
 act, and is there liable to be damage resulting from continued use? How 
 often would it be advantageous to use it?" 
 
 Reply. — As I have frequently written the cure for ordinary cases of 
 constipation is to eat bulkier food, particularly food containing a good deal 
 of roughening. I especially advise wheat, bran, unbolted corn meal, 
 breakfast foods which contain a good deal of bran or fiber, the stringy, 
 fibrous parts of meat, the peelings of apples, pears, peaches and apricots 
 and the hulls and seeds of grapes. 
 
 The receipt of this letter and several others indicates that the use of 
 sand for constipation is somewhat widespread. The first thought is that 
 it would be liable to cause intestinal stones. Yet intestinal stones are rare, 
 harm from them is so much rarer and we eat so much dirt with our food 
 and drink so much with our water that the danger cannot amount to- much. 
 If sand is used it should be free from clay and ordinary dirt. Possibly 
 it is best to bake it to make it sterile. 
 
 Even though we are careless about eating bacteria in milk it is just 
 as well to be careful about eating them in sand. It is probably better to 
 use peelings, bran and hulls than to use sand. But sand is better than 
 purgatives, oils, salts or ordinary constipation cures. 
 
 Breath of Dyspeptic. — W. E. H. writes : "Is there anything known that 
 will neutralize, deodorize or alleviate the breath of a chronic dyspeptic? 
 Mr. Howells, in a novel, alludes to the dyspeptic's breath in New England, 
 which might mean that it is hopeless; but is it entirely so?" 
 
 Reply. — The odor when not from the nose and throat is due to intes- 
 tinal putrefaction and the absorption into the blood of the gases that 
 result. The blood throws these gases into the air in the lungs. Nothing 
 neutralizes or deodorizes these gases. 
 
 To cure constipation and to prevent putrefaction use a diet composed 
 in large part of cheese, milk, buttermilk and sour milk. 
 
 Dr. Hawk of the University of Illinois in conjunction with several of 
 his colleagues has written a series of papers on water drinking. Among 
 other conclusions he says that drinking one pint to one quart of water 
 with each meal will decrease intestinal putrefaction and afford "many 
 other desirable and no undesirable features." 
 
 Cut Down Starches. — W. I. J. writes: "What is the meaning of 'intes- 
 tinal indigestion ? Am I right in understanding that all starchy foods are 
 digested in the small intestine? If so, isn't it best to eliminate such food 
 from the diet of one who is afflicted in that way? Kindly give me the diet 
 one should follow with this complaint. Is it curable? Is it the cause of 
 weak heart action, poor circulation, and cramps in the feet, as well as the 
 hands going Ho sleep' when in a lying position? What is your idea of fruit 
 eating under such conditions? Is deep breathing of any material benefit?" 
 
646 
 
 DIGESTION 
 
 Reply. — "Intestinal indigestion" is a rather loose term, which most 
 people use as meaning intestinal fermentation, and some as meaning 
 what nsed to be termed "biliousness." Some of it occurs in the small 
 intestine and some of it in the large. Starch digestion starts in 
 the mouth and keeps up under one kind of a change or another 
 until the starch is used for energy. The work which the stomach does in 
 digesting it is not of great importance. 
 
 If there is excessive fermentation it is an indication to cut in half 
 
 bread, potatoes, cere- 
 als, sugar and other 
 starches and to in- 
 crease meat and fats 
 enough to compensate. 
 Fruit eating is al- 
 ways advised. So is 
 deep breathing. 
 
 Intestines overdis- 
 tended with gas can 
 give a train of nervous 
 symptoms such as 
 "weak heart," "poor 
 circulation," "cramps," 
 "hands going to sleep," 
 and the like. 
 
 Sugar.— 0. C. B. 
 ivrites: "In your arti- 
 cle, 'To Live During a 
 Ripe Old Age/ you 
 speak of the 'lactic 
 bacilli of buttermilk 
 finding in the digestive 
 tube the ' sugary mate- 
 rial' required for their 
 subsistence. In a re- 
 cent newspaper item 
 Professor Metchnikojf 
 is said to have discov- 
 ered that the poisons 
 which produce old age 
 are 'nullified by sugar 
 and a 'bacillus living 
 in the human intes- 
 tines/ But my doctor 
 . warns me against the 
 use of sugar, saying it clogs the liver and harms the kidneys. (1) What 
 is the truth about the use of sugar? And what about the lactic bacilli 
 that live on 'sugar and 'sugary material'? I have been using buttermilk 
 for months, and find it a great deterrent of putrefaction. (2) In the use 
 of sugar, which is the more healthful, the brown or the refined white?" 
 Reply. — 1. Sugar is an excellent fuel and energy producer. It is all 
 right to use it in moderation but used beyond the capacity of the liver 
 to convert it it brings about glycosuria — or a variety of diabetes. 
 2. There is no difference from the health standpoint. 
 
 Fig. 228. — Position of Abdominal Contents. (1, 2, 4), 
 Liver; (3), Gall-bladder; (7), Stomach; (12), Small In- 
 testines; (13, 16), Large Intestines; (14), Appendix; (9), 
 Spleen. 
 
SUGAK EATING 647 
 
 Indigestion. — L. L. L. writes: "At times I have a heavy pressing feel- 
 ing just to the left of my heart. A doctor told me it was indigestion and 
 gave me some drops, but it does not seem to cure me. It makes me feel 
 nervous at times. Is it dangerous? Can it be cured? What is good food 
 to make one gain flesh?" 
 
 Reply. — Don't try to cure indigestion with drops. The cure for indi- 
 gestion is freedom from worry, mental calm, proper bowel habits, eating 
 small meals well chewed, never overeating and plenty of exercise in the 
 open air. Indigestion is not dangerous. Simple indigestion can be cured. 
 To put on flesh stop worrying. Drink milk and eat cheese and bread. 
 
 Catarrh of Stomach. — G. 0. D. writes: "What state or locality would 
 be the most helpful to one suffering from nasal and stomach catarrh? Is 
 there any relation between nasal catarrh and catarrh of the stomach, and 
 are climatic conditions a factor in catarrh of the stomach? Are gastritis 
 and catarrh of the stomach the same?" 
 
 Reply. — 1. Climate makes no great difference. 
 
 2. No. 
 
 3. One form of gastritis is sometimes called catarrh of the stomach. 
 If the term catarrh were abandoned we should get ahead faster. It is 
 loosely used to cover a lot of conditions. "The treatment for so-called 
 nasal catarrh is to have the particular disease diagnosed and then treated 
 properly. The treatment of catarrh of the stomach is to overcome con- 
 stipation, do physical work in the open air, quit worrying and pay a 
 decent regard to what is eaten and how it is eaten. 
 
 Intestinal Indigestion. — M. J. M. writes: "Will you kindly tell me what 
 kind of food and drink it is best to give one who is troubled with intestinal 
 
 Reply. — It is difficult to answer your question because it is not certain 
 what you term "intestinal indigestion." Most of the conditions called in- 
 testinal indigestion are food fermentations or putrefactions. Many of 
 these cases are the old condition called biliousness. 
 
 Now, to call them intestinal indigestion is getting somewhat nearer the 
 truth than biliousness but the cases require much closer analysis. 
 
 Suppose you decrease the amount of your food, increase your eating 
 time to three times what it now is and chew much more thoroughly. 
 
 If this does not give you relief you should have your condition studied 
 individually and find out just what your indigestion is and change 
 your habits accordingly. 
 
 Meaning of Proteid. — J. B. writes: "What is the meaning of proteid? 
 What is it obtained from? What is its use in the practice of medicine?" 
 
 Reply. — Proteid is albumin. There are different kinds of albumins, so 
 the term proteid is commonly used as standing for the group. We say 
 that milk is composed of water, fat (meaning cream), carbohydrates (mean- 
 ing milk sugar), proteid (meaning the albumins or curd part of the milk) 
 and salts. 
 
 We say that meat contains 20 per cent, proteid, meaning that if a 
 pound of meat is eaten the person eating gets one-fifth of a pound of 
 albumin. Proteids are food. It is that food element which is especially 
 needed for growing children and adults doing physical labor. 
 
648 DIGESTION 
 
 Salt Meat Diet. — W. J. T. writes: "Do salt meats as a diet allow 
 blood to become impoverished and produce, a bad complexion when the 
 digestion is good? Would you advise a fresh and salt meat diet for an 
 overstout person of middle age, whose bowels and circulation are sluggish?" 
 
 Reply. — Salt meat in ordinary quantities and not as an exclusive diet 
 will cause no harm. Too much salt meat and no green vegetables causes 
 scurvy. Salt or fresh meat as such has no particular effect on the bowels. 
 Eat salt or fresh meat but add plenty of roughening. 
 
 Exercise More; Eat Less. — A. B. writes: "Kindly advise me as to the 
 proper treatment for a bad liver. I have been affected for five years with 
 what seems to be sluggish action of that organ. At times I become de- 
 jected, dissatisfied with everything, including my food, and know that in a 
 few days I will have an attach of biliousness. It usually takes two or three 
 days then to get straightened up again, and for a time afterwards I will be 
 myself. A jaundice-like complexion and a desire for use of stimulants 
 and food to excess always accompany, or rather precede, these attacks. 
 Although I do not get much exercise, I take good care of myself, except at 
 these times, and my bowels always move regularly." 
 
 Reply. — Your attacks are a modified migraine or a gouty manifestation. 
 Although you are not constipated a saline purge will straighten you out. 
 The only permanent cure is to exercise more and eat less. 
 
 Don't Eat Apples. — E. F. G. writes: "Is there anything I can do to 
 overcome acid in stomach from eating apples? I am very fond of them 
 and they are almost a necessity to me, but if I eat three or four a day they 
 put my stomach on edge." 
 
 Reply. — If eating apples sets your stomach on edge don't eat them. 
 They are doing you more harm than good. 
 
 Onions and Health. — J. and K. write: "We ask you to please enlighten 
 us about the nutritive qualities (if any) of the onion. A says it is one 
 of the most healthful of foods, eaten either raw or cooked. He bases his 
 theory on tradition, and because so many well and healthy people eat 
 onions. He says they are conducive to sleep. B says they are indigestible 
 because they are belched back hours after having been eaten and their odor 
 is too strong." 
 
 Reply. — Onions have little food value. It is well to eat them in winter 
 for the same reason that we eat other vegetables and fruits of low food 
 value — for example, turnips, beets, celery, radishes, and oranges. It is not 
 because the odor is bad that onions are healthy. On the other hand the 
 fact that the taste and odor are appreciated when one belches does not 
 prove that they are hard to digest. Any strong odored food such as onions 
 or coffee flavors the gas belched. Odorless foods do not thus reveal 
 themselves. That is all there is to it. 
 
 Ptomain Poisoning Protection. — Mrs. T. N. writes: "Will you please 
 advise what precautions should be taken in using canned goods to prevent 
 ptomain poison? Would thorough heating make food safe? What home 
 medicine could one take if ptomain poisoning exists?" 
 
 Reply. — 1. Patronize reliable grocers. Select cans that are fresh look- 
 ing, unrusted and not swollen and that have but one soldered puncture hole. 
 
SUGAR EATING 64S 
 
 I am informed that two holes are always present in a salmon can. See 
 that the food when emptied from the can tastes, smells and looks right. 
 
 2. Some food poisons are destroyed by thorough heating. Some are not. 
 The risk is decreased more than half. 
 
 3. Produce vomiting by tickling the throat. Hot mustard water pro- 
 duces vomiting. Produce purging with salines. If there is much shock 
 use blankets and hot water bottles. 
 
 Unfortunately many of the food poisons develop without any change 
 in the taste, odor or appearance of the food. Inspection at the source, 
 dating and care in selecting one's grocer are about the only safeguards 
 against the tasteless poisons. 
 
 Appendicitis. — A reader writes: "1. What articles of food should he 
 rejected hy a young adult afflicted with chronic appendicitis and also chronic 
 constipation? 2. Should fruit he peeled, and are heans harmful? 3. Is 
 there any help in such a case outside of surgery?" 
 
 Reply. — 1. None. 
 
 2. Fruit should not be peeled except bananas, oranges, pineapples and 
 others with highly objectionable peeling. Grapes, apples, peaches, plums 
 and prunes should be eaten peeling and all. Beans are not harmful. 
 
 3. Chronic constipation can usually be relieved by eating bulkier food 
 and drinking more water. Nothing heals chronic appendicitis much except 
 operation. Some cases get well spontaneously. Prevention of constipation 
 is of some service. 
 
 How to Cure Heartburn. — Violet writes: "Will you kindly advise me 
 what to do for severe heartburn and helching immediately after eating? 
 I have heen troubled with it for ten years." 
 
 Reply. — Belching immediately after eating is a manifestation of nerv- 
 ousness. Nerves are also a potent cause of heartburn. Another important 
 cause is bad eating habits. In view of all this, it will be seen that the 
 remedy lies more along hygienic than medicinal lines. You might: 
 
 1. Cure constipation. 
 
 2. Eat slowly. 
 
 3. Put your teeth in order and keep your mouth clean. 
 
 4. Eat lightly; never gorge. 
 
 5. Drink a glass of water one hour after each meal. 
 
 6. Eat simple foods. 
 
 1. Avoid those foods the eating of which is followed by heartburn. 
 
 8. Exercise in the open air. 
 
 9. Keep your nerves in hand. 
 
 Take Cheese and Milk. — J. F. P. writes: "Will you kindly set forth 
 how intestinal putrefaction may he overcome? I presume flatulency is an 
 evidence of this condition. Is it possible for stomach eructations to come 
 from this cause?" 
 
 Reply. — Live on a diet of cheese and milk. Get the Department of 
 Agriculture bulletin on cheese. Indeed, write your congressman to send 
 you the diet series of bulletins. 
 
 Eructations of gas are due in the main to nervousness. It is a fre- 
 quent semi-hysteric manifestation in men and women. 
 
650 
 
 DIGESTION 
 
 Pork Must Be Cooked.— #. W. W. writes: "Does the process of curing 
 and smoking hams and sides make ham and bacon good, clean, healthful 
 food, the equal of No. 1 beef?'* 
 
 Eeply. — The curing and smoking of hams and sides makes the meat 
 good for eating after it has been cooked but not before. It has been 
 demonstrated that smoking does not kill trichina or bacteria. 
 
 Drink More Water.— J". J. writes: "1. What is intestinal indigestion? 
 I have had it for eight months. Is there any cure for it? 2. The amount 
 of urine passed each twenty-four hours is thirty-two ounces. Does that 
 indicate anything serious? My bowels will only move when I eat bran 
 bread." 
 
 Eeply. — 1. What is called intestinal indigestion is generally fermenta- 
 tion of the food in the intestines. Three hours after eating the food has 
 
 got out of the stomach. Its fur- 
 ther adventures take place in the 
 intestine where it lies for purposes 
 of digestion and absorption for 
 forty-five hours. Many people get 
 rid of intestinal indigestion by a 
 milk, cheese, vegetable and fruit 
 diet persisted in for some time. 
 
 2. It does not mean anything 
 serious. It does throw light on 
 your indigestion. If you will drink 
 twice as much water as you have 
 been doing you will be better off. 
 Don't economize on water. 
 
 Buckwheat Cakes.— Mrs. H. F. 
 
 R. writes: "1. What is the nutri- 
 tive value of buckwheat cakes? 2. 
 What is the difference between 
 graham flour and whole wheat flour? 3. Are pickles and spices such as 
 cloves, allspice, and others harmful or beneficial to the system?" 
 
 Reply. — 1. About the same as corn or flour cakes. They furnish heat 
 and energy especially. Eating them can be too long persisted in. 
 
 2. Wiley defines graham flour as unbolted wheat meal and whole 
 wheat flour, improperly so called, as fine wheat meal from which some of 
 the bran has been removed. 
 
 3. A moderate amount of pickle is beneficial, especially in winter. In 
 summer fresh vegetables and fruits are abundant enough to supplant 
 pickles. Spices, such as cloves, allspice and the like, I think do more harm 
 than good. 
 
 Fig. 229.— Trichina in Muscle. 
 
 Eat Three Meals. — C. M. C. writes: "Is it not better for a man of 50 
 in normal health and weighing 200 pounds or more to continue eating 
 three meals a day rather than omit luncheon for fear of becoming too fat? 
 He is a man of business and actively engaged." 
 
 Reply. — Yes, three meals a day are better than two. The aim should 
 be to decrease the amount of food taken. This can be more easily done 
 where several small meals are eaten rather than two large ones. 
 
SUGAR EATING 651 
 
 California Raisins. — V. F. N. writes: "Please advise me if it is well 
 for a person in good health who craves the large California raisin to eat 
 half a pound after dinner four or five times a week." 
 
 Reply. — The article is all right. The quantity is large, especially for 
 anyone who takes in other food anything like the usual quantities of starch 
 and sugar. 
 
 Cuts Out a Meal. — C. E. E. writes: "From time to time you are ashed 
 how to reduce weight, and recently you answered one person who ashed 
 you to outline certain food for that purpose. You said that what was good 
 for one might not he for another. I speak from personal hnowledge when 
 I say that it is not the hind of food but the quantity that does the business. 
 Here is the history of my own case. On December 31, 1911, I weighed 
 196 pounds. I am 5 feet 6 inches tall. This weight I hnew was wrong, 
 and I determined to reduce my weight to a reasonable basis. I also decided 
 that the less food I ate the less my weight would be. This was the hard 
 way, but it proved to be the right one. I cut out lunch. Then I ate less 
 at breahfast and dinner than before, and for a time walked five to ten 
 miles a day. It tooh some time to start to a lower weight, but in six 
 months I was down to 165. I wrote you, giving reduced weight and diet. 
 You advised me to eat more so as to slightly increase my weight because I 
 had reduced too rapidly, with the suggestion that later on, if I wished to do 
 so, I could start again. I was surprised to find that it was harder to start 
 uphill than it was down, for I had to double my ration and it was two to 
 three weehs before I could gain any at all. I went to about 170; then 
 reduced the amount of food, and held at that for some time. Later I got 
 to eating more at each of the two meals, and different food. I went to 185. 
 Then I reduced the amount, but used the same food and lowered to 162. 
 Now with a different diet but eating more I am at 17 If-. This proves that 
 if you eat more, regardless of the particular food, you will gain and lihewise 
 will reduce with the lessened amount. In fact, the way to reduce weight, 
 and in my opinion the only way, is the hardest of all ways: Eat less in 
 quantity and eat fewer meals." 
 
 Reply. — I think the average man will find it easier to distribute his 
 food into three or four meals rather than two. 
 
 Effects of Gum- Chewing. — ^Y. S. writes: "What are the good and bad 
 effects of chewing gum? Is oil of cinnamon injurious to the stomach?" 
 
 Reply. — 1. To chew gum after a meal aids digestion. Most people do 
 not chew their food long enough to mix saliva with it thoroughly. The 
 chewing of gum adds some saliva to the stomach contents. It is of more 
 service in stimulating the stomach muscle. It is especially serviceable in 
 helping the stomach to empty its contents. If one has overeaten and the 
 stomach is heavy something is gained by chewing gum for half an hour, 
 beginning two hours after eating. It helps to settle the stomach in a 
 "katzenjammer." So much for its good effects. 
 
 Gum does harm when continuously and everlastingly chewed. If saliva 
 is poured into the stomach all the time, if the stomach muscle is continu- 
 ously stimulated to work the digestion will be harmed. 
 
 2. Oil of cinnamon has a powerful effect on the stomach. Wisely used 
 it will help; unwisely used it will harm. By this I mean when used in 
 medicinal doses — more than a drop. The little used to flavor gum will 
 make no difference one way or the other. 
 
652 DIGESTION 
 
 Bicarbonate of Soda's Use. — Mrs. C. B. says: "In a recent Tribune 
 article you said that bicarbonate of soda was not harmful if taken occa- 
 sionally. I am obliged to take a teaspoonful about five times a week after 
 dinner, even though I am fairly careful with my diet, certain combinations 
 of food sometimes unexpectedly causing the heartburn for which I take 
 the soda. Will you kindly inform me if you think five times a week will 
 be injurious?" 
 
 Reply. — Five times a week is too frequently. You should have your 
 digestion investigated. Change your diet. 
 
 Sour Stomach. — M. M. writes: "Should a person who has been trou- 
 bled more or less with a sour stomach leave cereals alone? Often, no 
 matter how simple the meal, the food will sour before she leaves the table. 
 Sometimes hours later it seems to sour. She is 56 years of age and seem- 
 ingly, except for this disturbance, is in perfect health. She is careful in 
 her diet. Her breakfast of grapefruit, breakfast food, bran bread, and 
 cereal coffee often causes as much trouble as a heavy meal. Digestion 
 seems slow. She cannot eat anything of a lunch and then eat dinner at 
 the usual hour. Of late a mouthful of sour liquid comes up sometimes a 
 few moments after the meal. She occasionally consults a physician. He 
 gives her a few pellets, which do not seem to give any permanent relief." 
 
 Reply. — 1. No. Fruit acids such as enter into ordinary foods are not 
 related to the acid which causes acidity. 
 
 2. My guess is that she had a dilated, and perhaps also a displaced, 
 stomach but this is a guess and maybe wide of the mark. Have her go to 
 see a physician who will examine her thoroughly and then advise. Advice 
 as to hygiene is of first importance. A physician who superficially con- 
 siders the condition and gives a few pellets cannot help. 
 
 The Disease of "Bad Habits." — B. S. writes: "I am a man 65 years 
 old, good habits, fair appetite, sleep fairly well, but yawn continuously 
 during waking hours, feel tired, no ambition. Constipated badly for twenty 
 years, take Epsom salts every day before breakfast. Friends suggest my 
 trouble is kidney trouble. Tired always on arising. What is your advice?" 
 
 Reply. — Your case is easy. Your disease is bad habits and that is a bad 
 disease. It is worse because you don't know you have it. When one is 
 tired on arising it is because he has slept too much. Yawning continuously 
 means that you do not move about actively enough or fast enough in the 
 open air. Constipation means that you do not eat the right foods nor 
 drink enough water. Taking Epsom salts before breakfast is the worst 
 habit in the bunch of bad habits. 
 
 BELCHING 
 
 Belching is a sign of hysteria, neurasthenia or some other kind of a 
 "jimmy." Furthermore, it is a habit and a bad one. It belongs in the class 
 with stammering in that one learns how to do wrong when doing right is 
 easier. 
 
 It is true a little gas may form from decomposing food in the stomach 
 but the quantity will be small. A little gas may find its way from the intes- 
 
BELCHING 653 
 
 tines into the stomach but the gas inflated areas of the intestines are some 
 inches away and the direction of flow is away from the stomach. 
 
 Practically all the gas belched is first swallowed as gas. We swallow 
 some air when we eat hastily. We swallow gas with carbonated water, when 
 we chew and in many different ways. The profuse belchers, however, delib- 
 erately swallow air and then quickly belch it up. 
 
 If you will watch the Adam's apple of a person drinking water you will 
 notice a certain characteristic swallowing motion. Now notice the Adam's 
 apple of a belcher in action and you will see that he first swallows the air 
 and then belches it. Physicians demonstrate it more plainly by watching 
 the Adam's apple with X-rays. 
 
 How is the habit acquired ? A person overeats. In his distended stomach 
 there is a good deal of air. He belches and gets relief. Eecollection of this 
 remains with him in his subconscious memory. At some later time his 
 stomach is too tight. He can belch no gas to get relief. He swallows air 
 and then belches it. Before he knows it he has acquired the habit. 
 
 Neurotics, neurasthenics and hysterics are apt to get this habit just 
 as they are prone to get the whisky habit or the morphin habit or the tobacco 
 habit. 
 
 Of course, back of the habit lies some error. It may be overeating, 
 rapid eating, irregular eating, or indigestion, slow digestion, dilation of the 
 stomach or mild neuralgia of the stomach. 
 
 The habit has been acquired in an effort to find relief from some dis- 
 comfort. When such discomfort shows itself in a sensible person he changes 
 whatever is wrong. When it shows itself in a neurotic he leaves the cause 
 undisturbed but takes to belching just as another neurotic who feels off a 
 little takes to morphin or cocain or whisky. 
 
 Does any harm result? Yes, often. The belching of air siphons bile 
 into the stomach. Bile does not belong there. Bile persistently in the stomach 
 disturbs the digestion. The longer the belcher belches to relieve his stomach 
 the more surely he embarrasses his stomach. 
 
 The persistent swallowing of air upsets the working of the gate into the 
 stomach and also the gate out of the stomach. The stomach may become 
 dilated through the persistent swallowing of air. 
 
 However, as bad as any of these is the frame of mind of the belcher. He 
 is an "ailer." He probably regards himself as a dyspeptic. He is pretty 
 certain to have some form of persistent stomach complaint. He gets the soda 
 habit. 
 
 Of course, to start with a belcher is not thoroughly well poised or he 
 would not be a belcher. But the habit makes him more of an "ailer." 
 
 Cause of Belching. — F. D. writes: "What is the reason a person belches 
 about four hours after eating, and what should be the diet of a person so 
 afflicted? The belching generally lasts an hour or more" 
 
 Reply. — Belching is due to nervousness. The stomach should be empty 
 four hours after eating. If yours is not the irritation from the retained 
 food could start the nervous belching spells. If your stomach has not 
 emptied itself four hours after eating, the stomach muscle is weak, and 
 probably the organ is dilated. A dilated stomach requires attention. To 
 diet is not enough. 
 
G54 DIGESTION 
 
 Excessive Belching. — N. S. writes: "I have teen belching for three 
 days at intervals of from five to ten minutes, and I feel a lump in my 
 throat. Sometimes I find it difficult to belch and feel as if it would relieve 
 me, but it doesn't. It does not hurt when I eat and the lump in my throat 
 seems to resist the saliva and sometimes I feel a burning sensation when I 
 get through belching. What is the cause of this?" 
 
 Reply. — You are nervous. Control yourself. The only way to belch 
 every ten minutes is to swallow air, otherwise there would be no gas to 
 belch every ten minutes. You swallow air and then belch it just as some 
 people bite their finger nails. Get back on your keel. 
 
 Must Work Out Own Cure. — J. A. R. writes: "7 note you state that 
 nervousness is the cause of belching. Kindly give me some practical 
 remedy for nervousness, as I am troubled with belching/' 
 
 Reply. — Nervousness cannot be cured by a remedy. It means bad 
 mental training. A person must work out his cure by mental hygiene. 
 
 CONSTIPATION 
 
 There are few persons whether civilized or uncivilized who do not at 
 some time or other suffer from constipation. The old, the young and the 
 middle aged are troubled more or less. It matters not whether they are fat 
 or lean, outdoor workers, indoor workers or idlers; whether rich or poor, 
 well fed or half starved they have been, are now or will some time in their 
 lives be interested in the question. 
 
 Constipation has probably existed in all ages and in people of all nations. 
 No human ailment is so universally prescribed for by the medical profession 
 and no ailment is the subject of so much self-dosage. Doctors try to give 
 permanent relief but self-dosage looks chiefly to temporary relief. 
 
 To comprehend the problem one needs a little knowledge of the in- 
 testines and their contents. The entire alimentary canal including the 
 esophagus, stomach and small and large intestines is about five times the 
 length of the individual. The large intestine or colon is from four to six feet 
 long and from one inch and one-half to two inches and one-half in diameter. 
 It is of this part of the intestine that we are chiefly concerned in considering 
 the causes of constipation. 
 
 The colon is encircled by muscular fibers that contract and expand 
 alternately and this motion moves the contents along from above downward 
 toward the rectum, its lower and distant end. The lining membrane of the 
 colon is capable of absorbing fluids from its contents or of discharging fluids 
 into its cavity. 
 
 Too little fluid in the colon may be a reason for constipation. The lack 
 of fluid may be caused by too little being drunk and too little poured into 
 the bowel from its walls; or the fluid in the colon may be too readily absorbed. 
 
 Sometimes the character of the food is such that little residue is left to 
 pass on the colon because it all was absorbed in the digestive process. Under 
 these circumstances there is likely to be constipation, since there is little in 
 the bowel to be moved along. 
 
 The contents of the colon is made up of waste matter that has been 
 
CONSTIPATION 
 
 655 
 
 collected from all the tissues of the body thrown into the bowel and discarded 
 as no longer useful. Another item is the undigested particles of food that 
 are passed on from the stomach through the small bowel to the colon. The 
 next item is the fluid that is thrown into the tube from the mucous membrane 
 with which it is lined. 
 
 Only one of the three factors is subject to control and that is the 
 residuum from particles of food that have failed to be digested and absorbed. 
 
 Every adult of normal health and activity should have an action of the 
 towels each day, although two or three movements may occur with perfect 
 health. If hut little is eaten, and 
 especially if that little leaves a 
 small residuum to be passed on 
 to the colon, a normal movement 
 of the towels once in two or even 
 three days may te perfectly natural 
 and no harm ensue. 
 
 When the fluids are persis- 
 tently absorbed from the colon and 
 the contents become dry and hard 
 in the rectum with difficulty of 
 evacuation the condition is called 
 constipation. It is in some people 
 chronic — that is, continuous and 
 persistent. In those the bowel has 
 become distended with loss of the 
 contractile power of the muscular 
 fibers encircling it and the usual 
 warning sensations of a desire to 
 evacuate the rectum are lacking. 
 
 It must be remembered con- 
 stantly that the colon, especially 
 
 the rectum, is largely a receptacle for waste matter where it may be retained 
 under control for hours and even days at a time. 
 
 The most natural time for the emptying process is in the morning after 
 breakfast. With many persons it is possible to postpone this necessary act 
 for hours and even days but if such practice be persisted in the bowel witl 
 tecome accustomed to retaining an ever increasing quantity, the sensibility 
 will be lessened or lost, the normal desire for bowel movement will not occur, 
 and the pressure of the mass or reabsorption of excrementitious matter will 
 cause disability or ailment of some sort. 
 
 In the early morning when both the muscular and the nervous systems 
 are relaxed by sleep and rest an action of the bowels may be had in one who 
 perhaps has no promptings in that direction. It is important that one take 
 sufficient time before the mind and body become tuned up to the day's activi- 
 ties to attend to this important physical function. Children and youths, 
 both boys and girls, should be carefully coached in this respect by parents 
 and others responsible for their care and instruction. 
 
 It is important that parents should know that there is no sovereign 
 remedy, or drug, or combination of drugs that will effect a cure of consti- 
 
 Fig. 230.— V-Shaped Colon Mat Cause So- 
 called Intestinal Indigestion. 
 
656 DIGESTION 
 
 pation. Its remedy lies in knowing and practicing daily correct habits of 
 life. Nothing will take the place of daily "going to stool" in the right frame 
 of mind and getting relief. If this can be carried out faithfully in child- 
 hood and youth the majority of cases of constipation will be corrected. 
 
 Ultimate and permanent relief of long standing constipation must 
 come through education in the home, the school or the college, and through 
 the daily press; but as matters stand that is not possible today and other 
 aid must be sought, especially for adults in whom the habit has become more 
 or less confirmed. 
 
 Under these conditions the use of cathartics that throw into the colon 
 large quantities of fluids that wash it free from contents gives no tone to the 
 impaired bowel but leaves it flaccid and soft and more easily distended than 
 it was before. Mild laxatives may be resorted to daily but these do not cure. 
 All cathartics are for temporary relief only, and all take fluids from the body 
 that should be retained, while disturbing digestion more or less. 
 
 The foods that are eaten have an important bearing upon the constipation 
 habit. Fruit juices have a laxative effect with most people but there are some 
 in whom fruits only set up fermentation and create a gas that distends the 
 colon. 
 
 Foods that leave a residue to be carried along to the colon furnish bulk 
 and are beneficial because they make some irritation of the mucous lining 
 of the colon inducing a flow of watery substance that helps to soften the 
 mass and sweep it along. All vegetables such as spinach, other greens, let- 
 tuce, celery, asparagus, cabbage and radishes leave some residue. There is 
 also residue from lean meat. 
 
 Excessive fats and oils beyond what the digestion can absorb are carried 
 along and mechanically lubricate the bowel and hasten the emptying process. 
 These, however, may do harm by overloading the digestive apparatus and 
 creating indigestion. 
 
 The outer wall of all grains is indigestible and when eaten is carried 
 along to furnish the bulk. It does more than that. If the bran of wheat 
 or the outer skin of corn is examined under a magnifying glass it will be seen 
 to have a sharp edge. This sharp edge scratches the lining membranes 
 of the colon; the irritation excites contraction in the bowel and this forces 
 the contents along. It also increases the flow of juice into the tube, and 
 this also favors bowel action. 
 
 It is because of the above fact that all cereals have a vogue as break- 
 fast food and that whole wheat bread, bran and cracked wheat have been 
 found useful as remedies for constipation. 
 
 All kinds of nuts leave a residue and in addition they contain oil; 
 and all oil is a laxative if it finds its way into the colon. 
 
 The skin of most fruits are not digestible and are carried along to 
 make bulk in the colon and to excite it to action. That is the principal reason 
 why prunes have had a vogue as a breakfast food. 
 
 The pulp of oranges, even the inner part of the peeling, is edible and is 
 useful in forming bulk in the colon. Figs have a reputation of being useful 
 in constipation due to the multitude of indigestible seeds they contain that 
 scratch their way along the bowel in addition to whatever of aid there may 
 be in the fruit and skin. 
 
 
CONSTIPATION 657 
 
 Mucilaginous foods such as okra and flaxseed also are useful. Agar may 
 be regarded as a food if it is eaten. It is not digested. It travels through 
 the intestines as a moist, bulky mass. 
 
 Careful attention to a diet that leaves a residuum in the bowel will over- 
 come constipation in most people. In others where the habit is confirmed 
 and obstinate resort must be had to some laxative medicine taken judiciously 
 and at the right intervals. In the treatment of such cases the personal pecu- 
 liarities that may be the cause of the trouble must be inquired into, and this 
 is the field of curative medicine. 
 
 The Internal Bath. — A. R. writes: "1. What is an internal bath? 
 2. Should the internal bath be used as a regular routine?" 
 
 Eeply. — 1. Internal bath is a term which the manufacturers of a cer- 
 tain type of syringe are seeking to introduce. By it they mean the forcible 
 injection into the lower bowel of a considerable quantity of water. 
 
 2. No. 
 
 In explanation: After the food has been broken up and digested by 
 the saliva and gastric juice it enters the small intestine. During its travel 
 through this twenty-five feet of tube digestion is completed. Whatever is 
 soluble goes into solution and absorption progresses. 
 
 About five hours is required for the passage of food from the mouth 
 through the stomach and small intestine. The contents of the small intes- 
 tine are poured into the large intestine. This tube is about five feet 
 long. The progress of food through this tube requires about forty hours. 
 There is no digestion in the large intestine. That was completed in the 
 small. Absorption, however, is active. Bacterial action is at its maximum 
 in this part of the intestine. 
 
 The last eight inches of the large intestine is called the rectum. The 
 four feet above that is called the colon. The tube is the same, of the 
 same general structure, the same muscles, the same nerves and the same 
 arteries. It happens that toward its lower end the intestine makes a double 
 loop which, because of its S shape, is called the sigmoid. All of the intes- 
 tine below the sigmoid is called the rectum. 
 
 The intestine is lined by a self-cleansing membrane called the mucous 
 membrane. Whoever talks about using injections to wash that membrane 
 clean shows that he is an ignoramus or else that he is trying to put some- 
 thing over on the people because he thinks they are ignorant. 
 
 An internal bath consists in the injection into the intestine of water 
 under considerable force. In other words, it is a violently applied enema. 
 Now you have it and that is all there is to it. The enema causes the rectum 
 to empty itself. By its pounding force it may cause the colon to move 
 and empty some of its contents. So far as the washing effect is concerned, 
 the water docs not go above the sigmoid. It has the advantages and 
 disadvantages of an enema. 
 
 It is not good judgment for a man to be violently stimulating his lower 
 bowel every day with any form of enema. Presently he will have a lower 
 bowel which cannot be stimulated by anything. 
 
 The proper method of overcoming constipation is by changing habits of 
 eating and exercise. 
 
 Seeks Constipation Cure. — G. F. A. asks if there is any manner of cur- 
 ing chronic constipation, and if the constant use of laxatives is injurious. 
 
658 DIGESTION 
 
 Reply. — Chronic constipation does impair the health. If the teachings 
 of MetchnikofF are correct it is a factor in bringing abvut senility pre- 
 maturely. It is his teaching that absorptions from the lower part of the 
 digestive tract cause the arterial walls to thicken. There is a saying that 
 "a man is as old as his arteries." This means that with age the arterial 
 walls first become thicker and less elastic. Later they become brittle. 
 That which the affected person notices is that he does not feel up to par. 
 For years this may be all. But that is enough to make it worth while to 
 end it. It is a common condition especially among city people. 
 
 The reasons are many but two are more important than the others, viz., 
 lack of physical exercise and eating too small a quantity of bulky food. 
 Ordinary walking around a factory office or store or walking around the 
 house doing the household work does not suffice. If there is no better way 
 of getting exercise walking to and from work is commended. A daily walk 
 of two to four miles should help materially. If a man lives two miles or 
 less from his work let him walk to and from it. If he lives more than two 
 miles let him walk two miles before he takes the car or get off the car two 
 miles from his destination and complete the trip on foot. Walking to be 
 effective should be rapid. 
 
 The food of the city man is too nutritious and concentrated. One's 
 dietary should contain much fruit, cabbage, salads, corn, cucumbers, to- 
 matoes, turnips, carrots and vegetables of the rougher, tougher kinds. 
 Apples should be washed and eaten unpeeled. The peelings are just the 
 part which are most needed. The same is true of the peelings of plums 
 and most other fruits. Breads and cereals containing the husks of the 
 grain are advised. Ordinary flour is made from the inside of the berry. 
 It has discarded the outer cellulose parts that are not worth much for nutri- 
 tion, but are needed for bulk. 
 
 There is no short cut cure for constipation. Relief will only come from 
 methods persisted in until they become the daily routine., It is not the 
 proper plan, therefore, to rely on laxatives. When medical advice is 
 sought, as will be necessary in many cases, do not stop with a prescription 
 for pills and more pills. Have the physician find out the difficulty in your 
 particular case. Have him stay by it until he does find out and then go 
 after the cause. You cannot "short cut" in the medical end any more 
 than you can in the habit end. 
 
 Liver Does Not Cause Constipation. — E. B. aslcs : "Suppose the cause of 
 constipation is the liver, what should be done?" 
 
 Reply. — I doubt much if constipation is ever caused by the liver. I do 
 not know of any way by which anyone could say that the liver was caus- 
 ing constipation. I think that the simpler explanation is the better and 
 that is that constipation is practically always due to lack of physical 
 exercise and the eating of too highly concentrated food. After a habit has 
 been established a long time it sometimes becomes necessary to do some- 
 thing more than remove the cause in order that a cure may be effected. 
 These cases will require medical attention. I do not believe that anything 
 done to the liver will help them. 
 
 Remedy for Constipation. — 8. writes: "In replying to ( T. I. K! you 
 say, 'Do not take medicine for constipation' Being a chronic sufferer, I 
 ash what should be done to obtain relief by one 60 years old?" 
 
CONSTIPATION 659 
 
 Reply. — Try eating bran bread and bran muffins instead of white bread 
 and partake freely of fruits, especially figs, dates and prunes. Eat spar- 
 ingly of potatoes and meat but freely of vegetables, especially spinach, 
 rhubarb, and raw sauerkraut. Sometimes a glass or even two glasses of 
 cold water drunk about one-half hour before getting out of bed proves 
 effective. Where the condition is the result of lack of exercise practicing 
 bending exercises, forward, backward and laterally with the hands on the 
 hips is helpful. Walking, of course, is always helpful. Practice good body 
 hygiene. In some cases chewing and swallowing agar is of assistance. If 
 minor means of this sort do not help you then be advised by some physi- 
 cian. By all means do not take medicine unless so directed by a physician. 
 
 Constipation. — Mrs. M. T. B. writes: "My son, 2 years and 8 months 
 old, has been constipated ever since he was born. I give him a teaspoon of 
 cascara every night and that is not sufficient, for every little while he has 
 a sick spell, fever, and vomiting and his appetite is not good. He craves 
 sugar, candy, and sweet things generally. He is under weight and peevish. 
 Kindly suggest a good diet for him." 
 
 Reply. — My guess is that you are giving him too much starch and 
 sugar. Give him meat, fruit and vegetables. Correct his constipation with 
 vegetables and bran bread. Encourage him to play hard in the open air 
 and with other children. 
 
 Constipation and Pregnancy. — Mrs. M. K. writes: (( Would the fact that 
 a young woman has suffered for a long time from persistent constipation be 
 a danger if she should bear children? That is, would she be more liable 
 to Bright' s disease or other diseases that are liable to come on during 
 pregnancy •?" 
 
 Reply. — Practically, no. 
 
 Water in Constipation. — F. A. writes: "1. Is there any cure for con- 
 stipation? 2. Will drinking a quart of water or more a day make a person 
 fat who is naturally thin?" 
 
 Reply. — 1. Yes. The chances of cure of late cases is slight. 
 
 2. No. Drinking plenty of water makes the assimilation of food easier 
 than it would otherwise be and thus it contributes to "taking on flesh," 
 but as the only change in one's habits it would be ineffective as a fattener. 
 
 Castor Oil and Calomel in Constipation. — F. N. I. writes : "Please say 
 something as to the relative merits of castor oil and calomel as a cathartic. 
 There is a general idea that castor oil will not act as efficiently as calomel, 
 but that the latter is liable to be injurious in more ways than one. If 
 calomel is injurious and castor oil is not sufficiently far-reaching, what 
 would you recommend to take its place in cases where agar and fruits and 
 lots of vegetables and other coarse foods seem to be without effect?" 
 
 Reply. — Neither castor oil nor calomel should be used as a remedy for 
 constipation. For cases where fruit, vegetables, bulky food, bran and agar 
 fail some physicians are recommending nonabsorbable oils. My advice to 
 you, however, is to pass your problem up to a physician — one who has given 
 thought to the question. You have gone as far on your own hook as you 
 are justified in going. 
 
660 DIGESTION 
 
 Oatmeal in Constipation. — J. E. H. recommends as a remedy for con- 
 stipation the following: Put a cup of uncooked oatmeal into a quart of 
 cold water. Let it stand over night. Drink this water and eat the oatmeal 
 uncooked. 
 
 Reply. — The remedy proposed for constipation is good. 
 
 Wheat for Constipation. — Z. R. recommends the following as a cure for 
 constipation: "Take wheat in the grain, clean it as best you can, and 
 grind it in a coffee mill. Then cook it about an hour for breakfast. You 
 can eat it with milk or cream. It is cheap, wholesome, and good. It will 
 cure you of constipation." 
 
 Senna in Constipation. — R. writes: "Will the daily use of senna leaves 
 as a laxative tend to aggravate an obstinate case of constipation, or cure 
 it? Is there anything better to use?" 
 
 Reply. — It will have a slight tendency to produce constipation. Bran 
 or agar with plenty of rough food is better. 
 
 Laxatives. — R. E. V. writes: "What is your opinion of a laxative 
 compound from aloin, strychnin, belladonna and ipecac? If taken two or 
 three times a week by one troubled with constipation would there be any 
 harmful effects?" 
 
 Reply. — This is about as harmless a medicinal laxative as there is but 
 bran, vegetables and fruit are better. 
 
 Bowel Obstruction. — M. E. R. writes: "I have a strange feeling in my 
 stomach. Sometimes it seems as if it is in the right side of my stomach, 
 and sometimes near the center. It is not a pain, but seems as if some- 
 thing is clogged there. It has been like this for about a week. I have a 
 rumbling sound in my bowels. Do you think I have appendicitis?" 
 
 Reply. — Nothing in the history written suggests appendicitis. It does 
 suggest obstruction, partial and incomplete. If thorough purgation does 
 not prove this supposed partial obstruction to be fecal you had better see 
 a physician. 
 
 What to Do. — N. H. L. writes that he is "a young man greatly troubled 
 with indigestion." He then proceeds to describe a constipation which has 
 not yielded to the continued use of pills. He wants to know what to do. 
 
 Reply. — Constipation is prevalent among office and store employees in 
 cities. It is rare among laboring men and women. 
 Several things must be done to bring about a cure: 
 
 1. Eat bulky food in large quantities, apples unpeeled, all kinds of 
 fruits with the peeling wherever it is possible, cereals, whole corn bread, 
 whole wheat bread, wheat bran, celery, spinach and radishes. Especially eat 
 the tougher, woodier parts. Decrease the amount of meat, milk, white 
 bread and other less bulky foods. When meat is eaten consume the 
 stringier parts. The point is to go after the rougher parts of meat, vege- 
 tables and breads instead of trimming these off or leaving them on the 
 plate unconsumed. 
 
 2. Physical work, particularly strenuous work which brings the abdom- 
 inal muscles into play. 
 
 3. The plan mapped out must be persistently followed. Enemas and 
 pills are makeshifts. 
 
CONSTIPATION 661 
 
 If the above plan does not work out your salvation you must have your 
 case studied and a plan laid out for you and then you must follow it per- 
 sistently. Your condition is due to wrong habits and nothing short of a 
 changed habit will help you. 
 
 Pumpernickel in Constipation. — Inquirer writes: "I have been advised 
 to eat bran bread for constipation. My father says German pumpernickel 
 will answer the same purpose. Is this correct?" 
 
 Reply. — It has much rougher fiber in it and will give satisfactory re- 
 sults for most people if they will eat enough of it. Others will require 
 bulkier, coarser foods. 
 
 Try Eating Wheat Bran. — J. E. S. writes: "I have been troubled with 
 constipation as far back as I can remember. I am 28 years old. I also 
 am afflicted with indigestion. I always eat slowly, thoroughly insalivating 
 all my food." 
 
 Reply. — Cure the constipation by eating an abundance of wheat bran. 
 When you are relieved of constipation your indigestion should end of itself. 
 
 Try Eating Bran and Agar. — C. H. R. writes : "In obstinate costiveness 
 what is the fundamental trouble? Is it not torpid liver? Does not a weak 
 stomach cause costiveness? I eat cherries, pineapple, cheese, white bread, 
 and corn beef, and drink lemonade, buttermilk, chocolate, and coffee." 
 
 Reply. — As to torpid liver, no. As to weak stomach, no. Most cases 
 of constipation are due to concentrated food. Add to your present diet a 
 cup of bran, cooked if you like. Also eat a handful of agar a day. Drink 
 plenty of water. These methods failing, you had better see a rectal 
 specialist. 
 
 Use of Bran Bread. — E. B. writes: "Kindly state how much bran bread 
 one should eat daily for constipation. Is there any danger of eating too 
 much? You have published recipes, etc., but never have stated what 
 amount should be taken and how often. I eat several pieces at every 
 meal." 
 
 Reply. — Enough to get results is the measure. Eat plenty of fruit and 
 vegetables. Drink plenty of water. Remember the need of an abundance 
 of water in summer. 
 
 No Harm from Bran. — E. P. H. writes: "Is it harmful to eat bran 
 in its crude state, providing, of course, that it is well mingled with saliva 
 before swallowed?" 
 
 Reply. — No. 
 
 Suggestion for Constipated. — Well-wisher writes: "Here is a good, 
 tested, and tried recipe for bran gems: 'Mix a teaspoonful of baking soda 
 in one-half a pint of flour, with three-quarter teaspoonful of salt. Add 
 one pint of coarse bran. Mix six table spoonfuls of molasses in one-half a 
 pint of milk. Stir all together and bake in gem pans in a moderate oven 
 for about twenty minutes. Eaten with butter, they are as good as graham 
 or wheat gems and inexpensive, as they require no eggs and no butter. A 
 cup of prune juice drunk a half an hour before breakfast and agar taken 
 twice a day at meals with moist foods, together with bran gems, have been 
 known to cure aggravated cases of chronic constipation of years' standing." 
 
662 DIGESTION 
 
 Reply. — We print the above as a suggestion. 
 
 Uncooked Bran Better. — H. M. S. writes: "Will eating bran bread 
 aid constipation as much as using the uncooked article?" 
 
 Reply. — No. 
 
 Laxative Food. — Subscriber writes : "Is -flaxseed good for constipation? 
 If so, how should it be used?" 
 
 Reply. — Flaxseed meal as an ingredient of a laxative food would have 
 the advantage of containing a laxative oil as well as "roughening." It 
 would have the disadvantage of spoiling more rapidly. It is better suited 
 for use as an ingredient of a laxative food mixture than as a laxative food 
 of and by itself. 
 
 See Physician for Constipation. — L. S. writes: "I have been troubled 
 with constipation for about five years, although I have lived on a strict 
 diet of laxative foods. Can you tell me of any method of correcting this 
 trouble?" 
 
 Reply. — If agar, bran, plenty of water and an abundance of fruit have 
 not cured you you are in need of the services of a physician. There are 
 specialists on bowel troubles. Perhaps one of these can cure you without 
 an operation. 
 
 Enema in Constipation and Indigestion. — A. D. D. writes: "1. Would 
 you advise the use of a stomach pump, or enema, for indigestion and con- 
 stipation? 2. Do you think that by using one occasionally one will become 
 dependent or a slave to it? 3. Does indigestion cause cold feet and hands, 
 and a person to be cold natured in general?" 
 
 Reply. — 1. No. 
 
 2. Yes, though much depends on the frequency of use. A large pro- 
 portion of the indigestions are due to constipation. When constipation is 
 relieved the indigestion disappears. The way to cure constipation is not 
 by using drugs or enemas but by changing one's habits of eating. Cut 
 your meat and bread bill down one-half and double your bill for fruit, 
 vegetables, molasses, preserves and candy. 
 
 3. Yes. 
 
 Home Treatment for Constipation. — Dr. S. recommends the following: 
 1. Before rising, drink two-thirds glass cold water. 2. Automassage five 
 minutes. 3. Dress in union suit and, take constipation exercise. Jf. Go to 
 stool. 5. Breakfast. 6. Stool again, if first attempt was failure. 7. Lunch. 
 8. Dinner. 9. Bedtime. Wear moist abdominal bandage all night. 
 
 Constipation diet — [a] Liquid intake, [b] Food rich in fruit acids. 
 [c] Food rich in fruit sugars. [d] Food rich in cellulose, [e] Special 
 diet; cranberries, bran, agar, etc. 
 
 Food in Constipation. — Reader writes: "1. What foods should be 
 avoided by constipated persons? 2. Is it harmful to take any sort of a 
 bath after a meal?" 
 
 Reply. — 1. None. The condition is a sin of omission, not commission. 
 2. It is better not to take a cold bath or any other bath which is in- 
 tended to cause a shock. 
 
SEASICKNESS 66\ 
 
 What Is Agar? — M. S. writes: "What is agar? You mention it as a 
 cure for constipation. Where can I get it?" 
 
 Reply. — Agar is a seaweed. It has no taste and no nutritive value. It 
 is valuable because it holds on to water. Your druggist will get it for you 
 if you insist. 
 
 Keep On With the Oil. — Mrs, R. H. G. writes: "A great many of my 
 friends were converted to the use of paraffin oil after reading the article 
 in a magazine. The article said that a prominent London surgeon recom- 
 mended the use of the oil, refined and purified; that its use prevented auto- 
 intoxication; that it was not absorbed by the body. We all started its use, 
 enthused by the claims of the article, and the results have been great. One 
 person, a sufferer from bilious headaches, has had none since; another has 
 lost her depression. In fact, we all swear by the paraffin. Then along you 
 come and say of its use, 'Nothing is absolutely harmless.' We were all 
 frightened. Now, please be explicit. We are supposed to take a dessert- 
 spoonful of the oil every night forever. It is supposed to add to our years; 
 certainly it has added to our physical comfort. But if there's the least 
 modicum of future harm in its continued use we want to know it. Please 
 tell us and relieve us all." 
 
 Reply. — A few reports of harm from imperfectly refined oil have been 
 printed. Your attitude is wrong. To avoid everything absolutely without 
 risk you would quit breathing, eating, sleeping, riding on the cars, going 
 on the street, et cetera. Hazards cannot be escaped. Try to avoid the 
 extra hazards and forget the ordinary hazards. The oil is benefiting you. 
 Exercise care to get a good article and use it. 
 
 Patent Medicine in Constipation. — V. E. D. writes: "1. What is ver- 
 acolate and what are its properties? 2. Would its use for ninety days tend 
 to deaden the natural action of the bowels? In other words, would the 
 bowels learn to depend on the stimidation of the drug and not function 
 naturally? 3. I am 5 feet 5 inches tall and since July 5 have taken down 
 my weight from 190 pounds to 160 pounds by reducing amount of food con- 
 sumed and eliminating fats, sugars, and starches. I work in the open air 
 most of the time, but am constipated unless I use something to help. Will 
 veracolate do it?" 
 
 Reply. — 1. It is said to be a bile salts, phenolphthalein, cascara and cap- 
 sicum, and to be a mild laxative. 
 '2. In some measure, yes. 
 3. Yes. Probably bran and agar would be better. 
 
 SEASICKNESS 
 
 In The Dietetic mid Hygienic Gazette Dr. Boyd tells us that seasickness is 
 not a disease but a condition. Most of those who suffer from seasickness 
 will find themselves unable to judge whether Dr. Boyd is right or not but 
 they will agree with Grover Cleveland that it is a condition and not a 
 theory which confronts them. 
 
 Furthermore, Boyd tells us that most authorities recognize two forms 
 of seasickness — the psychical and the somatic and that it is often very hard 
 to make a differential diagnosis between these forms. In other words, some 
 
664 DIGESTION 
 
 of those who have it really have it and some think they have it and it is very 
 hard to tell the sheep from the goats. 
 
 There is no doubt but that many people can prevent seasickness and 
 that many others can make life more bearable while suffering from it by proper 
 attention to certain details. The first of these is to take a dose of citrate of 
 magnesia the night before sailing. The second is to eat frequently but very 
 sparingly during the voyage. 
 
 If the steamship companies would charge one fee for the haul and 
 the lodging and then serve all meals a la carte they would do more to 
 prevent seasickness than the ship surgeons have ever been able to do. 
 
 Then comes our old friend fresh air — the sovereign remedy, good for 
 all the ills that flesh is heir to. A good stateroom with plenty of window 
 access to the fresh air, a good deck place occupied by a good deck chair, and 
 that occupied by the party of the first part just as many hours a day as 
 possible are what is needed. 
 
 And do not forget that Boyd says it is almost impossible to tell the 
 imagination cases from the others. There is a pretty fair chance that you 
 may be one of the imagination cases and not know it. At any rate give 
 yourself the benefit of the doubt. 
 
 Bring your mentality to bear on the side of escape. Think about 
 the other fellow. He is probably worse off than you. Maybe your endolymph 
 is surging in your semicircular canals. If so, you may decrease the effect 
 of the surging by letting it surge unnoticed, and certainly by letting it 
 surge unanticipated. 
 
 If in spite of all you have done trouble overtakes you lie as quietly 
 as possible for as many hours as possible in the open air. Best a short while 
 after eating. Eat simple food and but little of it but eat. 
 
 Consult the Ship's Doctor. — C. B. C. writes: "I have taken a number 
 of long ocean trips, and, being susceptible to seasickness, I have used 
 Mother Sells' seasick remedy, which has prevented acute illness, and I have 
 not noticed any harmful results except extreme dryness of the throat. Can 
 there be anything harmful in its use?" 
 
 Eeply. — I judge you mean Mothersill's seasick remedy. If so, you will 
 find an article on it in "Nostrums and Quackery" (published by the 
 American Medical Association), page 475. According to that publication 
 it depends for its effect on its content of 8 per cent caffein and 46 per cent 
 acetone chloroform. The book referred to says it does not do all that the 
 label claims. If you use it have the ship's doctor keep an eye on you. 
 
 To Avoid Seasickness. — J. B. writes: "Would it be dangerous for a 
 woman who is five months' pregnant to cross the ocean? How can one 
 prevent seasickness?" 
 
 Reply. — 1. There is some danger but it is not great unless she is excep- 
 tionally subject to seasickness. 
 
 2. Eat lightly several days before sailing. Keep the bowels in good 
 condition. Keep the mind on other things. Do not expect to be sick but 
 keep cheery and optimistic and you will do much to avoid it. 
 
CHAPTER XXXVIII 
 
 Hernia 
 
 Why hernia? Whenever any part of the body contains organs of size, 
 weight, and importance the walls are bony. The head carries the brain in a 
 bony case. The chest carries the hmgs and heart likewise in a bony case. The 
 abdomen and pelvis constitute an exception. At that the method of forma- 
 tion of the abdominal wall during fetal life is the largest factor in pro- 
 ducing hernia. 
 
 Hernia runs in families. One practitioner found a family history of 
 hernia in one-third of his cases. Another 
 found that more than half of 700 hernias were 
 congenital. 
 
 Some of the external sexual organs start 
 their development in the abdomen and about 
 the middle of fetal life push their way to the 
 outside. This leaves a weak area, the inguinal 
 ring, in the abdominal wall through which 
 a hernia can escape either then or later. 
 
 The great blood vessel of the leg is formed 
 in the abdomen and pushes its way into the 
 leg. The point of exit, the femoral ring, makes 
 another weak area. 
 
 Until after birth the great blood vessels 
 which feed the child enter through the um- 
 bilicus making another weak ring. 
 
 There are an even dozen of these weak 
 areas in the abdominal wall. In about half 
 of them an open canal persists until after birth. 
 
 Not that there is an opening through the skin; that. is extremely rare. The 
 skin is only a covering. It has but little strength. The weakness is in the 
 muscles and fascia layers which should be and elsewhere are tough and strong. 
 
 If a man as he walks rapidly along will hold the palm of his hand 
 against his abdomen he will feel the jolt of his organs against the wall 
 with each step. But that jolt is nothing as compared with the drive of cough- 
 ing, sneezing and vomiting. 
 
 In a fit of coughing the intestinal drive against the abdominal wall is so 
 hard that occasionally some weak place gives and into the open space a loop 
 of intestines pushes. This is what is called an acquired hernia. When the 
 intestines push into a ring which has never closed it is called a congenital 
 hernia. 
 
 In addition hernias take the name of the weak spot through which 
 they push; for example, inguinal hernia, femoral hernia, umbilical hernia. 
 
 665 
 
 Fig. 231. — Method of Applying 
 Adhesive Strips for Maintain- 
 ing Reduction in Infantile 
 Umbilical Hernia. 
 
666 
 
 HEKNIA 
 
 Fig. 232. 
 
 -A Hernia Sack is a Pouch of Peri- 
 toneum. 
 
 Of every one hundred hernias eighty-four are in the groin — inguinal; 
 ten are just outside the groin — femoral, and five are at the navel — umbilical. 
 
 The other one per cent is 
 divided between the other nine 
 locations. 
 
 Hernias are important be- 
 cause of the inconvenience and 
 disability they cause and the 
 dangers they induce. Some 
 strain on the abdominal wall 
 converts a weak place into a 
 hole, just as a crawfish hole 
 breaks a levee in times of high 
 water. Through this hole any 
 organ in the abdomen or pelvis 
 may pass. As a matter of fact 
 only two structures pass with 
 any degree of frequency — loops 
 of the small intestine and 
 pieces of omentum. 
 
 In the exposed locations 
 the contents of the hernia are extremely liable to become strangulated or 
 ruptured or otherwise injured. One out of every thirty ruptures strangulates 
 or gets seriously hurt some- 
 how. A hernia emergency 
 is a great emergency. It is 
 no child's play. Quick eye 
 and instantaneous action 
 are required. None but the 
 best surgical skill will avail. 
 Hernias are also impor- 
 tant because of the disabil- 
 ity they cause. Six inches 
 of intestine outside the ab- 
 domen gets in the way, 
 limits work, and makes the 
 party timid about taking 
 necessary exercise. When it 
 is pushed back by a truss 
 some of the timidity will 
 pass away, but the truss it- 
 self gets in the way. Never- 
 theless, a truss must be 
 worn. 
 
 The question arises : 
 What should one do about 
 a hernia? If the hernia is Fig. 233. — Sites of Ruptures: 1 and 2, Epigastric 
 
 in a baby the chances are ^hST """"^ * lN ° CmAL HEENIA: 
 
HERNIA 
 
 667 
 
 six out of ten that a truss will cure it. If the person is between one and ten 
 years of age, the chance is one to ten. Of children less than fifteen years of 
 age trusses will cure one in twenty. When the affected ones are more than 
 fifteen a truss will cure an occasional case, but these cases are too few to count. 
 
 This, then, is about a reasonable policy : When a hernia is noted in a baby 
 give it about a year's trial under simple truss bands. If at the end of that 
 time it is not cured have it operated on. 
 
 What shall the adult do? The answer to that question depends on the 
 answer to other questions : Am I to be in reach 
 of the best surgical skill in case of strangula- 
 tion ? Do I want to run the risk of being the 
 unlucky thirtieth? How well does a truss hold 
 any hernia up? How many spells of pressure 
 colic have I had? How much am I incon- 
 venienced by the truss? How much am I dis- 
 abled by it? 
 
 If the decision is in favor of operation shall 
 the operation be by injection or by cutting? In 
 the injection method the canal is filled with 
 paraffin or with some irritating chemical. These 
 methods are both inefficient and dangerous. It 
 is dangerous to inject an uncontrollable irritant 
 poison into the tissues hoping that it will inflame 
 just enough and not too much. The cures are 
 exceptional and rarely permanent. 
 
 The cutting operation consists in damming 
 the hole by sewing over it the strongest muscles 
 and fascia found in the neighborhood. It is the 
 common sense method. 
 
 The best opinion is that no kind of an 
 injury or accident can cause a hernia. Dr. Plummer, chief surgeon of the 
 Rock Island Railroad, says : "In my opinion, a single strain can never be the 
 sole cause of a hernia. I have seen patients that had been run over by wagons 
 and by automobiles, squeezed between cars, struck by flying boards, who have 
 fallen from heights, been struck by locomotives, who have suffered ruptures 
 of the stomach, intestines, kidney, liver, and fractures of the bones from the 
 skull to the feet, but in no case have I seen an inguinal hernia resulting from 
 any of these injuries or from any injury." 
 
 Xow, there is no doubt that men have noticed hernias for the first 
 time just after an accident of some sort or another. They charged the 
 rupture to the accidents. They acted in good faith. What fooled them ? 
 
 What happens when hernia develops is this : 
 
 The intestines push their way through the wall of the abdomen; a loop 
 comes to lie in a sac; this sac is covered by skin but it is without the 
 wall of muscle which we call the abdominal wall. The sac is lined by the peri- 
 toneum, the covering of the intestines. The muscles of the abdomen are laid 
 clown in layers. There are weak places in the wall. The weak places are 
 the spots where the wall did not grow together until the child was nearly 
 ready for birth. For instance, one of the weakest spots is the navel. 
 
 Fig. 234. 
 
 Skein of Worsted 
 Truss. 
 
668 HERNIA 
 
 Hernia never happens except at one of these weak spots. Furthermore, 
 hernia does not come on suddenly. The protruding intestines must push 
 the peritoneum before them in order that the sac shall have a lining. 
 This lining pushes slowly. The weak place gives slowly. 
 
 Dr. Coley says: "In the vast majority of cases hernia is a disease rather 
 than an accident. The congenital defect is the main cause of a hernia, while 
 the immediate or exciting cause plays but a minor role." 
 
 The congenital defect he calls a disease. By it he means that the man 
 with a hernia was born with one or more weak places in his abdominal wall. 
 
 How does it happen that men frequently notice hernias for the first 
 time following accidents? The hernia was there before the accident. It 
 was small. It was gradually pushing its way through the wall. It caused 
 no pain. 
 
 When the accident had occurred the man felt of himself for the first 
 time, or for the first time he had a careful examination. The small soft 
 swelling was noticed. If the hernia was inguinal it may have pushed its 
 way to its final location. In case it was umbilical or femoral it was found 
 as a soft, non-tender swelling. 
 
 A hernia does not cause many symptoms. It is not tender or painful. 
 If pain is present it is because the loop of the intestine is being pinched. 
 The pain is colic and it is in the intestine. The sac does not pain or give 
 pain. Any painless condition is liable to steal upon those affected. 
 
 The history of hernia, then, is this: The person is born with a weak 
 spot in the abdominal wall. Through this weak spot a loop of the intestine 
 gradually pushes. Prolonged coughing and straining hasten the process. The 
 presence of hernia is generally discovered by some chance. Hernia usually 
 causes no pain. A painful hernia should have medical attention at once. 
 
 Hernia. — J. E. 8. writes: "In the case of a hernia in an adult, is the 
 person in as good a condition after a successful operation for it as he was 
 before he was afflicted? Do the life insurance companies reject an appli- 
 cant because he has had an operation for a hernia? I do not want to wear 
 a truss, because it keeps the abdominal muscles from healing over the 'hole' 
 that the intestine has made under the previous abnormal condition. A 
 hernial supporter is almost worthless in my case because it does not come 
 low enough, and at times it seems to bear down against the hernia. I 
 thought I should get an ordinary web abdominal supporter and have a few 
 thicknesses of felt sewed directly over the affected part. Is this a wise pro- 
 cedure? What causes a hernia ordinarily? I contend that it cannot be 
 lor is not] caused by ordinary coughing, except in a spasmodic cough or a 
 whooping cough." 
 
 Reply. — 1. Yes. 
 
 2. No. 
 
 3. I do not think it will avail. 
 
 4. If the wall is very weak an ordinary cough may cause hernia. As 
 the child is forming the abdominal walls grow from the region of the 
 backbone around toward the front to inclose the abdominal cavity. It is 
 very necessary that certain openings in this wall be left open until the 
 time of birth, or very near it. One of these openings is the navel; others 
 are in the groin. These openings close imperfectly because they close late. 
 If the imperfection is very great any cough will cause the weak place to 
 
HERNIA 669 
 
 open and let the intestines through. If the closure is very strong no cough 
 will break it. A truss should press on the opening and nowhere else (so 
 far as possible). If when a truss is worn there are colicky pains it is a 
 sign that the truss does not properly close the opening and the intestines 
 get pinched. This seems possible in your case. 
 
 No Bar to Marriage. — E. H. writes: "Do you think it would be advis- 
 able to marry a man with a double rupture? He is healthy otherwise. I 
 have been told not to marry him. I am healthy; a little hard of hearing 
 caused by catarrh/' 
 
 Reply. — Yes. Your difficulty is more liable to be transmitted than his 
 is. 
 
 Rupture. — P. S. J. writes: "Can a rupture on each side be cured with- 
 out an operation?" 
 
 Reply. — Sometimes a truss will cure — very exceptional. All other 
 methods of cure are operations. Sometimes injection of paraffin cures — 
 but it is uncertain and risky. Sometimes injection of' an irritant cures — 
 also uncertain and very risky. What is known as a radical operation is 
 safest and surest. 
 
 Operation Should Cure. — C. W. writes: "About fifteen years ago I 
 underwent an operation for hernia, and a supposed cure was effected. The 
 rupture has since come bach again. Do you think that, with the rapid 
 strides made in the treatment of this ailment, a permanent cure coidd now 
 be had by undergoing a second operation? Would you advise continuing 
 to wear a truss as long as no ill effects are felt and the truss is properly 
 fitted?" 
 
 Reply. — An operation should result in permanent cure. The exceptions 
 are few. If your hernia never gets caught and never produces colic you 
 should decide as to operation on the basis of the amount of inconvenience 
 from the truss [and the hernia]. If you are greatly inconvenienced be 
 operated on. 
 
 Need Operation for Rupture. — Jane writes to ask if there is any cure for 
 rupture besides operation. The rupture was caused after an operation for 
 appendicitis and fibroid tumor (abdomen). She asks: "Should one wear 
 a supporter or bandage all the time?" 
 
 Reply. — 1. No. 
 
 2. Yes. Rupture is purely a mechanical condition and cure must be 
 mechanical. In rupture the muscles have pulled apart leaving a weak area 
 through which pressure forces the intestines. The only cure is to pull the 
 separated structures together and fasten them securely. 
 
 Cure for Rupture. — A. E. G. writes: "Kindly state whether there is 
 any absolute cure for rupture outside of the knife, Christian Science, or 
 similar faith. I have come in contact with absolute proof of cures under 
 all of the above, but regarding other methods, nothing more than printed 
 testimonials." 
 
 Reply. — A man with a rupture should wear a properly adjusted truss. 
 When the rupture is so troublesome that radical cure becomes advisable 
 
 ^ 
 
670 
 
 HERNIA 
 
 the proper thing is an operation. Nothing else can be recommended. 
 
 Band May Help. — D. H. H. writes: "Can a child horn with a rupture 
 he cured without an operation? If so, how?" 
 
 Reply. — A band well adjusted sometimes helps the muscles and fascia 
 to cover over the hole. If this result does not follow within two months 
 it will not follow. No other method except operation need be tried. 
 
 Truss Will Not Cure. — Subscriber writes: "I have a single rupture. 
 Can it he cured by wearing a truss? Are doctors who advertise to cure 
 without an operation reliable?" 
 
 Reply. — 1. No 
 
 Fig. 235. — Abdominal Support, Plas 
 ter and Webbing (Dr. B. Schmitz). 
 
 it can be held up but not cured by a truss. 
 
 2. No; what they do is to inject 
 something into the sac. This is an 
 operation as much as the ordinary 
 surgical procedure. It is less certain 
 to cure and is more dangerous. 
 
 Not Cured; Held Up, — E. M. 
 
 writes: "Can hernia possibly be cured 
 by the so-called plaster pad truss 
 or by any form of manipulation?" 
 
 Reply. — Cured, no; held up, yes. 
 
 Patent Hernia Remedy. — W. P. 
 
 W. writes: "Has lymphol the proper- 
 ties claimed in this pamphlet, and 
 is this treatment likely to cure?" 
 
 Reply. — The remedy purports to 
 cure hernia radically by rubbing 
 with a liniment. 
 
 No, as to each question. 
 
 Knife for Cure. — A. L. T. writes: "For a healthy male, aged k0, do 
 you consider any treatment for inguinal hernia, other than the knife, 
 worth bothering with?" 
 
 Reply. — Truss for relief; knife for cure. Other methods are usually a 
 disappointment. 
 
 Rupture in Baby. — J. H. writes: "1. What is cause of rupture in boy 
 less than a year old? 2. What do you think of circumcision? 3. What is 
 indicated by baby now four months old that has been holding his head up 
 and tidying to sit up ever since birth?" 
 
 Reply. — 1. Straining; possibly violent crying. 
 
 2. Frequently advisable; sometimes necessary. 
 
 3. Nothing. Do not encourage him in his efforts. 
 
 Hernia and Rupture. — R. W. N. writes: "1. Is it generally advisable 
 to operate for cure of hernia or rupture? 2. Is the operation for rupture 
 often fatal? 3. Is laughing gas and oxygen superior to ether for an anes- 
 thetic? If so, why?" 
 
HERNIA en 
 
 Reply. — 1. Yes, when the operation is done by a careful surgeon and 
 the person operated on is not too young. 
 
 2. No. 
 
 3. In short operations, yes; in prolonged operations, no. It produces 
 less congestion and less degeneration. For this reason it is preferable 
 when operating on persons who suffer from chronic bronchitis, other lung 
 troubles, or Bright's disease. 
 
CHAPTEE XXXIX 
 
 Obesity and Thinness 
 
 TOO FAT OR TOO THIN 
 
 I presume the idea is general that the average man wants to be fatter 
 than he is if he is thin, or thinner than he is if he is fat. Certainly they 
 write that way and the getting fatter or thinner is talked about every time 
 a group get together. 
 
 You and I must not take these complaints too seriously. The speakers 
 are joking; they do not mean what they say and they do not intend that 
 you and I should believe them. 
 
 A woman will complain loudly about being fat when she has just seen 
 some woman whose lines are very graceful but she will not feel deeply 
 enough about it to change her methods of living. A man, having had trouble 
 fastening his collar, will talk about the tribulations of a fat man and will 
 then walk out to his dinner and eat in such abundance as to add still further 
 to his flesh. 
 
 Men are about what they really want to be, their complaints, pretensions 
 and idle statements to the contrary notwithstanding. A man's weight repre- 
 sents about that balance between eating and working which best suits him. 
 Though if he be thin he may feel inconvenienced by the cold or if he be fat 
 by the heat, he finds enough convenience all in all in eating just about what he 
 does and working about as he does to more than offset the inconvenience 
 which he feels. Fat people should either "put up or shut up." 
 
 A man who is willing to stand the inconvenience of it can be as fat or 
 as thin as he pleases. This is true of well men and even more than is com- 
 monly thought of those who are diseased. But the road is long and he who 
 travels it must tolerate with inconvenience. 
 
 Cures which claim that change in habits are not necessary are rank fakes. 
 We shall suppose that a man has carefully weighed the situation and has 
 decided that it is best that he should get thinner. He is wiping to undergo 
 the trouble of it all, to readjust his eating and his work. He can make use of 
 a system if he pleases provided he does not neglect to change his habits. 
 He may even be benefited by "a system," for unless he is unusually endowed 
 with "grit" he will need something definite as a staff to lean on. 
 
 How is obesity brought about? 
 
 Passing through some period in which extra work is done the person 
 gets in the habit of taking more food and the digestive organs of digesting it. 
 This extra food was needed on account of the extra work. When the period of 
 work was passed his eating and digesting habit have been established. The 
 extra nutritive material not being required for work is stored as fat. 
 
 672 
 
TOO FAT OR TOO THIN 673 
 
 Children and young people take an excessive amount of exercise; they 
 add to their bones and muscles; they get adjusted to this demand; they 
 grow up, quit growing, and take up sedentary occupations. Something must 
 be done with the -surplus of food to which they have become accustomed ; it is 
 stored as fat. 
 
 A woman nurses her baby for a year. She must eat enough for the two. 
 The demand stops; she stores the excess as fat. 
 
 Feeding, getting fat, and getting thin are matters of chemistry and 
 mathematics and nothing else. When Howe or Hawk at the University of 
 Illinois start out to make a feeding experiment, they begin by getting their 
 animals in a nitrogen balance — that is, they weigh and calculate just what 
 the animal takes in the shape of food and what it passes as waste. When the 
 nitrogen passed out exactly balances that taken in a state of nitrogen equi- 
 librium is established — the animal neither gains nor loses. 
 
 Starting with this they can run the weight of the animal up or dowr 
 precisely as they choose and can calculate to a nicety just how many food 
 units are required to make a given change. 
 
 In the same way Atwater of the United States agricultural department 
 establishes a heat equilibrium and with an instrument called a calorimeter 
 he can run heat up or down and measure the relation of foods to it. So 
 much of this work has been done, results are so certain, chemistry is such an 
 exact science that were it not for individual and species peculiarities it would 
 not even be necessary to "try it on the dog." 
 
 We can analyze foods and get their calories and their nitrogen units. 
 By calories we mean the heat and work value of foods; by nitrogen units we 
 mean their nourishing powers. 
 
 But a chemical analysis does not always give results which work out 
 right when the substances are put into practical use. In the first place, there 
 is no stone wall dividing these uses and each under certain circumstances can 
 get somewhat into the other's field. We use kindling to start a fire and coal 
 to continue it. But kindling can be used to continue a fire and one can 
 even start a fire with coal. 
 
 The principal reason for "trying it on the dog," however, is the differ- 
 ence in the powers of digestion and assimilation of different animals. One 
 of these qualities pertains to the food itself. It is called "units of energy 
 required for digestion." 
 
 Whole milk, as compared with bread in calories, runs 310 to 1,215; in 
 nitrogen, 3.3 to 9.2. But these are somewhat offset by the high digestibility of 
 milk, from 95 per cent for its fat and 97 per cent for its protein to 98 
 per cent for its sugars. Milk from an economic standpoint does not make 
 a good showing until this third point is taken into consideration. 
 
 In addition to the difference in the case of digestion of different foods 
 there is a difference in the digestibility of the same food by different kinds of 
 animals. A dog eating meat can extract the largest amount of units from 
 it with the least energy. A cow eating meat could get food units from it with 
 the greatest difficulty. This is, of course, the great value of milk; it is the 
 only common meeting ground for all higher animals. 
 
 In addition to the peculiarities of race there are individual peculiarities 
 and right here is where the great difficulties arise in our methods of dieting. 
 
6?4 OBESITY AND THINNESS 
 
 The cry is for "short cuts," "lazy measures." People want diet lists. The 
 handing out of diet lists is about the same sort of quackery as patent medicine 
 cures for obesity. 
 
 Of course, the really scientific way would be to follow the methods of 
 Chittenden, Atwood, Howe and Hawk and scientifically measure work, food, 
 intake and excretion and then adjust the diet and work in such a way that 
 on, say, January 1, 1913, the weight would be, say, 160 pounds. But that is 
 too much trouble and nobody would submit to it. 
 
 Is there any compromise way, any way founded on good science and good 
 sense and at the same time less difficult? Yes. 
 
 Let one keep his work and worry — for worry is work — as uniform as 
 possible. Let him weigh accurately. Let him measure and weigh his food and 
 increase or decrease it until he finds the quantities which cause him to change 
 in weight at the rate which he has planned for himself. 
 
 The plan provides that he keep accurate account of his work. In practice 
 he can allow a good deal of leeway for inaccuracy. There is no need for 
 the scientific exactness demanded by laboratory experiments. 
 
 It would be very much easier if a quantity standard could be set and 
 those who are "taking the cure" could follow that blindly. But the variants 
 are too great. The variation for the difference in percentage of values which 
 one man can extract from food as compared with another is conservatively 
 at as great as 25 per cent. 
 
 The second factor requiring variation is the amount of labor done. A 
 man doing hard physical labor will require 50 per cent more food than one 
 who does but little. The man doing hard mental labor — particularly as re- 
 gards worry and anxiety (since these work day and night) — will require more 
 food than the man following a routine mental occupation. 
 
 The third factor requiring variation is the season of the year. Between 
 cold and warm weather a difference of at least 20 per cent in the amount of 
 food is required. To keep up heat in winter requires food, especially fats. 
 This applies to the man who is exposed to cold in winter. It does not go 
 with the man who sleeps in a hot room, gets up, puts on lots- of wraps, walks 
 two blocks to a car and then stays in a warm office until he starts home at 
 night. 
 
 The stimulus of a cold skin means a need of more food. The second 
 man may call it winter but for him it is summer and he should not in- 
 crease his food. Say, then, 20 per cent variation according as men are exposed 
 to cold. 
 
 With such wide variation in the amount of food required for different 
 people it is just as impossible to lay down a quantity standard for all people 
 as it is to write out a diet list. The only plan is for each one to regulate 
 his quantity to suit his work, his experiences, the seasons, and his peculiarities. 
 Having established this, he can work up if he wants to get fat; he can work 
 down if he wants to get thin. But up or down, it will be work. 
 
 Getting fat will prove more difficult than getting thin but if consump- 
 tives who are in the nonfebrile stages do get fat whenever properly controlled, 
 "the lean kind" should not lose hope. 
 
 Finally there should be no intemperance in changing weight. A plan 
 of gradual change is wise. If getting fat and thin is subject to mathematical 
 
REDUCING AXD FATTEXIXG 675 
 
 and chemical control it is within the reach of any who are willing to undergo 
 the necessary inconvenience. 
 
 REDUCING AND FATTENING 
 
 Sugars and starches the chemist groups under the head of carbohydrates. 
 When the animal body burns carbohydrates energy is produced. Grease 
 and fats the chemist groups under the head of hydrocarbons. As the 
 word hydrocarbon is liable to be confused with carbohydrate by the readers 
 of this article I shall use the term fat instead. When the animal body 
 burns fat heat is produced. 
 
 Albumins, whether from meat, milk, or vegetables, the chemist terms 
 protein or proteids. When proteicls are burned the elements produced go 
 to repair tissue. The salt and similar substances in foods the chemist terms 
 salts. When these are absorbed and go into the tissues themselves, they are 
 used to repair tissue. 
 
 Anyone reading the above would get the idea that the different kinds of 
 food are pigeonholed to stay — that carbohydrates can make energy only; 
 fats heat only, and proteids repair material only. The fact is that a good 
 deal of interchange is possible. When one needs energy and cannot get 
 carbohydrates, fats and proteids can help out : when one needs heat and 
 grease cannot be had, the other groups help out. and when one is doing things 
 that ordinarily call for proteid and enough proteid cannot be had, by eating 
 plenty of starch and sugar the proteids of the body can be spared. 
 
 Arctic explorers have found that they can prevent their muscles from 
 being burned out by feeding their life fires plenty of sugar. 
 
 With this foundation, my readers will be able to understand what 
 follows. 
 
 The greatest authority on diet for disease is Professor von Xoorden of 
 Vienna. 
 
 Are you fat ? Do you want to reduce ? Then read what the great Aus- 
 trian says about it. He tells us that we must get rid of the idea of something 
 for nothing. The only way to have a cure is to earn it. 
 
 When a man buys one of those get-thin-quick-Wallingford obesity cures 
 he wants to cheat the game. He ends by cheating himself. The Wallingfords 
 in the obesity business know that the suckers want to cheat and they see to it 
 that they cheat themselves while Wallingford acts as receiving teller. 
 
 Yon Xoorden says : "It was formerly thought that certain foodstuffs 
 were especially bad for the corpulent, or the reverse. We now know this is not 
 true. The amount of fat gained or lost by the body depends ultimately on the 
 ratio between its requirements in calories and the actual supply." 
 
 I should have explained the term — calories — earlier. It means heat units. 
 It is a measure of the heat producing power of the food. As a measure of 
 the energy producing value it is fairly good. As a measure of the repairing 
 value of food it is only moderately good. Where we are limited to one way 
 of measuring the value of a food the calorie is the measure employed. 
 
 You will note that in the above quotation von Xoorden tells us that 
 the way to reduce is to reduce the fuel value of the food taken below the re- 
 
676 OBESITY AND THINNESS 
 
 quirements of the person reducing; in other words, to force him to supply 
 the deficiency by burning up his own fat. 
 
 The natural way to proceed is to reduce equally the three groups. Von 
 Noorden tells us that that does not work. The appetite is satisfied by bulk of 
 food, not by quality. The dieting man must not get too hungry. Further- 
 more if his food is not bulky he will become constipated. 
 
 The object should be to make the heaviest cuts in those foods presenting 
 the most nourishment in the least bulk. He therefore excludes cream, butter, 
 fat meat and all other forms of grease. 
 
 Those of us who eat the tender meats made from fat, high grade pointed 
 beef get a good deal of fat in the lean. His diet list allows about four 
 ounces (a quarter of a pound) of protein (lean meat, for instance) a day 
 and about eight ounces (half a pound) of starches and sugars. 
 
 Bread is more responsible for obesity than any single article of diet. The 
 reason is that bread does not usually figure in the count. If one eats at a 
 restaurant the rule is that bread is not charged. If one recounts what 
 he eats at home he tells his story in terms of meat and vegetables. Bread 
 is what the New Orleans man calls lagniappe — thrown in without charge. 
 
 When one weighs his food as a part of a dieting program he discovers 
 what a heavy bread eater he has been. 
 
 Von Noorden is of the opinion that rapid cures of obesity can be free 
 from danger if the food bulk is kept up and the blood pressure is adjusted 
 by drinking water. On the subject of cure by refraining from water he says : 
 
 "The amount of water is entirely without influence on the process of fat 
 reduction/' 
 
 Water should be used to fight the disturbances of circulation. When the 
 man feels exceedingly faint and "gone" he needs a drink of water to increase 
 the volume of blood. 
 
 Generally speaking, von Noorden is in favor of slow reduction and against 
 rapid reduction. 
 
 To sum it all up, the way to reduce is to eat less food than your 
 system requires, not somebody else's system — your system. In reducing the 
 food it is advisable to eat within limits of bulky food of low food value. The 
 group of foods to be most cut are the fats. 
 
 There are many people who think they want to get fat. Some of them 
 want to get fat and some only think so. If a person is of a consumptive 
 family, or has consumption, or has been cured of consumption he had better 
 get fat and stay fat. All others are better off as they are. 
 
 There is a large group of thin-as-a-rail, highly nervous people who are 
 most anxious to get fat. They sometimes go to great trouble to get fat. 
 Usually they have an idea that if they get fat they will be less nervous. 
 
 It is the other way round. When they quit worrying, move out into 
 smoother waters, get less nervous, they begin to fatten. But there is no use 
 lecturing; there are large numbers of thin people who want to get fat. 
 
 Von Noorden tells us that in his clinic they are able to fatten patients 
 on an average of four pounds a week. This is better than the average 
 in the consumption sanitaria. 
 
 This is the von Noorden way. He is seldom able to give more than 
 four ounces of proteid a day. If he tries to give more it brings on indiges- 
 
REDUCING AND FATTENING 677 
 
 tion which defeats the object. The carbohydrates are raised as much as 
 is possible but it is seldom possible to give more than ten ounces a day. 
 Four ounces of proteid and ten ounces of carbohydrate give 1,400 calories. 
 
 To this diet he then adds as much fat as the patient will stand. He 
 usually gets up to ten ounces. This gives 2,700 calories a day. 2,700 
 calories digested and absorbed by a man not doing manual labor will put 
 on fat. 
 
 In order to get a person to take that much food value in a day good 
 cooking is required. By good cooking is meant skillful covering up of tastes 
 and odors and development of new tastes and odors. Also an ability to 
 take milk, bread, meat, eggs, butter, cream and oils and to twist them first 
 this way and then that way. 
 
 Von Noorden warns us that when we fatten a man we do not gain much 
 for him. "We are only increasing the amount of fat in the body. Of course, 
 proteins are well stored in the body, but even under the most favorable cir- 
 cumstances their amount is very small compared to the increase in fats. 
 Moreover, it is very questionable whether the nitrogenous substances which 
 are retained during overfeeding really produce an increase in the living 
 protoplasm/' 
 
 Diabetes. — In diabetes sugar is present in the urine. The kidneys put it 
 there but in doing so they only did their duty. They put sugar in the urine 
 to get it out of the blood. The essential condition in diabetes is excessive 
 sugar in the blood. There is always sugar in the blood. The work of the 
 body requires it. In diabetes the amount is much beyond the require- 
 ments and the kidneys eliminate the excess. The sugar is in the blood 
 because the liver put it there. 
 
 Now we are getting back to the important causative factor in most 
 cases of diabetes. An excessive activity of the sugar forming function of 
 the liver is a chief feature in diabetes. The most important excitant of the 
 sugar forming function of the liver is the carbohydrates of the food. Note 
 that the starch and sugar eaten do not pass directly into the sugar of the 
 blood. They stimulate the liver to make sugar, using, however, elements 
 that they furnish. They are first torn down and then built up. 
 
 The first step then in treating diabetes is to cut down the starches and 
 sugars — to cut out bread, potatoes, sugar and sweets of all sorts; to use only 
 those diabetic flours that contain 20 per cent or less of starch and not to 
 eat bread from those unless the starch has been well cooked, cooked as is the 
 crust of the bread. 
 
 To keep this up for months is as far as many people need to go. But. 
 it cannot be kept up indefinitely. The man with diabetes burns up tissue 
 much more rapidly than does the well man. Absolutely at rest he burns 
 up more tissue than a healthy man digging ditches twelve hours a day. 
 American investigators have proved those points. 
 
 This waste must be provided -for. Naturally, we say increase the fat 
 and the proteid. Give the man enough butter, cream, olive oil, cotton seed oil, 
 butterine, lard and fat meat to compensate — which is good advice up to 
 a certain point. The stomach will only stand for a certain amount of fat. 
 
 Naturally, also, we say give the man an excess of lean meat, gluten 
 flour and other forms of proteid. But there a danger lies. The experi- 
 
678 OBESITY AND THINNESS 
 
 menters have found that proteids stimulate sugar production by the liver. 
 Eubner tells us that in healthy people this action is slight but in diabetics 
 it is great. 
 
 Von Noorden tells us that we must give proteins but that they must not 
 wholly replace the carbohydrates. They must not be given in excess. He 
 says that proteins of eggs and vegetables are better for diabetics than those 
 of meat and milk. 
 
 He furthermore says that mixed meals should not be eaten. Where 
 one is eating carbohydrates and proteids he should eat the carbohydrates 
 at one meal and the proteids at another and more than two hours should 
 intervene between the meals. 
 
 However, fats cannot carry all the load. The stomach will not stand 
 it. His advice is to give as much fat as the stomach will stand and then 
 to divide the balance of the requirement between starches and proteids. 
 
 After the first period of nearly complete carbohydrate starvation has 
 been gone through with von Noorden allows his patients to increase the 
 amount of starch and sugar taken and to decrease the amount of proteid. He 
 thinks the meals and flours from oats are the best forms of starch. Next 
 in order he places banana flour. 
 
 He thinks that when the amount of meat and other proteid is kept ex- 
 tremely low the patient can take wheat, rye and potato starch without harm. 
 
 Diseases of the Kidney. — By this name von Noorden designates the 
 different kinds of Bright' s disease. In them the kidneys are crippled. The 
 crippled organs must be spared as much as possible. "The more protein is 
 broken down in the body the more will the kidneys be tired out with work. 
 The fact that medical practice has for a long time insisted on the value of a 
 minimum intake of all forms of protein in nephritis is a special expression 
 of the general view that damaged organs require the greatest possible amount 
 of rest." 
 
 Chittenden of Yale has taught us that we can get along permanently 
 on a small amount of lean meat. People with Bright's disease need some 
 meat, milk and eggs but they do not need much. Von Noorden says that 
 spices and all extractives should be excluded from the diet. 
 
 Everybody knows what spices are. Most will need to be told what 
 extractives are. Extractives, roughly, are the flavors of meat. Beef tea 
 is rich in extractives; boiled beef is poor in them. Meat soup is rich in ex- 
 tractives; the meat removed from the soup is poor in them. A good rich 
 chicken soup made out of an old hen is exceedingly rich in them. 
 
 Von Noorden also lays stress upon the strain put on the kidneys by 
 the removal of water from the blood. The practical teaching of that is 
 that it is well for a nephritic to spend the winter in the far South where 
 the climate is both warm and even. 
 
 The idea is that in ridding the body of the surplus water the kidneys 
 must do what the skin fails to do. In such a climate the skin stays on 
 its job of exuding water all the year and the kidneys are never required 
 to carry an extra burden. 
 
 If spring waters are used the best are those with little mineral in them 
 — the plain flat, pure waters. 
 
 Von Noorden ends his article by cautioning against stereotyped rules in 
 
SCALE OF WEIGHTS 
 
 679 
 
 diet. What is too much for one man is not enough for another. What is 
 food for one man is poison for another. 
 
 It is an everyday experience that hard and fast rules are laid down 
 and carried out which only regard the name of the disease and do not 
 take any account of the individuality of the patient. 
 
 In dieting two pairs of scales are necessary — one to weigh the subject 
 on; one on which to weigh his food. 
 
 SCALE OF WEIGHTS 
 
 A woman 10 per cent overweight is fat. One 20 per cent overweight 
 is obese. These statements recently appeared in a leading medical journal. 
 To be called fat is bad enough ; to be called obese is intolerable. 
 
 To reduce is not easy. Self-denial is required. Sensations unpleasant 
 enough to be called suffering will be experienced. Something more than 
 impulse is needed. Perhaps knowledge that one is obese may supply the 
 necessary incentive. 
 
 The New York Life Insurance Company uses a scale of weights from 
 which the following table is made up : 
 
 4 FEET 9 INCHES 
 
 5 FEET 4 INCHES 
 
 Age 
 
 Sex 
 
 Normal 
 Weight 
 
 Obese 
 if Over 
 
 Age 
 
 Sex 
 
 Normal 
 Weight 
 
 Obese 
 if Over 
 
 20 
 30 
 40 
 55 
 20 
 30 
 40 
 55 
 
 Female 
 
 Female 
 
 Female 
 
 Female 
 
 Male 
 
 Male 
 
 Male 
 
 Male 
 
 100 
 105 
 110 
 118 
 104 
 110 
 114 
 117 
 
 125 
 
 131 
 
 137.5 
 
 147.5 
 
 130 
 
 137 
 
 144 
 
 147.5 
 
 20 
 30 
 40 
 55 
 20 
 30 
 40 
 55 
 
 Female 
 
 Female 
 
 Female 
 
 Female 
 
 Male 
 
 Male 
 
 Male 
 
 Male 
 
 123 
 
 129 
 
 135.5 
 
 145 
 
 128 
 
 136 
 
 141 
 
 145 
 
 148 
 155 
 163 
 174 
 160 
 170 
 177 
 181 
 
 5 FEET 
 
 5 FEET 6 INCHES 
 
 20 
 30 
 40 
 55 
 20 
 30 
 40 
 55 
 
 Female 
 
 Female 
 
 Female 
 
 Female 
 
 Male 
 
 Male 
 
 Male 
 
 Male 
 
 109 
 115 
 121 
 
 128 
 114 
 121 
 125 
 
 128 
 
 138 
 145 
 152 
 161 
 145 
 151 
 156 
 163 
 
 20 
 
 30 
 40 
 55 
 20 
 30 
 40 
 55 
 
 Female 
 
 Female 
 
 Female 
 
 Female 
 
 Male 
 
 Male 
 
 Male 
 
 Male 
 
 130 
 
 136.5 
 
 143 
 
 153 
 
 136 
 
 144 
 
 150 
 
 154 
 
 163 
 171 
 
 178 
 188 
 169 
 176 
 186 
 196 
 
 5 FEET 2 INCHES 
 
 5 FEET 8 INCHES 
 
 20 
 
 30 
 40 
 55 
 20 
 30 
 40 
 55 
 
 Female 
 
 Female 
 
 Female 
 
 Female 
 
 Male 
 
 Male 
 
 Male 
 
 Male 
 
 116 
 123 
 128 
 136 
 122 
 128 
 133 
 137 
 
 146 
 155 
 162 
 172 
 152 
 160 
 167 
 171 
 
 20 
 30 
 40 
 55 
 20 
 30 
 40 
 55 
 
 Female 
 
 Female 
 
 Female 
 
 Female 
 
 Male 
 
 Male 
 
 Male 
 
 Male 
 
 138 
 
 145.5 
 
 152.5 
 
 163 
 
 144 
 
 153 
 
 158 
 
 163 
 
 173 
 182 
 192 
 204 
 180 
 190 
 197 
 205 
 
680 
 
 OBESITY AND THINNESS 
 
 5 FEET 10 INCHES 
 
 6 FEET 
 
 Age 
 
 Sex 
 
 Normal 
 Weight 
 
 Obese 
 if Over 
 
 Age 
 
 20 
 30 
 40 
 55 
 20 
 30 
 40 
 55 
 
 Sex 
 
 Normal 
 Weight 
 
 Obese 
 if Over 
 
 20 
 30 
 40 
 55 
 20 
 30 
 40 
 55 
 
 Female 
 
 Female 
 
 Female 
 
 Female 
 
 Male 
 
 Male 
 
 Male 
 
 Male 
 
 147 
 155 
 162 
 173 
 153 
 163 
 168 
 173 
 
 184 
 193 
 203 
 217 
 191 
 203 
 210 
 217 
 
 Female 
 
 Female 
 
 Female 
 
 Female 
 
 Male 
 
 Male 
 
 Male 
 
 Male 
 
 156 
 164 
 172 
 183 
 163 
 172 
 178 
 183 
 
 195 
 205 
 212 
 227 
 204 
 216 
 224 
 227 
 
 A tendency to take on fat is of different significance according to age 
 or other circumstances. It has been asserted that obese children are especially 
 prone to develop diabetes in middle age. As will be noted from the above table 
 there is a natural tendency to take on fat as age progresses. Between 40 and 
 55 years of age this is very much more marked in men than in women. 
 
 Producing this change are several factors. One is an improper relation 
 between muscular work done and the amount and kind of food eaten. An- 
 other change is in certain internal secretion glands — the thyroid and the 
 sex glands particularly. A third is a general tendency toward equanimity. 
 
 When senile atrophy has advanced further the tendency to obesity is re- 
 placed by a tendency toward emaciation. People who approach three 
 score and ten will do well to forego all measures having for their end holding 
 the fat down. After that milestone has been passed effort should be made 
 to put on flesh. 
 
 OBESITY 
 
 In all cases obesity results from a disturbance of nutrition. Too much 
 food of all kinds is eaten and not enough exercise is taken. The body 
 cannot burn the food up into the final products of combustion — carbon dioxid 
 and water. The system uses a makeshift. It converts the excess of food, 
 particularly the starchy foods, into fat and shoves it aside into the tissues 
 to get it out of the way. 
 
 If the food did not come in such large quantities and at such frequent 
 intervals, if the body were given time and opportunity to oxidize the food by 
 work, it would take the materials essentially needed, burn up the rest 
 and not be burdened by excessive deposits of fat. Where laziness abides 
 fat resides. 
 
 All ease and pleasure loving peoples have their pleasure spoiled by the 
 fat accumulated. Thus obesity is met with in great frequency among the 
 oriental and African races. 
 
 Obesity and gout are closely associated and both thrive on the same 
 victim. Alcoholic indulgence, injury or invalidism preventing bodily exer- 
 cise do their share to load the body down with fat. 
 
 Outside of "looks" — which are sometimes in and at other times out 
 of fashion — obesity is a serious hindrance to the enjoyment and comfort of 
 life. The internal organs all have deposits of fat that may interfere with 
 their proper action. Shortness of breath, bronchitis, palpitation and other 
 
OBESITY 681 
 
 functional embarrassments are occasioned. It also results in lessened in- 
 stance to infection. 
 
 The prevention of obesity rests on regulation of diet, habits and exercise. 
 No more food should be taken than can be used up by the body. An exces- 
 sive diet of starch foods and malt liquors should be avoided. The real 
 burning up of food is not accomplished in the stomach but in the lungs and 
 muscles. They are the metabolic furnaces. Keep your lungs and muscles 
 active. 
 
 The treatment for those who already suffer is chiefly along the above 
 lines. The fundamental conditions should be removed. Stop feeding the 
 trouble. The diet should be cut to at least one-half the usual amount. 
 Fats and starches should be limited a little more than the proteids. The total 
 elimination of fats and starches is not thought advisable. The amount of 
 liquids should also be limited. 
 
 Indolence and disinclination to exercise should be strenuously combated. 
 Too much sleep or idle lying abed should not be encouraged. 
 
 Invalids not able to take active exercise should practice passive move- 
 ments. Frequent cold bathing by those who can tolerate it is beneficial. The 
 skin and kidneys should be kept active. There is an anemic form of obesity 
 that requires special treatment. 
 
 In most cases people can fight off fat if they are determined and per- 
 sistent in their efforts. 
 
 FAT AS A SIGN OF AGE 
 
 The normal man is about 12 per cent fat. If a man eats each day just 
 a little more food than he uses in his work and keeps it up he puts on fat. 
 The amount of excess food required is slight. In certain experiments a 
 nutritional balance was found by trial and then two slices of bread and a 
 good sized helping of butter were added to the daily diet. This was enough 
 to add on fifteen pounds in a year. Saundby calls obesity of this kind not 
 abnormal but the consequence of an abnormal kind of living. 
 
 The obese people of weak constitution only get 11 per cent of useful 
 energy out of the food they eat instead of the normal 25 per cent. We do 
 not care much so long as we are fat and useless whether it results from 
 abnormality of the body or an abnormal kind of living. 
 
 About the age at which occurs the change of life in women both men 
 and women fatten up. This is the first sign of age. It is generally agreed 
 that this change results from abnormality. Some say it is due to aged sex 
 glands; others to aged thyroid glands; others to combinations of these; and 
 still others to other causes. 
 
 While the scientists are arguing we may accept this as true — the man or 
 woman in the forties or in the fifties who slowly pui:s on flesh, who develops 
 the "fair round belly and good capon lined" of Shakspeare is showing the 
 signs of age. 
 
 Of course., his mind is poorer; he tires more quickly; he cannot walk 
 upstairs without panting; he snores because his head is filling up with fat; 
 he is in increased clanger of pneumonia and of diabetes, but that is not 
 the point. He is showing his first sign of age. Whether it be man or 
 
682 OBESITY AND THINNESS 
 
 woman, it is a change of life. It is just as good a sign of advancing years 
 as gray hairs. 
 
 It is true that all people do not fatten up; that many get busy walk- 
 ing, riding, playing golf, dancing, rolling ten pins and so keep the fat 
 from accumulating. But on the other hand the hair is not an infallible 
 sign. 
 
 This period is followed some twenty or more }^ears later by another 
 stage, "the lean and slippered pantaloon." In this stage the fat is con- 
 tinuously disappearing from all parts of the body. In consequence the 
 skin so long stretched to cover the body hangs in loose, inelastic wrinkles. 
 
 Not only is there loss of fat until the man's body is less than 12 per cent 
 fat but there is also a loss of water. The tissues dry out; the soft, almost 
 gelatinous tissues harden up. This is the stage of old age accomplished. 
 
 In this stage the body works extremely economically. There is little waste. 
 Wear progresses slowly. 
 
 In no other part of a man's career does he grow old so slowly. In no other 
 part of his career is he as free from danger of infection and disease. With 
 the exception of colds the body stands infection well. 
 
 HOW TO DECREASE GIRTH 
 
 The pouchy abdomen is in bad repute. It is rightly so, for, as Lyds- 
 ton says: "Given the firm, well developed abdominal muscle, it is hardly 
 necessary to examine the rest of the muscular system. Any set of exer- 
 cises w 7 hich gives good abdominal development imparts an excellent general 
 development. Abdominal protuberance in individuals out of condition is more 
 apparent than real, and is due to flabbiness of the abdominal walls rather 
 than to increase of fat or girth." ' 
 
 This is pretty generally recognized, and, being so, many men and women 
 put in some time each morning rolling back and forth on the floor. 
 
 Rolling persisted in will reduce the girth — but there is a simpler way 
 which is better in that it better builds up the abdominal muscles. 
 
 The abdomen has muscles in front which bend the body forward and 
 others behind which bend it backward. In addition there are three sets on 
 each side which run around from back to front — one set straight around, one 
 set diagonally downward, one set diagonally upward. The brain has excellent 
 control over these muscles; therefore, it is not difficult mentally to pick out 
 the muscles of a certain part of the abdominal wall and to throw them into 
 a state of tension. 
 
 First bend forward slowly and strainingly by making the front group 
 outpull the back group ; then backward by making the back group outpull the 
 front group. This exercises the up and down muscles. Next, by holding the 
 breath fix the diaphragm and then push the intestines hard against it by 
 pulling hard on the muscles which run around the abdomen straight and 
 diagonally. Next, while holding the abdomen against the edge of a table 
 take a deep breath thus using the diaphragm to press the intestines against 
 the abdominal walls. 
 
 In addition, from time to time during the day throw the abdominal 
 muscles into a state of tension moving systematically through the lower part 
 
OBESITY 683 
 
 right side, upper part left side and diaphragm back in the order named. This 
 can be done without attracting any notice as one sits at his work. 
 
 A good muscular tone to the abdominal walls will decrease the girth. If 
 the man continues to overeat he will store up fat but the abdominal tension 
 maintained by strong muscles will drive the fat to other parts of his body. 
 Fat makes areas soft. It also seeks out soft areas. Whenever a given area 
 becomes a work, or strength, or tension area fat packs up its baggage and 
 moves. 
 
 OBESITY CUKES 
 
 To cure obesity is the easiest thing in the world. Practically anybody can 
 be cured by any one else. The fattening of thin people is about as simple. 
 There is not one person in a thousand who goes into a tuberculosis hospital 
 while he is in the early stage but that can be fattened twenty pounds in 
 six months. 
 
 If this can be done with tuberculous people, given the same control 
 of mind and body, nervousness, exercise and food it can be done with well 
 people. All this means that anybody can add to or take from his flesh if he 
 desires it sufficiently to pay the price. 
 
 This is the method: 
 
 1. Cut down the amount of food to a point where the patient steadily 
 loses one or two pounds a week. To limit the water drunk helps some. 
 To limit the bread, potatoes, stuffings, pastries and alcoholics aids 
 some. But the crux of the situation is to get a pair of scales and weigh 
 out an amount of food that causes a loss of weight in that patient. People 
 vary in the food which is required to fatten them just as hogs do. What 
 would fatten one man would starve another. Cut the amount of food low 
 enough and the man will certainly lose weight. Xo man can be trusted to diet 
 himself by guessing. The whole scheme fails unless the food is weighed. 
 
 2. Exercise must be definitely taken. The record must show that a 
 given amount of exercise is taken each day. Here, too, individuals differ. 
 But the main difficulty is that the man cheats himself because he makes no 
 definite daily record. 
 
 3. Weigh each week. The amount of clothes must be uniform. The 
 heart of the scheme is scales. No dieting scheme without scales is worth 
 anything. With scales any man willing to take the trouble can reduce 
 his weight. Any obesity cure, except that of patiently day by day earning 
 the cure is worse than useless and is frequently harmful. It is in this broad 
 sense that I have written that obesity is a sign of laziness. It would have 
 been better to have said that it is a sign of lack of control and patient determi- 
 nation. 
 
 GETTING THIN 
 
 Growing children seldom get enough food. Eubner, Waters and Aron 
 have shown that full feeding will add to the stature attained by growing chil- 
 dren. Workingmen doing hard manual labor seldom eat an excess of 
 food. Therefore from the fat who would be healthier if thin these groups 
 should be dropped. 
 
 Financiers, merchants, office workers, clerks, and housewives, on the other 
 
684 OBESITY AND THINNESS 
 
 hand, go about their duties as a class panting because they are too fat. All 
 of them know it and some of them want to reduce. 
 
 There is some danger in reducing. The system, mechanically and chem- 
 ically, has become adjusted on the basis of fat, the mind is temperamentally 
 on that basis, the subjects usually have passed the years of elasticity — 
 readjustment is not so easy as it once was. 
 
 But if the man has weighed the inconvenience and danger and has 
 come to a determination to reduce — how shall he go about it? Let him begin 
 with the following as one day's diet: 
 
 Meat — Four ounces (four cubic inches). 
 
 Egg — One. 
 
 Cereal — One plate. 
 
 Bread — Three slices. 
 
 Butter — Two helpings. 
 
 Sugar and cream in coffee. 
 
 Vegetables (except potatoes) in small quantities. 
 
 Drink water freely. 
 
 Eat fruit freely. 
 
 This total quantity should be divided into three meals. It is the starting 
 point. The man, having weighed to begin with, should increase this quantity 
 or decrease it until he finds the amount of food which will cause him to 
 lose not to exceed a half pound a week in weight. 
 
 Exercise alone will not cause a loss in weight. The man who exercises 
 has more appetite, eats more and gets fatter. But increased exercise com- 
 bined with decrease of food, each change in moderation, will build up muscle 
 and replace tissue lost as fat. A fat man has a tight skin and below it his 
 tissues are under tension; in reducing the muscles should grow to maintain 
 part of this tension. 
 
 Water helps the stomach to break up the food. Taken two or three hours 
 after meals it liquefies the food and helps the stomach to empty itself. More 
 of the nutrition of food is absorbed where the stomach's contents are well 
 liquefied. 
 
 STRAIN OF REDUCING 
 
 Those who have an oversupply of thyroid secretion are disposed to be 
 restless, energetic and under weight. Those who have an undersupply are 
 slower mentally, have more poise and are disposed to be obese. 
 
 Among the first effects of the wear and tear of life is diminished secre- 
 tion of the thyroid. The first sign of this diminished secretion, therefore 
 the first indication of senility, is a tendency to obesity. Therefore obesity 
 is an effect. 
 
 In turn it acts as a cause. On the one hand obese and overfat people 
 not obese are less liable to be consumptive and perhaps also to disorders 
 belonging to the worry family. On the other, they are more liable to have 
 diabetes, pneumonia and fatty heart. 
 
 Since the obese are short-winded and indisposed to exercise and suffer 
 from a lot of disorders due to lives of physical inactivity they generally 
 want to reduce or think they do. The last phrase is added because at least 
 
OBESITY 685 
 
 nine out of ten who talk about reducing have not the determination to come 
 across. 
 
 On this feebleness of the average will the obesity cures are based. In 
 the first place they advertise that they are easy. That appeals, for the obese 
 want everything easy. In the second place, they figure that the fat man will 
 quit before he finds out that he is being bunkoed, for, in the language of the 
 political orator, each and every obesity "cure" is a fake. 
 
 There is no medicine which will reduce a person who eats when he pleases, 
 what he pleases and as much as he pleases. The same is true of exercise 
 methods, machine methods and every other short-cut method. 
 
 The person who has the determination needed to reduce by privation and 
 work should not be discouraged; yet there are some facts he should know. 
 Reducing does increase the tendency to certain conditions. 
 
 When in the reducing process the store of glycogen is drained out of 
 the tissue the susceptibility to infections is increased. There is an in- 
 creased tendency to boils and other forms of pus infection. There is an 
 increased tendency to consumption. 
 
 The strain bears on the brain as well as the rest of the body and insanity 
 has been known to develop. Insanity will not develop in a person of good 
 poise but people not previously of good mental timber are liable to develop 
 maniacal depressive forms of mental trouble. The drained out muscles record 
 pains and cramps that are commonly described as muscular rheumatism. 
 
 There is some increase in the tendency to Bright's disease. I have 
 seen one case of leukemia develop in a person who was reducing rapidly, 
 and I have heard that others have seen the same sequence. The person who is 
 reducing rapidly in winter time will surfer unduly from the cold. These draw- 
 backs are only liable to occur during the process of reducing. The desired 
 weight having been attained and the diet having been increased to the amount 
 needed to maintain that weight the above dangers and inconveniences dis- 
 appear. 
 
 Oertel Diet for Obesity.— W. J. T. writes: 'What is the Oertel diet 
 for obesity and heart?" 
 
 Reply. — Breakfast : 
 
 One cup coffee. 
 
 Three ounces bread. 
 Noon: 
 
 Three and one-half ounces soup. 
 
 Lean meat roasted or boiled — seven ounces. 
 
 Fish — one ounce. 
 
 Fresh fruit — three and one-half to seven ounces. 
 
 Bread — three and one-half ounces. 
 
 Perhaps a little light wine. 
 Afternoon : 
 
 Coffee. 
 
 Bread — one ounce. 
 
 Water — six ounces. 
 Supper : 
 
 Eggs — one or two. 
 
 Meat — five ounces. 
 
686 OBESITY AND THINNESS 
 
 Bread — one ounce. 
 
 A bit of cheese, a little fruit salad. 
 Six ounces wine and four and one-half ounces water. 
 Oertel places great stress on exercises. 
 
 Fifty Pounds Overweight. — Subscriber writes: "I am a young man of 
 23 years and a college graduate. While at college I took an active part in 
 almost all branches of sport. Since graduating two years ago I have 
 become stout, weighing 210 pounds. My height is five feet nine and one- 
 fourth inches. I am still an active member of the Y. M. C. A. and also of a 
 training club. I bowl, play baseball, handball, and medicine ball several 
 times a week. My general condition is excellent, except that I always feel 
 bloated, even after a light repast. I am naturally a light eater. Is there 
 any certain diet I should follow, and if so, will you aid me?" 
 
 Reply. — You are fifty pounds overweight. You evidently get large 
 values out of what you eat. Probably you have intestinal fermentations 
 by which the starches and sugars are in part converted into alcohol and 
 gas. The alcohol easily burns into energy and that means that the other 
 foods must be stored as fat because the tissues do not need them. People 
 who bloat easily and have much gas are prone to become obese. 
 
 One Way of Getting Thin. — C. E. S. writes: "I reduced my weight 
 from 23Jf pounds in two years to 180 pounds. I left off taking soup and 
 drank nothing with my meals and not for two hours after. I had been 
 drinking from two to five glasses of water with each meal. I missed it 
 at first, but soon forgot it and did not care for it. I soon got into the 
 habit of drinking water after the two hours. I made no change in my 
 diet and ate anything good that I could get, but I was careful to 
 stop eating before I felt full. The only guide I had was that I should be 
 hungry an hour before meal time and anxious to get to the table. If I 
 was not hungry before meals I ate still less but always enough. I did not 
 suffer any inconvenience and felt fine all the time. I did no hard work 
 and did not have much exercise, being at my desk all day. But I never 
 varied or had any lapses. I did not weigh the food and weighed myself 
 only when it happened to be convenient, but when I did I found I was 
 gradually dropping down. I did not make it a task and soon got into the 
 new habit. Maybe this plan will work on other fat men. What do you 
 
 think r 
 
 Reply. — Fifty-seven pounds in two years was reducing too fast for the 
 average person. Cutting down the amount of water with meals cuts down 
 the proportion of food absorbed. It works in many instances as well as it 
 did in this. A better plan is to cut down the amount of food eaten. Your 
 plan worked well because you stuck steadily to it. Where the average 
 man fails in any reducing plan is that he does "vary and have lapses." 
 Again, you scored when you "were careful to stop eating before I felt 
 full." 
 
 Reducing Weight at 68. — A. McE. writes: "Last July I was found to 
 have blood pressure of 226. I am 68 years old and then weighed 201/. 
 Previous to that time (July) I had always enjoyed good health. I have 
 been placed on diet and my weight is down to 190, blood pressure 185 at 
 present time. I am still on diet and hope to reach 175 pounds. My height 
 is 5 feet 8 inches, and I confine myself to sal hepatica one teaspoonful 
 
OBESITY 687 
 
 three times per week as a remedy. Is this sufficient? I am and have been 
 on a vacation since July and take moderate exercise every day. What 
 further would you suggest?" 
 
 Reply. — I would suggest nothing except that you consume at least a 
 year in taking off those additional pounds and, better still, that you do not 
 take them off at all. You are at the brink of the life period when obesity 
 naturally becomes less, when the tissues naturally shrink some and when 
 blood pressure naturally falls somewhat. In view of this I think you 
 had better go slow about reducing further, particularly at the rate of three 
 pounds a month. 
 
 Cut Down Quantity of Food. — J. 8. H. writes: "I have been getting 
 fat for the last ten years, about three pounds each year. My weight is 
 175 pounds, my height 5 feet 5 inches, and age 35 years. I generally walk 
 two or three miles each day, and sometimes more, also do some exercising 
 in the morning." 
 
 Reply. — You are about thirty-five pounds overweight. Walking ■ and 
 exercising increase your appetite. Cutting down the quantity of food is 
 your only remedy. 
 
 Take Less Food. — Mrs. 0. M. P. writes: "I am past 30 and much over- 
 weight. My head aches much of the time. Can you suggest something 
 that will relieve me?" 
 
 Reply. — Probably your obesity and your headaches are cut from the 
 same cloth. When more food is eaten than is needed the surplus is stored 
 as fat. Too much food and too little exercise together constitute one cause 
 of headache. 
 
 To get relief eat less. Decrease your food until you are losing weight 
 at the rate of one pound a week. Stick to that quantity until you get 
 where you should be. 
 
 Reducing obesity is work. The short cuts are fads. 
 
 Reducing Weight. — J. R. writes: "Please give me a formula for reduc- 
 ing weight. I am 16 years old and weigh 135 pounds. I think I am a 
 little too heavy for my age." 
 
 Reply. — About the only formula worth while is to eat less and exer- 
 cise more. What you eat is of little consequence. At 16' it should be easy 
 to form habits of exercising in the open air that would keep you physically 
 fit all the year round. 
 
 Don't Take Medicine. — M. E. G. writes: "I am desirous of dieting 
 in order to reduce my superfluous flesh, but find it extremely difficult to 
 refrain from eating enough to satisfy a hearty appetite. Is there any- 
 thing one can take to lessen one's appetite or relieve the pangs of hunger 
 without, of course, in any way injuring oneself?" • 
 
 Reply. — Poke root and iodids are sometimes taken as obesity cures. 
 Some part of their action is because they lessen the appetite somewhat. 
 
 My advice is that you do not take either of these or any other medicine 
 for obesity. Fill up on soup, fruit and bulky vegetables, eat sparingly of 
 bread, potatoes, meat and milk. A small amount of food eaten slowly is 
 as satisfying as a large amount eaten rapidly. After all is said, to reduce 
 obesity requires persistence and "grit." 
 
688 OBESITY AND THINNESS 
 
 Short Cut Obesity "Cures." — F. L. writes: "Do you consider rubber 
 garments to reduce flesh beneficial or harmful? I refer to rubber stock- 
 ings." 
 
 Keply. — They do no good. They do some harm to the skin. Eeduce 
 your food and take more exercise. All short cut obesity cures are fakes. 
 Rubber garments belong in the list. 
 
 Diet Held Successful. — H. writes that using the following diet he has 
 taken off fifty pounds in the last year. He has kept at work and felt well. 
 For a time he would get hungry in the afternoon. When hungry he would 
 fool his stomach with beef tea. 
 
 The Diet. — Upon rising sip a tumbler of hot water (with a squeeze of 
 lemon juice if you like). 
 
 Breakfast — One or two cups of coffee or tea without milk or sugar. 
 If sweetening is required dissolve a saccharin tablet in a little water and 
 add two gluten biscuits. Four ounces of lean broiled chops or cutlets 
 (four ounces equals about two chops), or four ounces of broiled or boiled 
 white fish, such as sole, cod, turbot, haddock, halibut or perch; or four 
 ounces of lean chicken, game, or broiled kidney. (Use plain condiments 
 as below.) 
 
 Lunch — Four ounces of lean broiled chops, steak, lean beef, mutton, 
 chicken or game, taken hot or cold, roasted or boiled (with gravy if free 
 from fat). Four ounces of green vegetables (given in list below). Four 
 ounces of stewed or baked fresh fruit, such as apples, gooseberries, cher- 
 ries, stewed pears, rhubarb, and the like (sweetened, if at all, with sac- 
 charin, dissolved in a little hot water). Two gluten biscuits. 
 
 Dinner — Any clear soup. Four ounces of fish (from breakfast list). 
 Four ounces meat (from lunch list). Vegetables, stewed fruit, and salad. 
 Two gluten biscuits. Shell fish, such as lobster, oysters, clams, and the like, 
 may be taken at lunch or dinner. 
 
 Details of Diet. — Before retiring at night sip a tumbler of hot water. 
 Drink freely at or between meals of plain or mineral water so as to keep 
 the kidneys acting well. The bowels must be kept open. Take gentle 
 exercise each day stopping short of fatigue. All beverages and stimulants 
 containing sugar must be eliminated. 
 
 For necessary sweetening use saccharin dissolved in a little hot water. 
 In place of bread use gluten biscuits. A cup of beef tea or strong, clear 
 soup may be taken when liked. A cup of black sugarless coffee or sugarless 
 tea can be taken when liked. 
 
 One need not necessarily eat all of the variety mentioned for meal if 
 less satisfies. Do not eat potatoes, green peas, butter beans, breads, pork, 
 fresh or dried fruit, eggs, cream or milk, or fried food. Vegetables and 
 salads allowed: Beets, cauliflower, eggplant, spinach, carrots, mushrooms, 
 turnips, oyster plant, squash, green beans, cabbage, artichokes, asparagus, 
 celery, cucumbers, tomatoes, lettuce, endive, water cress, brussels sprouts, 
 mustard and radishes. Condiments allowed: Flavoring sauce, catsup, 
 vinegar, pepper, salt, mustard, and horseradish. 
 
 Comment. — It will be noted that this diet prescribes definite quantities 
 and eliminates bread and starchy vegetables. The quantities may be large 
 for some persons. If so they should eat three ounces when four is specified, 
 or even less. 
 
OBESITY 689 
 
 Peril in Reducing Weight. — E. K. asJcs for "balanced ration" for one 
 who has dieted, reducing forty pounds in six months, to normal weight on 
 "greens," zwieback, and the like, omitting starches and sugars. How may 
 one retain this weight (greatly improved physical condition also) and also 
 have a more varied diet? Is there danger of malnutrition if one omits 
 sugars, starches, and fats? If there is a tendency to intestinal disturb- 
 ances, what diet is best for one inclined to obesity? No complications or 
 chronic ailments except rheumatism. Age fifty. 
 
 Of course this case is in physicians' care but general directions and 
 advice are desired. 
 
 Reply. — I cannot send you a balanced ration in detail. You say that 
 you are under the care of physicians and it is for them to determine what 
 ration is best for you. However, if you hare reduced forty pounds in 
 six months you are undoubtedly eating too little. Your internal organs 
 have all been adjusted to the presence of some fat around them. This 
 fat must not be suddenly removed. Your skin has been adapted to cover a 
 certain amount of volume. It is inadvisable to reduce the tension inside of 
 your skin too rapidly. You are not justified in reducing at a more rapid 
 rate than twenty pounds a year, and ten pounds a year would be better 
 judgment. 
 
 If your present method of eating has reduced you forty pounds in six 
 months it is evident that in order to make energy and heat sufficient for 
 your needs you have had to burn up forty pounds of your fat and muscle. 
 If you do not wish to lose more you will therefore have to increase the 
 amount of food which you are eating. 
 
 Zwieback is nutritious but greens serve in the main as filling. How- 
 ever, it is not so much the things you eat as the quantity which you eat. 
 You should therefore increase the quantity of food over that of the last 
 six months. You will eventually suffer from malnutrition if you do not 
 take some small quantity of meats and also sugars, starches, fats and 
 vegetables. 
 
 How to Check Obesity.— P. A. W. writes: "Please advise me as to a 
 way to stall off 'getting fat/ I am a young man employed in an office, and 
 although I get some exercise at night, am confined all day. Am now taking 
 on weight, not solid, but flabby. More strenuous exercise doesn't seem to 
 help me. Would a diet be effective? Also, what exercise do you recommend 
 as most beneficial?" 
 
 Reply. — Assuming you are increasing your weight more than three 
 pounds a year what you need is to diet in addition to exercise. Dieting 
 consists in reducing the amount of your food. While changing the articles 
 so as to decrease the amount of sugar and starch is of importance the 
 main thing is to decrease the amount you eat during the day in such a 
 way that you will stop gaining. It is practically impossible to do this 
 without being guided by the scale. You should weigh once every week and 
 record your weight. I know of nothing in which people cheat themselves 
 more than in reducing their food by guess. They cut down for a few 
 meals and then eat enough to make up. 
 
 Reducing Weight Intelligently. — Mrs. E. B. M. writes: "I have been 
 following your directions for reduction of weight, and am succeeding to my 
 own satisfaction and the astonishment of my friends. I find the amount of 
 food you allow as reasonable is too much for me to reduce on, but I have 
 
690 OBESITY AND THINNESS 
 
 worked out a diet for myself, which keeps me satisfied and yet allows 
 the loss of one pound of weight a week without any injury to my health. 
 The matter which troubles me now in hot weather is how much I ought 
 to drink. I crave water and I wish to know if it is safe (with a view of 
 losing weight) to drink water freely between meals if I avoid it at meal 
 times?" 
 
 Reply. — Water between meals can be taken freely. A moderate amount 
 of water with meals will not increase flesh if the food is reduced in quan- 
 tity. To take water with meals increases the available nutrition from the 
 food, say 10 per cent. Therefore, when water is taken with the meal the 
 food should be correspondingly decreased. Do not continue your present 
 rate of reduction long. Your organs must adjust themselves to the extra 
 room and that requires a little time. You are right in adjusting your diet 
 to your needs. One person will fatten on what scarcely suffices for another. 
 Wise people adapt standard diets to fit their peculiarities. 
 
 Reducing Weight Too Fast. — C. E. E. writes : "I am a trifle less than 
 five feet five inches in height and was 55 years old on May 10. About ten 
 years ago I began increasing in weight. I went to 196 pounds. Late last 
 year I decided that I ought to do something to reduce weight, and espe- 
 cially to overcome the tendency to increase. My health is good, I always 
 sleep well. I use no liquor or tobacco, but use coffee, also occasionally tea. 
 I started with two meals a day on Jan. 2. For breakfast I have bacon and 
 eggs with rolls and coffee, for dinner, for some time, rich cream with 
 shredded wheat biscuit and fruit, no pastry. My weight is now (June) 
 166, and I never felt better. Have I reduced weight too rapidly •? Am I 
 eating the proper food?" 
 
 Reply. — You are still a little above the proper weight for your height 
 and age but a drop of thirty pounds in six months is going too fast. In- 
 crease the amount of your food until you stop the drop. Do not increase 
 it enough to make you gain. Other than that, the diet is right. 
 
 Beware of Fat Reducers. — Mrs. G. McH. writes: "Have you ever 
 heard of the following drugs, and if you consider them dangerous to take 
 as a fat reducer? Aromatic elixir, 5 ounces; glycol arbolene, 1 ounce. 
 Mix and shake well and take a teaspoonful after each meal." 
 
 Reply. — This is an illustration of the new way of advertising a pro- 
 prietary medicine. It is called the hidden "ad." No person is justified in 
 taking any fat reducer. To decrease the amount eaten reduces fat. 
 Medicines do not. 
 
 Water and Weight. — H. E. B. writes: "I have not yet learned from 
 your articles what effect six or eight glasses full of water before break- 
 fast and two hours after eating, have upon the weight of a person. Would 
 it make fat or flesh? I drink very little with meals, but fear I have been 
 gaining fullness in the last month or two." 
 
 Reply. — Eirst, there is a chance that it would dilate the stomach; sec- 
 ond, it would contribute indirectly to "gaining fullness." If you wish to 
 lose flesh reduce the quantity of your food and drink several pints of water 
 a day but small quantities at a time, not six or eight glasses. 
 
 To Overcome Obesity. — Subscriber writes: "Will you please let me 
 know how to overcome obesity?" 
 
OBESITY 69J 
 
 Reply. — Obesity is caused when the starches and sugars taken into 
 the body are not completely burned up. The first effort should be to limit 
 the intake of these foods. In fact, cut down the total quantity of food. 
 The amount of fluids should also be limited. The next thing to do is to 
 assist the body in using up what is taken. To this end exercise — walking, 
 riding, swimming — is of great value. Cold bathing will help some. 
 
 Reduce Your Food. — 8. F. A. writes: "I am about fifteen pounds too 
 heavy. A friend told me I could reduce as much as I wanted to by tahing 
 a dose of sal hepatica every morning. It is reducing me nicely, but I am 
 afraid it will leave me in a run-down condition. Can you tell me some- 
 thing better to take to reduce my weight?" 
 
 Reply. — You are not justified in cutting down your weight by produc- 
 ing diarrhea. Reduce your food. 
 
 To Reduce Abdomen. — H. S. C. wants to know how to reduce an en- 
 larged abdomen. 
 
 Reply. — I cannot help you but I can help you to help yourself. My 
 part of the program is a short horse quickly curried ; your part must extend 
 through the forty-four years of your life. To speak more accurately you 
 must keep up your efforts until you are eighty. After that age the tissues 
 are disposed to shrink and you can let up. Enlargement of the abdomen 
 can go on without a generalized obesity, or as a part of such condition but 
 out of proportion to the enlargement elsewhere. We shall discuss that first. 
 
 The abdomen is held in bounds by the muscles in front and the back- 
 bone behind. The way to keep the front muscles from pouching is to make 
 them about as strong and immovable as the bones behind. Muscle exer- 
 cises to accomplish this end can be taught you by the physical director of 
 the Y. M. C. A. 
 
 There are several factors in the accumulation of fat at fifty-six — in- 
 heritance, overeating and thyroid atrophy. Some have it "in the blood" to 
 fatten up as they reach middle life. This means that such people must 
 strive the harder if they would keep thin. 
 
 The thyroid gland becomes senile in many people in middle life. As 
 this senile atrophy develops such people tend to put on fat. They get 
 relief from small doses of thyroid — just a little, enough to supply the de- 
 ficiency and, therefore, but a fraction of the several grain doses so fre- 
 quently given. In taking thyroid persistently you are imitating nature 
 but thyroid must never be taken except under medical direction, for it is 
 too powerful to be tampered with. 
 
 Much the most important instruction is to decrease the quantity of 
 food eaten. Whenever a man is getting fat he is eating too much and 
 that is the main thing wrong. He may be eating like a canary, or not eat- 
 ing enough to keep a sparrow alive, or eating less than other people, or 
 eating less than he formerly did — nevertheless, he is eating too much. 
 
 If his thyroid is atrophying or he is of fat stock there is all the more 
 reason why he should adjust his food to his body and his work. The best 
 evidence that it is not so adjusted is his increasing fat. 
 
 The right policy is a gradual reduction of the amount of food to a 
 point where the weight remains uniform, reducing just a little lower still. 
 A full waist line is not inevitable. Want to be slender hard enough — and 
 stick. 
 
692 OBESITY AND THINNESS 
 
 Buttermilk and Weight. — M. S. K. writes: "What effect has buttermilk 
 on one inclined to obesity? Is it a fat producer? Is it advisable to eat 
 dry toast with unsweetened fruit juice or tea without milk for two meals 
 each day when attempting to reduce one's weight?" 
 
 Reply. — 1. It is a fat producer. It is an easily digested food, having 
 all of the advantages of sweet milk except that it is less of a heat maker 
 (sometimes an advantage) and is usually more easily digested. If you are 
 reducing be sparing in your use of buttermilk. 
 
 2. Yes, provided you do not eat too much toast. It is of prime impor- 
 tance that the quantity of food taken be reduced. What foods to take and 
 what not to take is of secondary importance. 
 
 To Reduce Weight. — S. D. writes: "I have a daughter 10 years of age, 
 who weighs lJj-5 pounds. She has been fleshy all her life, but she seems to be 
 getting more and more so. She seems to be well in every way, and exer- 
 cises as much as any child does. Is there any harmless remedy for her?" 
 
 Reply. — 1. A girl ten years old of average height should normally weigh 
 about sixty-five pounds. A weight of one hundred and forty-five pounds is 
 certainly excessive. An excessive amount of sugar and starch in the 
 food is one of the most controllable causes. A disinclination to exercise 
 makes matters worse by failure on the part of the individual to burn up 
 the sugars and starches. 
 
 2. The remedy for the condition lies chiefly in limiting the amount of 
 fluids taken by promoting bodily exercise to the utmost possible extent, 
 and by cold bathing. If this program is persistently carried out satis- 
 factory results will be obtained in the course of time in most cases. This 
 course of treatment is best taken under the care of a skillful physician, 
 who can watch and regulate the diet and habits of the patient. 
 
 To Reduce Weight at 50. — I. M. H. writes : "I am a woman of 50 years 
 and am getting stout. I have been told to take the juice of one lemon in 
 water before breakfast. 1. Will this reduce my weight? 2. Is it injurious 
 to the system?" 
 
 Reply. — 1. No. 
 
 2. No. If you want to reduce your flesh reduce your food. There is 
 nothing to be gained by trying to short cut by using vinegar, lemon, or 
 other cures. 
 
 Reduction of Weight. — M. M. writes : "I was much struck by a recent 
 article from your pen on the subject of obesity. The writer has long 
 been afflicted with a good appetite and tendency to lay up surplus aliment 
 in the shape of fat. Your article seemed to me so simple that it was 
 most practical. To weigh daily and to cut one's food down in quan- 
 tity, if found to be more than enough to keep one at a regular weight, 
 appeared to me the summit of simplicity; no long list of interdicted dishes, 
 with the consequent constant suffering from desire to eat those interdicted 
 things, just simple abstinence in quantity. I have, in the past, had long 
 formulas written for me by various doctors with lists of food good or bad 
 for my constitution, and that course always seemed to me wrong in prin- 
 ciple and to lead to an unbalanced diet, for who knows better what one 
 needs to eat than the man himself, directed by instinct? So I resolved to 
 try your method, and, having a set of good scales in my room, I have been 
 testing your advice. Here is the result after eleven days' trial: 
 
OBESITY 693 
 
 Feb. 26 weight 231 lbs., 8 oz. 
 
 Feb. 27 weight 230 lbs., 8 oz. 
 
 Feb. 28 weight 230 lbs. 
 
 Feb. 29 weight 229 lbs. 
 
 March 1 weight 228 lbs., 8 oz. 
 
 March 2 weight 229 lbs. 
 
 March 3 weight 229 lbs., 8 oz. 
 
 March 4 weight 230 lbs. 
 
 March 5 •. .weight 229 lbs., 8 oz. 
 
 March 6 weight 229 lbs., 8 oz. 
 
 March 7 weight 228 lbs., 4 oz. 
 
 "This seems to me to show a proof of your statement that weight is 
 very much a matter of eating more or less food. These figures are not 
 anything extraordinary, as I have by no means starved and have par- 
 taken of any food that appealed to me. Only I have eaten a reduced quan- 
 tity. Of course one might reduce himself a pound a day without any harm, 
 perhaps, but I have seen so many cases where people adopted the so-called 
 Banting system of eating no sweet or starchy foods, and wound up severely 
 ill, that it never appealed to me. During this trial of your method I have 
 eaten sweets and. starches indiscriminately, only in reduced quantities. I 
 feel much better already, as that sensation of fullness in the morning, on 
 awakening, has already left me. My wind is also much improved, and the 
 steep steps I have to climb daily to and from my office I negotiate with 
 much less fatigue and short windedness. On March 3, by the way, I sat 
 reading all day indoors and, instead of eating almost nothing, gave way to 
 the usual Sunday stuff. The result shows in the weight column for two 
 days after. The weights are taken without clothing in the morning after 
 emptying the bladder and bowels just after rising." 
 
 Keply. — This rate of loss is a little too rapid. After your weight reaches 
 220 you had better reduce the loss to one pound a week until you reach 
 210 and arrange for a slighter weekly reduction after that. 
 
 How He Reduced Weight. — C. Mc. writes: "I have been reading so 
 many requests for advice on 'reducing weight' in your department that I 
 have fancied perhaps an account of how one woman worked out your advice 
 for herself may be interesting. 
 
 "I am — or had been for some ten or twelve years — 5 feet 3 inches tall, 
 weight 11^-116 pounds; am of large frame for my height. I have been a 
 heavy eater all my life, because I was going on the theory that I needed 
 lots of food to keep my strength up. Last year I had a severe illness, and 
 when I recovered began to get fat. By Christmas I weighed 138 pounds 
 and felt like a stuffed sausage. Stomach was upset all the time. Took 
 any amount of medicine, but it didn't work. After Christmas I decided to 
 try the starvation plan. I am employed all day long, so cannot get enough 
 exercise. I eat this year at a high grade cafeteria. I began by either eating 
 almost nothing at my evening meal or going without it. Also I cut out 
 potatoes, bread, and pie. It was pretty hard at first, and I got hungry. 
 My moral courage received reinforcement when Lent came, because I re- 
 solved for once to keep the rules of fasting and abstinence for my body's 
 health as much as my soul's. 
 
 "I could not weigh my food, so I merely cut it down more and more 
 and guessed at proper quantities. After a while I found I did not crave 
 the heavy meals I had formerly and was feeling infinitely better. So when 
 
694 OBESITY AND THINNESS 
 
 Easter came and my 'Lenten discipline' was over, I found no desire to 
 'make up' by excess. A week ago I found I weighed HJf. pounds. I feel 
 better, work better, digest better than I have in years, so much so that 
 I hear many remarks about my improvement in health. The only thing 
 I am still tied to is an occasional mild laxative. The sense of control, of 
 not being tied to the whims and vagaries of a sluggish body, of self-re- 
 spect and nerve poise gained from the knowledge that I can if I will, is 
 worth an infinite deal. About the middle of Lent I came across Courtney's 
 'Conquest of Nerves/ and found it helpful. I wish I had seen it a year 
 ago." 
 
 Reply. — This should prove a healthful experience. 
 
 Reduce Quantity of Food. — H. I. M. writes: "If you wish to reduce 
 your weight should you eat foods containing calories or protein? I am 
 interested in your statements of food values." 
 
 Reply. — Eat food low in calories — or, to put it more simply, decrease 
 the supply of bread, potatoes, sugar, and milk. Best of all, cut down the 
 quantity of food eaten. 
 
 Limit to Haphazardness. — Hotel Boarder writes: "Your suggestion 
 that everyone who tries to become either stouter or thinner by dieting will 
 fail unless he goes to the trouble of weighing every morsel of food he eats 
 seems to me wholly impracticable. It is certain that few will adopt it, in 
 any case, especially among hotel dwellers. If a man wants to increase his 
 weight, would it not meet the case if he would begin by simply eating a 
 little more than usual of everything he is accustomed to eat, by guess; get 
 on a weight scale once a week or so, and keep on eating a little more and a 
 little more until the scale showed satisfactory results'? I can't see any 
 difficulty in that, or any need whatever for spending half of one's time 
 in making arithmetical calculations as to the exact number of grains of 
 this, that, and the other that one has absorbed at the dining table." 
 
 Reply. — Theoretically your suggestion is all right. Practically, there is 
 a limit to haphazardness beyond which not much is gained. The man who 
 is not enough in earnest to take some trouble in his dieting does not get 
 results. He may think he is dieting but his "fingers are crossed." Arnold's 
 "Diet Tables" (any large book store) give approximate weights of ordinary 
 "helpings." The limit set by these is about as far as one can go and get 
 results. 
 
 Amount Varies for Persons. — E. D. L. writes : "As a stout man anxious 
 to reduce, I have been following your articles on diet with much interest. 
 I regret, however, that they are all negative — viz.: telling what not to eat. 
 May I suggest that you follow these articles up with one telling what to 
 eat, as, for example, a daily menu." 
 
 Reply. — As to a list of things to be eaten and another not to be eaten 
 I do not take much stock in them. As to specifying quantities for people 
 generally that I have not. much faith in. What is too much for one man 
 is not enough for another. 
 
 Why not do the proper thing — find out what amount of food causes 
 you to lose a pound a week and eat that amount? 
 
 Practice Is Harmful. — M. I. writes: "A friend is taking two heaping 
 teaspoonfuls of Epsom salts each night before retiring for the purpose of 
 
HOW TO GET FAT 695 
 
 reducing flesh. I insist that this is harmful. Will you kindly give your 
 opinion?" 
 
 Reply. — You are right. The salt will lose its effect and he will be left 
 with an intractable constipation. If he does not intend to let the excess 
 of food absorb, why eat it ? 
 
 Should Weigh 160 Pounds. — T. P. R. asks : "What is the correct weight 
 for a young woman 5 feet 9 inches? At one time I weighed 183 pounds, 
 out have lost thirty pounds." 
 
 Reply. — You should weigh about 160 pounds. 
 
 Proper Weight. — A. B. writes: "Will you please tell me the proper 
 weight for a woman Jj.3 years old, and 5 feet 4 inches tall?" 
 
 Reply. — 135 pounds. 
 
 Keeping the Weight Down. — E. I. W. writes : "I have been doing with- 
 out sweets and starches and eating meals dry for three months to reduce 
 weight. Have lost twenty-five pounds. Have been adding a little sweets 
 each day for a few days and find I am gaining, although I am still eating 
 gluten bread and keeping up the rest of diet. Will it be possible for me to 
 get into a general diet again without losing all that I have gained?" 
 
 Reply. — Yes — provided you cut out some meat, milk, eggs or some other 
 nutritious element in proportion as you add sugar. If you add sweets faster 
 than you cut out other foods you will fatten. 
 
 Bread a Fattening Food. — A. W. P. writes: "1. Is there any kind of 
 bread — about three pieces a day — one can eat that will not increase one's 
 weight? Some say white bread is the most nourishing. 2. Will half a 
 pound of Epsom salts added to the daily warm bath help make a person 
 thin?" t 
 
 Reply. — 1. One is about as fattening as another. Bread is the fattening 
 food. 
 2. No. 
 
 HOW TO GET FAT 
 
 First — Regulate the amount of food. 
 
 Second — Regulate the amount of work — worry is work. 
 
 A fat animal is one out of nutritional balance on the plus side — one 
 which eats and assimilates more food than is required to supply energy and 
 Tepair waste for and incident to the work which it does. The individual who 
 thus gets out of balance may have at first a series of diarrhea spells — nature 
 trying to get rid of the surplus — but presently the machinery settles down 
 into a routine of storing the excess — at first in the areas of low pressure and 
 later any and everywhere. 
 
 This storing is only an exaggeration of a normal process. Some fat 
 around the eyeballs, some under the skin rounding out the angles, some under 
 the bones of the feet to soften the jar, some here and there for special purpose, 
 is natural. 
 
 As the excess of food over work persists there is labored breathing — an 
 
696 OBESITY AND THINNESS 
 
 effort to burn up the surplus — kidney and liver strain, in an effort to unload, 
 perhaps migraine. The fat man then has an increased danger from heart 
 disease, kidney disease, sudden death and, above all, pneumonia. On the 
 other hand life insurance tables show that the fat man is less liable to 
 consumption. General belief is that he is cheerier, happier, and worries 
 but little. 
 
 If a man having weighed the arguments for and against obesity wants 
 to get fat or fatter, how shall he proceed ? 
 
 First — Limit his work, and particularly his worry. 
 
 Second — Leave his work where it is, but increase his food. 
 
 As a starter he should take in the twenty-four hours about the follow- 
 ing articles and quantities : 
 
 Meat — Five ounces (five cubic inches). Potatoes — Four ounces. 
 
 Milk — Three pints. Butter — Six servings. 
 
 Egg — One. Bread — Half a loaf. 
 
 Cereal — One plateful. Dessert — One helping. 
 
 A way to divide this is as follows : 
 
 BREAKFAST 
 
 Coffee — One pint, with milk and sugar. Egg — One. 
 Bread — Three slices. Fruit. 
 
 Butter — Three helpings. 
 
 LUNCH 
 
 Meat — Two ounces (two cubic inches). Pudding — Five ounces. 
 
 Fish — Two ounces. Butter — One helping. 
 
 Bread — Two slices. Cheese — One-fourth pound. 
 
 Vegetables. Milk — Eight ounces. 
 
 SUPPER 
 
 The same as lunch. 
 
 He should gain not to exceed one pound a week. If he is gaining more 
 than this he should decrease his food. If he gains less he can increase it. 
 
 He should be temperate in gaining. He will be a chump if he works 
 his kidneys to pieces or "pants like a porpoise" just to get some extra fat on 
 his frame. 
 
 Weight Gaining Foods. — H. L. B. writes: "1. 1 am twenty-jive years old, 
 5 feet 6 inches tall, and weigh IkO pounds stripped. Do you think this 
 underweight? 
 
 "2. I drink at least two cups of beef bouillon and one glass of butter- 
 milk a day. Will that help me gain in weight? 
 
 "3. Will patent foods guaranteed to put on weight do the work?'* 
 
 Reply. — 1. No. 
 
 2. The buttermilk will, the bouillon will not. 
 
 3. No. The best foods to put on weight are milk, meat, and bread. 
 The best of the advertised foods, pound for pound, are on a par with milk, 
 dried milk or other milk products. Most of them cost so much that none 
 but millionaires can afford to eat pounds enough a day to help much. 
 
HOW TO GET FAT 697 
 
 Would Gain Flesh. — W. K. R. writes: "Will two tablespoonfuls of olive 
 oil taken upon arising and two upon retiring cause a person to gain flesh?" 
 
 Reply. — Four tablespoonfuls of olive oil contains about 600 calories — 
 about as much as three-quarters of a pint of cream. Olive oil is princi- 
 pally used by the body to make heat. Nevertheless, if a man were eating 
 about enough food to repair wear and to take care of his needs and to that 
 amount were to add four tablespoonfuls of olive oil a day he would gain 
 flesh slowly. 
 
 To Increase Weight. — A. P. writes: "I am 11 years of age, and weigh 
 about 110 pounds. What is the best hind of exercise and the best food to 
 increase my weight?" 
 
 Reply. — 1. The best kind of exercise is some form of competitive sport 
 in the open air. Play football until Thanksgiving. Play in some con- 
 venient park playground or Y. M. C. A. until very cold weather. Skate 
 as soon as the season comes. The best kind of food is meat, bread, milk, 
 vegetables, and fruit. Don't waste time on diets. Eat plenty of plain, 
 wholesome, nutritious food. The point is to eat enough. 
 
 Weight Is Too Low. — Brevoort writes: "1. Is a weight of 11+5 below 
 the average for a height of 5 feet 11 inches? 2. At the age of 35 years 
 what can be done to increase weight? 3. Is wine after eating of benefit?" 
 
 Reply. — 1. The proper weight for a man of that age and height is 170 
 pounds. You are 15 per cent below on the Nylic scale. 2. Eat more; 
 worry less. 3. No. 
 
 Will Make One Fat. — F. C. H. writes: "Will the drinking of butter- 
 milk make a person fat?" 
 
 Reply. — Yes, if enough is used. 
 
 How to Increase Weight. — D. C. A. writes: "My appetite is good. I 
 eat three good meals a day. I am very thin and pale; haven t the energy 
 it seems to me I should have. I have been told by physicians time and 
 again that my food does not assimilate. What do they mean by it?" 
 
 Reply. — Food in being built into tissue undergoes the following — 
 mastication, digestion, absorption, assimilation, the last being the final step 
 in tissue building. If you are in good health you can put on flesh if you 
 want to bad enough. 
 
 First — Do not fret or worry. 
 
 Second — Weigh your food. 
 
 Third — Increase the quantity of milk, buttermilk, eggs and bread 
 until you commence fattening at the rate of one pound a week. Keep 
 this up until you are satisfied. 
 
 Milk to Increase Weight. — H. F. B. writes: "I drink an average of 
 one-half pint of milk and eat about same amount of ice cream a day. 
 Would that help me gain in weight? If not, what do you advise to use to 
 gain at least thirty pounds of good solid flesh?" 
 
 Reply. — It will help but it is not enough. Eat plenty of meat, bread, 
 vegetables and fruit and drink several pints of milk in addition. At 
 least a pint a day should be taken. A quart will be more satisfactory, 
 
698 OBESITY AND THINNESS 
 
 Eggs to Increase Weight. — M. M. writes: "Do you advise my taking 
 raw eggs — six daily — in an effort to gain in weight?" 
 
 Reply. — It will help but you should take an abundance of milk, bread, 
 meat, and vegetables in addition. 
 
 Below Normal Weight. — T. writes: "1. I am 5 feet 9 inches tall and 
 weigh but 132 pounds. 2. Will drinking one pint of buttermilk a day in- 
 crease my weight? 3. Is buttermilk better than sweet milk? 1/.. Is there 
 any danger of contracting disease from fresh buttermilk?" 
 
 Reply. — 1. Your proper weight is 148 pounds. You are 8 per cent 
 ■underweight on the Nylic scale. 
 
 2. No, you need more than that. 
 
 3. Not quite so good. 
 
 4. Depends on the buttermilk. Some is safe, some not. It averages 
 safer than sweet milk. 
 
 How to Get Fat. — F. L. B. writes: "1. I am trying to take on weight. 
 Would you kindly advise me on that point? 2. Are the following good: 
 Eating of fats, (3) drinking lots of water and milk, (If.) bathing a lot, 
 running quite a bit, and boxing?" 
 
 Reply. — 1. Eating abundantly of all kinds of food is good. Starches 
 and sugars are more effective than fats. 
 2. Yes. 
 
 3 and 4. Of no special service. 
 To get fat : 
 
 Do not worry or fret. 
 
 Eat more than you need. 
 
 Eat heavy suppers. 
 
 Sleep more than eight hours. 
 
 Eat More ; Sleep Long. — H. P. W. writes : "Being 6 feet 2 inches and 
 weighing but 165, I should like to increase my weight a little, if it can be 
 done with no detrimental effects. I have been advised to use three grain 
 hyponuclane capsules, and I wish to inquire if they are the proper thing. 
 What constitutes an adult's dose and with what frequency should they be 
 taken? What is their approximate cost?" 
 
 Reply. — You should not depend on any sort of medicine to fatten you 
 any more than you should depend on crutches to win you a foot race. To 
 get fat, eat more than you need, keep quiet, do not worry, be regular in 
 your habits and sleep long hours. Eat supper and go to sleep shortly after. 
 You know how we turn the trick with animals. Follow the same plan. 
 
 In Need of More Fat. — A. S. weighs 11+0 pounds, is 5 feet 10 inches high, 
 and 30 years old. He takes a teaspoonful of olive oil twice a day. Will 
 this do any good? 
 
 Reply. — You are about twenty pounds underweight. A teaspoonful of 
 olive oil contains 60 calories — not enough to be of any service though it is 
 good as far as it goes. 
 
 Should Increase Diet. — C. B. P. writes: "I am nearly 60 years of age, 
 5 feet 9 inches in height, and until a couple of years ago weighed 11+5 
 pounds. But I only weigh about 135 now. My general health is fairly 
 
 
HOW TO GET FAT 699 
 
 good. Lately I have been drinking a cup of hot milk before meals. Could 
 you suggest a line of food tliat would tend to fatten me up?" 
 
 Reply. — You are twenty-five pounds underweight. Hot milk before 
 meals is excellent. Increase your diet still further. If you are organically 
 sound you can gain some weight. 
 
 How to Gain. — E. J. A. writes: "I am 23 years of age and weigh 110 
 pounds. I have a great fondness for stewed apples, cake and milk. 1. I 
 don't think apples cooked in this way have any fattening tendencies, but 
 would like to know whether or not they are injurious. I work at night, 
 and when I reach home about If. a. m. I eat a big dish of stewed apples, 
 several pieces of sponge cake and a couple of glasses of milk. Then I go 
 to bed and don't arise until 12 or 1 o'clock. 2. I have heard eating just 
 before retiring is injurious, but suffer no ill effects. I don't seem to fatten 
 up any. 3. Could you tell me what I should or should not do in order to 
 flesh up a bit?" 
 
 Reply. — 1. They are not injurious. 
 
 2. Eating before you retire will not hurt you. 
 
 3. You do not say what you eat besides stewed apples, cake, and milk. 
 If this is all you eat you need bread, meat, and vegetables. If you will eat 
 enough plain, solid food, drink enough milk, sleep enough, and keep calm 
 you will put on weight. 
 
 Worry and Weight. — A. Z. writes: "About a year ago I worried a great 
 deal over domestic troubles which I think caused me to lose ten pounds of 
 my weight, making me look thin. The cause of my worry has been removed 
 for some time, but I have not gained a pound. What can I do to gain 
 weight?" 
 
 Reply. — If you have quit worrying your task is easy. Add food to your 
 present dietary until you eat enough to fatten you half a pound a week. 
 Continue on that ration until you have got back the ten pounds. Increase 
 particularly in your use of milk, buttermilk, cream, cheese, eggs, bread and 
 sweets. Drink plenty of water. 
 
 Would Lay on Fat. — A. W. writes that he and his wife had a breakfast 
 consisting of the following: Four pieces of toast, two cups of coffee} one- 
 sixth pound of cheese, one egg, four pats of butter, four heaping teaspoon- 
 fuls sugar, two ounces and a half 18 per cent cream, two teaspoonfuls 
 orange marmalade. He wants to know whether three meals similar in food 
 value would be too much for a man, who does office work, and his wife, who 
 has light household duties. 
 
 Reply. — This figures out 1,600 calories and 795 grains of protein. 
 Three such meals would be about 10 per cent too much. You would lay 
 on fat on such a diet. 
 
 Properties of Peanut Butter. — J. F. F. writes: "1. What properties as 
 a flesh builder has pure peanut butter? 2. Would the consumption of, say, 
 ten pounds in five weeks have a tendency to increase the weight of a very 
 thin person?" 
 
 Reply. — 1. Peanuts run about 1,500 grains of protein and 2,200 calories 
 to the pound. They are better at making heat than making flesh but they 
 are good for both. 
 
 2. Yes. Enough other food being eaten. 
 
CHAPTER XL 
 
 The Skin 
 
 The human body is in touch with its surroundings through the skin 
 which covers it externally and lines its cavities internally. These two sets 
 of structures at places merge into each other. They are built alike in some 
 ways and have work to do which in some particulars is similar. The lin- 
 ings are delicate, easily wounded and can only work when things are about 
 right. The skin is tough, hard to hurt and adjusts itself to widely varying 
 conditions. The linings to work well must be bathed in moisture. 
 
 There are those who believe that the reason for so much pneumonia, 
 consumption, and colds is that the lining of the lungs works in air which, 
 though moist, is a dryer medium than lining membranes work well in. Com- 
 pare the lung conditions with the variable conditions under which the skin 
 works — in contact with air sometimes wet and sometimes dry, sometimes 
 hot and sometimes cold, sometimes light and sometimes dark. If the 
 skin were at all delicate or had delicate work to do it could not adapt itself 
 to all these changes. 
 
 The reason for the toughness of the skin is in its structure. It is 
 composed of a true skin and over this a covering of epithelial cells called 
 the epidermis. The bottom layers are live cells and the outer layers are 
 dead. Dead cells are being constantly shed from the surface and in turn 
 replenished from the underlying live ones. The blood vessels and the 
 nerves are below the epidermis, which means that they are several layers 
 below the surface. Were it not for this blood would ooze out on the surface 
 and sensitive nerves would make life unbearable. It is the dead layer 
 which distinguishes skin from lining membranes, and this dead structure 
 is just as useful as any other, or maybe more so. 
 
 Out of the dead layer are developed the hairs and nails — each formed 
 for a special purpose. The nails are of service in protecting the ends of 
 the fingers and toes. The more we use them the better the nails. Our 
 custom now is always to protect the toes and seldom to use them and in 
 consequence the toenails, and, in fact, the toes, are disappearing. The only 
 toe now having a nail of any consequence is the big toe. To the contrary 
 horny masses called corns are becoming universal. We are shedding the 
 nails from the old places and developing pseudo nails at new ones. 
 
 The hair is for the purpose of keeping the body warm. The fur of 
 wild animals in the far north is heavier, better and more valuable than that 
 of the same species in the south. A few years ago a number of monkeys 
 in Lincoln Park were kept out all winter. By spring they were heavily 
 furred. 
 
 In human beings the growth of hair has practically disappeared from 
 all parts of the body except those which are habitually uncovered, and it is 
 
 700 
 
THE SKIN 
 
 701 
 
 gradually disappearing from these, largely because it is becoming unnecessary. 
 With the hair as well as with the nails, and with everything else, nature takes 
 from us through disease or heredity or some other agency those things of which 
 we make no use. Any policy which makes for thin, pink, pretty nails will 
 make for poor nails after a few generations, 
 though good -finger nails will persist for a 
 few centuries after toenails hav-e gone. If 
 we are not to become a hairless race we 
 must give more thought and care to con- 
 servation of the hair. 
 
 Just as the dead layers of the skin 
 pile up to protect the underlying nerves, 
 so there are layers of pigment in the skin 
 which prevent the underlying tissues from 
 the hurt of light. The difference between 
 the white, yellow, red and black man lies 
 in the skin pigment. Too much sunshine 
 may be just enough for some things but 
 not for the tissues below the skin. Wher- 
 ever races are subject to much sunlight 
 their complexions gradually darken. It is 
 held that the negro is black because as a 
 race he developed in the tropics. 
 
 In an interesting book entitled "Effects 
 of Tropical Light on White Men," Dr. 
 Woodruff of the United States Army argues 
 that acclimatization of the white men to 
 tropical light with its abundance of short 
 actinic rays will require many generations 
 and it will not come about until they have 
 developed skin pigment to protect the 
 underlying organs. In the interim they 
 should protect their tissues from the harm- 
 ful rays by wearing black or yellow under- 
 clothing and white, gray or yellow top 
 clothes. Black should be worn by those 
 who work in the shade. Helmets lined 
 with tinfoil and with wide brims are need- 
 ful. White men in the tropics should rest at midday. 
 
 There are those who argue that in the end those who live out of doors 
 will survive in the struggle for the survival of the fittest ; that for survival out 
 of doors the darker people are better fitted than the lighter. Therefore, the 
 darker races will survive, the blondes — the fair haired — will pass away. The 
 people of the world will all eventually be black, or at least dark. 
 
 The other side argues as follows: The light races live in cold climates. 
 No structure is in contact with the cold except the skin. Cold applied to 
 the skin — for example, cold air on a cold day — makes the man, woman, 
 and child eat more food, causes the tissues to burn up better, causes the life 
 fires to burn brighter and hotter. This, secondarily, means greater mental 
 
 Fig. 236. — Section of Hair Showing 
 the Epithelial Cells Which Pro- 
 duce It and Sebaceous Glands. 
 
702 
 
 THE SKIN 
 
 activity, greater physical stature, more physical force, more energy and 
 more stamina — and that these are the qualities that determine which people 
 are to survive. 
 
 The first group says the American people in conquering the diseases 
 and controlling the parasites of the tropics have made it possible for the 
 darker people of the tropics to do more work proportionate to needs than 
 the lighter people and therefore in another generation they will be out- 
 stripping them. To which the second group says that such people will always 
 be runty physically and "dolce far niente" mentally because they lack the 
 stimulus of cold air against the skin. 
 
 Sweat Pore 
 
 Epi- 
 dermis < 
 
 --— Hair 
 
 Bulb 
 
 Blood 
 Tube 
 
 Fig. 237. — Section of Skin Showing Hair, Sebaceous Gland, Sweat Gland and Blood 
 
 Vessels. 
 
 Whether the one or the other is right, it is interesting that the skin 
 is to settle the question. 
 
 Attached to the skin, or rather developing from it and a part of it, 
 are two sets of glands — those that make sweat and those that make grease. 
 
 The sweat is water and a little salt. Its only work is to help the 
 skin to get rid of the body heat. When scores of tissues are making heat and 
 but one is getting rid of it, that one needs help. The sweat glands with their 
 secretion, sweat, are doing a body service much in excess of that of the nails, 
 hair or pigment. 
 
 The skin having as one of its uses the protection of the body against 
 cold, it follows that one of its uses is to get rid of heat. We cannot live 
 or move, digest or think without making heat. Every tissue in the body 
 is engaged in making heat while but two, the lungs and skin, are engaged 
 in getting rid of it. In animals covered by hair the lungs have most of the 
 work to do. In consequence a dog or chicken breathes faster and harder, 
 pants more when exercising or hot, than does a man whose skin does most of 
 the work. 
 
THE SKIN 703 
 
 The blood brings the heat to the under surface of the skin and the air 
 absorbs it from the outer surface. But more important, the sweat glands 
 pour out warm water — sweat — by the pint and this evaporating liquid chills 
 and cools. When much heat is made the sweat glands pour out much heat. 
 When little heat is made the skin muscles shrivel and pucker the skin — goose 
 flesh — and close the pores of the sweat glands while the little muscles in the 
 blood vessel walls contract and press most of the blood away from the surface 
 and into the deeper tissues. 
 
 The grease glands furnish grease to keep the skin soft and pliable and to 
 keep the hair in good condition. In those parts of the body where there are 
 no hairs there are no grease glands — the palms of the hands and the soles of 
 the feet. Their usual location is at the hair roots. So important is grease 
 for the well being of the hair that heavily covered animals usually have 
 large accessory oil glands and with this oil they oil themselves. When you 
 see a duck reaching with his bill to a point on his back and then grooming 
 his feathers you may know what he is up to. 
 
 A dry skin cracks, fissures and breaks easily. The grease glands in 
 keeping the skin pliable and soft really help it in the doing of its work. On 
 the other hand people want to keep their hair as long as they can. More 
 people are interested in the grease glands and their help in preventing bald- 
 ness than in their other uses. The hair may be useless. It may have nothing 
 to do with the really important work of the skin but just the same men and 
 women want to keep it although they generally discover their interest when 
 it is too late. 
 
 The skin, having some contact with the blood, is occasionally the seat of 
 disease due to bacteria thrown out by the blood. This is the probable ex- 
 planation of the eruptions of typhoid fever, smallpox, and scarlet fever. More 
 frequently the skin is the seat of eruptions caused by chemical poisons in 
 the blood which act either on the skin itself or on the nerves. Such is 
 the explanation of eczema, urticaria, ivheals, herpes, shingles, food and drug 
 eruptions. 
 
 The idea that most of the skin diseases are venereal in origin is erroneous. 
 Of the three such diseases two do not affect the skin and the third does 
 not affect it in all of its stages. Skin diseases usually are due either to 
 local conditions or else to digestive disturbance. Skin eruptions do mean 
 bad digestion, overeating, fast eating or constipation. They come from 
 those gouty conditions which result from a man's eating one dollar's worth of 
 food and doing two cents' worth of physical labor. 
 
 As a general rule the skin diseases due to so-called impurities of the 
 blood are caused by the germ of the skin. Against these the dead layer stands 
 like a stone wall. A germ stands a slim chance of getting through so long as 
 that dead wall is there. Once it is brushed off enough to cause oozing any 
 germ which falls can go through. 
 
 This dead wall also stands as a barrier against the entrance or the 
 exit of anything. Through it neither flesh foods, foods, fats, medicines nor 
 drugs — nothing, passes in. Through it nothing from the interior passes out. 
 The only gates in or out through it are the pores of the sweat and grease 
 glands. A few bacteria go into the grease glands and make pimples, a few 
 infect the hair roots and make boils, a few hookworm parasites get in and 
 
704 THE SKIN 
 
 cause hookworm disease. The barrier occasionally fails ; generally it does its 
 work well. It protects, it works hard to get rid of heat made in excess, to 
 shield the underlying tissues against heat, cold and light. 
 
 It wears out its life trying to adapt itself to temperature, to wind, to 
 weather. It sometimes has diseases, sometimes spreads disease to the under- 
 lying tissues; more frequently it receives diseases from them. It is more 
 sinned against than sinning. 
 
 SKIN TAN 
 
 There are skins which naturally are thick and oily and others which are 
 thin and dry. The condition of the skin is the result of environment. 
 A woman out in the sun and wind a great deal must expect her skin to tan. 
 If she is in the dark and behind walls all of the time she must expect it 
 to be soft and white. 
 
 The object of the skin is to furnish protection to the underlying 
 tissues. If the light is bright the deeper layers of skin will pick up an 
 increasing amount of pigment so as to let less light through into the 
 underlying organs. 
 
 An albino is a person born without pigment, or with very little. It is de- 
 ficient in the hair, the eyes, the skin. All of the light which strikes him leaks 
 through into his underlying tissues and to him the daylight is as painful as 
 it is to an owl. 
 
 Sunshine is a good thing for a human being but too much of it is bad for 
 him and even a moderate amount is bad for his skin. Basking in the sun- 
 shine can be overdone, however pleasant it may be. When a tubercle bacillus 
 or the diphtheria germ tries it death follows in about seven minutes. In 
 order that he may indulge, the turtle must grow a thick shell, the man must 
 plant trees, build roofs, provide broad-brimmed hats and accumulate pigment. 
 
 As life in the open air is necessary for health a white, pliable skin is 
 proof that the owner is leading an unnatural and in the end an unhealthy life. 
 Tan, and sometimes freckles, indicate that the owner is leading a life which 
 is good for the body as a whole but is bad for the skin. 
 
 This should be kept clearly in mind : It is the exercise and the open 
 air which does the good, and the strong sunlight is of secondary importance, 
 in fact, is to be guarded against as much as is compatible with exercise 
 and air. Lying around on the beach loafing and tanning scarcely gains 
 enough good to offset its harm. 
 
 About the same conclusions apply to the wind's tanning. The winds of 
 a dry country make the skin brown and leathery. The moving, hot, dry air 
 must have water and it takes it from the skin. The climatic condition which 
 makes so much for improvement in tuberculosis of the lungs is harmful 
 to the skin. On the otheV hand, exercise in the open air on a wet day does 
 not harm the skin. The exercise makes heat, the hot blood is sent to the 
 skin to be rid of its heat, the sweat glands pour out sweat but the rain 
 and snow have filled the air with moisture and the skin is not dried out or 
 tanned or mummified. 
 
 The point to this article is that the skin is for the purpose of protection. 
 It has work to do. The things that are good for us such as open air and a 
 
SKIN TAN 705 
 
 moderate amount of sunshine are bad for our skins. If a woman wants 
 a lily-white or house complexion she must stay in the house. On the other 
 hand staying in the house makes her liable to get fat and flabby and to de- 
 velop indigestion from which a bad skin results, so that in the long run 
 nothing much is gained for the skin. A woman with a white skin will some- 
 times be ahead at thirty but not frequently; after that she is pretty certain 
 to be a loser and what woman wants to lose out at thirty? 
 
 SPARE YOUR SKIN 
 
 Tanning is a process by which the skin protects the underlying tissues 
 from the effects of light. This is accomplished by the development of a 
 heavier pigment layer. The point to keep clearly in mind is that violent 
 light is a harming agent. If the skin covering does not stop the work of 
 this agent the underlying tissues are harmed; if the skin stops it, the skin 
 is harmed; the tissues below are spared. If the skin is much hurt it 
 blisters, swells, becomes edematous. If less so, it becomes red and sore and 
 eventually peels. If still less so, it tans. 
 
 Pusey says: "As a result of long continued tanning and other results 
 of the action of light, very positive deterioration in the skin occurs. It is due 
 very largely to the effects of light that the skin of the hands and face 
 shows those changes which we recognize as those of increasing years." 
 
 This does not mean that people should not go in swimming, or lie on the 
 beach, or fish, or hunt. It does mean that they should try to avoid being 
 sunburned and tanned. Of course, there is no justification for sun blister- 
 ing. Such an excess limits the pleasure of the outing and gains nothing. 
 But if tanning is brought about so gradually that the skin does not get 
 sore it stops the light rays and makes one better able to stand the sun 
 glare. 
 
 The skin is harmed but the individual gains enough to compensate. To 
 lie around on the beach just to tan is foolish. To tan as a means of in- 
 creasing the pleasure of the out of doors is usually justified. The prospec- 
 tive resorter might well begin gradual tanning before he goes away. After 
 going it is well so to regulate the daily exposure that the skin does not 
 get sore. 
 
 Nothing is gained by going bareheaded and exposing unnecessary parts 
 of the skin. Tanning as a means in a given case may be justified; tanning 
 as an end is never justified. 
 
 Going bareheaded, exposing the head to the heat and light in sum- 
 mer, is not good for the hair. It is possible that it may do no harm, and 
 may even do good in the winter, spring and fall; but the conditions are 
 different in summer. 
 
 Baldness is a senility change. It may be contributed to by dandruff, 
 by disease and by bacteria. It may be in advance of and apart from 
 general senility. A man may be old in the hair but not demonstrably old 
 elsewhere. As Pusey says, "Too much sunlight assists in bringing about 
 senile changes in the skin. The hair is a part of the skin. Exposure of the 
 bare head to the glaring sunlight in summer is more apt to cause than to 
 prevent baldness." 
 
706 THE SKIN 
 
 THE SKIN AND BATHING 
 
 The skin consists of two layers — the true skin and the outer skin or 
 cuticle. In the skin are millions of oil and sweat glands which empty 
 their contents on the surface of the skin, hair follicles and hair. There are 
 also numerous blood vessels — veins and arteries and nerves. 
 
 In that great expanse of skin are a multitude of nerves sensitive to 
 heat and cold and a wilderness of thin-walled blood vessels filled with 
 blood. 
 
 To make use of warm water and soap baths for cleansing purposes is 
 well enough. To fail to use baths for their effect on that great expanse 
 of nerves and also for their effect on the great volume of blood contained in 
 the skin capillaries is to neglect a great resource. 
 
 • The skin grows from below. The old cells are pushed to the outside 
 by the young ones. As they move out they die. The dead cells are finally 
 pushed to the surface where they lie mixed with grease, sweat from the 
 sweat glands, and the bacteria of decomposition. This decomposing mass 
 must be removed; else the products of decomposition irritate the cells be- 
 neath. 
 
 The cleansing bath being for the purpose of removing dirt from the 
 ducts of the sweat and grease glands as well as from the surface, the water 
 should be warm enough to cause the small skin muscles to relax and to cause 
 perspiration and grease to pour out of the gland ducts washing out the 
 dirt and bacteria. 
 
 If the person is prone to bath itch a less thorough removal of the dead 
 layers will bare the sensitive nerves less and is therefore better. In such 
 people the cleanliness bath can be overdone. 
 
 The morning cold bath is in no sense a cleansing bath. Its purpose 
 is to get an effect on the skin nerves and blood vessels. It is a nerve treat- 
 ment rather than a bath. It consists of a few minutes of exercise to start the 
 heart to pumping harder, then a few seconds of exposure to cold. When 
 the exposure comes, whether it be through cold water or cold air, the 
 skin muscles contract and the skin blood vessels are in great measure 
 emptied. Then follows the rub and the exercise whereupon the blood 
 courses through the dilated capillaries, and the skin muscles become re- 
 laxed. 
 
 A cold bath is a stimulant, a tonic, and a preventive of cold feet, if the 
 person is able to get up a good reaction. Unless the afterglow is good, the 
 cold bath does no good. 
 
 The warm bath without soap soothes and calms. It induces sleep. 
 It is good for insomnia, for mental tension, for conditions bordering on 
 delirium. 
 
 A warm bath should be continued more than fifteen minutes. In hydro- 
 pathic establishments they have baths so arranged that the disturbed person 
 stays continuously in the bath for hours, even days. 
 
 To get at the nerves various methods of giving local baths have been 
 devised. Such are sitz baths, hot foot baths and wet packs. To get at 
 the nerves of a part by a hot or a cold bath is better than to do it by taking 
 medicine out of a bottle. 
 
ECZEMA 707 
 
 PIMPLES 
 
 We say that any consumptive whose disease is inactive can be made 
 to put on fat, from which we argue that if a well man does not fatten 
 it is because he will not take the trouble. 
 
 If a prize fighter stripped for battle were to show a back and face 
 full of pimples he would be booted out of the ring. Prize fighters are thick- 
 skinned, full-habited and right at the pimple age. What is the secret ? 
 
 1. They exercise violently every day and make much heat; in order 
 to get rid of it their skin blood vessels carry a great deal of blood, their 
 sweat glands pour out a great deal of sweat and their grease glands secrete 
 much grease. 
 
 2. They keep the quantity of their food in some relation to their work. 
 They eat a great deal but they work a great deal. Ninety-nine times out 
 of a hundred they are losing weight which means that, however much they 
 may be eating, they are in need of more fuel and in consequence they 
 burn up some of the fat of their bodies. 
 
 3. They keep their skins very clean. The openings of their grease 
 glands are not plugged up by dirt or scarf skin. Incidentally, I imagine 
 blackheads are squeezed out wherever found. 
 
 To sum up — the prize fighter takes the trouble to be rid of his pimples. 
 There would be no money in his business for him if he went around, instead, 
 asking for help — lying down on the job. 
 
 It is reasonable to conclude that every case of pimples or ordinary acne 
 would be cured by following the same program. Some persons with thick, 
 greasy skins very susceptible to local pus infection may have to play out the 
 string. Others may not have to go to so much trouble. 
 
 But everyone who wishes to be cured of pimples should begin at the 
 beginning and keep on going until results are had. Those subject to pimples 
 must either be troubled with them or take the trouble to cure them. 
 
 There is a relationship between the skin and the digestion and assimila- 
 tion. When the skin is being kept properly clean and pimples persist the 
 cause is to be sought in disturbance of the stomach or intestines or both. 
 That contributing cause is frequently chronic constipation. Almost as fre- 
 quently it is overeating. Often it is one of those stomach conditions that we 
 lump together and loosely call dyspepsia. 
 
 But this does not alter the original statement — most cases of stomach 
 trouble will yield to a sensibly restricted diet; nearly all cases of constipa- 
 tion to a proper diet. 
 
 ECZEMA 
 
 If one turns to a medical dictionary for the meaning of eczema he finds 
 salt rheum and tetter given as synonyms and then follows a definition which 
 allows room for almost every skin disease. Stedman's dictionary gives twenty 
 different kinds of eczema. . ■ . 
 
 Now it is • a well recognized fact that where there are many cures 
 for -a- disease there are no cures. Nature and nursing do the curing, some- 
 times aided by the cure, sometimes hindered by it. ■ - 
 
708 THE SKIN 
 
 Whenever one finds a shotgun disease he is not dealing with one disease, 
 but with a group. For instance, whenever catarrh is spoken of any one of 
 a dozen conditions may be meant. It follows that there is no catarrh 
 and there are no "catarrh cures," advertisements to the contrary, notwith- 
 standing. 
 
 There are scores of diseases called eczema and scores of eczema cures. 
 Occasionally somebody having a particular kind of skin disease and calling 
 it eczema happening to hit upon a cure for his particular disease can 
 thank his stars for his luck is with him. He has won in playing a game 
 where the odds were as much against him as in keno. 
 
 There is no clear cut disease known as eczema, though there is a certain 
 group of skin changes that are known as eczematous and often as eczema. 
 Eczema is a condition in which there is inflammation of the skin character- 
 ized by something wrong in the dead layer. This layer breaks up into a 
 soapy, greasy mass or it macerates and falls away exposing sensitive nerves 
 and allowing some of the tissue juices to ooze through. 
 
 But however striking the skin changes may be the trouble lies back 
 of there. The skin is the telephone bell which Tings to announce a con- 
 dition at the other end of the line. The bell rings in the skin but the 
 impulse which rings it and the cause which talks are elsewhere. If the bell 
 were not there then it could not ring — the skin is a contributing factor — 
 but the battery, the initiative, the starting cause is elsewhere. 
 
 Eczema on a baby's head calls for just enough local treatment to prevent 
 local aggravation. The fundamental treatment is to be directed toward the 
 baby's digestion and nourishment. The same is true of eczema in grown 
 people. As much local treatment should be given as is necessary to prevent 
 local aggravation. In so far as possible the unduly exposed cells of the 
 true skin must be protected from being harmed by maceration, by absorption, 
 rancid fats, decomposition or bacteria, or by irritation of the nerves. But 
 these are of secondary importance. The essential is to remove the basic 
 trouble — the constipation, the gout, the indigestion, the perverted chemistry, 
 the wrong habits, the nervous basis. 
 
 Almost without exception the doctor who takes off his coat and digs will 
 find a cause for a case of eczema and almost without exception the patient 
 who carries out directions persistently enough will be cured. 
 
 But to say "over and over the story ending as he began" — it is not a 
 blood disease. 
 
 ECZEMA IN BABIES 
 
 There are three kinds of eczema in nursing babies. One is a dry, scal- 
 ing, itching eczema, principally on the chest. This condition is found 
 in thin, scrawny, under-nourished children. When such children are fat- 
 tened up and proper attention paid to their diet the itching passes away. 
 
 The second is an ordinary eczema of face and head in fat babies. 
 While local applications of salves may be of some service the keynote of 
 treatment is to change the food. Generally the trouble with the food is that 
 it contains too much fat. Speaking generally, also, the indication is for a 
 food containing a low percentage of fat with some increase in the amount 
 of starch and sugar to offset the decrease in fat. 
 
DISEASES WHICH SHOW THEMSELVES IN THE SKIN 709 
 
 - The third variety is allied to the second. It is what is known as 
 tetter or milk eczema. The cheeks are very red and sometimes chapped. 
 Somewhere on the skin, usually on the head, there are curdy patches. 
 
 Dr. Grulee tells us that there are two often overlooked skin appearances 
 which are due to a mild grade of eczema. When they are recognized for what 
 they are and the food changed to what it should be these cases can be halted 
 before they develop. 
 
 One is that of the red cheeks slightly roughened and a bit chapped, to 
 which allusion has already been made. The other is a yellowish gray patch 
 on the top of the head near the soft spot — the cradle cap. These patches are 
 usually thought to be dirt and are treated as such until the disease develops 
 into a full blown case of tetter. 
 
 These children have other peculiarities. They are prone to constipation. 
 This constipation persists as long as the food is rich in fat. The weight 
 curve is peculiar. Generally these children are fat but they are apt to stop 
 gaining weight for a while, and then to shoot up rapidly for a while followed 
 by another stop. 
 
 They digest gruels well. They are free from tendency to diarrhea. The 
 tongue is apt to be white in spots. There is a great tendency to colds, coughs 
 and croups. Children a little older are very apt to develop enlarged tonsils 
 and adenoids. They are nervous and susceptible to contagion. 
 
 What is to be done with these children? First of all, and very much 
 the most important, the diet must be changed. In babies the fat in the milk 
 must be reduced to the minimum. To offset it the starch and sugar must be 
 increased. 
 
 These babies are able to digest well-prepared starch by the third month. 
 They can take malt food from the second week; as they get a little older, 
 vegetables and gruels, fruit and meat juices can be taken. Cod liver oil agrees 
 with these children better than cream. They must be kept in the open air as 
 much as possible. They must be wrapped well and kept warm in winter; in 
 summer they must be kept cool. 
 
 DISEASES WHICH SHOW THEMSELVES IN THE SKIN 
 
 A dry goods store which had no show window or did no display ad- 
 vertising would not interest many people. The skin is the show window, 
 the display ad. page of many internal conditions. Not every man knows 
 a bargain when he sees it in the window or reads about it in the adver- 
 tisements. Men vary in the skill with which they read what the skin tells 
 of conditions within. 
 
 Not every store uses its window display to best advantage. Not every 
 disease paints a skin picture. Of those that do, not every one tells a clear cut, 
 definite story. 
 
 Following are some of the physical conditions that display their wares in 
 the shin show window: A bronzing means that 'way off yonder in the adrenal 
 glands tubercle bacilli are destroying tissue. Sunburning of the hands, face, 
 and chest when there has not been exposure to the sun means that somewhere, 
 in some internal organ, the cause of pellagra is operating. 
 
710 THE SRItf 
 
 In the deeper layers of the skin are blood vessels and the blood in these 
 determines whether the skin is pink or pale. A thin skin allows the blood 
 to show through easily and a thick one poorly; bnt the hnman skin is never 
 so thick but that tint is given to it by the blood. If the blood is rich or 
 there is much blood the skin is pink and ruddy. On the other hand, poor 
 blood or little of it in the skin results in pallor. 
 
 A pale, white skin means anemia due to poor blood making or excessive 
 blood breaking. A faint lemon hue means that somewhere in the tissues 
 blood is being excessively destroyed and pernicious anemia is resulting. A 
 marked yellow means that bile instead of flowing where it is needed is being 
 poured into the blood. 
 
 Pimples and toils mean that the germs which naturally lie quiet and 
 inoffensive on the skin are traveling down the grease glands and hairs into 
 the deeper layers — part of the responsibility for which lies in the shin itself 
 and part in the chemistry of the body. Carbuncles mean that ordinary sur- 
 face germs have traveled still deeper. Not infrequently back of the carbuncle 
 lies diabetes, a profound change in the chemistry of the body. 
 
 Physicians diagnose scarlet fever and measles by the "looks" of the 
 skin. Often they prognose in the same way. These infections enter through 
 the throat and the skin manifestation is by no means the only one. Any 
 observer can see that the inside of the mouth also breaks out. It is reasonable 
 to conclude that the inside linings are in much the same condition as the skin. 
 
 The hair falls out after typhoid as well as several other profound poison- 
 ings. On the other hand, in some cancers and other diseases profoundly 
 affecting nutrition the skin becomes covered with a fine growth of hair — wit- 
 ness the poor, weazened, down-covered babies who have survived months of 
 summer complaint. 
 
 Finally, the red-veined and often bulbous nose, often called "whisky 
 nose," means protracted indigestion. If a whisky fiend has one it is because 
 he has burned out his stomach. But the stomach can be burned out in other 
 ways. The drunkard must share his honors. 
 
 STRAW ITCH 
 
 If our relations with Mexico are broken off and our army is forced 
 thereby to enter Mexico the soldiers will swap some of their present itches 
 for others. They will get rid of their winter itches. Those are due to the 
 hot, dry air common in houses, offices, stores, and some factories. Those 
 will disappear within a week after the men are put into tents. Summer 
 itch or bath itch will disappear. The supersensitiveness of the skin re- 
 sponsible for this condition will disappear. 
 
 In their place will come "chigger itch," old-fashioned, or seven-year 
 itch, and straw itch. These are due to small bugs. 
 
 A few years ago the First Cavalry was camping at Elgin, Illinois. It 
 bought straw from near-by farmers and filled ticks with it. At sick call each 
 day a mob of scratching troopers came forward. They were broken out with 
 an eruption that had the appearance of hives. In some of these wheals there 
 were small blisters and some of these blisters contained pus. 
 
PSORIASIS 
 
 711 
 
 Schamberg tells us that sometimes this straw itch looks like chicken 
 pox and occasionally it has been mistaken for smallpox. 
 
 The government men found that this straw,. or grain, itch was due to a 
 small oug, a first cousin to the red dug, and a second cousin to the ordinary 
 itch hug. This oug lives in the straw from grain fields. It lives on ordinary 
 grain insects and only feeds on man when its usual food supply fails. 
 
 The bug is found in straw which has been stored without airing or 
 sunning. Any commander who buys straw for his men can protect them 
 from this parasite in a simple way. Let him see to it that the straw is 
 exposed to the sun and air for one day before it is used to fill the ticks. The 
 parasite is so delicate that one day of sunlight and air kills it. 
 
 The men who han- 
 dle the infested straw 
 should grease their bodies 
 well with lard or vase- 
 lin. At night they should 
 bathe thoroughly. The 
 clothing should be sunned 
 and aired for a day. Wil- 
 dermuth showed that the 
 parasite would starve to 
 death in a day. 
 
 When the eruption 
 is present the treatment 
 is simple. The clothing 
 should be changed and 
 the infested clothes 
 
 should be thoroughly aired. The bug does not bore in. The red bug buries 
 itself in the skin; the tick buries its head; the itch bug bores deep but the 
 straw parasite stays on the surface. A good bath and rub get rid of most of 
 those that have not already turned loose. 
 
 To grease with a mild sulphur ointment helps somewhat. If there is 
 much itching a soda water bath followed by a zinc oxid ointment will help. 
 
 Straw that has been exposed to summer heat or that has been cured out- 
 side does not contain parasites. 
 
 Probably an army in Mexico would not be troubled with this parasite. 
 The troops in the state camps will suffer. This story concerns them. 
 
 It also concerns some people who do not go to war. Farmers working 
 in grain fields suffer. Occasionally city people who sleep on straw mattresses 
 suffer from it. In fact one of its names is straw mattress disease. 
 
 Fig. 238. — Red Bugs (harvest mites). Highly magnified. 
 Dots under anal extremity indicate natural size. (After 
 Riley.) 
 
 PSORIASIS 
 
 Probably few people are justified in going to much trouble about 
 psoriasis. However, a person with psoriasis usually thinks he is willing to go 
 to a good deal of trouble to control it. Some of them are. This may be 
 accepted as an axiom. Anyone who wishes to spare himself trouble from 
 psoriasis must go to some trouble. 
 
712 THE SKIN 
 
 Schamberg thinks that eating too much protein is a large factor in 
 psoriasis. He argues that a man can cure his psoriasis or put it in such 
 a condition that chrysarobin will cure it by changing his eating habits. In 
 the discussion which followed the reading of the paper several excellent men 
 disagreed with the proposal, but any suggestion from Schamberg is worth con- 
 sidering. 
 
 He advises the following diet: 
 
 BREAKFAST 
 
 Ounces. Ounces. 
 
 Bread 2/3 Apple 4V 2 
 
 Butter x /2 Cream 1 
 
 Breakfast food 1/3 Tea 4 
 
 Orange 5 
 
 LUNCH 
 
 Ounces. Ounces. 
 
 Bread x /2 Turnips 2*/ 2 
 
 Butter V2 Cornstarch 6V2 
 
 Grapes 5 Potato cake 10 
 
 Lima beans 1 2/3 Tea 4 
 
 SUPPER 
 
 Ounces. Ounces. 
 
 Bread 1 Corn 31/3 
 
 Butter y 2 Celery 1 
 
 Prunes 3 Potatoes 7 
 
 Cauliflower 2V2 
 
 This furnishes for the day a total of 1,888 calories and seventy-five 
 grains of nitrogen, enough for a man engaged in any form of desk work. 
 This he varies by substituting Diet No. 2, as follows: 
 
 BREAKFAST 
 
 Ounces. Ounces. 
 
 Bread 2/3 Bananas 3y 2 
 
 Butter y 2 Rice 1/3 
 
 Grapefruit 5 Cream 1 
 
 LUNCHEON 
 
 Ounces. Ounces. 
 
 Bread M> Cabbage 2y 2 
 
 Butter y 2 Lima beans 2^ 
 
 Cornstarch 5 Potato cake 8 1/3 
 
 SUPPER 
 
 Ounces. Ounces. 
 
 Bread 5/6 Corn meal 4 
 
 Butter y 2 Prunes 3 
 
 Lettuce 5/6 Sweet potatoes 3 1/3 
 
 Beets 3 1/3 Cream 2/3 
 
BOILS 
 
 713 
 
 This diet furnishes 1,812 calories and sixty-nine grains of nitrogen. 
 
 It will be noticed that this is a vegetarian diet. The percentage of 
 protein is brought up by such articles as bread, lima beans, potatoes and 
 corn meal; the calories by cornstarch, potato cake, corn meal, sweet potatoes 
 and butter. But of more importance than the regulation of articles of 
 diet is the regulation of the quantities eaten. 
 
 BOILS 
 
 Since the time of Job a man's behavior when afflicted with boils has 
 been the standard by which his patience has been determined. Boils hurt; 
 they are diabolical in their selection of locations and they keep coming. 
 
 It is an ill wind that blows good to no one. The blood purifier people 
 have reaped a rich harvest by selling blood medicine to people with boils. 
 
 Fig. 239. — Infections at Root of, Beneath and Near End of Nail. 
 
 Their easy money is at an end. Almost everybody knows now that boils 
 do not result from impure blood and that blood purifiers do not help 
 one to get out of the Job class. 
 
 When a person near middle life has crops of boils it is advisable that he 
 go to a physician and find out if he has diabetes. With that ruled out the 
 cause of boils comes back to infection of the skin and the tissue below it by 
 pus germs. 
 
 The age-old custom of poulticing a boil with a hot flaxseed poultice made 
 the skin soft and soggy and a dull knife could cut it without difficulty. In- 
 cidentally it infected the near-by skin and caused a crop to grow where one 
 boil had grown before. Therefore the plan now followed is to clean the skin 
 and keep it clean — bacteriologically clean. 
 
 Berger advises to paint the boil and an inch around it on every side with 
 tincture of iodin. Give it a good coat. Then apply ichthyol vaselin, 10 
 per cent, on a piece of gauze, cover with cotton and a bandage. The next 
 day the dressing is to be removed, the skin cleaned with benzin, then the 
 painting with iodin and the application of the ichthyol ointment are to be 
 repeated. 
 
 This is kept up day after day unless the skin is irritated by the 
 
714 THE SKIN 
 
 iodin. If so, the iodin is left off and the ichthyol ointment alone is 
 used. When the boil heads it may be lanced or left to open by itself at 
 the discretion of the physician. 
 
 PRICKLY HEAT 
 
 Use talcnm powder freely. If severe, wash with one part water and 
 three parts alcohol. Dust afterward with talcum powder or wash with 
 lime water containing two drops of carbolic acid to the ounce. 
 
 DERMOIDS OF THE FACE AND NECK 
 
 Not infrequently in the developing child some part of the machinery 
 will not work just right. When two plates of bone are due to grow toward 
 each other along an edge they may not get together at all and a cleft 
 persists after birth, or one may get there first and turn the other to grow into 
 the underlying tissue, or some other accident may happen. Many things 
 are responsible for the location of these developments. 
 
 Miss Bevington wrote : 
 
 The softest dimple in a baby's smile 
 Springs from the whole of past eternity, 
 Tasked all the sum of things to bring it there — 
 
 which caused Sir Francis Wilks to say "that there is a material basis for 
 these pretty and significant lines." Bland Sutton says these small benign 
 congenital tumors are prone to develop in the locations on the face where 
 dimples occur. 
 
 Many of the congenital tumors, moles, birthmarks, hairy patches, tabs 
 and clefts found on the face and neck are dermoids. 
 
 A dermoid is liable to result whenever in the development of the unborn 
 child a bit of skin grows into some place where it does not belong. Among 
 the better known dermoids are the following: 
 
 The tabs which frequently are seen on the neck of hogs, goats and 
 
 sheep and occasionally on the throat of a man. In fact the old 
 
 Greek statues of fauns always showed these tabs — dermoids — on the 
 
 neck. 
 
 The small tumors on the ears or just in front of, below or back of the 
 
 ears. In some cases these little mounds are covered by hair. 
 The small tumors, out of which a tuft of hairs grow, so frequently seen 
 on the cheek about an inch from the corner of the mouth. Dermoid 
 tubercles in this location are almost the rule in terriers. 
 The small tumors at the outer corner of the eye below the eyebrows and 
 
 on the nose near the inner corner of the eye. 
 The small tumors on the bridge of the nose. 
 
 The tufts of hair which are sometimes seen on the bridge of the nose 
 or at its tip. 
 
DISEASES CONTAGIOUS THKOUGH THE SKIN 
 
 715 
 
 DISEASES CONTAGIOUS THROUGH THE SKIN 
 
 Those whose conceptions of the contagiousness of leprosy are due to 
 the Bible accounts are more disturbed by the proximity of a leper than is 
 warranted. It is possible that leprosy was more violent two thousand years 
 ago than now but it is probable that in those days many different diseases were 
 called leprosy and some of them were very contagious. At least such is the 
 
 
 Fig. 240. — Hookworms, a, newly laid egg; b, beginning segmentation; c, egg, further stage 
 segmentation; d, e, advanced stage segmentation; f, preceding formation embryo; g, embryo 
 in first stage; h, embryo just before leaving shell; i, embryo after leaving shell; j, embryo 
 several days old; k, embryo covered by chitinous envelope in stage to infect. 
 
716 THE SKIN 
 
 conclusion of Ih\ Ernest L. McEwen, who has studied the subject carefully 
 and has written the results of his study in the Biblical World of September, 
 1911. 
 
 Leprosy today is a mildly contagious disease, the contagion spreading 
 through the scarf skin. 
 
 Louisiana, Minnesota, California and the Hawaiian Islands find even 
 moderately careful segregation enough to control the contagion of leprosy. 
 
 Nowhere does the problem of stamping out leprosy present great diffi- 
 culty; certainly no difficulty comparable with diphtheria or measles. 
 
 Tuberculosis of the skin — lupus — can be spread by any case where there 
 is secretion of pus but the danger of tuberculosis from this source is scarcely 
 worth considering. 
 
 In some cases of typhoid fever there are typhoid patches on the skin — 
 small, obscure, and easily overlooked. When cultures are made from fluid 
 these red areas from typhoid bacilli grow — but typhoid is never spread in this 
 way. The germs are always below the layer of dead cells of the skin. 
 
 In scarlet fever and measles there are skin 
 
 Female % / 1 # Male eruptions in a rough way similar to those of 
 
 \ / typhoid. In these diseases the contagion is 
 
 Fig. 241. Hookworms, Actual spread by the mouth and nose secretions but not 
 
 Size. by the skin. 
 
 Smallpox infection is distributed by the 
 blood to many organs including the skin. It is probable, though it is not 
 certain, that the germs of smallpox are thrown off with dead skin and skin 
 ►exudates — that it is spread by the skin. 
 
 In itch and in ring worm the parasites causing the disease are just under 
 the skin but do not wander any deeper. By applying proper insect destroy- 
 ers to the skin they can be killed almost as easily as can those insects which 
 are on the outside of the dead layer. Itch and ring worm are spread by 
 the skin. 
 
 On the other hand, there is a group of parasites, of which hookworm 
 is the only widespread illustration in this country, which get in through the 
 skin but travel to find a field of activity elsewhere in the body. Whether 
 a boy with "ground itch," "dew itch," or "dew poison" can spread hook- 
 worm through his skin I do not know. 
 
 People have quit poulticing boils, because poultices spread the pus germs 
 of the boil from infected to noninfected areas. 
 
 Finally, there is a skin infection so widespread that it overshadows every 
 other. It is that little known skin infection which causes somewhere about 
 70 per cent of the baldness. This infection is spread by brushes and combs. 
 
 HIVES 
 
 The scientists call hives urticaria. Until recently the man who knew 
 the disease as hives had about as much information about it as the man who 
 called it urticaria. He knew that raised red wheals or whelks which itched 
 almost beyond power for restraint were hives. 
 
 Further he knew that a simple wash of witch hazel or soda water gave 
 
HIVES 717 
 
 some relief to the itching; that behind the trouble lay some irregularity in 
 digestion and that a free purge was indicated. 
 
 In some cases attacks followed eating shellfish, strawberries or some 
 other food toward which the individual had an idiosyncrasy. 
 
 The scientist is gaining on the man of general information. He has 
 learned that the eruption is in the nature of a neuralgia; that behind the 
 neuralgia lies the presence in the blood of a substance poisonous to that 
 person. In most instances the poison has been absorbed from the intestines. 
 
 The poison most frequently present is an amin, formed out of an amino- 
 acid named histidin. There are certain foods rich in histidin. Such are fish, 
 blood, milk, juicy meat and especially meats from carcasses that have not 
 been drained of blood and are classed with blood. 
 
 Acting upon this information, Salomon, Eustis and other physicians 
 treat their hives patients by keeping them on a diet. For the first two weeks 
 they live on tea, coffee, bouillon, lemon and grape juice, potatoes, rice, cereals, 
 plenty of butter and sugar, and seven ounces of bread made from coarse 
 flour. After the two weeks beets, celery and spinach are added to the diet. 
 
 In reestablishing one's eating habit care should be taken to restrict 
 greatly the quantity eaten of milk, buttermilk, cheese and all foods made 
 from whole milk, eggs, fish and juicy meats. Boiled meat is less harmful, 
 particularly if the meat is soaked in cold water before being boiled. 
 
 It is not possible to cure hives by this method unless the bowels are 
 cleaned out and kept open. To bring about the first Dr. Eustis gives a 
 calomel purge. To accomplish the second purpose he uses two or three 
 ounces of albolene, agar in oatmeal in the morning or fig paste containing 
 chopped up senna leaves. Drinking a full glass of water upon rising in the 
 morning is a great help. 
 
 A method of giving relief to the itching and reducing the swelling used 
 by Swan is of interest to the physician only. It consists of injecting under 
 the skin a small dose of extract of adrenal gland. The hives disappear at 
 once and stay away for eight hours. More than half the cases of hives are 
 of the type which yields to this treatment. 
 
 The man who wants to escape hives can do so by eating the right food 
 and refraining from eating the wrong food. 
 
 Eczema Loose Term. — R. E. L. writes: "Bo you mean to say that 
 cleanliness will cure eczema? My uncle, himself a doctor, was slowly tor- 
 tured into his grave with eczema, and my fathers life is made miserable 
 with the same trouble. It certainly is not a question of cleanliness with 
 him, as he gives most of his time to caring for it. Father s is called, I 
 believe, 'hidden eczema.' " 
 
 Reply. — I do not. Cleanliness is of very limited value in the cure of 
 eczema. It will cure some cases. 
 
 Eczema is a very loosely used term. It covers a variety of skin dis- 
 eases. Cleanliness helps some of them. Most cases of eczema will respond 
 to a properly regulated diet, a hygienic life and proper toilet of the skin. 
 I do not know what is meant by "hidden eczema." 
 
 Eczema in Babies. — Mrs. L. G. F. advises for eczema of the head in 
 
 babies that the following plan be tried: 
 
?i§ THE SKIN 
 
 Besides the regulation of diet, I found, after costly experience, that 
 eczema, if taken in time, will readily respond to simple remedies, such as 
 vaselin, zinc ointment, and olive oil, if applied (according to the stage) in 
 alternate treatments. In both my cases one thing used alone lost its effi- 
 ciency in a short while, but the cure was effected by not using the same 
 ointment in succession. 
 
 Cause of Dry Skin. — W. J. writes: "What causes roug\, dry skin on 
 the arms and upper portion of the lower limbs, especially in winter?" 
 
 Reply. — Dry air in the living room and office. 
 
 Holds No Theory. — B. B. B. writes: "I have understood that what 
 eczema really is is unknown; that the American Medical Association's 
 theory is that it is a parasite or germ attacking and imbedding itself in the 
 skin at the most susceptible point: hence, it. can be eradicated by external 
 applications of germicides. Is this so?" 
 
 Reply. — If you mean that no definite single cause of eczema is known 
 you are right. 
 
 The American Medical Association has no theory as to the cause of 
 eczema. To take positions on such questions is not in its line. While any 
 member may hold any theory he pleases not many of them think eczema 
 is the result of a parasite or germ, nor do they use ordinary germicides 
 in the ordinary way for the cure of eczema. 
 
 Eczema Not Contagious. — B. L. C. writes: "We have an acquaintance 
 who is suffering from eczema. It comes of blood poisoning caused by vac- 
 cination. Is there danger of giving this disease to members of a family 
 where she has access to the bath and uses soap, towels, etc.? Being a dress- 
 maker, is it safe to have her handle goods, do fitting, etc.?" 
 
 Reply. — Eczema is not caused from blood poisoning nor from vaccina- 
 tion. It is not contagious. It is not spread by soap or towels. It cannot 
 be communicated in fitting clothes. 
 
 Has No Effect. — Reader writes: "1. What effect does muriatic acid have 
 upon a person having eczema, if taken one drop in half a glass of water 
 twice each day? 2. Will it cause the eyes or lids of the eyes to swell?" 
 
 Reply. — 1. None. 
 2. No. 
 
 Eczema. — Subscriber writes: "I have a patch of eczema on my foot. 
 1. Please tell me what eczema is, and how it spreads. 2. Is it always heredi- 
 tary, and, if not, may it be transmitted to the children of one having it? 
 S. What is the best method of curing it? -4- When cured will it stay cured?" 
 
 Reply. — 1. Eczema is a mild inflammation of the skin. If you mean 
 by "how it spreads," is it catching — No. 
 
 2. No as to each question. 
 
 3. Your physician will advise you how to change your habits and the 
 care of your skin so as to put yourself in shape to have the patch get well. 
 He will give you local applications which will help. Persist in doing as 
 you are told. 
 
 4. It will if the new methods of caring for the skin and new habits are 
 kept up. If not it may recur. 
 
HIVES 719 
 
 Scalp Eczema. — A. F. writes: "I am bothered with eczema around 
 the hair line. Sometimes it itches terribly, and I find dry sulphur is the 
 only thing that stops it. What will cause this complaint to disappear?" 
 
 Reply. — Probably you have a seborrheic eczema. This is the most 
 frequent cause of dandruff and loss of hair. The remedy is to take good 
 care of your scalp, to wash your hair frequently, to grease it slightly, to 
 use sulphur daily one way and another, to brush your hair well. To cure 
 the condition by giving your hair attention all of the time, in season and 
 out, is not difficult but you must stick to it. 
 
 Must Cleanse Daily. — A. F. W. writes: "What causes itching, cracking 
 of shin, and festering between one's toes? How can this condition be 
 prevented?'' 
 
 Reply. — This is an eczema. It results from decomposition of secretions 
 and wastes. In other words, it starts from lack of cleanliness. Having 
 started it may persist in spite of great care and cleanliness. 
 
 If the oozing is extremely bad cleanse daily with oil. If it is not so 
 bad cleanse with soap and water. After everything has been made clean 
 use powdered boracic acid as a dusting powder. 
 
 Daily attention is the keynote to success. 
 
 Sensitive Skin. — B. S. B. writes : "I suffer from a severe itching on my 
 chest and limbs after bathing. I have tried all temperatures of the bath 
 water, but the itching is no less irritating in cold than in hot water, or 
 even with the omission of soap. It usually lasts from twenty minutes to 
 half an hour, and ceases only when I have taken a walk in the cool air. 
 I have tried many patent remedies, but none of them has given me any 
 relief." 
 
 Reply. — Do not bathe frequently and do not stay long in the water. 
 Bathe in tepid water containing from two to five pounds of bran to the 
 bath. After bathing anoint the skin with a little fresh oil or dust with 
 talcum powder. 
 
 What Sycosis I s . — C. M. D. writes: "Can you tell me what sycosis is 
 and what causes it? Is it contagious? One of the neighbors is all broken 
 out with it and I am wondering if it is best to go there." 
 
 Reply. — Sycosis is an inflammation of the skin, due either to pus cocci 
 or ringworm infection or some allied cause. Ringworm is one form of 
 sycosis. Barber's itch is another. It is mildly contagious. You are in no 
 danger provided you do not use the same brushes, wash basins, and towels 
 as are used by the affected person. 
 
 Warts. — W. S. G. writes: "I want to "know how to remove numerous 
 warts from my hand" 
 
 Reply. — Trim them down to the quick, then burn with a hot pin or with 
 nitric acid. Repeat after a week if necessary. Your physician would 
 probably burn them with a carbonic acid crayon or carbonic acid snow — a 
 better method. 
 
 Let Your Moles Alone. — 8. Q. P. writes: "Let me tell B. A. K. how I 
 removed a mole which was growing near my left temple : It was nearly the 
 size of a nickel when I applied oil of cinnamon occasionally for a few days, 
 when I was able to remove it clean by picking. I then applied extract of 
 
720 THE SKIN 
 
 witch hazel a few times and the shin healed. That was about two years ago 
 and there has been no sign of a mole since." 
 
 Reply. — I judge you mean a wart. Warts are easily removed. Some- 
 times it is entirely safe to remove them by any simple method; sometimes 
 it is not. When it comes to moles the story is different. The penalty for 
 tinkering with moles is death. 
 
 Mole on the Nose. — Mrs. G. G. writes : "I have a mole on the end of my 
 nose. It is conspicuous and getting larger. 1. Should I have it removed 
 by an electric needle? 2. Is it dangerous or will it leave a noticeable scar?" 
 
 Reply. — 1. I think you had better have it removed if it is growing. 
 2. Most moles are not dangerous, but from some of them sarcomas — a 
 kind of cancer — develop. One should be suspicious of a growing mole. 
 
 Have Mole Cut Out. — L. F. A. writes: "Would it be perfectly safe for 
 me to have a hairy mole removed by the electric needle? It is located on 
 my chin and seems to be growing larger." 
 
 Reply. — Perfectly safe ? No ; have it cut out. 
 
 Removal of Scar. — W. W. writes: "Is a long scar caused by an opera- 
 tion in the neck removable by any means? It has caused great sensitive- 
 ness." 
 
 Reply. — Yes. A surgeon would cut out the scar and bring the edges 
 carefully together. The new line of healing in a short while would fade 
 to a delicate line. Massage begun soon after healing was complete would 
 remove practically all trace of the incision. 
 
 You no doubt wonder, if this is true, why a scar was left after the first 
 operation. The first operation was done to remove tubercular glands or 
 abscess walls. The skin was affected more or less. The main object was 
 to cure a deeper condition. Under those conditions scarring was unavoid- 
 able. 
 
 In the second operation there would be no infection; the field would 
 be clean and the skin sound. The removal of the scar would be the prime 
 and only object and therefore a cosmetic result would be possible which 
 was not possible in the first operation. 
 
 Treatment for Eczema. — E. R. H. writes: "What is eczema? When 
 does it break out all over the body? Is it catching? Is it curable?" 
 
 Reply. — Eczema is generally a chronic oozing eruption. It affects 
 patches of skin here and there. It is not catching. Most cases of eczema 
 are curable. All cases are benefited by good care. 
 
 As to the remedy for eczema, what helps one case harms another. When 
 a man discovers he has eczema the first step is to correct whatever in his 
 habits bears on eczema and is in need of correction ; the second, to correct 
 contributing constitutional states ; then to give proper care to his skin and 
 especially his eczema areas. 
 
 In other words, treatment must be individual and it must also be 
 broad. Salves and other eczema cures miscellaneously applied are usually 
 disappointing. 
 
 Tetter. — Tribune Reader writes: "What do you consider the best treat- 
 ment for the disease known as tetter? Is it curable?" 
 
HIVES 721 
 
 Reply. — Tetter is another name for eczema. It is sometimes curable 
 and sometimes not. Eczema is dependent upon a cause. If that cause can 
 be found and cured the eczema gets well. The crusty eruption on babies' 
 heads is frequently called tetter. It means the food is not quite what the 
 baby needs. The proper treatment for this disease is to regulate the baby's 
 food. When this is done the inflammation and oozing of the scalp stops. 
 
 Scalp Eczema. — Paris writes: "What can I do to prevent my hair from 
 falling out? My scalp is covered with a thick, oily dandruff. After wash- 
 ing the hair the dandruff soon appears again with an itching sensation. 
 After drying my hair it is sticky and lusterless, so I can hardly get a comb 
 through it. What causes such a condition?" 
 
 Reply. — I think you have a seborrheic eczema. It is reasonably certain 
 that you neglected your scalp for years. Wash thoroughly with soap and 
 water every day, rub in a very little vaselin and spend several minutes 
 twice a day brushing your hair. Do not brush hard enough to make your 
 scalp sore. Carry out this program persistently. 
 
 Has Flour Eczema. — W. J. M. writes: "My work necessitates having 
 my hands in flour a good deal, and on them has appeared a kind of scale 
 with much irritation. A friend calls it 'flour eczema.' Does flour cause any 
 such trouble? Doctors have prescribed different remedies, but they bring 
 me no relief. I hear of others being troubled in the same way. What will 
 help us?" 
 
 Reply. — Your trouble is flour eczema. Some bakers have this disease. 
 It is more common among candy makers. If you will keep your hands out 
 of the dough the condition will get well of itself. I think X-rays would be 
 of service. 
 
 Would it be possible to wear rubber gloves while at work? 
 
 Cause of Fever Blisters. — S. J. writes: "Will you please tell me the 
 cause of so-called 'fever blisters/ and how can they be prevented? Why 
 do they usually come around the mouth and always on the face?" 
 
 Reply. — Fever blisters may occur on any part of the body. They occur 
 more frequently around the mouth than elsewhere. Fever blisters are 
 found in pneumonia, in bad colds due to the pneumococcus, in typhoid, in 
 malaria, and in several other diseases. 
 
 Digestive disturbances cause them. If a man has them without a defi- 
 nite disease or infection the probability is that the cause lies in the diges- 
 tive apparatus. Too much food is being eaten or the food is not wisely 
 chosen or the bowels are not acting properly. 
 
 In such cases they are to be prevented by changing diet, by better 
 adjusting the food taken to the day's work and by correcting improper 
 bowel habits. 
 
 Camphor for Cold Sores. — E. W. 8. writes: "1. What is the cause of 
 ulcerated sores in the mouth? Have they any relation to cold sores? It 
 has been found that camphor is a good cure for cold sores. Would it be 
 harmful to rub camphor on the inside of the mouth? 
 
 "2. What is the cause of large abdomen in a man SO years of age? 
 What exercise or remedy would you recommend to reduce the abdomen? 
 
 "$. What diet would you recommend for a man SO years of age who is 
 troubled with ulcerated sores of the mouth? He leads a sedentary life. 
 
 "If. Is the mortality from pneumonia high in Colorado or other places 
 
722 
 
 THE SKIN 
 
 of high altitude in the West? Is it true that pneumonia generally results 
 fatally in places of high altitude? If so, why is this the case? 
 
 "5. Is it true that a person who is inclined to he gouty or rheumatic, and 
 who has had rheumatism, is not so apt to contract tuberculosis as others? 
 Is it true there is an antipathy of the two diseases, rheumatism and tuber- 
 culosis?" 
 
 Reply. — 1. The ulcers in the mouth result from digestive trouble; cold 
 sore from an infection. Camphor on the ulcers will do them good. Touch 
 the ulcers with a bit of cotton saturated in spirits of camphor; or a 
 stronger caustic will be better. 
 
 2. There are several causes. Obesity is one. If the other muscles are 
 flabby the abdominal walls will be flabby. When the abdominal walls are 
 flabby the weight makes them pouch out. As the abdomen pouches the 
 
 shoulders are 
 thrown back to com- 
 pensate. This bows 
 the back and makes 
 the abdomen pouch 
 still more. Cut down 
 the food and take 
 exercises to 
 strengthen the mus- 
 cles of the abdo- 
 men. 
 
 3. You are right 
 in thinking that the 
 cure lies in the diet. 
 How much you eat 
 is of very much 
 more consequence 
 than what you eat. 
 Eat vegetables, 
 fruit, meat and bread, varying your diet from day to day, but eat 
 not more than two-thirds what you are now eating. It is evident that 
 all your troubles are cut from the same cloth — too much food and too little 
 exercise. 
 
 4. [a] Yes; [b] The mortality rate is high, but the disease does not 
 generally terminate fatally; [c] I do not know. 
 
 5. Yes. There are certain families which run to rheumatism, and other 
 families that run to consumption. 
 
 Itch. — W. writes: "Is a shin irritation of bright red spots that do not 
 appear on the hands, but itch violently, a parasitic infection? Can the 
 itch be communicated to a family by a washerwoman through the clothes? 
 Are sulphur remedies the only treatment, or isnt there a treatment less 
 offensive? Must the patient destroy all infected clothes, or is boiling a suf- 
 ficient means of making the clothing aseptic and preventing reinfection?" 
 
 Reply. — 1. It is difficult to say from so little data but red spots without 
 break in the skin are not liable to be due to ordinary itch. 
 
 2. Yes. However, the danger from laundried clothes is not great. 
 
 3. If you mean applications to the skin there are other efficient prepara- 
 tions besides sulphur. However, sulphur preparations are not offensive. 
 
 4. The boiling temperature kills the itch parasite. 
 
 Fig. 242. — Itch Mite. Female. Fig. 243. — Itch Mite. Male. 
 
HIVES 723 
 
 Ordinary itch is due to a parasite which burrows through the skin, espe- 
 cially in thin places such as between the fingers. The eruption is a mixture 
 of blisters, pustules and scratch marks. The parasite is easily killed by 
 chemicals and by heat. The disease is contracted by contact of sound 
 skin with infected skin. Some infection by clothes as a carrier is possible. 
 The disease is easily cured. 
 
 Cause of Itching. — A. J. B. writes: "I read so many good articles in 
 'Hoiv to Keep Well' that I shall venture to ash a question that seems to 
 puzzle several. 1. What causes itching of the shin? The shin is as smooth 
 as a baby's and yet at times I have that acute itching which comes in 
 spots, generally when I am sitting still or lying down. 2. Does tea heep 
 one awahe nights?" 
 
 Reply. — 1. Dry air in the living room. 
 
 2. Yes. 
 
 Has Winter Itch. — Mrs. J. D. C. writes: "The last four years I have 
 had a rash break out on me every fall as soon as cold weather comes. It 
 disappears in the spring. It first appears in spots and loohs lihe tiny 
 pimples and then turns scaly. Water seems to irritate it and cause it to 
 spread. It is on nearly every portion of my body, but is worse at the joints. 
 Will salves or blood medicine do any good? Kindly tell me what it is and 
 what to do for it. I am 39 years old." 
 
 Reply. — This is winter itch. The most important factor in its causa- 
 tion is too little moisture in the air. Blood medicine will do no good; 
 salves will do no good. Get a hygrometer. Keep the humidity of the air 
 in your house above 50 degrees and you will get well. Drink an abundance 
 of water. 
 
 Winter Itch Cure. — A. T. C. writes: "I am troubled with an itching on 
 the calf of the leg and occasionally on the forearm. The itching is much 
 worse after tahing a bath. At times it does not bother me, but after a bath 
 it starts, and after a day or two a rash appears. My legs are usually cold, 
 although I wear woolen underclothes. Is there any way that this disease 
 can be permanently cured? It seems to be worse in winter than in summer, 
 although I wear woolen all the year." 
 
 Reply. — Winter iteh results from drying of the skin. Rub the skin 
 with a little grease. Do not scratch. The air in your flat probably has a 
 humidity of 10 or 15. Get a hygrometer. Evaporate enough moisture to 
 keep the humidity over 50. When you do this your trouble will cease. 
 Otherwise it will hold on until the heat is turned off in the spring. 
 
 Palliative for Itching. — 8. E. writes: "I noted with interest the article, 
 'Steam Heat Itch,' and feeling that I may be of service I offer, subject to 
 your approval, the following remedy to 8. H.: Three per cent carbolated 
 vaselin, to be rubbed over the affected parts or surfaces with the hands. 
 This is also a great remedy for prickly heat in summer. My experience 
 seems to have been the same as S. H.'s, but, since using this remedy for 
 the last few years, my two complaints have lost all their terrors. At times 
 I had to { cut out' fats and considerable of the meat in my diet. I had used 
 many things, but this is the only one I found to relieve the trouble. In 
 both cases the vaselin apparently oils the dry, parched shin and the carbolic 
 acid tahes away the sensations of itching, priching, and irritation. Vaselin 
 without the carbolic acid I found useless. At retiring time, when I dis- 
 robe, the sensations begin; I rub on the carbolated vaselin and put on 
 
724 
 
 THE SKIN 
 
 pajamas. In a few minutes all disagreeable sensations have disappeared. 
 The carbolated vaselin of commerce (of 2 per cent strength) I found not 
 strong enough in my case, and I found the 3 per cent salve to he magical. 
 For several years I have observed people with prickly heat make themselves 
 worse with evaporating, cooling liquid applications and various kinds of 
 powders. I use the salve as often as the skin gives trouble and desist when 
 there is no itching or irritating/' 
 
 Eeply. — Carbolated vaselin is a palliative. The cure is moister air. 
 
 Barbers' Itch Treatment.— J. E. B. writes: "Kindly advise me as to the 
 treatment for barbers' itch. It has got into the eyes and scalp now and is 
 annoying." 
 
 Eeply.— The hair should be cut short and the affected hairs pulled out. 
 Wash the places twice a day and then rub in sulphur ointment. Eub it in 
 well. Spend twenty minutes on the job. It is important that other mem- 
 bers of the family do not catch this disease. It is contagious. 
 
 Dry Air Rash Cause. — B. S. asks the cause of a rash breaking over the 
 body and arms, but not on the face or neck. She asks if it is caused by 
 
 heavy underwear, as she wears a 
 light fleeced weight, or by the con- 
 dition of the blood? 
 
 Eeply. — Few rashes are caused 
 by the blood. There is almost no 
 relation between skin diseases and 
 the blood. Your rash is due to liv- 
 ing in a room where the air is too 
 dry. Put an air vent in the radia- 
 tor in your bedroom and let steam 
 blow into the air. If you will keep 
 the air so moist that the windows 
 are always sweating your eruption 
 will stop. 
 
 Fig. 244. — Crab Louse (pediculus pubis). 
 
 Cuban Itch. — M. writes: "I hope that you will give the public some 
 data as to the nature and particularly the characteristic symptoms of a 
 highly contagious eruption called sometimes 'Cuban itch'; also some sug- 
 gestions as to treatment and prevention." 
 
 Eeply. — Cuban itch is smallpox. It came into the United States from 
 Mexico about the time our troops were returning from Cuba. Some- 
 one jumped to an unwarranted conclusion and dubbed this brand of small- 
 pox Cuban itch. The Cubans tell us they never heard of Cuban itch. 
 
 Cuban itch should be cared for in the smallpox hospital. It requires 
 no treatment. The disease gets well spontaneously in about ten days. 
 Treatment then consists in intelligently "standing by." 
 
 Bath Itch Relief. — B. writes: "I wish to tell you of my experience with 
 bath itch and the relief I have had from it lately. I spoke of my trouble 
 with bath itch to a doctor, who said he had been troubled the same way, and 
 told me how he got relief. After bathing, rub one portion of the body 
 thoroughly with a perfectly dry towel before drying another portion. Use 
 two bath towels, if necessary. This doctor said that a good deal of bath 
 itch was really chapping from not thoroughly dicing the body. I have 
 
 
HIVES 725 
 
 tried this for a year, dusting with powder afterwards, and can now go to 
 bed after my hath without the annoying itching sensation of old" 
 
 Reply. — Readers will note that this is for bath itch, not winter itch or 
 dry air itch. 
 
 Wrong Kind of Itch. — M. J. L. writes: "I sympathize with A. T. C, 
 who is troubled like so many others with winter itch. I have suffered from 
 it for years, but I have found an absolute remedy at last. It is a tablet 
 composed of reduced iron, 1 grain; arsenous acid, 1-50 grain; strychnin 
 sulphate, 1-60 grain. I take one .after each meal for three or four days, 
 and begin one day before a hot bath is indulged in. The itch always 
 follows a hot bath." 
 
 Reply. — You have had a bath itch and not winter itch. Yours was 
 due to too little grease in your skin. It may be your iron-arsenic-strychnin 
 has cured you, as you think. It may cure others ; probably not. 
 
 Nails Have Diseases. — E. A. writes: "Hay I ash you to give a few lines 
 concerning the cause, but more especially, the cure for brittle finger nails? 
 My nails are so brittle that I am obliged to keep them cut down to the 
 quick, because if allowed to grow longer they soon split or crack and become 
 annoying. My thumb nails are so troublesome that I am obliged to wear 
 adhesive plasters on them for months at a time. If one of these plasters 
 comes off in the night I have to get up and put on a new one, as the nail is 
 otherwise sure to catch in something and tear the tiny rent farther down. 
 The nails grow slowly." 
 
 Reply. — The nails have about as many different diseases as the other 
 parts of the skin. If you can discoYer any disease of your skin around 
 the root of the nails ha Ye that attended to. If you ha Ye diabetes, gout or 
 Raynaud's disease haYe that looked after. If you work in a place where the 
 air is extremely dry see that the air is humidified. 
 
 Keep your nails well greased. Once a day at least soak the ends of your 
 fingers in water for a half hour or more; then dry them and grease your 
 nails. Grease them well. Repeat the greasing process seYeral times a day. 
 
 Can you not work out a way to protect your nails that will harm them 
 less than adhesiYe plaster ? AdhesiYe plaster is good enough for them in 
 that it protects them; otherwise it harms them, it makes them more 
 brittle. 
 
 Ingrowing Nail Treatment. — J. R. H. writes: "I have been troubled 
 with an ingrown nail for over a year. I have been to several chiropodists, 
 but they do not seem to do me any good. I shall appreciate a little of your 
 valuable advice, as I believe you can help me, as you have helped others." 
 
 Reply. — Shoes that press against the nail gradually push it to the side 
 of the toe. As the front end is more easily displaced than the root end the 
 nail comes to run somewhat diagonally from the root toward the side of the 
 toe. In some of the toes the flesh OYerlaps the nail at the side. In these 
 toes' tight shoes cause ingrowing nails. In other toes they cause displace- 
 ment of the nails but not ingrowing nails. In the light of these facts, 
 what is to be done? 
 
 1. Adjust the shoes so that they do not push the toenails to one side. 
 
 2. Use cotton to lift the edge of the nail so that it rides aboYe the bed 
 along the side — the bed that the nail is irritating and that it sometimes 
 causes to be infected. Lifting the edge of the nail so that it no longer 
 irritates cannot be done in a day. The corner can be lifted and a Yery 
 
726 THE SKIN 
 
 small bit of cotton inserted today. Tomorrow the pledget may be a bit 
 larger. In the course of a month it may be materially larger. The nail 
 has consumed months in swinging to the wrong position; months will be 
 required to get it into an unoffending position. 
 
 Keep Nails Oiled. — J. T. M. writes: "My finger nails are ridgy and 
 continually crack and become so sensitive that I can scarcely button my 
 clothes. What is the cause of it, and what is the remedy?" 
 
 Reply. — The nails are subject to diseases. It is possible that you have 
 one of these. If your nails get brittle in cold weather only, it is probably 
 because they dry out. Even the outside air in zero weather contains little 
 moisture. Room air is a Sahara, of course. 
 
 Do the best you can to find moist air to live in. Keep your nails well 
 oiled. 
 
 Split Finger Nails. — 8. writes: "For several years I have had trouble 
 with my finger nails splitting. They divide into layers, split down often 
 half the length of nail, and break off until they get very uneven. The top 
 of the nail is rough. Will any outward application help?" 
 
 Reply. — This condition develops especially in people who are under 
 mental strain. It is much more likely to occur in winter than in summer. 
 Care of the nails is of prime importance. Keeping the fingers warm is of 
 importance. It is advisable to wear loose, woolen, fleece-lined gloves or 
 mitts. A kid glove that binds or lets the hand get cold is harmful. To 
 grease the nails helps. 
 
 Run-Around. — B. C. W. writes: "What can I do for a felon or run- 
 around? I have had one on my thumb for three weeks. It started with a 
 white spot under the nail which has worked to the end of my thumb and 
 has broken and pus has come out of it. I have put flaxseed poultices on 
 it, and iodin, but they do not seem to do any good." 
 
 Reply. — Stop the poultices or you will never stop the run-around. 
 Clean it with soap and water and then with peroxid. To paint the nail and 
 skin with tincture of iodin occasionally may be of some service. Keep 
 pockets of pus drained out. Put a light, loose, clean, aseptic gauze bandage 
 around it. Let plenty of air get to it. A run-around treated in this man- 
 ner will get well of itself in a few days in nearly every case. When the 
 infection gets around the root and bed of the nail it may be necessary to 
 slit or even remove the nail. In that event you had better not try to go 
 farther on your own hook. 
 
 Removing Tattoo Marks. — 0. E. B. writes: "Can tattooing be removed 
 from a persons arm and is it painful or serious to have it done?" 
 
 Reply. — To a limited extent it can be done. Rarely is one justified in 
 •having it done. 
 
 Spots on the Face. — W. F. writes: "During the cold spell this winter 
 I came in one evening and white spots were visible on my face. I rubbed 
 them with snow and my face did not get sore, but since then my face gets 
 black and blue when the least bit cold or on a windy day and at all times 
 a white spot is visible and my face looks so red. Is there anything I can 
 do to cure this?" 
 
 
HIVES 727 
 
 Reply. — Did you read the article on Raynaud's disease? Read the 
 article on the subject in Osier's "Practice of Medicine" in the public 
 library. You probably will have no trouble during the summer. 
 
 Bad Complexion Cause. — E. R. writes: "What is the cause of catarrhal 
 jaundice? Does eating much sugar or sweets have anything to do with a 
 yellow complexion?" 
 
 Reply. — 1. Infection and inflammation of the gall bladder and bile 
 ducts. The inflammation shuts off the narrow bile tube leading from the 
 liver to the intestines and the bile, instead of flowing out, is absorbed by 
 the blood. 
 
 2. Eating too much of anything and exercising too little in the open 
 air are important causes of a bad complexion. Particularly does open air 
 exercise in bad weather help the complexion. Sugars and sweets in mod- 
 eration are no worse than other foods. 
 
 Will Discolor the Skin. — Constant Reader writes: "Will ammonia and 
 peroxid discolor the skin if used for a certain length of time to destroy 
 superfluous hair?" 
 
 Reply. — Yes, to some extent. 
 
 Bleaching the Skin. — Actress writes: "Would it he safe to use peroxid 
 of hydrogen for bleaching my arms? If you think it is too strong, please 
 tell me how to dilute it. Do you think this will whiten my arms?" 
 
 Reply. — It will be safe in the sense that you will survive. You might 
 use it for a year or so without harming your skin. In time it will spoil 
 your skin. It will bleach what it can easily reach. Why not powder your 
 arms? It will do less harm. 
 
 Liver Spot. — K. X. Y. writes: "When I was 6 years old I was sick 
 with some kind of bowel trouble for three or four months. After I got well 
 there appeared a brownish spot on the right side of my nose. It is now 
 about the size of a dollar. Can you tell me the cause and how I can 
 remove this disfiguring mark?" 
 
 Reply. — This is probably one of those chloasma spots usually called 
 liver spots. They do no harm. If the appearance is objectionable per- 
 haps a skin specialist can bleach it fairly well. Unless it disfigures your 
 face you had better let well enough alone. 
 
 White Spots on Body. — E. M. writes: "For years I have noticed small 
 and large white spots appearing on my hands and neck, some small ones 
 on my body. At times they are more pronounced than other days. Lack of 
 pigmentation, I am told. Is there no cure for them, and is there any danger 
 to life?" 
 
 Reply. — No doubt you notice these spots more than anyone else does. 
 There is nothing to be done. They will never endanger your life. 
 
 Brown Patches on Face. — L. E. writes: "What is the cause of brown 
 patches upon the neck? Can they be removed by external application? Is 
 it liver or kidney torpidity or what?" 
 
 Reply. — Brown patches on face and neck are due to constipation or con- 
 gestion of the liver. External applications are of no value. The heart 
 
728 THE SKIN 
 
 should be examined. Proper treatment under the care of the family 
 physician should be taken for the underlying conditions. 
 
 Sweating Arm Pits. — Subscriber writes: "How can I prevent excessive 
 sweating in the armpits? I am a man of 19. Every day I sweat under 
 my arms down to my waist, during the cold weather more than when it is 
 hot. It goes through my clothing, destroying the suit." 
 
 Reply. — The sweat glands are influenced by the mind to an exceptional 
 degree. To watch for and dread this phenomenon makes it worse. To 
 wear rubber sweat shields also makes things worse. Try dusting the arm- 
 pits with powdered tannin. 
 
 Chapped Hands. — F. 0. V. G. writes: "My fingers chap, or crack open. 
 I work at an editorial desk in a steam heated but well ventilated room. 
 I live in a hot water heated house, also well ventilated. I have tried 
 many lotions, camphor creams, vaselin, and other remedies, with only 
 temporary relief. What would you suggest?" 
 
 Reply. — As you refer to the heating I assume that your trouble mani- 
 fests itself only in the winter. To keep the humidity of your rooms over 
 50 will help but probably will not wholly remedy the condition. Various 
 obscure conditions relating to the nourishment of the skin of the hands, 
 such as Raynaud's disease and allied conditions, get worse in winter. The 
 temperature and humidity conditions are to them important contributing 
 causes. My guess is that the main cause lies in some ductless gland per- 
 version. Why not let your physician try thymus, thyroid or adrenal 
 on you ? 
 
 Cure for Cracked Hands. — E. J. J. writes : "My brother froze the back 
 of his hand three years ago. During the summer it seems to be healed, but 
 every winter the sores become renewed and keep cracked open all winter. 
 He has used patent salves and prescribed medicines, but they do not help 
 him." 
 
 Reply. — The circulation in the skin of the back of his hands is poor. 
 The skin nutrition is bad. When the cold makes the skin anemic and the 
 cold air dries it further, it cracks. Patent salves will do no good. To keep 
 the hands warmly covered all the time is the only remedy. Out of door 
 work is better than indoor work when the hands can be kept warmly cov- 
 ered ; otherwise indoor work is better. If indoor work is done the air must 
 be kept moist. 
 
 Psoriasis. — Inquirer writes: "What is psoriasis — the cause and symp- 
 toms?" 
 
 Reply. — Psoriasis is a chronic, patchy, scaly eruption of the skin. The 
 patches are reddish or brownish and covered by dry, silvery scales. There 
 is slight itching. There are no symptoms except as noted above. People 
 with psoriasis are healthy and happy, or ought to be. Nobody knows the 
 cause. 
 
 Treatment of Psoriasis. — M. K. writes: "Do you know of any remedy 
 for psoriasis? I am not constipated, eat moderately, seem to be in good 
 health, but every two or three years I have a general outbreaking of 
 psoriasis." 
 
 Reply. — There is no remedy for psoriasis. At the same time, psoriasis, 
 taken care of, causes little disturbance and sometimes disappears for years. 
 
HIVES 729 
 
 It is well to wash the patches thoroughly and grease them with a mildly 
 stimulating ointment — oxid of zinc ointment or one somewhat more stimu- 
 lating — tar or creosote ointment. Sometimes a simple diet such as a gouty 
 person would follow is advisable. Most cases of psoriasis do not call for 
 any attention. 
 
 Not a Bar to Marriage. — Reader writes: "Is psoriasis a bar to mar- 
 riage? Have been troubled with it for about sixteen years and have been 
 told there is no absolute cure. I have been taking Fowler's solution of 
 arsenic in doses ranging from five to ten drops. Is there danger in taking 
 arsenic?" 
 
 Reply. — Psoriasis is not a bar to marriage. Do not take Fowler's 
 solution as a matter of routine. Occasionally it helps psoriasis but that 
 does not mean that one should take it in a routine way. 
 
 Psoriasis Not Hereditary. — C. S. writes: "In a recent issue you say 
 that psoriasis is incurable. Is there no internal remedy that will affect 
 the condition of the skin sufficiently to make at least a temporary cure? 
 Will climate affect the disease? Is it hereditary?" 
 
 Reply. — Temporary abatement of psoriasis, in a certain sense a cure, 
 is frequently brought about by care of the habits and of the skin and by 
 the careful use of local applications and internal medication. Climate 
 sometimes helps in a general way. It is not hereditary. 
 
 Peroxid and Psoriasis. — J. J. D. writes: "I have been afflicted with 
 pso?'iasis for a number of years. By accident, I spilled a quantity of 
 hydrogen peroxid on the affected area. The peroxid ate up the scales, and, 
 while it has by no means effected a cure, it has reduced the frequency of 
 appearance of the scales, and destroyed irritation/' 
 
 Reply. — While curing psoriasis is difficult, keeping the patches in con- 
 dition is not exceedingly so. The use of peroxid occasionally is one way. 
 Occasional use of wet packs is another. 
 
 Pityriasis. — Chicago writes: "Is there any possible cure for phthiriasis 
 of a number of years standing?" 
 
 Reply. — I suppose you mean pityriasis — a scaly, scurfy eruption some- 
 times attended by itching. It is of no particular consequence. Nobody is 
 liable to die from it nor is it found in people in poor health. Use sulphur 
 ointment regularly. 
 
 Have It Removed. — C. A. A. writes: "I have had a wen on my head 
 for a long time. Do you think it is harmful? If so, how could I get 
 rid of it?" 
 
 Reply. — A wen on the head is about the most harmless of tumors. 
 Have it removed with the knife. 
 
 What Ringworm Is. — I. R. writes: "What is ringworm? Can it be 
 cured? If so, please outline the best and surest treatment for it? Is a 
 doctor able to cure it through some specific remedy?" 
 
 Reply. — 1. Inflammation of the skin due to a parasite. 
 
 2. Yes, the best and surest method of cure is the use of X-rays. A 
 good method is to pull out the hairs in and around the ringworm patch 
 and to keep them pulled out. Wash the patch twice daily with soap and 
 
730 
 
 THE SKIN 
 
 Illinois Medical Journal. 
 
 Fig. 245 — Ringworm of the Scalp. 
 
 water and then paint with iodin or rub in a sulphur and mercury oint- 
 ment. Spend at least ten minutes rubbing the ointment in. 
 
 3. Ringworm cannot be cured by anybody in a short time. Patient, 
 persevering thoroughness is a necessity of treatment. It matters little 
 what drug is used. It matters much that patient, thorough care be 
 given. 
 
 May Be Ringworms. — Mrs. G. N. writes: "Will you tell me what three 
 or four bright red patches on a man's scalp might be? They are covered 
 with a crust and are of a month's duration. He says they do not itch, but 
 he is constantly scratching them when home. 
 
 "The scales 
 are showing in 
 his hair. He 
 'poohs' at the 
 idea of their be- 
 ing anything, but 
 his mother has 
 had eczema all 
 her life and other 
 members of his 
 family have had 
 the disease, and 
 now his 10-year- 
 old daughter 
 shows a spot sim- 
 ilar on her scalp 
 and he laughs at the coincidence. This man won't be careful about using 
 others' combs or put his wash rag out of the children's reach. Should he? 
 "He also has a hard lump on the bach of his neck. When it gets uncom- 
 fortable he squeezes bad smelling matter out of it. It does not pain him." 
 
 Reply. — These patches may be ringworms, psoriasis or eczema. Some 
 of the scale patches are contagious, others are not. Individual brushes 
 and combs, rags and towels should be the rule where there is no scalp or 
 skin disease; doubly so when there is a skin disease. You should make this 
 family see a skin specialist if you have to tie them down to accomplish it. 
 The lump is probably a sebaceous cyst. It should be treated at the same 
 time. 
 
 Cures for Ringworm and Warts. — G. B. writes: "I know from experi- 
 ence that iodin will kill ringworm and chromic acid will kill warts with- 
 out pain." 
 
 Cure for Ringworm. — F. R. of Cleveland writes: "For the last ten 
 years I have been troubled with ringworm on my lower legs. One physi- 
 cian prescribed tincture of iodin and another a white mercury ointment. 
 They seem to do the work temporarily. What do you think is the cause? 
 I bathe daily — that is, a shower bath — and eat regularly. My bowels are 
 regular, with now and then a little constipation. My meals are light. Am 
 a traveling man and my business requires me to do a great deal of walking, 
 which I consider plenty of exercise. I weigh 175 pounds, height 5 feet 
 6 inches. My general health is good. I was examined for life insur- 
 ance seven years ago and passed as extra fine risk. Is ringworm con- 
 tagious?" 
 
HIVES 731 
 
 Reply. — If you have ringworm it is contagious. You could suffer a 50 
 per cent reduction in the present excellent state of your health and still 
 be above the line when the general health has any effect on ringworm. 
 Ringworm can always be cured by: (a) persistent cleanliness; (b) per- 
 sistent use of iodin, mercury ointment ; or in bad cases (c) use of a vaccine 
 on or in the skin. However, I doubt if a cleanly fellow like you would 
 have ringworm for seven years even though you are a drummer and not 
 long enough in one place. Haven't you psoriasis or some other sticker? 
 If so, it is not contagious and one's physical condition is of importance. 
 
 Scars and Their Removal. — Reader writes: "Can scars be removed? 
 About a month ago you said in an article that they could not be re- 
 moved, but I read some time ago that whenever a criminal had scars he 
 could go to a specialist and have them removed. Can real small scars, 
 such as little holes made by pimples and blackheads, be removed?" 
 
 Reply. — 1. Scars can be removed. I presume you refer to some reply 
 in which I told someone his scars could not be removed. If it would be 
 necessary to skin a man to get rid of his scars that man should content 
 himself with his scars. 
 
 2. Massage will minimize acne scars. Beyond this it is not good judg- 
 ment to go. 
 
 Warts and Moles. — R. C. C. writes : "Kindly tell me what will remove 
 warts and moles. Also could you tell me how to make 'sage tea and sul- 
 phur tonic for the hair?" 
 
 Reply. — 1. Ordinary warts can be removed by any one of the following 
 plans so they will not return : Run a redhot needle through the wart. 
 Clip the wart with scissors and burn the bleeding point with a little nitric 
 acid on a match. Apply salicylic acid as in corn salve. 
 
 2. Do not do anything with a mole. If a mole is touched at all it 
 should be completely removed by a surgeon. 
 
 3. The sage tea and sulphur combinations as advertised are merely 
 blinds for the sale of a patent medicine. Sage tea and sulphur is not good 
 as a hair tonic. Use soap and water, rubbing and brushing. 
 
 Wrinkles' Can Be Reduced. — J. F. wants to know: "1. If it makes any 
 difference which direction the head is when sleeping at night? 
 
 "2. She is nearsighted. Her face is beginning to wrinkle around the 
 eyes. What causes it? Is there a cure? 
 
 "3. Does massage with cream prevent wrinkles?" 
 
 Reply. — 1. No, if you mean with regard to the points of the compass. 
 
 2. Your eyes are being strained. The remedy is glasses which relieve 
 the strain. 
 
 3. In some measure, yes. Wrinkles come because (a) the under- 
 lying muscles fold the skin so continuously that it becomes adjusted to 
 the new position; or (b) the fat and water absorb from the space just 
 below the skin so that the skin no longer fits; or (c) the natural elasticity 
 of the skin is lost. 
 
 Cure can be brought about : 1. By getting fat — the loose space fills up. 
 2. By preventing the muscle contraction which wrinkles the skin. 3. By 
 rubbing it into a smooth position, remembering always that a few minutes 
 each day rubbing out wrinkles cannot offset twenty-four hours of wrinkling 
 by muscular action. 
 
732 THE SKIN 
 
 Wrinkles Defy Lotion. — J. G. writes: "Will a wash lotion made by 
 dissolving one ounce of powdered saxolite in one-half a pint of witch hazel 
 eradicate lines and wrinkles in the face? If not, what will? Would this 
 lotion be harmful to the skin?" 
 
 Reply. — It will not eradicate lines and wrinkles. Getting fat will. 
 Massage will be of some service. No lotion will be of any service. 
 
 Shingles. — 8. A. L. writes: "1. What causes shingles? 2. Is it con- 
 tagious? 3. Will alcohol and cold baths cure it?" 
 
 Reply. — 1. It is a form of neuralgia. 
 
 2. No. 
 
 3. Yes, anything cures it; that is to say, it gets well automatically. 
 A purge and light diet with proper attention to the cleanliness and care 
 of the blisters is the best treatment. 
 
 Shingles Not Dangerous. — Mrs. S. writes: "Kindly give me some 
 information regarding the shingles — what causes them and how they 
 affect a person? Are they dangerous for an old person, and what are 
 the effects they leave? How long does it take to get over them?" 
 
 Reply. — Shingles is a form of neuralgia. The condition is not danger- 
 ous and leaves no after effects. Purgatives, local applications and neu- 
 ralgia medicines effect a cure. 
 
 Cause of It Not Known. — Sufferer writes: "Will you kindly give me the 
 following information: 
 
 "1. What is the cause or origin of ichthyosis? 
 
 "2. What relieves or cures it? 
 
 "3. What work on the subject, easily obtainable and intelligible to a 
 layman, should I read? 
 
 "J+. Is it a common ailment?" 
 
 Reply. — 1. Ichthyosis is a congenital disease the cause of which is not 
 known. 
 
 2. Nothing cures it. 
 
 3. You can understand all the essential points in any textbook on skin 
 diseases. 
 
 4. No. 
 
 Boils. — A. J. 0. writes: "What causes boils? My husband, who is 57 
 and has never had a boil before, has just had five inside a month. He does 
 office work and is always studying and reading, so he gets little physical 
 exercise except walking. We eat no meat during the three summer months 
 and only three or four times a week the rest of the year. We have fruit 
 three times a day the year round. I have 160 quarts canned now for this 
 coming winter. There are only three in our family, and husband eats fully 
 half the fruit. Can fruit eating be overdone? We use no coffee. Husband 
 drinks tea for breakfast and lunch." 
 
 Reply. — There are germs capable of causing boils on the skin all the 
 time. Occasionally some of these travel down a hair shaft or into a grease 
 gland and set up an infection called a boil. When such an accident occurs, 
 usually something in the internal economy is wrong. Where a man — a 
 heavy eater of canned fruits — gets a succession of boils the first thing to 
 be thought of is diabetes. If an examination shows diabetes not present 
 
HIVES 733 
 
 the next suggestion is low opsonin index as regards the pus cocci. This last 
 calls for a vaccine. I assume that the toilet of the skin is properly done, for 
 both before the boils and during their existence wet, soggy poultices foul the 
 near-by skin and thus help to cause secondary crops of boils. Fruit eating, 
 particularly sweetened, preserved fruits, can be overdone — leading to indi- 
 gestion, glycosuria — a form of diabetes — and boils. 
 
 Don't Poultice a Boil. — H. K. writes: "Kindly inform me if there is 
 anything besides hot flaxseed poultices that is as effectual in relieving and 
 maturing boils/' 
 
 Eeply. — A boil will get well whatever is done for it. A flaxseed poul- 
 tice is a bad thing to use on a boil as it often causes secondary boils to 
 come. The hot, wet, dirty mess occasionally infects the near-by skin. Crops 
 of boils and fresh boils around the old boil were frequent when poultices 
 were in vogue. If you want to apply heat use a hot boracic acid solution 
 pack made with gauze and covered with rubber tissue or well bandaged, 
 or use a hot water bottle. 
 
 Carbuncles. — J. F. writes: "I have been troubled with carbuncles on 
 the bach of my neck. What is the cause of them? Can I take something 
 that will keep them from returning? What should I eat? I use no tea, 
 coffee, or any alcoholic drinks. I am 70 years of age. Are carbuncles 
 dangerous?" 
 
 Eeply. — Carbuncles may be dangerous, especially in a man seventy 
 years of age. First find out if you are a diabetic. If so regulate your diet 
 accordingly. If you are not diabetic eat about what you have been ac- 
 customed to eating. Look well to the cleanliness of your skin. That 
 means be firm in refusing to use poultices. Some of your friends will 
 want to poultice your neck. Fight them off. A poulticed neck is a dirty 
 neck and a dirty neck will mean more carbuncles. Carbuncles are due to 
 an infection of the deeper tissues beneath the skin with pus germs that 
 have traveled down from the surface of the skin. Keep in the open air and 
 keep your secretions right. 
 
 Cause of Pimples. — C. L. W. writes: "What causes red pimples, which 
 are hard under the skin, to break out continually on my face?" 
 
 Reply. — It is due to fat and debris that accumulate in and around the 
 sebaceous follicles of the skin. This fat and debris, being foreign bodies, 
 irritate the skin and when not removed cause inflammatory lesions — '''red 
 pimples" — such as you complain of. 
 
 Having resorted to minor measures for relief you would do well 
 to have a careful doctor examine you and advise as to plan of treatment. 
 He may give you the vaccine treatment. He may have you wash your face 
 night and morning with lukewarm water and soap, rinse well, dry thor- 
 oughly and then apply freely and rub briskly with equal parts of alcohol 
 and a saturated solution of boracic acid. He will also direct you as to diet, 
 exercises, baths and habits of sleeping. 
 
 Blackheads. — Anxious Mother writes: "Please give me advice as to 
 what to do for my daughter. She is 15 years old. For the last six months 
 she has been greatly troubled with pimples and ugly blackheads on her fore* 
 head." 
 
734 THE SKIN- 
 
 REPLY. — The skin is filled with grease glands. They are necessary. 
 When they clog up, the secretion is called a blackhead. Yon should see that 
 she does not overeat, that she is not constipated, above all that she exer- 
 cises in the open air. Keep her face clean and keep the blackheads squeezed 
 out. You could not stop the secretion of these glands if you tried and you 
 should not try. 
 
 Cause of Whiteheads. — R. L. writes: "I am troubled with whiteheads. 
 I press them out. How can I get rid of them?" 
 
 Reply. — There is no way except the one you are using. The pores of 
 the grease glands are liable to be grown over by skin, especially when 
 spectacles press or where the skin forms fine wrinkles. When the duct is 
 overgrown the secreting gland causes the small accumulation of white 
 grease called a white head. 
 
 Acne. — C. C. A. writes: "The face of a friend is in a very pimply con- 
 dition and has been for a number of years. It is not itchy, merely covered 
 with red spots. Some time ago I had another friend troubled in a similar 
 manner. He went to the sea and bathed in it every day, and when he re- 
 turned home his skin appeared in a perfectly healthy condition. If not sea 
 or salt water, what do you recommend in the former case? He has been 
 talcing blood medicines." 
 
 Reply. — I judge your friend has pimples or acne. Blood medicine will 
 not be of any service. His skin is probably greasy and if so salt water or 
 sea water will help. In the main, however, reliance must be put on such 
 measures as limiting the diet, correcting constipation, keeping the skin 
 clean, expressing blackheads, and vaccine in cases when it is needed. 
 
 Pimples and Blackheads. — F. A. S. writes: "I am troubled with pim- 
 ples and blackheads. Please suggest a remedy for them." 
 
 Reply. — In some cases, squeeze them out, then wash vigorously with 
 soap and hot water and dry with rough towel. This materially aids in 
 keeping the grease glands open, the closing of which has much to do with 
 the cause of the blackheads. Apply alcohol morning and night at the same 
 time rubbing the face vigorously with the hands. See that the bowels move 
 freely and regularly each day. Eat sparingly of meats, especially greasy 
 meats, but eat freely of fruit, especially apples, prunes, figs, dates, cran- 
 berries, and the like. If this does not cure you, have your family physi- 
 cian direct you to some reputable skin specialist. 
 
 To Prevent Pimples. — "1. Will you be kind enough to tell the causes 
 for pimples on a young man's face, and how to prevent them? 2. Does 
 electric massage help any?" 
 
 Reply. — 1. (a) Wash the face with soap and water and then with alco- 
 hol often enough to keep it clean, (b) Squeeze the blackheads out. (c) 
 Eat less and exercise more, (d) Cure your indigestion and constipation. 
 
 2. No. 
 
 Acne Vaccine. — W. G. writes: "What is acne vaccine and where can 
 it be procured? Can it be used without consulting a physician?" 
 
 Reply. — Acne vaccine can be had from the large manufacturing phar- 
 maceutical houses direct . or through local druggists. It can be made 
 from germs grown from the patient's pustules. Most of the laboratories 
 
HIVES 735 
 
 make vaccines after this plan. It cannot be used except by a physician. 
 No good would be accomplished. 
 
 Alcohol for Blackheads. — G. of Kenosha, Wis., writes: "1. In spite of 
 my daily baths and fairly good digestive system, my face is filled with 
 blackheads and it breaks out with pimples, especially on my chin. Will 
 you please tell me what will remedy this? 
 
 "2. In school I notice after about an hours work my hands become 
 cold and clammy. What is the cause of this?" 
 
 Reply. — 1. Eat less, keep the blackheads squeezed out, keep your face 
 cleaner, use alcohol if necessary. 
 
 2. Exercise more in the open air. Control nervousness. 
 
 Pimples Not Blood Disease. — G. H. R. writes: "The writer has been 
 troubled with acne [so the local doctor calls it] for some five or six years. 
 At times the face will clear off altogether and then pimples will break out 
 afresh. I have been advised to leave off eating greasy foods and pastries, 
 but it seems that does not help, for the skin will break out just the same. 
 I have also tried dieting. Does dieting help or hinder the ailment, or 
 should it be treated locally? Is it caused by bad blood or is it merely a 
 skin disease? Do different foods affect or help the disease in any way, or 
 will it gradually go away of its own accord?" 
 
 W. C. H. wants to know if smoking causes pimples on the face. If not, 
 what does, and what can be done to get rid of them? 
 
 Reply. — Smoking does not cause pimples. When it comes to answering 
 your other questions the difficulty is greater. Certain glands of the skin 
 secrete grease. This grease normally oozes out on the skin and keeps it 
 pliable. Sometimes these glands stop up. The top of the gland may grow 
 together, the gland may be plugged by dirt or some grease may become 
 hard and plug it. Such glands distended with grease are usually called 
 blackheads. 
 
 Skin bacteria frequently get into these distended glands and cause little 
 boils, called pimples. So, back of the pimples lie the blackheads; back of 
 the blackheads lie the state of general nutrition and the state of the skin. 
 
 Before we go further there is one thing that should stand out clear. 
 Pimples is not a blood disease. They are not due to a condition of the 
 blood. They have nothing to do with the blood — certainly not in the sense 
 in which the statement is commonly made. Broadly speaking, skin dis- 
 eases have less to do with the blood than any other diseases. 
 
 Pimples usually develop in the middle of the teens — the boy or girl 
 eating too much and exercising too little. Some of the food which should 
 be burnt up into energy is going into fat. Some of this fat is stored 
 under the skin. Some of it is stored in the liver. Some of it goes through 
 these grease glands. 
 
 So the first step in the cure is to exercise more and eat less. The second 
 step is to scour the face with soap and water and occasionally with boracic 
 acid and alcohol. After the case gets to the pimple stage, the person af- 
 fected had better quit following general advice and get individual counsel 
 and follow it persistently. 
 
 Serum Treatment for Acne. — "A Reader" writes: "I am 22 years old 
 and have had acne for six or seven years. It seldom shows upon my face, 
 but my shoulders are always covered with large pustules. I have taken 
 quite a lot of blood medicine, but it seems to do no good. I tried the serum 
 
736 THE SKIN 
 
 treatment last summer, taking two treatments of staphylo-acne bacterin. 
 During this treatment the pustules disappeared rapidly, but after a month 
 or two they returned and are now worse than ever. Is there any cure for 
 acne?" 
 
 Reply. — The vaccine did you more good than anything else. Use it 
 again. Keep it up longer than you did before. Keep blackheads pressed 
 out systematically. 
 
 Cause of Hives. — L. W. D. writes: "What is the cause of hives and 
 general itching of the skin? What is the remedy?" 
 
 Reply. — Hives is the result of eating some article of food which is 
 poisonous to that particular person. To another person the food may be 
 wholesome. To cure hives someone recommends painting the patches 
 with collodion. A purgative should be taken. To prevent hives avoid the 
 foods which disagree. 
 
 I do not know just what you mean by general itching of the skin. 
 Hives is not a general itching. 
 
 Cause and Treatment of Hives. — E. P. A. asks cause of hives and 
 how to get rid of them. He asks if there is any kind of diet for them 
 and how long they last. 
 
 Reply. — Hives is an eruption of the skin in the nature of a neuralgia. 
 Just as behind the eruption there is neuralgia so behind the neuralgia 
 there is a cause. There are many different causes of hives. Sometimes 
 one is responsible, sometimes another. There is no cause of hives that is 
 common to every case. The thing to do is to find what has been the cause 
 in each individual case. Probably food poisoning is the most frequent 
 cause. Sometimes the food which has caused it is of good quality, at other 
 times it is spoiled. The most frequent cause is a hypersensitiveness to cer- 
 tain foods. 
 
 How to Avoid the Hives. — W. A. writes: "Would you kindly state the 
 cause of hives? About every month or two I break out with them. I have 
 thought that it was something that I eat, but what it could be I do not 
 know." 
 
 Reply. — Hives generally are caused by some disturbance of the alimen- 
 tary canal. Certain articles of food, such as shellfish and strawberries, 
 often produce hives. The treatment generally consists of a good purge 
 and bathing the affected parts with baking soda and water. Find out what 
 foods cause hives and avoid them. 
 
 Freed of Hives. — R. L. writes: "For years I suffered from hives in 
 summer, and I accepted it as a summer trouble of some kind. My brother 
 also suffered from it every summer. Several years ago I was advised to 
 eliminate meat that summer and eat all the fruit I wished. This I did, and 
 from that day to this I have never been troubled with the hives. I never 
 eat meat more than twice or three times a week at any time of the year, 
 but in the warm weather I do not eat it more than once a week. My 
 brother also follows the same course in summer, and he is no longer troubled 
 with the hives. To eliminate meat from one's diet means gravy, meat 
 soups, and meat fats. Eat nothing fried in meat fats or made with lard 
 or suet. Substitute butter, cream, milk, cheese, and eggs. Vegetable soups 
 
HIVES 737 
 
 and cream soups made without meat are good. I have had only one cold 
 in four years, which improvement I also attribute to the change in diet." 
 
 Reply. — Some will benefit from following your plan; others will not. 
 
 Treatment for Hives. — W. F. N. writes: "My wife is troubled with 
 hives. New irritations have been coming daily for a week. We have 
 applied camphor spirits and they have given her local but only temporary 
 relief. She is not an abnormal eater of pork, and it is not the strawberry 
 season. Her appetite is so normal and healthy that it is difficult to dis- 
 cover any cause in her diet. What other things may cause the disturbance, 
 and what remedy should we apply?" 
 
 Reply. — Hives usually results from eating something that disagrees. 
 The food that causes hives in one person may be the most wholesome of 
 foods for the average person. Buckwheat, fish, salmon, oysters, straw- 
 berries and pork are among the more frequent offenders. 
 
 Have your wife take a large dose of castor oil. Have her go on a 
 bread and milk diet and gradually increase her diet list. 
 
 How to Prevent Hives. — A. R. writes: "Will you kindly tell me the 
 cause of hives? Is there any cure?" 
 
 Reply. — Hives is a nervous eruption due to some kind of food poison- 
 ing. A good dose of a purgative cures it. The purgative may have to be 
 repeated. Foods which cause it must be avoided. They may be entirely 
 wholesome for other people; the peculiarity is in the person rather than 
 in the food. 
 
CHAPTER XLI 
 
 The Teeth and Hair 
 
 THE TEETH 
 
 THE TEETH AND HEALTH 
 
 The thumb sucker has a face that tends to narrow just below the nose. 
 The arch of the palate is high and the front teeth, especially in the upper 
 jaw, point forward. Over them the upper lip must curve and in consequence 
 it appears shortened. 
 
 The mouth breather has a long and somewhat lantern- jawed face. The 
 lower jaw tends to narrow and the mouth hangs open. Once you have seen one 
 or more mouth breathers you will have little difficulty in picking them out. 
 
 However, if you are intent upon thus employing your idle thought you 
 must be up and doing. The purpose of nature is to fit the face to a certain 
 inheritance. Thumb sucking and mouth breathing interfere with the plan. 
 But nature stays on the job and in time the deformity may be remedied. 
 Many beautiful women and handsome men had thumb sucking and mouth 
 breathing stamped on their faces in childhood as plainly as one of these new 
 style advertising signs. 
 
 When nature fails all is not lost. The dentist remains. The parent 
 whose child was neglected until a bad "bite" was acquired can make amends 
 in part by having the dentist push and draw the teeth until the "bite" is 
 right. Ordinarily this is not done until the permanent teeth are out — say, 
 when the child is ten to fifteen years old. 
 
 In one sense that is a good period to do the work — just before and at 
 puberty. Certain biological changes are taking place. In consequence the 
 bones are changing form and shape in many particulars. It is therefore a 
 propitious time to mold jaws and rearrange teeth. 
 
 A better beginning time, though, is when the baby teeth are still in 
 place. As the jaw is molded in the days of baby teeth it is apt to grow. 
 
 A proper "bite" is necessary for health. A good digestion is dependent 
 on good chewing. When the "bite" is poor it is difficult to keep the teeth 
 clean, and, finally, teeth that grind against other teeth are much more liable 
 to keep sound and to set still and firmly in their sockets than useless ones. 
 Nature does not long tolerate teeth or anything else that does not do work. 
 A proper "bite," then, has health relations as well as dental relations. 
 
 The teeth are not dead structures. They are always undergoing change. 
 The horse trader judges of the age of a horse by the shape of the grinding sur- 
 face of its teeth and the shape and size of a certain dark area on that grinding 
 surface. 
 
 A horse is constantly grinding off the surface of its teeth. It grinds 
 
 738 
 
THE TEETH 
 
 739 
 
 through the enamel into the dentine, whereupon the dentine gets enamel-like 
 in its hardness and denseness. It grinds down to the pulp chamber, where- 
 upon the pulp chamber fills up with dentine and gets, as hard and dense as 
 enamel. 
 
 The small, dark area by which the dealer judges age is the former pulp 
 chamber. In the pulp chamber are contained the arteries, veins, nerves and 
 lymph vessels of the tooth. Bacteria have been known to travel from the 
 pulp down into the neighboring tissue. 
 
 Fig. 246. — Uncared for Teeth Showing Food 
 Particles, Which, Fermenting, Form 
 Acid. {Dental Summary.) 
 
 Fig. 247. — Uncared for Teeth. Acid At- 
 tacking the Lime in the Enamel 
 Rods. {Dental Summary,) 
 
 A number of years ago the elk in Lincoln Park, Chicago, got lumpy jaw. 
 The infection was manifest in the glands of the neck just below the jaw. But 
 Cy De Vry found that the teeth contained great cavities and that the cavities 
 were filled with infected food. The lumpy jaw infection had traveled as 
 ordinary infections travel. 
 
 The preferred route is down the side of the tooth to the lymph spaces in 
 
 Fig. 248. — Uncared for Teeth Showing 
 Decay Attacking Dentine. {Dental 
 Summary.) 
 
 Fig. 249. — Uncared for Teeth. Fur- 
 ther Progress of Decay — Tooth 
 Begins to Ache. {Dental Summary.) 
 
 the socket. From this area the germs go into the neighboring lymph glands. 
 In the lower jaw the glands most frequently infected are those just below 
 and just to the side of the chin. These glands seem to be almost in the floor 
 of the mouth. 
 
 Another set of glands that get infected through the teeth and their sockets 
 are those at the angle of the jaw. 
 
740 
 
 THE TEETH AND HAIE 
 
 The infection can also travel into the cavities opening off the nose — the 
 antra. Most of the cases of so-called catarrh are due to chronic infection 
 of these antra and some of these cavity infections are due to absorption from 
 the teeth. Among the infections that may get in by this route are tubercle 
 bacilli. When these locate in the glands of the neck the condition is known 
 as scrofula. 
 
 Scrofula was called in the old days "king's evil." In human history kings 
 got into the field before dentists. Had the dentists got the spotlight first 
 scrofula would have been known by another name than king's evil. The kings 
 would have had first call on the dentists and the poorer man's teeth would 
 have been the routes of infection. 
 
 However, the possible infections through and around the teeth are not 
 limited to tuberculosis. Colds, scarlet fever, diphtheria and measles — in fact, 
 pretty nearly every infection can travel this route. 
 
 Fig. 250. — Uncared for Teeth. Under- 
 mining and Breaking Down of the 
 Enamel Walls, Exposing Large 
 Cavity Which has been Forming, 
 Unsuspected, for Months. (Dental 
 Summary.) 
 
 Fig. 251. — Uncared for Teeth. Death 
 of Dental Pulp or Nerve. Forma- 
 tion of Pus and Gas in Pulp Cham- 
 ber. (Dental Summary.) 
 
 The finger of probability is pointing toward bacteria as the cause of rheu- 
 matism. There are as many kinds of rheumatism as there are kinds of 
 catarrh. Two of them seem to be due to infections through the mouth — or- 
 dinary acute inflammatory rheumatism and some forms of rheumatoid 
 arthritis. It is especially in rheumatoid arthritis that the indications point 
 to the teeth as the route of infection. 
 
 Nobody has been able to say just why teeth decay. We know that they 
 decay in youth rather than in maturity; that young people lose their teeth 
 from decay, old people from pyorrhea; that decay is more liable to start on 
 certain surfaces than on others, in certain teeth than in others. A few facts 
 like these are known but certain important facts are still unknown. 
 
 It is generally held that the teeth decay because the lactic acid bacilli 
 produce acid which eats out the lime salts. There are more than fifty kinds 
 of germs in the human mouth and many of these are alkali producers. The 
 saliva is often alkaline because the alkali producers are in excess. 
 
 Hopkins found that about one-fifth of the mouth bacteria are lactic acid 
 producers. He could never grow these bacteria so that they would make more 
 than one-half of 1 per cent acid. On the other hand, he kept teeth for months 
 in one-half of 1 per cent lactic acid solution and they were not harmed by it. 
 
THE TEETH 741 
 
 • 
 
 While the scientists are at work on these problems of chemistry and bac- 
 teriology the man whose job is to keep his teeth sound and in his head can 
 succeed by following the simple plan of keeping his teeth clean and having 
 them inspected by a dentist twice a year. Following this plan, no infection 
 at least will go through his teeth. 
 
 Of more importance from the health standpoint is pyorrhea. — the disease 
 which deprives grown people of their teeth. It has much to do with ill health. 
 In this disease the teeth are loose and the gums are sore. 
 
 To chew well is out of the question. The food must be bolted; nothing 
 else is possible. On top of this there goes more or less systematic poisoning 
 from the suppurating, discharging gums. 
 
 It is possible, as Khein suggests, that several different conditions are 
 called pyorrhea. Not infrequently the disease is developing just at the time 
 when it is natural for the ridges around the teeth's sockets to begin to absorb 
 and disappear. 
 
 There are two schools of scientists on the pyorrhea question each school 
 fighting for its position. One contends that the important condition is a gouty 
 or some other sort of a constitutional state; the other that the important 
 condition is an infection. 
 
 Here, too, the man who wants to keep his teeth has a line to cling to. 
 If he will have his teeth periodically examined his pyorrhea will be discovered 
 in the early stages and it can be cured or held stationary for twenty years 
 or more, which comes to nearly the same thing. 
 
 In late pyorrhea the gums are inflamed and pus sockets burrow down 
 by the side of the root of the tooth. There are dentists who go down into 
 these pockets and clean them out. Some even go so far as to take the tooth 
 out, clean it and stick it back. 
 
 Many of these late cases of pyorrhea can be cured but it takes time 
 and money. It is like late consumption — somewhat curable but only for 
 those with fortitude and patience. 
 
 The proper plan is to watch so systematically as to detect the disease 
 when cure is within the reach of all — when cure is cheaper than plates and 
 bridges. 
 
 The teeth make up a part of the facial neuralgia equation. Sometimes 
 the pain of facial neuralgia is felt in the teeth even when they are sound. 
 Sometimes the cause of facial neuralgia is found in the teeth. 
 
 The nerves of the teeth come off the same stem as do those of the other 
 structures of the face. Their hurts will not stay separate. 
 
 Unfortunately as we go hunting around for relief from pains in the 
 face we frequently turn the wrong doorknob. We go to the office of the 
 physician when we should go to the office of the dentist and vice versa. 
 
 We are made to feel the desirability of Magitol's dogma. All dentists 
 ought to be doctors and all doctors ought to be dentists. In facial neuralgia, 
 Prinz says, we are apt to join sincerely in this wish of Magitol. 
 
 IMPORTANCE OF GOOD TEETH 
 
 Infection can get into the body only through the mouth and nose. To 
 this statement there are a few exceptions, albeit very important. Bacteria 
 
742 THE TEETH AND HAIR 
 
 do not remain long on the smooth, free surfaces, for food, drink and air 
 sweep them away. It is in inaccessible places, in pockets, corners and crev- 
 ices, that they get a chance to multiply. 
 
 Everybody has read of the absorption from pockets in tonsils and adenoids 
 and the cavities which open off the nose and throat. Few have thought of 
 the teeth as harbor ers. 
 
 It is not by absorption that bacteria in teeth cavities do harm, for while 
 teeth can take up stains the power of absorption is so slight that it may be 
 forgotten. The germs multiply in tooth cavities and recesses from which 
 they are carried by food into the stomach causing disturbance of digestion, 
 and by the saliva to the outside, spreading infection. Whether a man is an 
 infection spreader is in part determined by the teeth he keeps. 
 
 I suppose nothing is more natural than to blame someone else or some- 
 thing else for one's own shortcomings. In consequence indigestion and 
 dyspepsia are charged up to foods when they should be charged to the feeders. 
 Almost anybody can eat anything which is clean, wholesome and fresh, pro- 
 vided he will limit the quantity eaten, take plenty of time to eat and keep his 
 mouth and teeth always clean. It is the method of eating rather than the 
 things eaten which causes indigestion — aside from those cases which are due 
 to mental impulses — and a part of the method of eating is the condition of 
 the teeth. 
 
 About the best cleaning they get is from polishing by food, in which 
 process bacteria from the cavities and food particles, decomposing for hours 
 or days in the cracks, are swept down into the stomach. The stomach being 
 pretty capable takes care of itself under ordinary circumstances but every 
 now and then trouble results. 
 
 Clean teeth, free from cavities, are attractive. They do not decay or 
 become painful so promptly as dirty teeth; they are not so prone to harbor 
 infection; and, on top of all this they do not pass harmful substances into 
 the stomach. 
 
 Food can be chewed with decayed teeth but it takes more time. We 
 so begrudge the time needed to eat with good teeth that we are certain to un- 
 duly hurry the job when we try to eat with poor ones. In consequence we 
 swallow food which is not well broken up. 
 
 Now the gums are set with "ivories" devised for the purpose of breaking 
 %p food, while the stomach is a simple, muscular bag. A few minutes of 
 tooth work will break up the food more than hours of stomach work. 
 
 One thing is certain — the food must be broken up, and the only ques- 
 tion is whether a few additional minutes will be consumed in doing this 
 efficiently with the teeth or an hour or more consumed doing it inefficiently 
 with the stomach. A man's indigestion is largely determined by the teeth 
 he keeps. 
 
 Still decayed teeth are not the most frequent cause of faulty chewing 
 and faulty chewing is not the most important result of decayed teeth. Teeth 
 are especially prone to decay in childhood — just the time when the jaws 
 are developing and taking shape — and their premature loss causes the 
 jaws to develop irregularly and the uppers and lowers not to meet so as 
 to make a good chewing surface — the most important cause of poor diges- 
 tion. 
 
THE TEETH 
 
 743 
 
 Fig. 252. — Points Usually Neglected in 
 Brushing Teeth and Where Decay 
 Begins. {Dental Summary.) 
 
 CARE OF TEETH NECESSARY 
 
 Man having learned to soften his food by cooking is not so good a 
 chewer as some other animals; in consequence his teeth and gums do not 
 automatically keep themselves as well as those of other animals — all of which 
 means that the man who leaves the care of his mouth to automatic agencies 
 loses his teeth. 
 
 In this narrow sense human teeth 
 are not the best. But nature has en- 
 dowed him with knowledge and judg- 
 ment to compensate him for his loss in 
 other directions. The man who cares 
 for his teeth with judgment and dili- 
 gence keeps them better than does 
 any other animal. The combination of 
 human brains and teeth is the fittest 
 and the best. 
 
 It is a far stretch from the enamel 
 with 96 per cent inorganic matter 
 and 4 per cent water and organic mat- 
 ter combined to a soft, pulpy organ 
 
 such as the spleen which is nearly all water and organic matter. The peculiar 
 chemistry of the enamel means that it is very resistant to bacteria as well as 
 all sorts of chemicals. 
 
 CAVITIES IN TEETH 
 
 When acids and alkalies derived from food are eliminated from the 
 
 causes of decay of teeth nothing remains but bacteria. There are more 
 than thirty varieties of bacteria naturally in the mouth. 
 They are not present when a baby is born but they begin 
 arriving very soon and are present ever after. In addi- 
 tion to those which are universally present, so to speak, 
 there are others such as the pneumonia and diphtheria 
 bacilli which are present in some mouths but not in 
 others. 
 
 The ordinary bacteria secrete alkaline substances 
 which do not harm the teeth; but there are a few acid 
 producers and these cause decay. The enamel being com- 
 posed of inorganic matter will not support germ life. 
 Therefore they must live on food remnants. A little bit 
 of food refuse or food detritus lodges in a crack, fissure 
 or some shielded place and into it some acid-producing 
 germs find their way. 
 
 They grow and secrete acid and when this dissolves 
 the enamel a cavity results. The larger cavity means more 
 
 detritus, more bacteria, more acid and more decay. 
 
 The point to the story is that decay comes from acid acting in one place: 
 
 acid comes from germs; germs feed on food detritus. Moral: If the teeth are 
 
 kept microscopically clean there will be no decay. 
 
 Fig. 253.— Growth 
 and Multiplica- 
 tion of Bacteria 
 in Such a Tooth. 
 (Dental Summary.) 
 
744 THE TEETH AND HAIR 
 
 Decayed teeth, like swollen tonsils, mean an advanced process. The 
 cavities must be cleaned out and filled just as the tonsils must be removed. 
 But the wise procedure with each is to keep the mouth so clean that the 
 process will not advance to the stage where filling or cutting will be required. 
 This means cleaning several times a day with toothpicks, floss, powders and 
 soaps. 
 
 The ordinary brushing cleans the parts of the teeth which do not 
 need it much since eating is so efficient as a good cleaner. Cleaning means 
 emptying the pockets, the little crevasses, the fissures — these are the places 
 which count — and do the best one can, periodic cleaning by the dentist will be 
 required. 
 
 Commonly adults keep their teeth clean enough to hold decay down. 
 It is children that need dental care. Theirs are the teeth which should be 
 daily picked, flossed, brushed and polished, and which periodically should 
 be gone over by the dentist. Above all, care should begin with the first 
 set of teeth because when these drop out before their time the result is 
 some sort of a twist in the jaw. Children would gain if mothers would put 
 some of the time on washing the teeth that they now put on washing faces 
 and ears. 
 
 IRREGULAR JAWS 
 
 Once there was an old woman who could not be thankful for riches 
 or looks or anything else worth while and yet determined to thank the 
 Lord for something she said: "I have but two teeth, but, thank heaven, 
 they meet/' 
 
 When teeth do not meet properly they are not satisfactory to chew on; 
 food is commonly swallowed without being thoroughly chewed, chewing 
 does not clean them even average well and they are more prone to decay. 
 The pressure of chewing falls on them at improper angles and, therefore, 
 they are more apt to become loose and, eventually, to be the seat of pyorrhea. 
 
 All in all, teeth are more secure and digestion averages better when the 
 teeth meet normally, each tooth striking the exact place in which it belongs. 
 If any one is out of that position an eighth of an inch the system is spoiled, 
 the links in the chain disarranged. 
 
 The system in the human mouth is more complicated than in that 
 of the lower animals. The animals which eat vegetables have one kind of 
 teeth throughout. If a tooth in the upper jaw strikes the wrong tooth in 
 the lower jaw it still strikes its kind. The animals which eat meat have but 
 one kind of teeth throughout. But in man teeth for vegetables are near to 
 teeth for meats and when the bite is wrong it may throw teeth adapted to 
 tearing in opposition to teeth adapted to grinding. 
 
 When an engineer starts a tunnel from the both sides of a mountain 
 and so calculates that the tubes meet just as planned the world applauds as it 
 should; but that is simplicity itself compared with the plan by which the 
 jaws of a forming child start from separate centers and grow in a complicated 
 way until they reach exactly the right positions. It is expected that this 
 development will work out right and when it does nothing is said. When it 
 fails we search for something to blame. 
 
 It is after the child is born that the jaws go wrong. Summer complaint, 
 
THE TEETH 
 
 745 
 
 contagious disease, enlarged tonsils, month breathing, thumb sucking, scurvy, 
 rickets, syphilis, decay— these are the things which cause jaws to over- 
 grow, undergrow or to grow irregularly. A wise dentist looking in the 
 
 SATj 
 
 Fig. 254. — Temporary and Permanent Teeth: 1,1, temporary central incisors; 2, 2, tem- 
 porary lateral incisors; 3, 3, temporary canines; 4, 4, temporary anterior molars; 5, 5, tem- 
 porary posterior molars; 6, 6, permanent central incisors; 7, 7, permanent lateral incisors; 
 8, 8, permanent canines; 9, 9, permanent first bicuspids; 10, 10, permanent second bicuspids ; 
 11, 11, first molars. 
 
 mouth can tell just when the blighting illness or neglect came and in 
 many instances its cause. Of greater importance is his ability to regulate 
 jaws and teeth so that they "meet." 
 
 EROSIONS 
 
 There is a very peculiar condition of the teeth called "erosions" which is 
 not of much consequence but which I am writing about because of its peculiari- 
 ties. Occasionally it causes a tooth to fall out or to break off but generally 
 it does little harm. It causes a furrow near the gum margin and running 
 parallel with it. This triangular furrow, about one-tenth as deep as the 
 tooth, is thick and usually runs in a straight line across several teeth. It is 
 not a decay and it does not result in pyorrhea. It comes in those who have 
 been undergoing severe nervous strain — financiers in times of panic and 
 soldiers in time of war. 
 
 A tooth is simple in its arrangement. In the center is a pulp carrying 
 a few blood vessels, a few nerves and a little tissue — like the marrow of 
 
746 THE TEETH AND HAIR 
 
 bone; around this is the dentine, a bony mass having few vessels, few nerve 
 filaments, few cells, few spaces, and these of small size — changing a little, 
 but very little; set over this like a cap is the enamel — hard, resistant, negative 
 to everything, with few cells, small spaces, no vessels, no nerves and in- 
 capable of change. 
 
 Now teeth are supposed to be as immutable as the mountains; as they 
 erupt so they remain. But they are not so changeless as is generally believed. 
 The orthodontist moves them around over considerable latitude. The dentist 
 treating pyorrhea may pull one out, clean it, and put it back. 
 
 As the enamel wears the underlying dentine and the pulp becomes dense, 
 the nerves, vessels, cells and spaces disappear, the worn surface of an 
 old tooth has a dentine and pulp zone as eburnated, hard, shiny and bony as 
 enamel. The fact is that the teeth adjust themselves to their work just as 
 does everything else. 
 
 In the light of this the furrows which worry may plow in teeth and 
 which we call erosions, are not so difficult to understand as they were when 
 we regarded teeth as Gibraltars. Nevertheless, among human diseases 
 erosions remain the great mystery — the Egyptian sphinx — which tells us 
 some things but leaves us much to guess. 
 
 PYORRHEA 
 
 For a long time the man with pyorrhea notices that his gums are softer 
 and flabbier than they once were ; and between the gums and enamel the necks 
 of his teeth can be seen. In this stage cure is easy. The patient goes to his 
 dentist who cleans the teeth not only above the gums but as far down the 
 roots as a deposit is found, after which the patient keeps the teeth and 
 gums well rubbed. The art of cleaning and rubbing the teeth he learns from 
 the dentist. 
 
 The next stage is that in which the teeth are loose, the gums are flabby 
 and more of the neck is exposed. In this stage the disease is curable but more 
 time and care is required. 
 
 In the last stage the gums are soft and spongy, the teeth loose, and 
 pus oozes up beside the roots. Cure is now difficult. The added factor 
 of pus infection makes treatment much more complicated and greatly 
 decreases the possibility of cure. 
 
 See how the parallel with consumption continues : after the consumptive 
 has got a pus infection of his lungs on top of his original disease cure is 
 impossible or for it long, patient and expensive open air treatment is re- 
 quired. 
 
 Even after the teeth are so loose that they can easily be moved by the 
 fingers and pus oozes from around the roots thorough removal of all deposits 
 from the roots and applications to the gums followed by banding of the teeth 
 so that they cannot rock will be effective — except when the bony socket has 
 been absorbed. 
 
 There are those who think constitutional diseases such as gout, rheuma- 
 tism, diabetes and senility have much to do with pyorrhea and there is 
 some truth in these ideas. There are those who believe pyorrhea is a cause of 
 rheumatism and other constitutional diseases. But pyorrhea usually can 
 
THE TEETH 747 
 
 be cured without paying much attention to the constitutional state and it is 
 important enough to stand on its own base. 
 
 The important tiling to know is that spongy gums falling away from the 
 teeth with deposits below the gum margin mean pyorrhea which, taken care 
 of then and rightly, can be cured but which, neglected, means toothlessness — 
 before the period of "lean and slippered pantaloon, sans eyes, sans teeth, sans 
 everything/'' 
 
 ANEMIA AND DIRTY TEETH 
 
 The surgical operating room is a perfect machine. From operating 
 surgeon through assistants, nurses, instruments, walls, floors — all down the 
 line the technic and equipment spells 100 per cent efficiency. What efficiency 
 engineers talk about is seen in daily operation in the highest grade surgical 
 amphitheaters. 
 
 The technic of asepsis in the surgical ward is not 100 per cent, as in 
 the operating room, but it is much nearer so than is that in the medical 
 ward. Time was when the surgical ward reeked with pus infection and 
 from it infection extended over into the medical ward. Now the surgical 
 ward is aseptic and the effort is to prevent infections overflowing from the 
 medical ward. 
 
 From sources here and there is heard a plea that medical cases be sur- 
 rounded with the same aseptic conditions that prevail in the case of surgical 
 cases. Of these was the argument of Hill before one of the meetings of the 
 Canadian Public Health Association, that infection would lessen as cases of 
 infectious diseases, scarlet fever, diphtheria and the like were treated asep- 
 tically. 
 
 The strongest plea that I have read is that of William Hunter of 
 England. His argument is for clean mouths — oral asepsis. He does not 
 discuss the theory that a dirty mouth promotes the decay of teeth. That 
 needs no argument — nor that diphtheria, scarlet fever and similar infections 
 are spread by the mouth secretions. 
 
 His argument is that the continued absorption of such bacteria as 
 staphylococci and streptococci and their secretions from tartar accumulations 
 around the teeth and from pockets in the gums is responsible for rheumatism, 
 joint troubles, heart troubles, stomach troubles and severe anemia. 
 
 Any physician will tell you that William Hunter is a world authority 
 on severe anemia. In his argument he cites a list of cases of profound 
 anemia, some of which would be called pernicious anemia, which were 
 due to foul mouths and which got well when the mouth was kept clean. 
 
 In some of the cases the absorption of pus was from some pocket other 
 than the mouth. One was a case of catarrh due to an accumulation of pus 
 in the frontal sinus. One was a pus absorption from a pus pocket in the 
 lung in a case of consumption. But oral sepsis as a cause overshadowed 
 all others. 
 
 TOOTH BRUSHES 
 
 In the spring of 1913 Dr. Anglemire, then a contagion inspector in 
 Chicago, now health officer of Saugatuck, Michigan, was sleuthing an epi- 
 demic of diphtheria in a Jewish orphan asylum. He caught Abe C. spreading 
 
748 THE TEETH AND HAIE 
 
 the disease. Abe was innocent of wrong intent. His sore throat was just an 
 ordinary everyday sore throat so far as ordinary appearances went but 
 cultures from his throat showed that the cause of his ordinary sore throat 
 was diphtheria bacillus. 
 
 Dr. Anglemire had had several years of sanitary training, so he stuck 
 to the trail. In the boys' toilet room he found the tooth brushes of 100 
 boys arranged in regular order. It was decided to make a culture from 
 Abe's tooth brush. Diphtheria bacilli were found. 
 
 In the meanwhile cultures from the throats of every child in the school 
 had been made. Diphtheria was found in the throats of twenty. Investigat- 
 ing, it was found that the twenty tooth brushes nearest Abe's belonged to the 
 twenty boys whose throats harbored diphtheria bacilli. Cultures showed 
 that there were diphtheria bacilli in twelve of these brushes. 
 
 Maybe the brushes gave the disease to the boys and maybe the boys 
 gave the disease to the brushes. Dr. Anglemire thought that the fact of the 
 infected brushes being so closely bunched was proof of the brushes. In ad- 
 dition Dr. Anglemire thought that "in the bristles of the brushes were the 
 media and moisture, and the steam heated room had the proper tempera- 
 ture for bacterial growth." He recommended the following method for car- 
 ing for tooth brushes. (The method would be a good one for your tooth 
 brush and mine.) 
 
 "A simple, hygienic method of keeping a tooth brush would be, first, 
 to keep it clean and free from debris, boil it occasionally; or better yet, 
 sterilize it. An easy way of doing this would be to procure a one-quart 
 jar, or a glass candy jar, cut a piece of blotting paper to fit in the bottom 
 of the jar. About once a week saturate the blotting paper with a teaspoonful 
 of formalin, place brushes inside, bristle ends up. By this method you can 
 have a sterile and sweet smelling tooth brush. 
 
 "There appears to be another advantage in this : As formalin is a tissue 
 hardener, it will be found that the slight traces present upon the bristles de- 
 posited by the fumes will abort easy bleeding gums. The brushes should 
 be rinsed after taking from the jar, as too much formalin would be harmful. 
 It is also possible that the presence of a small quantity of formalin upon the 
 brush each day also may be a deterrent to the terrific onslaughts of pyorrhea 
 alveolaris, from which most everyone suffers." 
 
 Pyorrhea Curable Disease. — M. J. B. writes: "My dentist has been 
 treating a mclar, which has been loose for several months, but only lately 
 discovered pus organisms. The upper front teeth are separating, and 
 there is a slight discharge from the lower gums in front. He tells me that 
 he can do nothing, for pyorrhea cannot be successfully cured. Is this cor- 
 rect? Is it a systemic disease? I went to see a specialist who says that 
 while the molar will never be a sound tooth he can save it for years and 
 cure the others. He asJcs $100, which seems an exorbitant price, especially 
 if it cannot be permanently cured. My experience with specialists in 
 medicine has not given me confidence in high-priced men. Is the per- 
 centage of persons troubled with the disease high?" 
 
 Eeply. — Pyorrhea is a curable disease. However, long neglected pyor- 
 rhea cannot be cured. It is the results of neglect which are incurable 
 rather than pyorrhea. It is a local disease. It is not systemic. It is 
 
ft 
 
 A . _ 
 
 DENTAL CLINIC \ 
 
 
 iM'^JlM llllM'i. 
 
 |ll«! 
 
 New York State Dept. of Health. 
 
 Fig. 255. — First and Second Lines op Defense Against Dental Disease. 
 
 749 
 
750 THE TEETH AND HAIE 
 
 responsible for most of the loss of teeth in grown people. It affects sound 
 teeth and those with cavities without discrimination. 
 
 The way pyorrhea progresses is as follows : As people grow older the 
 bony processes which hold the teeth to the gums absorb to a slight extent, 
 whereupon the gums do not grip the teeth as firmly as before. Saliva oozes 
 down into the spaces left. From it small concretions form both above and 
 below the gum line. These lime deposits irritate and inflame the gums and 
 in consequence they pull away from the teeth and leave increasing room 
 for deposits. 
 
 Bacteria are always all around the teeth even in health. When there 
 are irritated gums, deposits and cracks everything has been made ready 
 for bacterial infection. Therefore the next stage in pyorrhea is the pus 
 stage characterized by pus welling up to the gum margin from the sockets 
 of the teeth. 
 
 Pyorrhea Not Contagious. — E. A. B. writes: "Will you please tell me 
 what is pyorrhea? Is it curable? Is it contagious?" 
 
 Reply. — 1. Pyorrhea is a chronic inflammation of the gums. Falling 
 away of the gums from the teeth characterizes it. Early in the disease 
 deposits occur on the teeth, the bony processes around the teeth are ab- 
 sorbed, pus oozes up from around the roots and loosening of the teeth 
 occurs. 
 
 2. Yes, in early stages; in late stages, no. 
 
 3. No. 
 
 Pyorrhea Often Factor. — J. B. writes: "Would the removal of ap- 
 parently healthy tonsils he a benefit in a case of rheumatoid arthritis? 
 Would pyorrhea be a factor in producing it?" 
 
 Reply. — If the absorption is taking place through the tonsils they 
 should be removed. Pyorrhea is often a factor. Have the physician in 
 the case diligently search for the point where infection is entering. 
 
 Pyorrhea Cures. — Reply to C. C, C. A. W., and others: 
 Each of you knows of a remedy which has cured a case of pyorrhea. 
 The pyorrhea cures seem to be nearly as abundant as the consumption 
 cures. Perhaps there is the same reason. These diseases are frequently 
 curable, sometimes spontaneously, sometimes with ease, sometimes with 
 difficulty. In consequence almost everybody knows of a cure and if it 
 happens that some particular treatment was used that treatment is given 
 credit for the cure. To draw conclusions from a single experience is always 
 likely to mislead. Karl Pearson says that about 6,000 experiences are 
 necessary to eliminate error. While this may be unattainable more than 
 one is necessary. Better go early to your dentists and persist in doing 
 what they tell you to do. 
 
 Bleeding Gums. — Miss 8. 8. writes: "Please advise me how bleeding 
 gums can be cured. I have gold crowns in my mouth which bother me. 
 When there isn't bleeding there is a rather bad taste, seemingly coming 
 from beneath the crowns. What will cure this? The mouth is kept clean, 
 but no amount of scrubbing and rinsing will correct this tendency." 
 
 Reply. — Bleeding gums may mean pyorrhea or scurvy or some one of 
 a few other conditions. Aside from what it may mean the condition is of 
 
THE TEETH 751 
 
 no consequence. Go to your dentist and have him find out why your gums 
 bleed and then have that underlying condition attended to. 
 
 Unclean Dental Tools. — A Citizen of Chicago writes:, "I went into a 
 dentist's office a few days ago to have some work done. I noticed the tools 
 were not clean. I would not sit in the chair until the tools had been thor- 
 oughly toiled. The dentist informed me that out of some sixty of his fel- 
 low dentists there were only about three who had a method of boiling for 
 disinfecting the instruments, and that many of them never attempted to 
 do aseptic dentistry" 
 
 Reply. — A person who notices that his dentist's methods are not cleanly 
 should change his dentist. Clean dentists are easy to find; dirty ones 
 should not be supported. 
 
 Decaying Teeth. — E. H. S. writes: "I have been troubled for two years 
 with decaying teeth, and, considering the habit of care for them instilled in 
 me by my mother since infancy, I cannot understand this except that my 
 teeth are not so hard as they should be. I am 25 years old. Is there too 
 much acid in my system, and if that is the cause, what should I take to 
 correct itf Also are there foods which will harden my teeth at my age?" 
 
 Reply. — There are no medicines that you can take. All you can do is 
 to keep your teeth clean both through your own efforts and those of your 
 dentist. 
 
 Pulling Wisdom Teeth. — H. L. writes: "1. Should gas be taken to have 
 two wisdom teeth pulled? 2. What should I do to remedy dullness of 
 hearing, lost sense of smell, and tenderness of upper air passages? I am 
 not able to go to a specialist." 
 
 Reply. — 1. You can have your teeth pulled without gas but it will hurt 
 unnecessarily. Gas is safe and wisdom teeth are well rooted. 
 
 2. Beyond question you have an old, long-standing infection of your 
 upper air passages. If you have allowed it to continue until your "hearing 
 is dull and your sense of smell is lost" you cannot be wholly relieved. If 
 you cannot pay for the treatment go to the nose clinic at the medical col- 
 lege nearest you. 
 
 Some Good in Fletcherizing. — Mrs. P. W. writes: "I noticed an article 
 headed 'Fletcherizing as a Preventive for Pyorrhea.' Would you please 
 tell me what fletcherizing is, as my teeth get loose and fall out?" 
 
 Reply. — Fletcherizing is chewing food until it is thoroughly masti- 
 cated. Fletcher advises that chewing be kept up until the mixture slips 
 down the throat semi-consciously — as saliva usually does. It will be of 
 some service in pyorrhea though it will not do away with the necessity of 
 having the roots of the teeth cleaned. 
 
 Consult Your Dentist. — C. D. C. writes: "Almost at will I can draw 
 blood from some place in my mouth or throat. I have tried to learn 
 whether it comes from the throat or gums, but am not certain, although I 
 think it comes from the gums. My mouth is seldom free from canker 
 sores under the tongue, on the roof of the mouth, inside the lip, or on the 
 gums. Sometimes a period of a week or ten days will elapse without a 
 
752 THE TEETH AND HAIE 
 
 canker. The sores last two or three days and disappear. I am in fine 
 physical condition, as far as I know. There is no trouble whatever from 
 the stomach. The bowels are regular, and I take plenty of exercise. I 
 had appendicitis about two years ago. What do you think is the matter? 
 What causes the sores in the mouth, and from where does the blood come?" 
 
 Reply. — Canker sores mean a badly balanced diet. You must change 
 your eating habits. Just how is for you to work out. 
 
 Bleeding from the gums may be due to scurvy, which also results from 
 a badly regulated ration. It may be due to pyorrhea. If so you are 
 probably in an early and curable stage. Have your dentist examine your 
 mouth. 
 
 Go to Dentist. — Mrs. B. J. writes: "How about the care of teeth of 
 pregnant women? I understand there is a preparation to counteract an 
 acid secreted in the mouth during this period which is harmful to the teeth. 
 I have asked my physician what precautions I should take to preserve my 
 teeth, and he advises just keeping them clean and being more particular 
 than usual about brushing them. I would appreciate your advice on this 
 subject, as I am now six months pregnant, and, if not too late, will take 
 further precautions if necessary." 
 
 Reply. — In the main the advice is good. Frequent and careful clean- 
 ing is the proper plan. However, go to see your dentist, have him put 
 your mouth in order and then see him again about your teeth at least once 
 during the next three months. 
 
 Hardening the Teeth.— M. L. writes to E. H. S. : "I saw your letter to 
 Dr. Evans in regard to soft and decaying teeth. I was once afflicted as you 
 state. I took to eating whole wheat bread, well chewed nuts, and fruits 
 freely and I noticed at once a marked change in my teeth for the better. 
 They became hard as flint. I have cut out all sweets save honey from my 
 diet, as well as all flesh foods, and I clean my teeth thrice daily. I have 
 used this diet for fifteen years, and at 7J/- am pronounced in many ways 
 similar to men twenty years younger/' 
 
 Reply. — This suggestion of M. L.'s may help some who have soft teeth 
 and bad gums. 
 
 Keeping the Mouth and Nose Clean. — E. F. D. writes: "I have made 
 a practice for some time of gargling my throat and rinsing out my mouth, 
 night and morning, with a solution of about 25 per cent of peroxid and 75 
 per cent of water, the idea being to offset the effect of any germs which may 
 be taken in with the dust of this disgustingly dirty city. 
 
 "Is this good practice? Is the solution used effective for the purpose, 
 and is it harmless? 
 
 "I also wash out the nasal passages with clear, warm water, using a 
 douche which is operated by placing one tube in the nose and another in the 
 mouth, blowing gently on the latter. This causes the water to go up one 
 side of the nose and out the other, without getting into the throat. 
 
 "Is here any objection to this form of douche? Is it good practice? 
 
 "Would salt water or some antiseptic fluid be better?" 
 
 Reply. — The plan which you have adopted is excellent. It is just as 
 
THE TEETH 753 
 
 necessary to keep the mouth clean as it is to keep the face clean. Most 
 infections occur through the mouth and nose and any reasonable effort to 
 keep these clean is advisable. The solutions which you use are good. 
 
 Consult Your Dentist. — H. G, R. writes: "What causes a brownish 
 (sometimes reddish, resembling blood) discharge from my mouth while 
 sleeping? I have noticed for a year or more that my pillow is so stained 
 every morning. My general health is excellent. This discharge cannot 
 originate with my lungs. I have suffered from catarrh for many years" 
 
 Reply. — The blood is not from your lungs. It is probably from your 
 gums. Have you pyorrhea or scurvy ? Have your dentist find out. If not 
 it is probably a chronic infection or subinfection of your nose or some 
 cavity opening into your nose. 
 
 Loose Teeth. — E. 8. writes: "I have three or four teeth in the lower 
 jaw which are loose. They are not decayed. Have tried several drug store 
 remedies. Is there anything that will tighten them?" 
 
 Reply.— You have pyorrhea. Drug store remedies cost money and are 
 useless. A good dentist may be able to clean, scale and anchor those teeth 
 and thereby save them for you for several years. Pyorrhea is like consump- 
 tion, easily curable in the early stage and incurable after years of neglect. 
 
 Sore Gums. — W. E. L. writes: "About three months ago my physician 
 told me that I had symptoms of a gum or tooth trouble called pyorrhea. 
 He advised me to consult a specialist and I did so. This man did nothing 
 but clean my teeth apparently. My gums ache seriously when I chew my 
 food and my teeth feel sore. My throat also feels a bit sore sometimes 
 when eating. If you will let me know what is the matter with me I will 
 thank you." 
 
 Reply. — Your gums might be sore from neuralgia. If a physician who 
 saw you said you had pyorrhea, that probably is the cause of your pain. 
 Talk with the dentist who saw you and get his opinion as to whether you 
 have pyorrhea. If you have it you need something in addition to one 
 simple cleaning. 
 
 May Save Teeth. — A. B. C. writes: "I have had the same dentist con- 
 tinuously for twenty years and he sees my mouth two or three times a year. 
 Several months ago I discovered that my gums were becoming diseased 
 and called his attention to the matter. He told me that the trouble was 
 invariably incurable and that there was nothing for me to do. So I was 
 greatly surprised to read your statement that pyorrhea is easily cured in the 
 early stage. None of my teeth is at all loose, but in several places the 
 gums are receding somewhat. Please tell me what I can do to cure or to 
 arrest the disease." 
 
 Reply. — Ask your dentist to send you to some dentist who treats 
 pyorrhea or to take counsel with some pyorrhea dentist as to the proper 
 course for you to pursue. By starting care early you will save your 
 teeth. 
 
 Tumor of Gums. — Miss H. S. writes: "Immediately bach of where my 
 two front teeth join there is a tiny cleft in the roof of my mouth, which has 
 
754 THE TEETH AND HAIK 
 
 been there ever since I can remember. For several months it has been sore 
 and seems slightly swollen. It bothers me considerably when eating and I 
 have difficulty in biting anything but soft food. It is in the way when 
 my mouth is closed. My lower jaw fits so that my front lower teeth just 
 rest there, but it is so painful I have to bring the lower jaw behind it. 
 Should I ash a physician to clip it off, or do you think it will eventually 
 lose its inflammation and cease to bother me?" 
 
 Reply. — I judge you mean there is a little projection there. Projections 
 at this point are frequent. The two plates forming the roof of the mouth 
 grow together there and in consequence defects and errors occur. Have a 
 dentist or physician remove the little tumor. 
 
 Lime Water and Gums. — Reader writes: "Is it advisable to use ordi- 
 nary commercial lime in water so that it may be used by the tablespoonful 
 in milk and bread for hardening loose teeth?" 
 
 Reply. — I presume you mean for the purpose of hardening your gums 
 and making your teeth immovable. If so no form of lime will be of 
 service. Have your dentist clean the roots of your teeth and anchor them 
 wherever possible. Have him treat your gums at the same time. 
 
 Fletcherizing as Preventive. — B. L. D. writes : "In reading your article 
 'Pyorrhea Curable' I became very much interested, as I had a very bad 
 case of it. All my teeth were loose, and two fell out during the night, but 
 now my teeth are as strong as ever. March 16, 1911, I was taken to a 
 hospital and was confined there until June 9, 1911. All they gave me to eat 
 was milk toast, soups, cereals, weak coffee, and stewed dried fruit. I spoke 
 to the chief physician of my trouble, but he ignored it. I consulted my 
 dentist on my return home, but did not have the money to spare for treat- 
 ment at that time. The last week in August I made a business trip to 
 Battle Creek, Michigan, and there met an ardent admirer of Horace 
 Fletcher. He invited me to his house for supper. I could not refuse, so 
 accepted the invitation. They had for supper beef tenderloin with mush- 
 rooms, potatoes, lettuce salad, dessert, and black coffee. Being humiliated 
 on account of my teeth, I said, 'Here goes, if all my teeth fall out.' Doctor, 
 I never enjoyed a meal so in my life. I had been craving for meat, but 
 could not chew it. I learned to fietcherize that night, and today I can eat 
 anything." 
 
 Reply. — Fletcherizing will do much to prevent pyorrhea. I doubt if 
 it can be relied on to cure well developed cases. 
 
 Treatment for Pyorrhea. — G. writes: "Please give me some remedies 
 for pyorrhea and ulcers of the mouth." 
 
 Reply. — 1. Pyorrhea — Dentists cure pyorrhea by painstaking attention 
 to the gums and teeth, supplemented by vaccines or emetine according to 
 the case. Where bony processes have been absorbed the teeth must be lost. 
 
 2. Ulcers of the mouth result from eating an ill balanced diet. When 
 the diet is readjusted the ulcers quit coming. 
 
THE HAIR 755 
 
 THE HAIR 
 
 BALDNESS 
 
 Baldness, premature and permanent, is caused by the hat. 
 
 It is not due to the weight, texture, stiffness, or heat of the hat so 
 much as it is to the fact that the hat girdles the head like a band inter- 
 fering with the circulation of the blood and starving the roots of the hair. 
 
 Baldness can be prevented. Doubtless it will be prevented when it 
 comes to be generally understood that the hat commonly worn by men and 
 boys is the cause practically of all the premature and permanent baldness 
 of the male sex. Frequent reference to the hat as the cause of baldness is 
 made in the literature of the subject but not in a way to reach the public. 
 
 The blood supply necessary for the growth and nutrition of the hair is 
 received by the scalp between the skin and the bony skull, principally in 
 front of the ears and also at the sides of the forehead and behind the 
 ears. 
 
 That some men are bald and others are not although all wear hats 
 is due to the difference in the shape of the head. Baldness appears to be 
 peculiar to some families while others are exempt. This gives rise to the idea 
 that baldness is hereditary. It is the shape of the head that makes the differ- 
 ence and it is the shape of the head that is influenced by heredity. 
 
 Some heads are so cone-shaped that a hat fits like one length of stovepipe 
 over another making pressure not only on the sides but all around the 
 head. This class becomes bald most frequently and earliest. Other heads 
 are so shaped that the pressure of the hat does not come upon the blood 
 vessels on the sides of the head. These do not become bald or at least do not 
 become so until the nutrition of the hair bulbs is impaired from some other 
 cause. 
 
 I have observed that the heads that are full in front of the ears and 
 with rounded foreheads are most frequently bald. This is because the 
 blood-vessels in front of the ears and at the sides of the forehead are sub- 
 ject to the pressure of the hat while the square forehead which only permits 
 the pressure of the hat on each temple and on the back of the head leaves 
 the sides free from pressure and the hair free to be nourished. 
 
 Every horseman knows that if a horse's tail be kept tied up for a week 
 or ten days the hair at the end of the tail will fall off, and most of them 
 know that this is because the blood circulation is interfered with. A 
 wart may be made to drop off by tying a ligature around its base thus cut- 
 ting off its blood supply; similarly if the blood supply of the scalp is cut 
 off the hair will fall out. 
 
 Baldness begins in the area where the blood supply is weakest — usually 
 at the top or upper back part of the head, because the pressure on the 
 vessels in front of the ears (the temporal arteries) and on those at the 
 side of the back of the head (the occipital) is most frequent. If the 
 pressure be on the vessels above the eyes (the supra-orbital) the baldness 
 will be of the "high forehead" type. Usually the head becomes bald above 
 the line of pressure by the hat, but not below that line. 
 
756 THE TEETH AND HAIR 
 
 The foundation of baldness is often laid in boyhood, since pressure upon 
 the blood-vessels at that time retards their growth and prevents their perfect 
 development. This accounts for occasional baldness in the twenties. The 
 inference is that children should not wear any covering for the head except in 
 inclement weather and then only a cap that rests upon the top of the head 
 and does not grip the scalp. 
 
 Women are less subject to baldness than men regardless of the shape 
 of the head; first, because their "crowning glory,' 1 more luxuriant than that 
 of man, forms a cushion which protects the scalp from pressure; and 
 second, because a woman's headgear does not constrict the scalp but rests 
 on top of the head. 
 
 The hat accounts for the baldness of men and the exemption of women. 
 It accounts for the baldness of civilized men and the exemption of savages. 
 
 On reflection it seems that the hat is more for ornament than utility 
 anyway. A good head of hair is all the protection that is required except in 
 severe weather. 
 
 So-called "restorers'' applied to the seal]) to remedy hat baldness are use- 
 less. Rubbing the scalp with the fingers or a brush stimulates the circula- 
 tion and is useful. Too much washing destroys the natural oil of the hair 
 and renders it brittle. 
 
 Forms of baldness other than hat baldness may follow the debility 
 caused by exhausting febrile diseases and local diseases of the scalp. It is, 
 however, as a rule, temporary. Baldness in old persons is due to the im- 
 paired general circulation of the blood common to the aged. All baldness 
 except hat baldness may occur in people of any nationality and in either sex. 
 
 Has Scalp Disease. — J. R. H. writes: "I am 29 years old. For a number 
 of years I have teen troubled with a sore scalp, which has caused most of 
 my hair to fall out. Now I am almost bald. I am troubled with dandruff, 
 and when the scalp gets dry it is itchy. Also after using any hair tonic it 
 gets so itchy that I am forced to pick dandruff out, causing the scalp to 
 have red blotches. Please tell me what causes my head to be sore. Is it 
 possible I have had some disease, and do not know it? My health is good." 
 
 Reply. — Evidently you have a scalp disease. Probably, though not cer- 
 tainly, you have seborrheic eczema. Mild cases resulting in dandruff can 
 be cured by persistent cleaning and brushing and by using sulphur or 
 resorcin ointment. You apparently have a more severe case and had better 
 see your physician. 
 
 See a Skin Specialist. — J. M. K. writes: "My hair has been falling out 
 in spots for the last two months. It appears to be growing again, but of a 
 decidedly light color. My hair is brown. Is this caused by a germ? Have 
 had my hair clipped close. Will this help? Are any of the advertised hair 
 restorers of any use? My health is good." 
 
 Reply. — It probably is due to an animal parasite, though sometimes 
 other diseases cause it. You had better see a skin specialist. 
 
 Care of the Hair. — Jo writes: "Is there any truth in the assertion that 
 dry salt copiously sprinkled over the scalp and vigorously and frequently 
 brushed through the hair promotes its growth?" 
 
THE HAIE 757 
 
 Keply. — No. The same amount of plain brushing and cleaning would 
 do just as well. 
 
 Bald Head. — Subscriber writes: "Should a bald-headed man have his 
 head covered while sleeping in cold weather in a small bedroom with the 
 window open?" 
 
 Reply. — In very cold weather, yes. In ordinary weather, v.o. 
 
 Care of the Hair. — Reader writes: "My hair is falling out rapidly. 1 
 am advised by friends to apply a weak salt water or brine about twice a 
 week. If I use this regularly will it be beneficial? What proportion of salt 
 to water?" 
 
 Reply. — It will be all right if you will use it thoroughly enough to keep 
 your scalp clean, will use a little grease afterward, and brush your hair fre- 
 quently and well. In other words, care will save your hair. Salt water 
 washing will be a part of the care given. The proportion is not a matter 
 of consequence. Use a tablespoonful to a pint of water. 
 
 Dandruff. — E. H. writes: "What is the cause of dandruff, and how can 
 it be cured?" 
 
 Reply. — Dandruff is a variety of seborrheic eczema — the skin disease, 
 possibly bacterial in origin, which is responsible for much of the premature 
 baldness. It is a mild condition which if neglected leads to loss of hair 
 but if cared for usually yields to treatment. It can be cured by frequent 
 washing of the scalp followed by mild greasing. The hair must be brushed 
 frequently and well. 
 
 To Remove Dandruff. — L. 31. writes: "Will you kindly tell me of a* 
 scientific method for removing dandruff?" 
 
 Reply. — Avoid sources of infection such as toilet articles in common 
 use, and keep the scalp clean. To keep the scalp clean wash it two or 
 three times or even more each week with a good tar or sulphur soap. Cor- 
 rosive sublimate soap may be used on an unbroken scalp. 
 
 In some cases the free application of alcohol will cleanse sufficiently. 
 If the alcohol leaves the scalp and hair too dry add five or six tablespoon- 
 fuls of castor oil to each pint of alcohol. After the scalp is cleansed a 
 resorcin or sulphur lotion should be applied and well rubbed in. 
 
 Superfluous Hair. — Mariak writes: "Please advise me what to do to 
 stop growth of hair on my chin. A few months ago only two or three hairs 
 grew out. These I pulled out and was advised to use peroxid and ammonia 
 as a remedy, but this only stimulated the growth." 
 
 Reply. — Nothing stops it except the electric needle and that does not 
 succeed unless it is used so as to kill the hair bulb. Pulling them out 
 makes them worse. 
 
 Removal of Superfluous Hair. — C. B. writes: "Will you advise if, in 
 your opinion, the use of the electric needle for removing superfluous hair 
 from the face is perfectly safe — that is, if scars are apt to result or any 
 growths form under the skin after its use, or is there any other suggestion 
 you could offer in the way of removing these hairs permanently?" 
 
758 THE TEETH AND HAIE 
 
 Eeply. — When in the hands of a skillful operator no scars or growths 
 will follow the use of the needle for the removal of hairs. 
 
 Bald in Spots. — Reader writes: "About a month ago three little bumps, 
 each the size of the tip of the little finger;, appeared on my head. They 
 were sore to the touch. I have just noticed that one of these bumps has 
 gone completely bald. Is there any danger of all my hair coming out? 
 What would cause the bumps to appear? I am a woman of 22" 
 
 Reply. — You will not lose all your hair in any event. Alopecia areata 
 is a disease which causes the hair to fall out in spots. Ringworm is an- 
 other. Have your physician tell you which you have and what to do. 
 
 Bald Spots. — A. C. writes: "I am 23 years old and for the last three 
 months my hair is coming out in bunches. Please let me know of any 
 remedy that will cure it." 
 
 Reply. — If you mean your hair is coming out in patches you should see 
 a skin specialist. Bald patches may be due to any one of several skin dis- 
 eases each of which is of consequence. 
 
 Thin Hair. — M. K. writes: "Is there anything one can do to make the 
 hair grow thick? My hair is thin and oily." 
 
 Reply. — I doubt if anything can be done. If you mean that your hair 
 was always thin certainly nothing can be done. If it has been gradually 
 falling out you can stop it by washing, brushing and rubbing it well. 
 
 Gray Hair. — E. P. H. writes: "I am much interested in the replies on 
 gray hair. Can it be that, considering what medical men and scientists 
 have done and are still doing for humanity, what seems to be much 
 simpler is baffling them? The majority of people go through the greater 
 part of their lives with gray hair. Cannot someone solve the problem?" 
 
 Reply. — Members of certain families turn gray young. To avoid marry- 
 ing into those families is one thing that can be done. The next most 
 important cause of gray hair in relative use is worry, anxiety and emotion. 
 To live with equanimity is another thing that can be done. The subject of 
 gray hair, these two factors being eliminated, becomes the same as senility. 
 
 Measures effective for the postponement of senility are effective against 
 gray hairs. These are embodied in a normal, wholesome life, lived from 
 childhood up. Medicines to change the color of the hair are dyes by what- 
 ever name they are called. To dye the hair is to cheat. If a man is pre- 
 maturely gray and is discriminated against on account of gray hair he is 
 being cheated. The remedy is to carry his birth certificate and not to dye 
 his hair. 
 
 Why Does Hair Turn Gray? — N. W. writes: "What is the cause of hair 
 turning gray at 30? My health is good, I am not given to worry, and it is 
 not hereditary that I know of, yet my hair is rapidly turning gray. I am 
 trying massage with vaselin, but it does not seem to help any. Do you 
 think that the taking of iron and sulphur internally would have a tendency 
 to stop the graying ?" 
 
 Reply. — No, as to iron and sulphur. Nothing will stop it. Metchnikoff 
 found that white blood cells entering the hair roots caused it to turn gray. 
 
 
THE HAIR 759 
 
 This is a step toward an answer but not an answer. The next question is, 
 Why do the white cells enter the roots? 
 
 Hair Turning Gray. — H. D. writes: "What can I do to prevent my hair 
 from turning gray? Does it come from the blood? Am only 21+ and 
 anemic. My scalp is scaly and sore." 
 
 Reply. — Get your scalp in good condition and keep it so and you will 
 do about all that you can do to keep from turning gray. Wash your scalp 
 frequently — every day or three times a week until you get rid of the scales. 
 Rub in a little grease after washing. If you have much dandruff probably 
 a sulphur ointment will be better than a plain grease. Spend some time 
 each day brushing your hair. The condition of the blood has no especial 
 influence on the hair. Anything that profoundly influences the nutrition 
 including profound anemia will affect the hair ; slight anemia will not. 
 
 Keep Hair Clean. — M. E. writes: "I am 30, and my hair is becoming 
 white. Would you have the kindness to tell me how I can bring bach my 
 original dark hair?" 
 
 Reply. — There is nothing that you can do except wash your scalp often 
 enough to keep it clean and brush your hair frequently and thoroughly, 
 using a little grease if required. 
 
 Nothing except dyes ''brings back" the color and they do harm. 
 
 Hair Dyes Injurious. — 0. B. writes: "1. Are preparations for the pre- 
 vention of gray hair or coloring injurious to the eyesight? 2. Can you 
 prescribe a wholesome hair preparation? 3. Is it better to discontinue the 
 use of these preparations at once or to do this gradually, and let the hair be 
 restored to its natural color? k- Is a glass of salt water before breakfast 
 helpful?" 
 
 Reply. — 1. No, but they are otherwise injurious. Read the article in 
 "Nostrums and Quackery" (published by the American Medical Asso- 
 ciation) on hair dyes. 
 
 2 and 4. No. 
 
 3. At once. 
 
 Dyes Not to Blame. — Interested Reader writes: "Would the use of a 
 hair dye or one of the so-called hair restorers be any cause for, or in any 
 way relate to the extremely nervous condition of a person, such as sleep- 
 lessness, irritability, etc.?" 
 
 Reply. — I have heard of inflammations of the scalp and severe head- 
 aches from the use of these advertised hair dyes but never of sleeplessness, 
 irritability and a nervous condition. I do not think the use of the dyes 
 is responsible. 
 
 Wash Scalp Daily. — Young Subscriber writes: "What causes the terri- 
 ble itching of the scalp, especially when one gets out under the sun? I am 
 in my twenties, and my hair is gradually losing its color, turning gray. 
 Can you suggest a remedy?" 
 
 Reply. — You have a scalp condition which you should remedy by care 
 of your scalp. Wash your scalp well with soap and water every day. If 
 
760 
 
 THE TEETH ANT) HAIR 
 
 the hair is too dry rub in a little grease after washing. Brush your hair 
 thoroughly with a clean brush several times a day. 
 
 Little Absorbed by Scalp. — B. writes: "Will you kindly tell me whether 
 the use of cantharides as an ingredient of a hair tonic could lead to any 
 injury to the health?" 
 
 Keply. — None. Very little will be absorbed. 
 
CHAPTEE XLII 
 
 The Feet 
 
 CARE OF THE FEET 
 
 Several years ago when a certain city made a physical examination 
 a part of its civil service test for positions on the police and fire department, 
 it was found that a rule against flat foot practically barred negroes from 
 the service. 
 
 Inquiry as to the ability of whites and blacks to walk and stand without 
 discomfort did not show the same disproportion. The conclusion was that flat 
 foot is not so disabling as is generally supposed. When the test of the arch 
 of the foot by impression on paper is made in a routine way it is found 
 that there are lots of people with high arches and painful feet and lots of peo- 
 ple with flat feet who suffer no discomfort. 
 
 Now whenever the calf muscles cramp, pain, ache or tire easily or the 
 feet burn or hurt something is the matter with the feet. On the other hand 
 when the foot is flat one must go slow about announcing that the foot is 
 inefficient or predicting that painful feet will ultimately develop. 
 
 In the problem of the feet there are many elements that enter in besides 
 the arch. There are twenty-seven bones and all the ligaments that tie them 
 together, a lot of muscles and many more tendons, a multitude of blood vessels 
 and a myriad of nerves, for the foot is a regular meeting of the ways. 
 Think of the tracks in the most complicated railroad yard you ever saw and 
 then remember that all that complication of rails is simplicity itself as com- 
 pared with the trackage of the foot. 
 
 If in the railroad yard a single rail slips six inches out of its groove, 
 trouble results. If in that foot yard a nerve slips a fraction out of its groove 
 or the bone tilts a wee bit wrong trouble results. 
 
 I have sometimes wondered why those men who were building up schools 
 of medicine around pinched nerves did not use the foot nerves as the basis 
 of their theory since foot nerves are so frequently pinched, pressed upon 
 and "nagged." Instead they use the nerves coming from the spine — nerves 
 that are buttressed like one of Scott's armored knights. 
 
 The practice is to cramp and bind the feet for years until the twisted 
 toes, displaced bones, atrophied muscles and lax ligaments make a condition 
 past remedying and then to attempt some superficial, ill considered remedy 
 too tardily for any good result. 
 
 The real remedy is to encourage children to go barefooted wherever 
 hookworm will permit; to encourage them to wiggle their toes and to take 
 exercises that will develop the calf muscles and those lower down; to study 
 where the shoes wear (both heels and soles) for what we can learn of the 
 foot mechanism that we seek to conserve; to study the toeing in or the 
 
 761 
 
762 
 
 THE FEET 
 
 toeing out to discover whether it means wrongly made feet or whether it 
 means that the trouble is beyond the feet in the legs. 
 
 As most of the people now complaining of their feet were children in 
 
 the 70's and 80% years when men were 
 thinking a great deal about the Hotten- 
 tots but little about their own feet, most 
 of the sufferers will exclaim: 
 
 "Advice to wiggle the toes and ex- 
 ercise the calves is all right; but our 
 toes will not wiggle. How about metal- 
 lic arches ?" 
 
 Such people know that they can 
 never score 100 but would like to 
 know if insole arches will help them to 
 make 50. 
 
 A foot arch held up by a metal arch 
 tends constantly to get weaker. Its 
 muscles become flabby, its fat absorbs 
 and its tendency is downward. Never- 
 theless some people require a metal arch. 
 Those who can get relief from felt pads 
 had better do so. 
 
 SLEW-FOOTED" OR 
 TOED" 
 
 PIGEON- 
 
 Mr. Webster seems never to have 
 heard of it but "slew-footed" is a com- 
 mon term for those who walk with the 
 toes turned out. For some reason those 
 who walk with the toes turned in are 
 called pigeon-toed. Notice people walk- 
 ing the streets and you will find that a 
 large percentage of them walk with their 
 toes pointed out or in. 
 
 Every person unconsciously finds 
 
 his own method of walking. You can 
 
 be certain that however foolish it may 
 
 seem for any man to go down the street 
 
 walking slew-footed it is really the 
 
 best way for that man to walk. For him 
 
 to try to turn in his toes would mean speedy tire. On that basis, slew-footed- 
 
 ness, his bones are shaped and set, his tendons are placed and his muscles 
 
 developed. To walk according to one's bony parts is wisdom. 
 
 If you will inquire more closely you will find that athletes are never 
 slew-footed. A slew-footed runner or a slew-footed jumper would be a seven 
 days' wonder. 
 
 The meaning of this is that while walking slew-footed is the most 
 efficient way for a slew-footed man to walk slew-footed people never walk, 
 
 Fig. 256. — Bones of Right Foot. 
 
FLAT FEET 
 
 763 
 
 run or jump at high efficiency. Their best is always below the other fellows 
 best; also their average is below the other fellow's average. Observation 
 will convince yon that the ordinary slew-footed man cannot walk so much 
 without tiring excessively as can the average man. 
 
 I have sometimes thought a military training made for slew-footedness. 
 The soldier is re- 
 quired to keep his 
 heels together. As 
 his shoulders are 
 broad, this makes 
 his base much nar- 
 rower than the 
 shoulder zone five 
 feet above the 
 ground. No animal 
 ever stood that way 
 naturally since the 
 upward climb from 
 the Stone Age be- 
 gan. 
 
 The natural 
 way to stand 
 
 with the heels separated several inches and thereby with the base line 
 broadened. But the army men having decided on "heels together" the base 
 line must be broadened somehow so out go the toes. Gradually the mechanism 
 of the feet and legs come to adjust themselves to the basis of "toes out." 
 This, however, is not of much consequence. 
 
 Usually military life does not catch the men young enough to change the 
 mechanism greatly — at least not army life. It should make a difference 
 with those boys who are going through a preparatory school where they have 
 military discipline. 
 
 Fig. 257. — Shoe to Prevent 
 or Cure Bow-legs in 
 Children. (By courtesy of 
 Best & Co., New York.) 
 
 Fig. 258.— "Toe-in" Shoe. (By 
 courtesy of Best & Co., New 
 York.) 
 
 FLAT FEET 
 
 The work of the heel is to bear the weight of the body. The work 
 of the toes is to push it forward. In order that the toes may work to the 
 best advantage and that the nerves, tendons, muscles, and blood vessels under 
 the bottom may not be pinched with each step there 
 are arches in the foot. One is the instep ; another less 
 well known is that at the ball of the foot running across 
 from the big to the little toe. 
 
 When these arches are not just right, muscles 
 and ligaments are put under improper strain and the 
 bones, joints, nerves and blood vessels are pinched. 
 There is not only aching feet and legs but tire of the FlG 259. — Ankle and 
 whole body. A smallpox epidemic comes once in thirty Arch Supporting 
 years but every night thousands go home all worn out ^°i s ' t ^ y c COUT N Sy 
 from tired, aching feet. York.) 
 
764 
 
 THE FEET 
 
 Painful feet, 
 A shoe with a 
 
 Fig. 260. — Print of Foot 
 with High Instep (A) 
 and Print of Flat Foot 
 with Pinched Toes. 
 
 In maintaining the arches the muscles are the key to the situation. 
 Flabby, weak foot muscles have more to do with broken arches than stretched 
 tendons. The muscles concerned are those which wiggle the toes. This 
 being true the way to prevent flat-foot is to develop the muscles which move 
 the toes. 
 
 Now toes are becoming useless, rudimentary, distorted, 
 broken arches and "flat-foot" are increasing at the same rate, 
 high heel tends to break 
 down the foot arches 
 because it pitches the 
 weight from the back 
 where it should be car- 
 ried to the ball of the 
 foot, where it causes un- 
 due strain and tire. If, 
 in addition, the toes are 
 pinched or the ball com- 
 pressed the arch is almost 
 certain to give. 
 
 The method of pre- 
 venting flat-foot and of curing it in its earlier stages follows: 
 
 1. Children should be allowed to go barefooted or to wear sandals. The 
 foot muscles — those which move the toes — must be kept vigorous, strong, in 
 use and under control. 
 
 2. Adults must build up their foot muscles by walking, running, jumping 
 and also by room exercises which bend the foot and particularly move the toes. 
 
 3. The shoe heels should be low, flat and broad; the toes wide and the 
 
 shoes roomy enough so that the 
 foot can give naturally as the heel 
 catches the weight and the ball 
 pushes the body forward. 
 
 If you would avoid tired feet 
 keep your toe muscles in good con- 
 dition. 
 
 Fig. 261. — Weak Feet — Seen 
 Behind. 
 
 Fig. 262. — Weak Feet — Seen in Front. 
 
 LOW HEELS 
 
 The girls are walking low 
 now. Maybe they have given heed 
 to all this talk about foot arches 
 and painful feet. Maybe the writer 
 who told them that high-heeled shoes were making the toes do what the 
 heels should do has been heeded. And then maybe not. 
 
 However, why discuss the reason for it? The fact is here— the correctly 
 dressed girl is wearing a broad soled, no heel shoe. 
 
 The present type of shoe is a good one but the change has come about 
 too suddenly. There will be a reaction. When a person has walked on 
 high heels for years the bones have become adjusted to the position. 
 
FOOT HABITS 
 
 765 
 
 When the rear end of the long heel bone is raised the front end is 
 pitched downward. The leg bones come to sit on the forward, slanting sur- 
 face. The foot bones in front of the heel bone join the heel bone at a 
 new angle. Much of the weight of the body is carried to the toes without the 
 accustomed spring. 
 
 The ligaments readjust themselves : the muscles and tendons lengthen or 
 shorten as needed. After this mechani- 
 cal adjustment has been working for 
 a long time it cannot be suddenly 
 changed without causing trouble. 
 
 When the heels are left off the 
 shoes the rear end of the heel bone 
 drops down an inch or more. The pitch 
 is backward, at least it is more so than 
 it was. The facets of the bones must 
 readjust themselves. New facets must 
 be fashioned, and while the process is 
 going on the bones move on each 
 other with some friction and heat — 
 and pain. 
 
 The length of tendon and muscle required is not the same for the two 
 positions. The muscles running from the calf to the sole are not quite 
 long enough. 
 
 In consequence the girl tires easily. As a result of fatigue the muscles 
 of the calf ache or spasmodically contract from time to time. 
 
 The change for the time results in loss. To bring about the same result 
 by gradual change is another matter. To have lowered the heel bit by bit, 
 giving the muscles time enough to elongate, and the bones time to readjust 
 their facets gradually, would have been wise. 
 
 There is not the same objection to the rapid widening of the sole but 
 there, too, something would have been gained by a more gradual change. 
 
 The quarrel, then, is not with the change but with the suddenness «* it. 
 
 Fig. 263.— A, Print 
 of Normal Foot. 
 B, Print of Flat 
 Foot. 
 
 Fig. 264. — Modified 
 Thomas Heel. 
 
 FOOT HABITS 
 
 As age advances and the weight increases a naturally normal foot may 
 and generally does become worked out of shape. A foot that is constructed 
 to bear a weight of 130 pounds must yield in time, if the weight is increased 
 to 200 or 250 pounds, and become more or less flat. 
 
 With increasing years and weight the necessity of toeing out to main- 
 tain the balance while standing is apt to become the habit so that in middle 
 life most people will toe out too far in walking. This brings the strain of 
 raising the heel on the inner and longer side of the foot and makes an undue 
 strain upon the tendons that support the arch. It also turns the large toe 
 in and in time the joint of the big toe becomes enlarged from the strain and 
 projects inward toward the other foot. 
 
 The spring of the foot in walking should be on the outer and shorter 
 side of the foot for the reason that the smaller and shorter bones of the foot 
 
766 
 
 THE FEET 
 
 are more elastic and springy and the motion of raising the heel requires less 
 
 effort. 
 
 In running one unconsciously toes in so as to take advantage of the 
 
 shorter and more springy part of the feet. To toe in, then, is the natural 
 
 and correct way to walk. Toe- 
 ing out is a habit and one that 
 should be avoided and can be 
 corrected by giving the subject 
 attention. 
 
 With this knowledge we can 
 understand why high heels give 
 a degree of comfort to the flat- 
 footed. They throw the weight 
 on the outer and smaller bones of 
 the feet and take the strain off 
 the arch on the inner side of 
 the foot. 
 
 The natural way to walk is 
 barefooted, and in considering 
 footwear for a normal foot the 
 one thing to consider is to so 
 arrange the shoe or stocking that 
 the tread of the foot and its 
 
 natural action will not be interfered with. This probably will take us back 
 
 to the moccasin of the aborigines, to the sandal of the Orient or to the sneaks 
 
 of the children. 
 
 The shoemaker should make the shoe with the sole broad enough for the 
 
 bottom of the foot to rest on a 
 
 flat surface instead of having the 
 
 outer edges of the foot on a 
 
 rounded surface as is the case 
 
 when the sole of the shoe is not 
 
 so broad as the sole of the 
 
 foot. 
 
 Trouble comes to many from 
 
 wearing stockings that are too 
 
 short and too small, which con- 
 stantly prevent the spreading of 
 
 the foot when the weight is put 
 
 upon it and which tend to curl 
 
 the small toes under. They are 
 
 frequently as much to blame for 
 
 corns and for ingrowing nails as 
 
 the shoes. 
 
 Fig. 265. — Shoes Should Have a Broad Toe. A 
 line from the inner side of the front of the great 
 toe along the inner side of the ball to the inner 
 side of the heel should be straight. 
 
 Fig. 266. — A Harmful, Narrow-Shaped Toe. 
 
 COVERING OF THE FEET 
 
 Whether the lodging-house inmate be a tramp or a seasonal worker, if 
 he be wise he will keep himself equipped with warm socks. Yet Flynt 
 
COVERING OF THE FEET 
 
 767 
 
 Fig. 267. — Toes 
 Pressed out of 
 Position, Weak- 
 ening Both the 
 Instep and the 
 Ball of the Foot. 
 
 tells us that the tramp's poorest equipment is with footgear, both shoes and 
 
 socks. He frequently has no socks, and when he has them they are full 
 
 of holes and dirty. 
 
 The key to the man's situation is his feet. For one thing he uses them 
 
 a good deal. For another, they frequently "go bad on him." When he rides 
 
 on the bumpers or in a freight car in winter he is liable 
 
 to freeze his feet. When he gets to middle life he is 
 
 always a hobbler. 
 
 Keeping equipped with water-tight shoes is not an 
 
 easy job. One can always pick up shoes on dumps and 
 
 in alleys but such shoes are not water-tight. 
 
 The lodging-house man will do well to do the best 
 
 he can as regards shoes. Whenever he can he should wash 
 
 his socks. When the socks are wet or their mesh is filled 
 
 with dirt the heat of the body travels from the skin 
 
 through the socks and shoes to the ground almost as fast 
 
 as though the feet were bare. 
 
 One cannot be expected to make heat enough to warm 
 
 the ground. Clean, dry socks hold the heat in; so the 
 
 lodging-house man should spend some time in keeping his 
 
 socks clean and dry. If he cannot get hold of socks he should try to wrap 
 
 his feet in some warm, dry, clean cloth. Sometimes he can get a piece of 
 oilcloth or a piece of paper worked in in such a way 
 as to help. 
 
 A newspaper is of great service in "keeping out the 
 cold," especially when the wind is blowing. Spread on a 
 floor, it keeps out cold air. Slipped in between garments, 
 it keeps the wind from blowing away the warm air from 
 next the skin and replacing that warm air with cold. 
 Clean clothes are warmer than dirty ones. Every 
 lodging-house now has some facilities for bathing and 
 some of them have a tub or so for the men to wash their 
 clothes in. 
 
 If the feet get nipped they should be thawed out 
 slowly with as much rubbing as they will stand. The 
 skin must not be broken. For chilblains the feet should 
 be plunged frequently into cold water containing salt or 
 
 a little ammonia or bathed with kerosene oil ; they should be dried thoroughly 
 
 and rubbed gently; and should be dusted with talcum powder. 
 
 Woolen stockings should not be worn and the feet should be kept away 
 
 from heat. The feet should be painted with two coats of iodin, the first 
 
 coat being allowed to dry thoroughly before the second is applied. 
 
 Aching Feet. — Reader writes: "What causes one's feet to burn at night 
 when to the touch they do not feel hot? The feet pain generally in the ball 
 of the foot, also at the heel, and standing is painful during this time." 
 
 Reply. — Have your urine examined to exclude Bright's disease, a fre- 
 quent cause of swollen feet. Have your heart examined to exclude heart 
 disease, another frequent cause. These having been excluded, there is 
 left "painful foot," an unpleasant condition and one difficult to remedy. 
 
 Fig. 268.— A Nar- 
 row-Toed Shoe 
 and the Natural 
 Shape of the 
 Foot When Sup- 
 porting the 
 Body. 
 
768 
 
 THE FEET 
 
 It seems to me most of the cases result from improper care in childhood 
 and youth and the condition as it presents itself in middle life cannot be 
 remedied. The feet have not been encouraged to grow. Rather they were 
 cramped in the years of growing. In consequence they are not large 
 enough to carry the weight of the body. Tight shoes have caused a loss of 
 power over the toes. The toe muscles have atrophied. In consequence of 
 this group of influences the foot bones slip just enough to pinch nerves. 
 Your only hope of relief, as I see it, is through a good shoemaker and 
 physical culture. Perhaps some reader can offer help to this considerable 
 group of sufferers. 
 
 Broken Arch Remedy. — Mrs. 0. B. wants to know if tight shoes break 
 down the arch. What can be done for a broken arch? 
 
 Reply. — The important arch is the instep arch. In the natural arrange- 
 ment the heel carries the weight. If the shoe heels are high the weight 
 pitches forward to the ball of the foot. If the ball can spread out this 
 
 shifting of the 
 weight is taken care 
 of; if the shoe 
 pinches it is not so 
 easily cared for. 
 
 If the toes are 
 pushed, distorted 
 and pinched around 
 the arch is endan- 
 gered ; first, because 
 in any arch, if any 
 of the elements, 
 even those at the 
 ends, are displaced 
 or changed the arch 
 Fig. 269.-Cross Section of a Corn. is wea kened; sec- 
 
 ond, because good 
 muscles in the foot are necessary for a strong arch and many of the foot 
 muscles have as their work the moving of the toes. When the toes, per- 
 petually unused, become useless the muscles which work the toes also go 
 out of business. 
 
 The remedy: Build up the general muscle system by exercise. Build 
 up the foot and leg muscles by exercise. Wear shoes which are "easy in the 
 toes" and support the instep. 
 
 Treatment for Chilblains. — E. 0. writes: "As soon as the cold weather 
 approaches I am bothered with chilblains, or frosted feet. I have tried 
 several things, but nothing has helped me. Kindly let me know how to get 
 rid of this affliction/* 
 
 Reply. — Plunge the feet frequently into cold water containing salt or a 
 little ammonia ; or bathe with kerosene oil. Dry thoroughly and rub gently. 
 Dust with talcum powder. Do not wear woolen stockings and keep away 
 from heat. Paint with two coats of iodin, allowing the first coat to dry 
 thoroughly before applying the second. 
 
 Danger in Using Acid. — L. A. S. writes: "Is there any danger in using 
 nitric acid in removing corns, for instance, on the little toes, and down 
 fairly close to the bone, provided it is done gradually and without causing 
 bleeding? Would blood blisters on the same toes be caused from the acid 
 
COVEEIXG OF THE FEET 769 
 
 or from new patent leather shoes? Is it practical and a good way to remove 
 corns by electricity?" 
 
 Reply. — 1. Yes, one would have to be quite skillful to remove corns 
 with so powerful an agent and not do harm. 
 
 2. Might be due to either. Probably is due to acid. 
 
 3. Do not think so. 
 
 How to Cure Bunions. — K. G. writes: "Please tell me what to do for 
 inflamed bunions" 
 
 Eeply. — Eest and hot foot baths followed by the application of hot com- 
 presses of witch hazel will afford immediate relief. If it is necessary to 
 use the foot the first thing to be done is to wear a shoe large enough for 
 five toes instead of four, with a straight line on the inner side. The ap- 
 plication of camphor or carbolated salves on a piece of old linen protected 
 by covering with rubber, chamois or buckskin washers will often afford 
 relief. Where the pain persists and the affected part continues to enlarge 
 it is wisest to consult your physician. 
 
 Bothered by Great Toe. — B. F. writes: "Can anything be done to re- 
 move the tendency to bunion swelling beyond wearing of proper shoes? 
 Such a tendency was started in my case by shoes a trifle short. Of course 
 I abandoned these when trouble developed, but still have trouble. Are 
 patent contrivances for the straightening of the big toe of use when there 
 is no great deformity present?" 
 
 Reply. — 1. A light splint to pull the toe inward, worn at night, and 
 methodical manipulation of the toe together with massage of the affected 
 parts will strengthen the muscles, hasten absorption and often restore 
 normal conditions. 
 
 2. In selected cases especially it is desirable to force the toe inward ; a 
 toe post may be used to advantage. I advise you to get expert help. You 
 can scarcely work it out for yourself or with general directions. 
 
 For Tender Feet. — E. J. C, M. D., writes: "You ash suggestions as to 
 what to do for painful feet. I have a patient who is wearing the first 
 leather shoes he has worn for over twenty years. I took him to a shoe dealer 
 and had him buy a pair of shoes three sizes too large. Then I directed 
 the cobbler to cut out a pair of insoles from cowhide, and cut or scoop out 
 holes in the insoles to match the enlarged tender places." 
 
 Reply. — This suggestion is excellent. I have written and will write 
 again on the harm of tight shoes and the advantage of loose shoes. In 
 addition to the advantage of looseness your plan gains a soft, padded sole 
 surface. 
 
 For Perspiring Feet. — A. B. writes: "I am troubled greatly with perspir- 
 ing feet, accompanied by an offensive odor. It necessitates a change of 
 stockings every day and keeps my feet, around the toes, tender and sore. 
 What is the probable cause of this, and could I do anything to benefit it?" 
 
 Reply. — Wash the feet night and morning with soap and water and 
 rinse. Then apply freely a solution of alcohol and salicylic acid in the pro- 
 portion of one quart of alcohol to one tablespoon of salicylic acid. Where 
 the condition results from some disturbance in the general health have your 
 family physician find the cause and prescribe. 
 
 Effect of High Heels. — M. S. A. wants to know how high-heeled shoes 
 break down the arch. Also if carrying weight breaks down the arch, why 
 do not toe dancers have flat feet? 
 
770 THE FEET 
 
 Reply. — Nature intended the heel to carry the weight. High heels 
 pitch the weight on the toes. Toe dancers have exceptionally strong foot 
 muscles. All their muscles are strong. Broken arches are found in soft, 
 flabby people, particularly, however, in people with rudimentary distorted 
 toes and poor foot muscles. 
 
 Aid for Flat Feet. — G. A. B. writes: "Is flat-foot and weak ankles 
 hereditary and can it be cured?" 
 
 Reply. — No doubt there are inheritance factors in these conditions, 
 but I do not know of anyone who has worked them out. I think that both 
 flat-foot and weak ankles are as much dependent upon weak and poorly 
 developed muscles as upon changes in the shape of bones. Proper exercises 
 for the feet and lower legs and shoes that permit the toes to be moved and 
 do not push, cramp and bend the toes are the proper means of prevention. 
 Cure of cases where the condition is well established sometimes can be 
 done but it is slow and tedious. 
 
 Reason for Flat Feet. — M. C. writes: "Will you kindly tell me the best 
 treatment for flat-foot or broken arch? Is the origin of the trouble rheu- 
 matic? Is it curable by the shoe made with arch support in it?" 
 
 Reply. — Rheumatism may be a contributing cause. Tight shoes is 
 another. Poor muscle tone is a third. To prevent flat-foot follow the exer- 
 cises given for the feet. To cure a broken arch is difficult. Arch supports 
 may help some. They often relieve symptoms. 
 
 Wear Easy Shoes. — Reader writes: "I am suffering from bunion and 
 corn formation and don't find a quick remedy to relieve me at once and 
 for all." 
 
 Reply. — Remove the excess of dead tissue with a knife or any of the 
 corn removers. Wear easy shoes with cork insoles. That is all that you 
 can do. Corns are a habit — a skin habit. The habit is incurable. The 
 skin got the habit of thickening up because back yonder in the habit- 
 forming days of youth you had the habit of wearing tight shoes. The 
 only solution of the corn question is proper shoes before the corn days. 
 You are doomed to hobble on. Do what you can to better things for your 
 children. 
 
 Chilblains. — F. W. M. writes: "About three years ago the toes on my 
 left foot were frostbitten. One of the toes became infected, probably from 
 the dye in the stocking. I consulted two reputable physicians, neither of 
 whom gave me any relief. After about a year and a half the sore appar- 
 ently healed of its own accord and for six months gave me no trouble. 
 It has recently broken out again and seems to be spreading. It starts as a 
 blister or cluster of blisters and the rubbing of the shoe irritates and breaks 
 the skin, then it becomes a raw sore from which oozes a yellow liquid con- 
 tinually. It itches a great deal and burns when anything touches it or when 
 put into water, either hot or cold. Will you kindly advise me what the 
 trouble is and how to overcome it?" 
 
 Reply. — You have chilblains I should say. From time to time I ad- 
 vise the following for chilblains: Plunge the feet frequently into cold 
 water containing salt or a little ammonia, or bathe with kerosene oil. Dry 
 thoroughly and rub gently. Dust with talcum powder. Do not wear woolen 
 
COVERING OF THE FEET 771 
 
 stockings and keep away from heat. Paint with two coats of iodin, allow- 
 ing first coat to dry thoroughly before applying the second. 
 
 Itching Feet. — Mrs. 0. E. A. writes: "My father, aged Ik, HI only once 
 in his life and recently from acute indigestion, suffers horribly from 
 'burning' and itching feet. What can be done for him?" 
 
 Reply. — Commonly the advice is to wash the feet in boracic acid 
 water and then to dust them with boracic acid powder. The advertised 
 medicines for aching feet are composed of boracic acid in the main. It has 
 always seemed to me that it is the result of pinching and pressing the 
 nerves and that arch supports, cushion soles, or easy shoes are a more 
 promising plan. When tight shoes have been habitually worn the bones 
 get pushed around into all sorts of bizarre positions and nerves that nat- 
 urally run in protected grooves get jammed into exposed places. 
 
 Causes of Cold Feet. — R. S. W. would like to Jcnow what to do for the 
 trouble he has in keeping his feet warm. He says he wears heavy woolen 
 socks and yet if the weather is the least bit damp or his feet get cold at 
 all he is unable to get any life in them for a long while. 
 
 Reply. — Cold feet may be caused by any one of several diseases. It 
 would be good judgment for you to see your family doctor and have him 
 examine you to determine whether there is any organic disease in your 
 case. 
 
 If there is none you have nothing to complain of except inconvenience 
 and there is nothing so good for inconvenience and discomfort as com- 
 placency. 
 
 The wearing of cork or cushion-soled shoes is a great help. But the 
 principal thing to do is to make more heat and to get more of it in your 
 feet. 
 
 This means active physical exercise. When the feet are cold deep 
 breathing for a few minutes will put the body in a glow. The feet should 
 be bathed in cold water each night. The cold bath should be followed by 
 brisk rubbing. 
 
 Treatment of Feet. — 8. F. J. writes: "I have suffered for years from 
 excessive perspiration and mattering between the toes. I have tried every- 
 thing that has been suggested by friends, but to no avail. I consulted a 
 chiropodist and he called the condition 'hoof rot,' and merely prescribed 
 walking barefooted as much as possible. Will you give me the benefit of 
 your advice?" 
 
 Reply. — Walking barefoot is good enough but it cannot be made use 
 of by many. Try the following: Wash the feet night and morning with 
 soap and water and rinse. Then apply freely a solution of alcohol and 
 salicylic acid in the proportion of one quart of alcohol to one tablespoonful 
 of salicylic acid. 
 
 Change Style of Shoe. — W. S. writes that he has noticed the soles of his 
 shoes split at the instep. Does that mean his feet are out of shape? 
 
 Reply. — It means that your instep arches too high for your shoes. 
 The top of your instep pulls hard on the sole and finally splits it. The 
 remedy is to wear shoes higher in the instep, for if the foot lifts hard 
 against the sole the sole pulls down on the instep equally hard. 
 
772 THE FEET 
 
 Cold Hands and Feet. — J. A. B. writes: "What is the cause of a per- 
 son having cold hands and feet continuously when the thermometer is below 
 70? During cold weather the finger nails and hands turn purple. I am 
 twenty-four years old and have been troubled with this for four or five 
 years. I am not a hearty smoker or drinker and do not keep irregular 
 hours." 
 
 Reply. — If I were such a person I would get the advice of the best 
 clinicians possible as to whether I had a modified mild form of Raynaud's 
 disease. 
 
 Trouble with the Feet. — E. K. writes : "I am troubled with my feet and 
 at times it seems as if I am walking on the bones. I have corns and 
 bunions. Do you know of any shoe that would give me relief?" 
 
 Reply. — The cause of bad feet goes back to improper shoeing of chil- 
 dren and youths. Oliver Wendell Holmes said the proper treatment of a 
 disease should begin with the patient's grandparents. The proper treat- 
 ment of foot ills may not go back of the youth of the suffering individual. 
 But the present is all we have in mind in your case. If loose shoes and cork 
 insoles or soft insoles as a part of the shoes do not help you your proper 
 founts of help are shoemakers who study the foot and then build a shoe 
 to conform to conditions as they can best be conformed to or even condi- 
 tions which have been rectified sometimes. 
 
 Need of Arch Support. — W. F. V. writes: "What can be done for 
 
 broken-down arches in the feet?" 
 
 Reply. — A simple remedy for a broken-down arch is to slip an arch 
 supporter into the shoe. If this does not suffice you should see a shoe- 
 maker expert on apparatus — very much better, an orthopedic surgeon. 
 
 Look Out for 
 Heels.— H. S. L. 
 
 writes: "I have a 
 very bad case of 
 fallen arches; in 
 fact, am fiat-footed. 
 I have pains in my 
 
 Fig. 270.— The Rocker Fig. 271.— The Flat Sole insteps, and my 
 
 Sole (Whitman). (Whitman). right ankle pains 
 
 me severely at 
 times. I stand a great deal during the day. I wear arch supports. I 
 would like to know if there is any possible cure. What would you advise 
 me to do?" 
 
 Reply. — Be certain that your shoe heels are of the right height. Some 
 people wear them too low, some too high. Get shoes which pitch your 
 weight on the outside of the ball, rather than on the big toe side. Stand 
 and walk pigeon toed. Nothing saves the arch more than to walk toeing 
 in. Nothing strains it more than to walk toeing out. 
 
 Treatment of Cold Feet. — 0. C. B. writes: "I see that R. S. W. has 
 been appropriately answered regarding cold feet, but let me add a bit of 
 personal experience. 
 
 "Several years ago I discarded woolen clothing next the skin. I sub- 
 
COVERING OF THE FEET 773 
 
 stituted linen and cotton. On my feet I wear cotton socles, the year around, 
 fleece-lined in the winter. 
 
 "Woolen absorbs and holds the moisture or perspiration of the feet, 
 and so surrounds them with damp clothing, which is a promoter of chilli- 
 ness. The leather clothing of the feet prevents a proper ventilation; hence 
 low shoes are better than high laced ones. But in any case, cotton socles 
 keep the feet in a drier condition. 
 
 "Every night and morning I rub my feet and legs some fifty times or 
 more, taking care to rub up from the toes. There are valves in the veins 
 which prevent the blood from going back to the extremities. Rubbing up 
 draws arterial blood through the capillaries into the veins. This produces 
 circulation and warms the feet. 
 
 "I find this rubbing of the feet has lessened the thickening of the toe 
 nails and has reduced that numb feeling of the bottoms of the feet which 
 is apt to come on with old age. 
 
 "As to shoes, I wear those that are roomy with low heels or with no 
 heels at all. The tyranny of the high-heeled shoe is a wonder, especially 
 among women. It is a question which is the worst — the bound feet of the 
 Chinese or the high-heeled shoes of the American women, with the inevi- 
 table accompaniment of cramped, misshaped feet, and painful corns and 
 bunions. Nature made the human foot to rest flat on the ground. We cant 
 improve on the beautiful feet of a baby." 
 
 Cure for Sore Feet. — P. 8. writes: "Water sets my toes afire, if used 
 too often and the toes are not dried thoroughly." 
 
 To which A. F. replies as follows : 
 
 "For sore feet, such as scalding and cracking between the toes — keep 
 clean, but do not wash oftener than once a day. Dry thoroughly between 
 the toes. Drying is important. When ready to put the shoes on sprinkle 
 powder between the toes and interlace white tape with the toes. Begin 
 by putting the tape under the little toe, over the next toe, under the next 
 one, till you run out of toes. This is to give space for air to circulate. 
 The tape will not interfere in any way with walking. This cured my feet 
 and may cure others." 
 
 Support the Instep. — M. R. writes: "1. Kindly advise me whether it is 
 inadvisable, in cases of fiat-foot, to wear heelless shoes, such as gymnasium 
 slippers. 2. Are there exercises which are helpful to the muscles in such 
 cases?" 
 
 Reply. — 1. Heelless shoes are no better than low-heeled shoes but low- 
 heeled shoes are much better than high-heeled. After flat-foot has devel- 
 oped about as much as can be done is to support the instep. 
 
 •2. Yes, in some measure. To prevent flat-foot, yes, in much greater 
 measure. Exercise in which the toes and ankles are bent — rising on the 
 ball of each foot at once, standing on the heels and bending the feet up- 
 ward, bending the ankles backward and forward, exercising the toes — 
 general muscular exercise. 
 
 Has Flat Feet. — A. B. C. writes: "I am a girl of eighteen and have 
 flat feet. My ankles are weak. The ankle of my left foot sticks promi- 
 nently out, bending over towards the instep. Kindly let me know if there 
 is a remedy for it." 
 
m THE FEET 
 
 Reply. — If a loose shoe and an insole do not relieve you (and your case 
 is probably beyond their reach) go to see an orthopedic surgeon. Any one 
 of the large hospitals has an orthopedic surgeon on its staff. 
 
 Best to Consult Doctor. — Mrs. W. C. H. writes: "I am a woman 6^ 
 years of age, and for the last year I have been troubled with swollen feet 
 and legs and pain in my back. The limbs are more than twice their nat- 
 ural size and very hard, and pain when I use them any length of time. 
 Have been to two physicians, but they do not seem to know what to do." 
 
 Reply. — Swollen limbs may result from heart, liver or kidney disease. 
 Have your physician find the cause in your case by examination of your 
 urine, your heart and your liver. Have him tell you what to do for it, 
 then follow directions. Nothing is gained by going from doctor to doctor. 
 Much swelling of the legs in a woman of sixty-four is not to be trifled with. 
 
 Swollen Feet. — J. C. writes: "What causes my mothers feet to swell 
 at the instep and below the ankle, at various times, paining her dread- 
 fully? She thought perhaps it was rheumatism. There are times when 
 it is difficult for her to walk." 
 
 Reply. — Rheumatism or gout could easily cause a painful swelling 
 in the instep and below the ankles. Don't try to take care of a case of 
 inflammatory rheumatism or gout by yourself. Have your physician see 
 her. 
 
CHAPTEE XLIII 
 
 Obstetrics 
 
 PRECAUTIONS AT CHILDBIRTH 
 
 ,A woman writes to know what can be done by those in attendance 
 on a woman in confinement in case the baby is born before the doctor 
 arrives. Let us assume that the mother has been told what to provide and 
 what to do and has followed instructions. 
 
 When the earlier vague pains come on she should take a cleansing bath, 
 put on clean clothes, and arrange her bed as she has been instructed. She 
 should prepare a lysol solution, one teaspoonful to the pint, which she 
 should use for local external bathing according to the instructions she 
 has had. 
 
 It is advisable that she should restrain from bearing down. It is better to 
 go slow. She must not take chloroform in the absence of the physician. 
 The danger is too great. 
 
 The child having been born, is it advisable to cut the cord ? If the child 
 and mother are doing well do not cut the cord so long as it pulsates. If either 
 the child or mother gets into trouble cut the cord at once so that attention can 
 be centered where it is needed. To cut the cord tie it twice with a piece 
 of sterile string. 
 
 The ligatures are tightly tied about four inches apart, the nearest 
 being one inch from the child's body. Place a small piece of sterile cloth 
 below the cord at the point of division and cut with scissors sterilized by 
 boiling. When the head is born and the cord is found to be around the neck 
 it must be drawn upon enough to permit it to be slipped from this position. 
 
 So long as mother and child are doing well there must be no inter- 
 ference. Let the afterbirth come away of itself. Do not pull on the cord. 
 
 If at the end of two hours the afterbirth has not come away a cloth 
 wrung out of cold water may be laid on the abdomen. If this fails the uterus 
 should be gently rolled between the fingers and thumb of one hand. Through 
 the limp abdominal walls the uterus can be felt deep in the abdomen. It 
 feels like a hard lump. The fingers are to be pressed down behind this 
 lump while the thumb and hand extend over the top and front. Very 
 gently squeezed but not shoved in any direction the uterus contracts and thus 
 expels the afterbirth. The same method stops hemorrhage. 
 
 The woman must be watched for profuse hemorrhage, ordinary oozing 
 requiring no attention. If there is such hemorrhage the foot of the bed 
 must be raised and then the uterus must be grasped through the abdominal 
 wall as described in the preceding paragraph. 
 
 After the afterbirth has been expelled the mother should be allowed 
 
 775 
 
776 OBSTETEICS 
 
 to rest for an hour or so if she wishes. Then she should be bathed with 
 warm water at least as much as is required, dressed in clean clothes and a 
 previously prepared aseptic pad applied. The bed having been put in 
 order the woman is ready for a quiet nap. 
 
 Never touch a raw surface or a mucous membrane with the fingers 
 or cloths that have not been made clean or aseptic. 
 
 The meat of the answer to the woman's question on what to do is to do 
 nothing! Labor is a natural process. When something needs to be done 
 the something needed requires more knowledge than untrained persons have. 
 
 TWILIGHT SLEEP 
 
 By reason of the publicity given twilight sleep it became necessary 
 for members of the medical profession to mature their opinions or, where they 
 had none, to form them. 
 
 Although the method was proposed in 1899 and many thousands of 
 cases had been reported the method was not in general use. It was used 
 in the main in large hospitals and the several thousand cases were in the 
 services of a few men. 
 
 A moderate number of obstetricians and surgeons had visited Freiburg 
 and studied its use there. Of these the larger part had made no extended 
 use of the method when the publicity precipitated a demand for opinions. 
 Everywhere physicians were being asked: What is your opinion on twilight 
 sleep? 
 
 In an effort to supply the need medical societies have been holding 
 discussions and medical journals have been collecting symposiums. A typical 
 symposium is that in the Medical Times from which the following opinions 
 are abstracted. Professor Lucke of Cincinnati wrote: 
 
 "I am much in favor of giving the method a thorough test. I think 
 there is something in it. The term 'painless childbirth' is in a measure 
 misleading. All of these patients suffer during labor, but forget about it 
 afterwards." 
 
 Professor Polak of Brooklyn says: 
 
 "Adoption of the method will do much toward reducing obstetric mor- 
 bidity if properly done and intelligently administered. It is in practice in 
 private practice — that is, outside of hospitals." 
 
 He believes in giving morphin but once and continuing the effect by an 
 injection of a half a dose of hyoscin every three or four hours. He thinks 
 the harm to the babies is due to the morphin and if the dose of that drug is not 
 repeated the babies get on all right. 
 
 Dr. Knife of New York reports that in the Gouverneur hospital for 
 several months a large proportion of their maternity cases have been given 
 twilight sleep. 
 
 "This has required considerably more attention from the staff physicians 
 and nurses," he writes. "We have felt justified in devoting sufficient care to 
 these cases because of the excellent results obtained both for the mother 
 and child. . . . The method is practicable under proper conditions." 
 
 He discusses four questions and answers them essentially as follows; 
 
TWILIGHT SLEEP 777 
 
 As to the dangers to the mother his answer is that they are not of 
 much consequence. As to the danger to the child his answer is that there 
 is no especial danger that cannot be met. 
 
 "The child is subjected to extra hazard," he says. "If too much of the 
 drug is given the labor will be prolonged and the child will suffer. The chil- 
 dren's breathing is liable to be interfered with. However, by not pushing 
 the drug too far, by close watching and prompt action, the danger to 
 the child will be small." 
 
 The question : "Is the anguish and pain of childbirth of such a 
 degree to warrant alleviation ?" he answers in the affirmative. He says : 
 
 "Anyone who will compare the mothers who have had twilight sleep 
 with those who have not had this aid must come to the conclusion that 
 the absence of physical and mental exhaustion alone justifies the use of 
 twilight sleep." 
 
 To the question as to whether the difficulties of administering the method 
 are so great as to make it impracticable he answers no. In this answer 
 he assumes that the cases given twilight sleep must be more closely watched 
 than labor cases now are. The basis of his answer is that practically 
 all babies should be born in hospitals. Groups of neighboring physicians 
 working together may carry out twilight sleep in their private practice 
 through cooperation. 
 
 Dr. Gellhorn witnessed the use of twilight sleep at Freiburg but was 
 not sufficiently impressed by it to make use of it in his own practice. 
 
 Dr. Schloessing of New York, formerly of the Freiburg clinic, thinks 
 that the fact that the Munich, Heidelberg, Inbengin and Dusseldorf clinics 
 have adopted the Freiburg method is proof that it is safe as well as other- 
 wise advantageous. He says: 
 
 "Women of today with their hypersensitive nervous systems are, as 
 Prof. Kronig says, far removed from being natural and therefore we can 
 no longer look on their labor as being physiological. The best proof of 
 this is that out of one hundred women who are in labor ninety used to ask for 
 chloroform and are now asking for twilight sleep." 
 
 Professor Dehee says: 
 
 "The drugs used in producing the twilight sleep carry inherent dangers 
 which have not been completely eliminated, even in Freiburg. The general 
 reemployment of the method — discarded ten years ago and again seven 
 years ago — will result in the repetition of the bad experience of those times. 
 
 "Practiced by specially trained obstetricians in a specially equipped 
 maternity hospital with an abundance of trained assistants and nurses, the 
 dangers to mother and child may be reduced to bring them to a point 
 where one may well consider the advantages and disadvantages more nearly 
 balance each other. 
 
 "Even under these circumstances one will have to reckon with a 
 certain toll of infants' deaths and injured mothers. For general use — 
 especially in the home — the drugs are contraindicated." 
 
 Professor Applegate of Philadelphia thinks the method has a limited 
 place in obstetrics. 
 
 "It usually prolongs the labor from three to six hours," he says. 
 "While the full treatment of three hypodermics of morphia and hyoscin 
 
778 OBSTETRICS 
 
 have been given not infrequently, the child is affected by twitching and stupor 
 for a day or two after birth/' 
 
 Where only one dose is given, whether because no more is required 
 or as a starter for chloroform, he thinks much good and little harm 
 results. 
 
 Professor Hirst of the University of Pennsylvania does not approve of it 
 as a routine procedure. He has witnessed its use at Freiburg and tried 
 it a few times in his own practice. 
 
 "Had it been a good method it would have spread throughout Germany 
 and some outside/' he says. "The Germans who have had the best op- 
 portunity to judge are not making wide use of it." 
 
 In the opinion of Professor Hirst, if enough morphin is used to put the 
 patient to sleep both the mother and baby will be endangered. 
 
 Professor Booer of Washington thinks the method has a very limited 
 place in obstetrics. He says: 
 
 "It demands careful, continuous, and tedious observation on the part 
 of the obstetrician. I believe it endangers the welfare of the infants." 
 
 Dr. John N. Bell of Detroit says: 
 
 "I see no objections to the use of twilight sleep in well regulated 
 hospitals." 
 
 Professor Charles M. Greene of Harvard opposes it because it en- 
 dangers the baby and because the effect on the mother is uncertain. 
 
 Professor J. Whitridge Williams of Johns Hopkins reports that in neither 
 of two series of cases in which it was used in Johns Hopkins hospital 
 was twilight sleep satisfactory. 
 
 Dr. Charles B. Eeed of Wesley hospital, Chicago, has informed me that 
 they have used it in a series of forty-five cases without any accident to 
 mother or child. As the method has advantages and as in their experi- 
 ences there have been no disadvantages so far as the mother and child 
 were concerned they advocate the method. 
 
 The twilight sleep method consists in the use by hypodermic injection 
 of a freshly made solution of morphin and hyoscin. The dose of morphin 
 given — one-sixth of a grain — is a small one. Larger doses than this are 
 in common use. The dose of hyoscin given — one one hundred and fiftieth of 
 a grain — is a small one. One one-hundredth of a grain is a frequent dose. 
 
 Assuming that the twilight sleep method satisfies the patient, why is there 
 any objection to it? When morphin and hyoscin are combined in a single 
 dose the effect is increased unduly. A small dose of morphin plus a small 
 dose of hyoscin is greater than the effect of double the dose of morphin 
 or double the dose of hyoscin. 
 
 In order to get a satisfactory result it is necessary to keep the patient 
 in a state of contented somnolence for several hours. This degree of in- 
 toxication with the drug prolongs the labor somewhat and somewhat en- 
 dangers the child. 
 
 Let us see how far the objections to the method hold against -other 
 methods. The method is not painless since the women suffer during labor but 
 forget about it afterwards. This is an objection urged against chloroform 
 and ether. 
 
 Either there is no register of pain or else there is no conscious recollec- 
 
TWILIGHT SLEEP 779 
 
 tion of such registering. The test here is the after shock. The observers 
 generally agree with the opinion of Dr. Knife that there is absence of mental 
 and physical exhaustion in those who have had twilight sleep as compared 
 with those who have been treated otherwise. 
 
 As to the dangers to the child the authorities are somewhat divided. 
 Among the authorities quoted above those who have had the most ex- 
 perience with this method place least emphasis on this objection. Clearly 
 the weight of evidence is to the effect that there is added danger to the child. 
 Being born is a hazardous occupation. 
 
 Between the accident rates of those born in high grade maternity hos- 
 pitals and the accident rates of those born in the poorer homes there is 
 a vast difference. The accident rate among babies born under twilight 
 sleep is higher than the first and lower than the second. Where in be- 
 tween it comes no one can say. Accidents happen under other forms of 
 anesthesia. Of a comparative statement of these risks I do not know. 
 
 Every authority quoted is agreed that morphin scopolamin should not be 
 used except where there is a plentiful supply of nurses and attending 
 physicians. This in the opinion of those quoted above comes to this: The 
 method should not be employed except in equipped hospitals. 
 
 Now the pressure is coming from a certain group of women. That 
 group is willing to go to hospitals or to equip their homes with nurses and 
 doctors as their physicians direct. 
 
 The method was proposed as a method for surgical anesthesia in 
 1899. After it came to be used as an obstetric method it was twice aban- 
 doned. It will not down. This means that those who bear the pain are not 
 altogether satisfied with chloroform. 
 
 Recalling Professor Kronig's statement that "women of today, with their 
 hypersensitive, nervous systems are far removed from being natural" we feel 
 that at any rate they do not approach pain or bear it with the stoicism of 
 the savage. 
 
 Dr. Schloessing says: "Out of one hundred women who are in labor 
 ninety used to ask for chloroform and are now asking for twilight sleep." 
 
 The women are as they are. A large part of them have fearful dread 
 of the pain of childbirth. Twilight sleep puts the woman in a condition 
 of somnolent content. When through she shows less signs of shock and 
 fatigue than do those who have had chloroform and those who have had no 
 anesthetic. 
 
 To a great many high-strung women the appeal made by this prospect 
 will be mastering. The somewhat greater degree of injury to themselves 
 and the definitely greater hazard to the child will not deter them. They will 
 insist on twilight sleep. It will be the duty of the hospitals and their 
 physicians to make the method safe. 
 
 It may be that it is now safer than the methods of obstetric service 
 prevailing in the general run of poorly equipped homes. But that is no 
 answer. The method must be made reasonably safe and the ordinary 
 obstetric service in poor homes is not reasonably safe. 
 
 But there should be no great difficulty. There is nothing extraordinary 
 about morphin and hyoscin. They are in common use. 
 
 Nervous, apprehensive, high-strung women will continue to insist on 
 
780 OBSTETEICS 
 
 twilight sleep and they will get it. The method will be modified to over- 
 come its disadvantages. 
 
 CARE OF NEWBORN BABY 
 
 In a previous article I answered a correspondent who wrote asking 
 what should be done in case the baby were born before the doctor arrived. 
 The answer related what should be done to the mother. 
 
 What should be done to the baby? 
 
 If the child cries lustily upon arrival, breathes normally and appears 
 to be all right nothing should be done for a while at least. It does no 
 harm to leave a child attached to the cord for an hour or even two. As 
 cutting the cord is a simple process it can be cut as soon as pulsation has 
 stopped and before if the baby or mother needs attention. 
 
 It is natural for a newborn baby to breathe at once and then to cry 
 lustily. If the air does not cause the child to breathe it should be held 
 by the feet, head down, and lightly slapped on the back with the palm 
 of the hand. If this does not suffice the baby's body can be placed in warm 
 water and then plunged into cool water being then removed at once to the 
 warm. 
 
 The use of alternating baths of warm and cold water is about as far as 
 the friends can go without the doctor. Before starting efforts to make 
 the baby breathe, the little finger, covered with a handkerchief, should be run 
 into the baby's mouth and any mucus found should be cleaned out. Go as 
 far back as possible into the throat. 
 
 Assuming that the baby has breathed satisfactorily, that the cord has 
 been cut and the mother is resting quietly the baby is to be cleaned. To begin 
 with the eyes are to be washed with soft sterile cloths or cotton dipped in a 
 saturated solution of boric acid. The cloth used on one eye should not 
 be put back into the solution. A fresh cloth is used for each eye. In 
 addition the doctor upon arrival will drop one drop of a 1 per cent solu- 
 tion of nitrate of silver into each eye. 
 
 The head and then the body and limbs are to be thoroughly greased with 
 olive oil, vaselin or lard to remove the cheeselike matter and then with soft 
 cloths, warm water and soap to remove the grease. The head is to be washed 
 and dried before the body is washed. Pat the skin dry with soft cloths. The 
 navel is to be dressed with sterile gauze. Previous to the bath and for a 
 short time thereafter it is advisable to note the cord occasionally to be 
 sure that there is no hemorrhage. 
 
 As soon as the baby is dressed let mother and baby sleep for six 
 or eight hours. Water can be given every three hours. The danger that 
 too much will be done is fairly great; the danger that too little will be done 
 is slight. 
 
 SUPPLIES FOR CHILDBIRTH 
 
 "If a woman is to be confined at home she should provide the fol- 
 lowing : 
 
 Two to four pounds of absorbent cotton. 
 
SUPPLIES FOR CHILDBIRTH 781 
 
 One large package of sterile gauze (twenty-five yards). 
 Four rolls of cotton batting. 
 
 Two yards of stout muslin for abdominal binders. 
 Twelve old towels or diapers. 
 Two old sheets. 
 
 Two yards of bobbin, or very narrow tape, for tying the cord. 
 "Other things that may be needed are: 
 
 One hundred bichlorid of mercury tablets. 
 Four ounces of boric acid. 
 One bottle of white vaselin. 
 One pound of castile soap. 
 One quart of grain alcohol. 
 One douche pan. 
 One stiff hand brush. 
 One^ slop jar or covered enamel bucket. 
 
 Three pottery or agateware basins, one sixteen inches and two eleven 
 inches in diameter. 
 
 At least three pitchers — holding one quart and upward. 
 One and one-half yards of rubber sheeting, at least thirty-six inches 
 wide, or one and one-half yards of white table oilcloth to protect the 
 mattress. 
 
 One two-quart fountain syringe. 
 One medicine glass. 
 One medicine dropper. 
 One drinking tube." 
 The above is quoted from "Prenatal Care." We can indorse all of it ex- 
 cept possibly the advice to lay in 100 bichlorid of mercury tablets. 
 
 This list is followed by detailed instructions on how to make and 
 sterilize pads, sponges, pledgets and bobbins. 
 
 "Prenatal Care" is a simple treatise on the care of the mother in 
 pregnancy and during confinement and the care of the mother and child 
 after confinement. Any woman can understand it. Every mother and 
 every prospective mother should read it. The cost? Nothing. 
 
 It is issued by the Children's Bureau of the United States Depart- 
 ment of Labor and is No. 1 of the Care of Children Series. If you want 
 it write for it. If the supply gives out write your congressman asking 
 him to work for a new supply. That's what congressmen, congresses and 
 governments are in Washington for. 
 
 Books on Pregnancy. — Mrs. C. G. writes: "Will you give me the name 
 of some good books on pregnancy? What boohs can I read to which I can 
 give a great deal of thought and at what period of pregnancy will it have 
 the most effect to influence or rather stimulate the child's mind? I am 
 very much subject to constipation. Bran bread, cooked and raw fruits and 
 even purgatives have little or no effect. My only relief is an enema." 
 
 Reply. — 1. "Prenatal Care," published by Children's Bureau, Depart- 
 ment of Labor; "The Prospective Mother," by Slemons. 
 
 2. It is evident that you have been told that a pregnant mother can 
 influence the mentality of her developing child by reading books. You have 
 
782 
 
 OBSTETEICS 
 
 been misinformed. Good books will be good for you, but they will not 
 affect your child. 
 
 3. Drink lots of water; try agar; try mineral oil. 
 
 No Age Limit. — Mrs. E. T. writes: "Will you please state the age limit 
 for a woman to bear her first child without endangering her own life? Does 
 it make a difference if the mother is of slight build? Can a child be marked 
 physically before birth?" 
 
 Reply. — 1. There is none, if she is skillfully cared for. 
 
 2. No. 
 
 3. No, so far as birthmarks and deformities are concerned. 
 
 Infection in Childbirth. — N. M. T. writes: "I am writing to you to 
 know if when the mother has had gonorrhea will it infect her offspring? If 
 so, in what way? She is very anxious, but in fear of infection. Her doctor 
 
 says she has been cured, 
 but is left with leukorrhea, 
 which is bad. Should she 
 be this way?" 
 
 Reply. — If she is cured 
 her offspring is in no dan- 
 ger. The leukorrhea may 
 be due to gonococcal infec- 
 tion ; it may be due to other 
 causes. If it is due to gon- 
 ococcal infection her child 
 is in some danger of de- 
 formity due to infection 
 before birth. Its eyes may 
 be infected at the time of 
 birth. If your inquiry relates to a child that has been born and no acci- 
 dent has taken place infection may still occur from contact. If she will 
 be very cleanly in her habits the child is in very little danger. 
 
 Presumptive Symptoms. — R. B. writes: "1. What are the first symptoms 
 of pregnancy? 2. Is it possible for conception to occur ten days before the 
 menstrual period? 3. Does pain in the right breast indicate that condition? 
 Jf. How soon do symptoms occur? 5. Is dancing dangerous during that 
 time — that is, will it be apt to cause a miscarriage? 6. If menstruation 
 occurs will it signify that the woman is not pregnant?" 
 
 Reply. — 1. (a) Cessation of menstruation; (b) changes in the breast; 
 (c) morning sickness; (d) irritable bladder. Slemons calls these the pre- 
 sumptive signs. 
 
 2. Yes. 
 
 3. By itself it would not be a sign of much value. 
 
 4. Varies in different women. In some women some one or several of 
 these signs appear in a few days. Usually the first indication is the ces- 
 sation of menstruation. Diagnosis within the first two months, even by a 
 physician, is a good deal of a guess. A laboratory test known as the 
 Abderhalden test is now being tried out. 
 
 5. There may be a little danger within the first month. It is not great 
 if the dancing be in moderation. 
 
 6. Yes, though there are exceptions. 
 
 Fig. 272. — Bed Rest and Table. 
 
OBSTETKICS 783 
 
 Should Forget Worries. — Reader writes: "Will you kindly advise if a 
 pregnant woman, who is weak and nervous, can undertake a long travel to 
 the South or West without injury?" 
 
 Reply. — This is a matter to be decided as the result of personal observa- 
 tion. However, my guess is that you can. Traveling is comfortable and a 
 pregnant woman can do about as other women. If you will forget your 
 fears and worries probably the trip will not tax you greatly* 
 
 Fig. 273. — Pregnant Uterus Containing Young Embryo, c, embryo; i, alimentary canal 
 of embryo; r, p, m, m, various structures composing umbilical cord; q, n', q, a, placenta; m, 
 a', q' , s, membranes surrounding embryo; n, n, lining membrane of uterus. 
 
 "Marking" of Child. — Mrs. A. D. writes: "Will you kindly settle a 
 question which has long puzzled us as well as many others. 
 
 "1. Is it possible to 'mark' a baby through mental impressions of an 
 expectant mother? 
 
 "2. Is it true no nerves whatever connect mother and child, connection 
 being entirely through the blood through the cord? 
 
 "3. Will mental impressions of mother mark or disfigure a babe durin/g 
 first two months of pregnancy?" 
 
 Reply. — 1. No. 
 
 2. Yes. 
 
 3. No. After conception the mind of the mother cannot influence the 
 child except indirectly. For instance, if she worries and in consequence 
 is illy nourished the growing baby is less liable to thrive. That, however, 
 is a matter of nutrition, not marking 
 
 The Nipples. — Mrs. A. B. writes: "An expectant mother has as yet no 
 pronounced nipples. What can be done to hasten development?" 
 
784 OBSTETRICS 
 
 Reply. — Wash the nipples daily with alcohol, then gently pull them for 
 a few minutes. The nipples tend naturally to assume the right shape. A 
 little help suffices. 
 
 No Harm to Child. — M. L. writes: "Can you tell me what can he done 
 to prevent an expectant mother (six months) from being despondent? She 
 wakes in the morning perfectly well but despondent, and falls asleep at 
 night in the same condition. Will it affect the child?" 
 
 Reply. — 1. Keep the bowels open. Exercise in the open air. Read 
 entertaining, optimistic books. Keep with bright, cheery people. 
 
 2. The condition described will not harm the child. There is nothing to 
 worry about. 
 
 Amenorrhea. — C. E. W. writes: "What is the meaning of 'amenor- 
 rhea'?" 
 
 Reply. — The accurate meaning is absence of menstruation. 
 The accepted meaning is scant menstruation. 
 
 No Bar to Marriage. — Miss M. writes: "I had one of my ovaries re- 
 moved some years ago. Is it possible for me to have children? If not, 
 would you advise me to get married?" 
 
 Reply. — The removal of one ovary has no effect on one's ability to bear 
 children. It is no bar to marriage. 
 
 Is No Proof. — Mrs. J. M. writes: "Is the fact that menstruation takes 
 place at all proof that the Fallopian tubes are not closed? Why? Would 
 a nervous woman's chances of bearing children be greater if the external 
 causes of nervousness were removed?" 
 
 Reply. — 1. No. 
 
 2. Menstruation is from the uterus and the tubes lie beyond that organ. 
 
 3. Nervousness does not prevent a woman from bearing children. To 
 relieve nervousness will not cause a barren woman to become child bearing. 
 
 Abderhalden Test Tells. — Mrs. W. B. writes: "When a woman is preg- 
 nant does menstruation stop? Can a woman's abdomen increase in size 
 daily unless she is pregnant? Is there any way to tell?" 
 
 Reply. — 1. Yes. The exceptions are too few to be of any importance. 
 
 2. Yes. It may enlarge from tumor, from fat, or from increasing 
 laxity of the wall muscles. 
 
 3. Yes, an Abderhalden test; also physical examination. 
 
 Hazard Is Decreased. — Mrs. D. A. C. writes: "Here is the case of a 
 woman whose first baby was born when the mother was within a few days 
 of 36 years of age. Before the birth the attending physician said, though 
 the prospective mother was in perfectly normal condition, it was impossible 
 to predict a safe first confinement in a woman of her age. Is this uncer- 
 tainty or danger considered to exist in case of the birth of a second child 
 to a woman beyond 38 or 39 years of age?" 
 
 Reply. — There is some extra hazard with the first child. The extra 
 hazard is somewhat less with the second. 
 
 Danger Not Great. — A. B. writes: "Is it dangerous for a woman of Jfl 
 to give birth to a child for the first time in her life?" 
 
OBSTETRICS 785 
 
 Reply. — In a good hospital under good medical care the danger is not 
 great. It would be less than the average danger of the average woman 
 under average city conditions. 
 
 When the Stork Is Expected. — G. F. writes: "How soon should a 
 doctor be consulted regarding the arrival of the stork? Should the pros- 
 pective mother be examined at regular intervals? Is there any benefit 
 derived by rubbing to soften the abdomen? If so, would any pure oil do? 
 Should the mother be given tonics to strengthen her?" 
 
 Reply. — 1. About the fifth month if everything is going well; other- 
 wise earlier. This visit should be for advice and counsel as to hygiene, 
 sanitation, habits, what to read and what to do. It is of prime importance 
 that mothers should know all about themselves and their expected babies. 
 
 2. In the average case, in the sense of physical examination, no. Such 
 physical examination as the physician may need to determine that every- 
 thing is physiologically correct should be made. Beyond that the visits to 
 the physician should be educational. 
 
 3. Massage of the skin mildly done may add to the comfort. Any oil 
 will do. It is scarcely worth while. 
 
 4. No. Food and rest from hard work but with mild exercise is the 
 proper tonic. 
 
 Prospective Mother. — H. L. J. writes : "Would any of the following be 
 injurious during pregnancy : Scalp treatments, examination and treatment 
 for catarrh, having teeth attended to?" 
 
 Reply. — No. 
 
 Reply to M. W. — Let nature take its course. A woman is in no better 
 condition to bear a child two or five years after marriage than in ten 
 months after. She may be in worse condition. I expect that you have also 
 seen many babies born three years after marriage. All you need to know 
 you can learn in ten months. Write to the Child Welfare Bureau at 
 Washington, D. C, for its pamphlet on prenatal care; or buy Slemons' 
 "Prospective Mother." 
 
 Reply to R. S. — Thirty is not too old to marry. It is generally agreed 
 that children born of parents around thirty are better specimens than those 
 born to parents under twenty. As to whether a nervous woman should 
 marry, everything depends on what is meant by nervous. If she is now well 
 her case is probably one of bad mental training. If so, it constitutes no bar 
 to marriage. 
 
 Can't Determine Sex. — J. H. J. writes: "A few days ago someone 
 ashed if the parents could determine the sex of their child. I wish to 
 state that Fowler says in his 'Sexual Science' that where there is no love 
 there will be no conception, and if there is love on one side and none on the 
 other there may be conception and the child will take the sex of the parent 
 whose love for the other is the stronger." 
 
 Reply. — Bosh! How did Fowler find that out? 
 
 Will Do No Harm. — /. E. H. writes: "Is it harmful for a pregnant 
 woman to wear maternity corsets?" 
 
 Reply. — No, 
 
786 
 
 OBSTETEICS 
 
 Follow Doctor's Plans. — A. C. E. writes: "Eight years ago I had an 
 operation for extra-uterine pregnancy, followed by infection, and have since 
 had a stiffening and cracking in the joints that began in the ankles. It 
 has reached the shoulders, elbows, and knuckles, and at times is exceedingly 
 painful. For the last couple of months I have noticed a soreness in the 
 cords of the back and sides of the neck. 1. Has the joint trouble anything 
 to do with the neck? Is it a form of rheumatism? 2. Would any kind of 
 diet help conditions? Do red meats aggravate? I also have a ringing in 
 
 one ear,' much like the ef- 
 > (^e^c^^^ feet of quinin. 3. Is this 
 
 caused from the same trou- 
 ble and is there any positive 
 cure? I am J/.5 years old." 
 
 Eeply. — 1. I judge that 
 you have a rheumatoid ar- 
 thritis. The neck and joint 
 trouble are parts of the 
 same disorder. In all prob- 
 ability the infection caus- 
 ing your joint trouble en- 
 ters through your throat or 
 nose and is related to the 
 cause of the ear trouble. 
 2. A good nutritious 
 diet proportioned to the ex- 
 ercise you take will do you 
 good, 
 much relation if any to your 
 Cure is improb- 
 
 Fig. 274. — Section of Ovary. 1, 2, 3, Early stage 
 graafian follicles; 4, 5, 6, graafian follicles approach- 
 ing maturity — ovum can be seen; 7, mature graa- 
 fian follicle — arrow points to ovum; 8, corpus 
 luteum. 
 
 3. No. Your trouble probably has not 
 operation. Have your nose, throat and teeth put in order, 
 able, but by following a plan laid down by some sensible physician you can 
 keep in good condition. 
 
 No Legal or Moral Right. — J. M. K. writes: "1. When a woman becomes 
 aware that another child is coming has she the moral right to determine 
 whether that child shall be given the right to exist or not? 2. If it would 
 be a horrible crime to deprive a child of life the day after it was born, would 
 it be any less a crime the day before? 3. Or the month before? J^. Or at the 
 first moment that the mother becomes aware of the existence of another 
 life? As I understand it, eugenics and the modern sophists generally 
 would have us believe that we know a great deal more than the God who 
 made the laws of nature, and may complacently transgress them as we 
 see fit." 
 
 Reply. — 1. No, neither the legal nor the moral right. 
 
 2. No. 
 
 3. No. 
 
 4. No. 
 
 J. M. K. fails to understand eugenics. Control goes farther back than 
 the questions in his letter indicate that he has in mind. I should think 
 it impossible to find Scriptural warrant for the crime, injustice, immorality, 
 disease, want and death to which improper mating and riot of passion 
 foredoom some of God's creatures. 
 
 No Need to Fear for Child. — S. 8. writes : "If a woman, marrying for 
 
OBSTETRICS m 
 
 the first time at the age of JfS, should bear a child, would it be below normal 
 mentally or 'physically, provided all conditions, except the age of the mother, 
 were of the best?" 
 
 Reply. — No, decidedly. Averaging 5,000 children born to women 43 
 years of age with 5,000 born to women 25 years of age the first group would 
 not equal the second but if those of the first group had a good inheritance, 
 they would be far above average children. Advanced age of the mother is 
 a factor but it is insignificant as compared with venereal disease, alcohol- 
 ism, neurasthenia, hysteria or a score of other ills which might be men- 
 tioned. 
 
 Childbirth is more difficult and more hazardous for a woman of forty- 
 three than for one of twenty-five; that is, averaging, say 5,000, and this is 
 found to be true. But women in childbirth at forty-three now are safer 
 than women at any age were twenty-five years ago. 
 
 Such a woman with good obstetrical care is much safer than is the 
 woman of any age who is cared for by a midwife. 
 
 Need Not Worry. — Mrs. O. A. H. writes: "I have been pregnant for 
 three months, and had the misfortune to fall, not injuring myself or even 
 having pains. I was of course sore for a few days on the side on which I 
 fell. A neighbor has told me she lost a baby just by slipping at this 
 time." 
 
 Reply. — Nothing for you to worry about. You ought to feel sorry for 
 your neighbor but that is far enough to go. 
 
 Marrying at 48. — R. writes: "Would it be possible for a woman marry- 
 ing for the first time at the age of Jf-8 to become a mother?" 
 
 Reply. — Possible but not probable. 
 
 Medicine No Help. — Mrs. O. T. B. writes: "1. What is the cause of in- 
 fantile uterus? 2. Will medicine of any hind help it? 3. Is it the cause of 
 scant menstruation and continuous bach- and headache?" 
 
 Reply. — 1. The cause is failure to undergo full development. 
 
 2. No. Pregnancy is about the only effective cure. 
 
 3. It is one cause. 
 
 Fibroid Tumors Not Cancer. — Mrs. M. R. writes: "Will you tell me the 
 nature of a fibroid tumor; also what causes it? When my baby came I had 
 quite a large lump at my abdomen. It did not cause me any pain, only 
 since I hnow it was a tumor it worries me. Most persons say tumors 
 are cancers." 
 
 Reply. — A fibroid tumor is a tumor composed of fibrous tissue. Fibroid 
 tumors are not cancers. They are benign. Occasionally, though rarely, 
 they become malignant cancers. Since fibrous tissue is to be found every- 
 where in the body fibroid tumors are found everywhere. Yours is develop- 
 ing from some pelvic organ. Sometimes fibroid tumors can be cured by 
 radium, sometimes by X-rays applied in a special way. Usually operation 
 is required. Get good surgical advice and follow it. Nothing is gained 
 by worry. 
 
 Treatment for Fibroid. — Parent writes: "1. Is a fibroid on the womb 
 dangerous in a woman of 26? Does it grow, and is an operation advisable? 
 
788 OBSTETRICS 
 
 7s there any cure other than an operation, and, if not, is the operation 
 absolutely sure to cure? 2. What is the best method of handling a fistula in 
 a child of 2 years?" 
 
 Reply. — 1. Not necessarily. As it grows it may endanger life. Fibroids 
 are liable to become infected, to strangulate or to produce hemorrhage. 
 They are very liable to accidents. Operation while the fibroid is small is 
 generally advisable. Some cures have been made by X-rays and by radium. 
 
 2. While a fistula may heal spontaneously it is not good judgment to 
 leave the condition to home treatment. You should take counsel. 
 
 Operate for Fibroid Tumor. — E. M. G. writes : "Your article on uterine 
 fibroid tumors was of great interest to me, as I am afflicted with a five- 
 pound tumor. The surgeon who examined me said my tumor was a dense 
 mass. Do you think it would be possible for my dense tumor to be re- 
 moved by radium or X-ray treatments? I am 1^1 years old." 
 
 Reply. — Possibly, though operation would be surer. 
 
 Radium and Fibroids. — L. K. writes: "Some time ago I saw an article 
 in which Dr. Howard Kelly of Johns Hopkins University was quoted as 
 saying that '90 per cent of all fibroid tumors can be cured or relieved by 
 radium.' Has that result been found by the Chicago practitioners also?" 
 
 Reply. — Radium is still on trial. I doubt if it has enough penetrating 
 power to reach a fibroid. The experience of Chicago practitioners with 
 radium has been limited. 
 
 Operation Will Relieve. — S. K. writes: "A friend has been troubled 
 with falling womb for about ten years. Because she believed her condition 
 incurable and did not want to distress anyone, she foolishly told no one 
 about it, until it has become so aggravated that the womb is now wholly 
 exposed. Can anything be done now? Would an operation be possible or 
 advisable? If so, what would be the danger and the expense? The woman 
 is sixty-seven years old and otherwise strong, though she has attacks of 
 weakness with abdominal pains quite frequently." 
 
 Reply. — The condition is not so infrequent as you think. It can be 
 relieved by operation. 
 
 Operations No Barrier. — Anna B. writes: "I am a girl of 18. I have 
 had operations for growths. 1. Do you think it possible that I could have 
 had a fibroid tumor? 2. Shall I have change of life earlier due to the op- 
 erations, and at about what age? 8. Will I be prevented from bearing a 
 child? Jf. Would my marrying early prolong change of life?" 
 
 Reply. — 1. Fibroid is possible but not probable. 
 
 2. No. The age for change of life varies. You probably will have it 
 about the same age your mother did. 
 3 and 4. No. 
 
 Should Go to Hospital. — Mrs. S. G. R. writes: "I am $k years old; 
 have one child, and expect to have another within three months. My 
 husband thinks I do not get enough exercise. Will you answer the follow- 
 ing questions: 1. Is two hours' brisk work every morning, making beds, 
 dusting, putting to rights five rooms, enough exercise, or should I also 
 take long walks? 2. Would the possible complications on account of my 
 age make hospital preferable to the best of home treatment during con- 
 
OBSTETEICS 
 
 789 
 
 finementf 3. Please recommend some book that will be beneficial, some 
 work on the care and feeding of a baby. 4. Please tell me if there is any 
 virtue in the medicine called 'Mothers Friend' which is to be applied 
 externally?" 
 
 Reply. — 1. Go for a short, easy walk each day. You are taking enough 
 exercise considering the 
 stage of your pregnancy 
 but you need some air. 
 
 2. Yes, it is always 
 to be preferred. 
 
 3. There is nothing 
 better than Siemens' 
 "The Prospective 
 Mother." Send to the 
 Children's Bureau, De- 
 partment of Labor, 
 Washington, D. C, for 
 the pamphlet "Prenatal 
 Care." For the care of 
 the baby get Holt and 
 Kilmer. 
 
 4. None. Fig. 275. — Massage of the Breasts, to Increase 
 
 Their Size. (Herb.) 
 
 No Danger to Off- 
 spring— H. A. E. writes: 
 "1. If a man of 60, in 
 good health, should 
 marry a spinster of 31, 
 also in good health, 
 would any of the pos- 
 sible offspring be likely 
 to suffer mentally or 
 physically owing to the 
 age of the father or the 
 discrepancy in ages be- 
 tween husband and wife? 
 2. In other words, has a 
 baby boy with a father 
 aged 60 as good an 
 equipment for life's bat- 
 tles as though the father 
 were only 30 f 3. How 
 
 much is the danger of childbirth increased by the mother waiting until she 
 is 31 years of age before marrying ?" 
 Eeply. — 1. No. 
 
 2. Yes. 
 
 3. Say 10 per cent. 
 
 Artificial Change of Life. — Mrs. J. F. writes : "Kindly tell me the cause 
 of hot flashes, nervousness, overanxiousness, physical weakness, stupidity, 
 laziness, and everything that tends to make up a human wreck. I had an 
 operation some years past. The sexual tubes were removed. I had no 
 trouble with the operation, which was quite a success, but since I have been 
 on the verge of prostration and have had quite a lot of financial troubles 
 
 Fig. 276. 
 
 ■Massage of the Breasts, to Decrease 
 Their Size. (Herb.) 
 
790 OBSTETRICS' 
 
 which worry me. I am as irritable as can be. I have palpitation of the 
 heart terribly. I awake quite suddenly from really no cause. I have 
 nervous indigestion. Is my case hopeless?" 
 
 Reply. — My guess is that you are suffering from lack of ovarian secre- 
 tion. Possibly you would be helped by the use of preparations of ovary. 
 
 However, you will be helped more by cultivating poise. Your trouble is 
 self-limited. It does not threaten your life. Therefore be cheerful. That 
 will help you more than spoon medicine. 
 
 Try Eating More. — W. A. M. writes: "Kindly let me know what you 
 would advise in my case. I am 25 years of age and have had three chil- 
 dren. The youngest is 11 months old. I have suffered with a sort of neu- 
 ralgia ever since the birth of my second child. I had all my lower teeth 
 extracted two months ago. It is not an acute neuralgia, but a nag, nag, 
 nag. I generally weigh 90-odd pounds, but have only weighed 78 this 
 summer/' 
 
 Reply. — You need to feed up. Caring for three children, the youngest 
 less than a year old, is hard work and you need to eat enough milk, bread, 
 meat, vegetables, and fruit for the day's work and a little besides. 
 
 If lessening your work and increasing your flesh does not stop your 
 facial neuralgia see your physician. 
 
 Evidently you are disposed to neglect yourself. That you had to have 
 all your teeth pulled proved that. People who take care of themselves do 
 not have to go through that ordeal. 
 
 Not Too Late. — Mrs. C. M. L. writes: "I am thirty-six years old and 
 have had thirteen children. The last one came four years ago. The baby 
 was presented wrong and was born so, causing great suffering. I was 
 lacerated and the doctor in attendance did nothing for me at that time. 
 Is it too late now to have the work done? I know I woidd be better off 
 could it be remedied. Otherwise I enjoy good health." 
 
 Reply. — No. It is not too late. 
 
 Affliction Not Dangerous. — L. M. K. writes: "1. Will you kindly let me 
 know if a young woman of 28, unmarried, could have ulcers of the uterus? 
 2. Are they dangerous? 3. What is the best treatment?" 
 
 Reply. — 1. Yes. 
 
 2. No. 
 
 3. Local treatment. 
 
 Pregnancy Test. — A. L. R. writes: "Kindly tell me if there is a positive 
 test to determine pregnancy at three months. If so, where is it obtain- 
 able?" 
 
 Reply. — A physician can make the diagnosis. It can be diagnosed by a 
 laboratory test. 
 
 Difference Not Great. — Mrs. H. R. writes: "Will you please tell me 
 what the danger is, if any, to a woman of 38 becoming pregnant for the 
 first time, having been married nine years?" 
 
 Reply. — The danger of accident during labor is somewhat greater than 
 with a younger woman. However, the difference is not great. 
 
OBSTETRICS 791 
 
 Leukorrhea. — W. B. writes: "What is the cause of leukorrhea?" 
 
 Reply. — Leukorrhea is the result of infection of the lining of the uterus 
 or Fallopian tubes or both. The infection may be with any one of several 
 organisms. 
 
 Need Not Fear. — Mrs. R. T. H. writes: "Will you kindly tell me if 
 there is any danger for a woman of Jf3 to give birth to a child for the first 
 time in her life?" 
 
 Reply. — Labor probably will be a little more trying than with a younger 
 woman. Cared for by a good physician, preferably in a good hospital, she 
 need have no fears. 
 
 Regularity Should Rule. — G. T. writes: "After a woman is curetted, 
 having had a three months' miscarriage, how soon should she menstruate 
 afterwards, and will she be regular?" 
 
 Reply. — The next month. There is no reason why she should be 
 irregular. 
 
 Consult Your Physician. — M. A. L. writes: "Is it of any importance 
 to a woman who is pregnant to show signs of flowing? I flowed slightly at 
 four months and the same at six months. I am Jj.0 years old." 
 
 Reply. — It is of importance. Frequently it occurs without meaning 
 any injury to the child. My advice to you is to be very quiet when bleed- 
 ing. Have your physician see you each month from now on. 
 
 Operation Not Necessary. — D. A. writes: "A young married woman, 
 aged 25, is anxious to become pregnant. For several years she has had a 
 small hernia. During one winter only, when engaged in work that required 
 much walking, it was large and painful. For the last year it has given 
 no trouble whatever, but a slight swelling remains. Is an operation neces- 
 sary before pregnancy?" 
 
 Reply. — I judge not. It should not trouble you much more during 
 your pregnancy than now. During labor, it should not be difficult to keep 
 the hernia "up." Pregnancy will increase the inconvenience from the 
 hernia somewhat but not much. 
 
 Doctor's Guess Better. — M. B. S. writes: "Will you kindly tell me the 
 first symptoms of pregnancy? How soon after conception can it be detected 
 by such symptoms?" 
 
 Reply. — Amenorrhea and nausea are early signs present in most cases. 
 Women who have had children can usually sense the condition by illy 
 denned changes in their feelings. Those trying to conclude from signs and 
 symptoms will be wrong about as often as they will be right. Doctors 
 guess at the condition before the second month. 
 
 Nevertheless, a doctor's guess will be much better than yours and you 
 had better proceed in that way. A highly promising new test is known 
 as the Abderhalden serum test. It can be made only by a laboratory. 
 
 Can Regain Ground. — B. M. F. writes: "1. Does the return of menstrua- 
 tion six weeks after the birth of a first child (the mother nursing the 
 child) indicate that the mother has overexerted herself after confinement? 
 2. If menstruation recurs after another month, should she take anything to 
 check it, providing the child appears to be unaffected by it? 3. If mother 
 
792 OBSTETEICS 
 
 and child both appear to be in normal, healthy condition during these 
 periods, is there any reason for deploring the fact that menstruation has 
 returned? Slemons says: 'Many operations in later years are dependent 
 upon imprudent exertion soon after the birth of the first child/ k> What 
 would such operations be for? 5. If a mother has reason to suspect that she 
 has worked too hard during and after the fourth week after confinement, 
 can she, by proper care, regain the lost ground, or must she permanently 
 suffer the consequences?" 
 
 Eeply. — 1, 2, and 3. No. 
 
 4. Subinvolution for one; that is, the uterus does not decrease to the 
 normal size. Displacements for another. Incompletely cured infections for 
 another. 
 
 5. In most instances she can. 
 
 Will Have No Effect. — M. E. S. writes: "I am a woman, 25 years of 
 age, the mother of two children. I am now pregnant seven months and 
 have had a slight menstruation every month. Otherwise the balance of 
 the time I am well and strong. Kindly advise me what effect this will have 
 on the coming child and also on myself." 
 
 Reply. — It will have no effect on either of you. This opinion is based 
 upon the statement that the hemorrhage is slight, and that it has come once 
 a month for a few days and then has stopped. 
 
 May Last Four Months. — Mrs. W. McG. writes: "What can be done to 
 relieve the sick stomach of pregnancy? I do not vomit, but am weak, 
 dizzy, and seasick nearly all day. Over how much of the period does this 
 condition generally last? How early in pregnancy should one see a physi- 
 cian?" 
 
 Reply. — 1. Eat a little food, say two crackers and a peach, before getting 
 out of bed. Dress leisurely, resting occasionally. Eat a light breakfast; 
 keep the bowels free; exercise in the open air. Eat what you have an 
 appetite for; do not eat what you dislike. Chew well; eat slowly. If you 
 vomit you will probably be hungry soon after. If so, eat. 
 
 2. It sometimes stops in one month, frequently in two months, gen- 
 erally in four months. 
 
 3. If the nausea is troublesome have a physician at least once in that 
 period. He should examine the urine especially. Have the physician from 
 time to time after the fifth month according to how things are going. 
 Why not get Slemons' "The Prospective Mother"? 
 
 Two Books Suggested. — Mrs. L. B. writes: "Please refer me to a good 
 work on the subject of what a woman should know before and after giving 
 birth to a child." 
 
 Reply. — "Woman and Marriage," Stevens; "Chavasse's Advice to a 
 Wife," Barnes. 
 
 Read Slemons' Work. — Mrs. H. writes: "Kindly advise some good 
 book for an expectant mother to read." 
 
 Reply. — Read "The Prospective Mother," by Slemons. 
 
 Be Examined by Physician. — J. B. K. writes: "Since the birth of my 
 child, about seven years ago, I have been troubled with swelling of the 
 legs, with considerable ache and pain accompanying. Sometimes the 
 
OBSTETEICS 793 
 
 swelling leaves almost entirely; then again it shows in the face. What is 
 the probable cause and can it be cured?" 
 
 Reply. — Have an examination to discover the reason for this abnor- 
 mality. Probably you have Bright's disease. 
 
 Morning Sickness. — R. W. writes: "1. Does 'morning sickness' appear 
 as early as fifteen to twenty-one days from beginning of pregnancy? 2. Can 
 you recommend a good booh for a young prospective mother which will 
 guide her in preparation for the coming child?" 
 
 Reply. — 1. Yes, not infrequently. 
 
 2. "The Prospective Mother," by Slemons, published by D. Appleton. 
 
 Cause of "Blue" Baby. — C. R. writes that recently his wife gave birth 
 to a "blue" baby. It died when a few hours old. What causes babies to be 
 blue? Is the next baby liable to be blue? Both the mother and father are 
 healthy. 
 
 Reply. — The condition known as "blue" baby is due to blood passing 
 through an opening from the veins at the heart into the arteries near by. 
 In consequence, the dark blood of the veins does not pass through the lungs 
 and is not changed into red blood. 
 
 This opening is natural and is of service before the baby is born. 
 It should close in order that the lungs after birth can properly do their 
 work. It sometimes remains open. From certain deformities of the heart 
 of this kind "blue" babies result. 
 
 The cell starting out to build up a child in nine months has many com- 
 plicated things to do. Sometimes it slips a cog, and some deformity results. 
 
 Considering the wonderful complexity of the things which it does the 
 wonder is that it does not slip a cog more frequently. 
 
 We stand by a Hoe press and are amazed at how each thing nicks in at 
 just the right time and place. A Hoe press is as simple as A B C com- 
 pared with the development of an unborn baby. 
 
 Heart deformities are not due to disease of, injury to, or mental con- 
 dition of the mother. The machinery just failed to click right. 
 
 There is no reason to fear the same trouble in the next baby. 
 
 Should Not Overeat. — L. B. E. writes: "What is the proper food to 
 eat, and what the correct exercise for a woman aged 39, whom the stork 
 will visit for the first time in three or four months?" 
 
 Reply. — Whatever is good personal hygiene for a woman under ordi- 
 nary circumstances is good personal hygiene for her in pregnancy. The 
 idea that a pregnant woman should eat for two is wrong. If she tries it 
 she will get indigestion or both she and her baby will get too fat. An 
 authority has said: 
 
 "Prospective mothers neither want nor need to eat for two. The fact is 
 more likely that enough for one is too much for two." 
 
 Ordinarily too much food is eaten. This excess is ample to take care of 
 the needs of the developing child. The little excess of starches and sugars 
 needed in the last months will come from this excess. If a woman craves 
 any special food let her have it. But be certain that she does not overeat. 
 
 As to exercise, if the woman has been doing physical labor or factory 
 work she should take it more easily during the last two weeks. Women who 
 do not work out should get some out of door exercise. Nothing is better 
 
794 OBSTETRICS 
 
 than the customary walk. Slemons says the daily walk should be more 
 than two and less than six miles. 
 
 No Need to Fear. — M. J. K. writes: "Could a woman 1$ years old 
 become pregnant after years of married life? She has never had children. 
 I have had hot flashes every fifteen minutes all summer and at present I 
 think I shall lose my mind. I am nervous and think all manner of things 
 are going to happen. Doctors have told me I have adhesions and that the 
 womb is tipped backward. I eat well, but sleep at times fitfully on account 
 of the hot flashes. What shall I do?" 
 
 Reply. — A woman of forty-eight can become pregnant, but the chance 
 is exceedingly slight. Evidently you are neurasthenic. The hot flashes 
 mean change of life. You are not losing your mind; you need not fear 
 that. Cease thinking about it, or harm from adhesions, or anything else 
 that is dire. 
 
 Pregnancy. — R. 8. writes: "A woman at the beginning of the eighth 
 month of pregnancy develops severe dropsical conditions, convulsions 
 set in and the child has to be taken. If she ever becomes pregnant again, 
 are these conditions liable to occur if she is constantly watched by a com- 
 petent physician?" 
 
 Reply. — It is possible but not probable. 
 
 Milk Leg. — G. S. writes: "1. What are the causes of milk leg? 2. What 
 is the duration of milk leg? 3. What is the average result? 4. What is 
 the most common treatment? I have had it three months. The pain has 
 left, but the swelling remains about the same. 5. Do you think it is im- 
 proving ?" 
 
 Reply. — 1. Inflammation of the main vein of the leg. Usually there is 
 a clot in this vein. Infection with mild germs is one cause. Extension of 
 a clot from the uterine veins is a cause. 
 
 2. Usually a few weeks; varies, however. 
 
 3. Recovery. 
 
 4. Keep the leg warm and comfortable. 
 
 5. Keep your limb warm. Massage it carefully every day. Your acute 
 condition has passed. The plugged blood vessel is permanently plugged. 
 In time your other leg veins will get large enough to make up for the one 
 now plugged. Exercise should help that on. 
 
 
CHAPTEE XLIY 
 
 The Baby 
 
 HELPING BABY LIVE 
 
 The baby's hardest day is his first day. His hardest week is his first 
 week. His hardest month is his first month. The men who study figures tell 
 us that never again will baby have as many hazards as during the first month 
 of life. 
 
 Whether or not the baby is to live to be a month old depends upon inheri- 
 tance and its experience in "gittin' borned." After it passes one month and 
 until it passes two years, whether or not it is going to live depends upon the 
 care it gets. 
 
 After two years of age it has a pretty good grip on life and can live in 
 spite of a good deal of neglect. 
 
 This article deals with the period when care is of most importance — 
 from one month to two years of age. 
 
 Lately the Chicago health department published a table showing that 
 the business of being a baby was an extremely hazardous occupation. 
 
 In certain parts of the city being a baby is not so hard a job. For in- 
 stance in a part of the city where good, homey conditions prevail, out of 
 each 1,000 children under 2 years old only ten died from diarrhea in a year. 
 
 On the northwest side, just north of the railway tracks, about 66 died 
 out of each 1,000. Being a baby in that neighborhood is a harder job than 
 being a baby in Russia — and that is supposed to be about the last word. 
 
 This city bulletin tells us that a baby in certain parts of town has a 4 to 1 
 chance to live; that a baby on the boulevards has a 100 to 1 chance. Why the 
 difference ? 
 
 The people in the one district can afford to and do secure for their babies 
 such care as saves their lives. 
 
 The people of the other district do not, and usually cannot, secure for 
 their babies the care necessary to reduce the chances from 4 to 1 to 100 to 1. 
 
 Now, what are the main elements in the needed care? The most impor- 
 tant is that the milk be just right. Almost right, nearly right, will not do. 
 What is needed is cranky care — the kind of care that will not have it unless it 
 be just right. 
 
 The bottles and nipples must be clean. Nearly clean, almost clean, clean 
 enough will not do. A certain way to clean must be followed in minute detail, 
 and doing it nearly the advised way will not lift the chances from the 4 group 
 to the 100 group. When it comes to other details, more leeway is allowable. 
 
 Perhaps the next most important element of care is to see that diarrheas 
 are not neglected. If the bowels become loose, or green, or bloody, or mucous, 
 see that proper measures are taken to correct the underlying cause. 
 
 795 
 
796 
 
 THE BABY 
 
 NEW. YORK CITY (POPULATION 1915 - 5, 468,190) 
 V///A STATE OUTSIDE OF NEW YORK CITY (POPULATION 1915-46*452$ 
 
 6,000 
 
 % 
 
 ^ 5.000 
 
 4.000 
 
 3 000 
 
 2,000 
 
 S 
 
 000 
 
 
 
 1905 1910 1915 
 
 D/ARPHOEAL DEATHS UNDER TWO YEARS OF AGE IN NEW YORK 
 CITY jAJWJN THE STATE OUTSIDE OF NEW YOPK CITY 
 
 New York State Dept. of Health. 
 
 Fig. 277. 
 
 165 
 
 160 
 
 ^ 155 
 ^ 150 
 
 145 
 140 
 135 
 
 iS 130 
 
 ^ 125 
 
 ^ 120 
 
 ^ 115 
 
 fir HO 
 105 
 100 
 95 
 
 g 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 WM 
 
 :w y 
 
 IRK C 
 
 ITY 
 
 
 
 
 
 
 
 
 V 
 
 
 
 
 
 
 
 
 
 
 
 
 \ 
 % 
 
 
 
 
 
 
 
 
 
 
 
 \* ■ 
 
 r STA 
 
 TE OU 
 
 TSIDE 
 
 OF Nt 
 
 V YOf 
 
 \kcit 
 
 Y 
 
 
 
 
 \ 
 \ 
 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 
 /^^^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 N 
 \ 
 
 "V 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 '""***„ 
 
 N 
 
 "\ 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 ^" 
 
 
 
 
 
 
 
 
 
 
 
 
 5 so 
 
 ^ 1904 '05 '06 '07 W '09 10 'II 12 '13 '14 '15 
 
 INFANT DEATH PATE IN NEW YOPK CITY AND IN THE STATE 
 OUTSIDE OF NEW YORK CITY 1904-1915 
 
 New York State Dept. of Health. 
 
 Fig. 278. — Comparison of the Health of City and Country Babies. 
 
 It may be boiling the milk, or changing the food, or calling the doctor, or 
 going to the baby tent ; whatever the need, see that it is promptly attended to. 
 
SAVING NEW LIVES 797 
 
 Other elements of care are that the baby be dressed in a cool fashion and 
 kept in a cool place; that flies be kept away; that the baby be kept clean, be 
 given water, be kept free from nervous strain. 
 
 SAVING NEW LIVES 
 
 We judge of the baby welfare by the baby death rate. Nobody collects 
 any health data about babies except the health department. It gets a full 
 record of deaths. Its record of baby sickness is incomplete. Therefore all 
 that we have to judge by is the baby death rate. 
 
 In the first place, there is the total number of deaths — the deaths from 
 diarrheal diseases, the deaths in the first month of life, and the deaths during 
 July, August, and September. 
 
 The total number of deaths, when we compare the records of the different 
 years, gives us some information as to whether we are taking better care of 
 babies than in former times. This group of figures tells us that things are 
 getting better. 
 
 The deaths during the first month of life are the result of birth accidents, 
 bad maternity service, and neglect of the mother during the last months of 
 pregnancy. This rate is not improving. 
 
 The death rate during the first month of life has not fallen during the 
 last ten years. The conclusion is that more pregnant women are having to 
 work, that midwife and medical service is going back a little, and that the 
 number of birth injuries and accidents, congenital deformities, and abnor- 
 malities is slightly on the increase. 
 
 The increasing complexities of society make the wagon roll downhill 
 unless definite, proper action is taken to scotch it. The pivotal point in the 
 baby situation is the hot weather care. Therefore the July, August, and Sep- 
 tember death rate is that by which the community's efforts to save the babies 
 are to be gauged. 
 
 The New York milk committee report shows that most of the annual 
 saving in babies in the last few years has been in these months. For instance, 
 in 1911 the number of babies dying in the three hot months was only 30 per 
 cent of the total for the year. Ten years ago it was well over 40. The actual 
 number of babies dying in the hot months was 1,700 less than eleven years 
 before, in spite of the increase in the size of the city. 
 
 Philadelphia, Chicago, Boston, and Buffalo made the same kind of 
 showing, although none except Buffalo did so well as New York City. 
 
 This continued talking about clean, cold, fresh, pasteurized milk, about 
 keeping the baby cool, and all this warning not to push the baby's growth in 
 weight during the hot months are bearing fruit. 
 
 Under the new plan the baby is within 10 per cent of being as safe in the 
 hot months as in the cool. 
 
 NURSING THE BABY 
 
 A baby should always be nursed by its mother, unless the mother has 
 tuberculosis or some other grave disease. The mother saves herself trouble by 
 
798 THE BABY 
 
 nursing her baby. When she figures up the saving from diminished illness 
 and adds to it the trouble of fixing the baby's bottle during the night as well 
 as the day, she finds that she nets a gain by nursing her baby. 
 
 During the first two days the baby should be nursed four times a day and 
 once at night. From three days to six weeks the baby should be nursed 
 every two hours during the day and twice at night; from six weeks to six 
 months every three hours and once at night; from six months to a year, six 
 times between 6 o'clock a.m. and 10 o'clock p.m., and not at all during the 
 night. 
 
 In addition to milk, babies require water from the very first. The old 
 granny who gave the baby teas was a pretty good scientist, though she did not 
 know it. Of course, the herbs which she used to make the tea had no particu- 
 lar effect, but she was giving the baby sterilized, warmed water, and that was as 
 it should be. 
 
 After about the second month the baby should have some orange juice 
 every day. The juice should be given freed from pulp. The amount should 
 begin with two teaspoonfuls a day and should be gradually increased to four 
 tablespoonfuls, especially where there is a tendency to constipation. It is 
 much better to relieve constipation with orange juice than by enemas, and cer- 
 tainly than by medicine, since babies need a little fruit juice to correct any 
 tendency to scurvy and rickets. 
 
 That the mother may give enough milk to supply the baby, it is necessary 
 that she be free from worry and not called upon to do a great amount of 
 physical labor. Emotion has more effect on the secretion of milk than does 
 the food taken. Occasionally a woman will overeat until she becomes obese 
 trying to give milk enough for her baby, and then worry so, fearing her milk 
 will fail, that she gains nothing for her trouble. 
 
 There are no special foods which make milk. Beer does not; neither 
 does milk. Some women have the idea that milk taken as a food runs with- 
 out much change into milk for the baby. This is not correct. A mother 
 should eat good, nutritious, simple, staple food containing a good deal of 
 fluid. 
 
 That which she eats does not go directly to milk. It is digested and 
 changed chemically thereby. It is absorbed and still further changed. Even- 
 tually it is changed into milk. She should increase the quantity of food 
 eaten, since for her own use she needs more than she usually does, and in 
 addition she is eating for the baby. 
 
 The average woman nursing one baby can supply the child with food out 
 of her surplus if she will keep her mind calm, her rest unbroken, and not have 
 too much work to do. The average woman who thinks she cannot nurse her 
 baby can do so if she will try. 
 
 NEW ZEALAND BABY RULES 
 
 In 1914 New York City had a death rate of 9.46 per cent among its 
 babies less than a year old. No other American city has ever had a rate any- 
 where near so low. 
 
 The New York state board of health reports that the death rate among 
 
WHAT WOULD YOU DO? 
 
 799 
 
 Fig. 279.— Shape 
 of a Baby's Jaw. 
 
 farmers' babies in rural New York is higher than the New York City rate. 
 Probably the figures for New York State are not very accurate. At that, 
 they are about the most accurate we have. The chances are that the rate for 
 rural New York is about the same as that for rural Illinois. 
 
 When we turn to Australia we find that they have found a way to reduce 
 the sickness rate among farmers' babies. The New Zealand 
 rate for 1910 was 5.1. The 1913 rate in Dunedin was 3.8. 
 New Zealand comprises two thinly populated islands. 
 The largest city, Auckland, has 110,000 inhabitants. There 
 are three cities with between 50,000 and 100,000 and three 
 with between 10,000 and 20,000. In the main the people 
 of New Zealand are country people. 
 
 There are several reasons for the healthfulness of babies in New Zealand. 
 The laws are good. One gives $10 to each prospective mother, that she may 
 have a little more rest and a little better food. A powerful factor is the 
 Society for the Health of Women and Children. Through this society the 
 newspapers carry a great many helpful articles on mothercraft. 
 
 This society maintains hospitals, dispen- 
 saries, and a corps of nurses — one for every 
 sixteen people. They publish a series of 
 small handbooks in popular form. Among 
 these are "The Baby's First Month" and 
 "Feeding and Care of Baby." 
 
 They stand for a policy in baby core. 
 Among the details in this policy are the 
 following: 
 
 1. The widespread adoption of clocklike 
 regularity in the feeding of babies. 
 
 2. The extension of the intervals between feedings throughout the early 
 months to three hours instead of feeding every two hours. 
 
 3. The entire abandonment of night feeding — that is, between 10 p.m. 
 and 6 a.m. 
 
 4. The early use of hard, dry, or tough foods needing mastication. 
 
 Dr. Arthur Newsholme indorses the opinion that babies after the first 
 month do better if fed every four hours and not at all during the mother's 
 sleeping period at night. This society finds that under this policy the babies 
 thrive better. An indirect good effect is that it increases the proportion of 
 mothers who breast-feed. 
 
 Another of their policies is to promote the use of pure, cold, fresh, out of 
 doors air. 
 
 Fig. 280, 
 
 -Shape of an Adult's 
 Jaw. 
 
 WHAT WOULD YOU DO? 
 
 Suppose you had a baby less than a year old ; you are without breast milk ; 
 you have no icebox. What would you do? Forty-five per cent of homes are 
 not supplied with ice. Fortunately a large percentage of the babies are borne 
 by women who are able to nurse them. Not 45 per cent of the mothers are 
 confronted by the problem of feeding a baby artificially when ice for keeping 
 food is not available. 
 
800 THE BABY 
 
 Another group of dry-breasted mothers lives in the country. They solve 
 the question by keeping a cow in the barn and milking her whenever baby- 
 feeding time comes around. More of them get fresh milk twice a day, which 
 is not so good by far. 
 
 After all these eliminations there remain thousands of dry-breasted 
 mothers who can neither have fresh milk nor ice. Put yourself in place of one 
 of these. What would you do? You would make an effort to get ice. But 
 suppose you failed, what would you do then ? 
 
 You might get a high grade clean milk to start with and then keep it 
 wrapped with a cloth wet with tap water. Evaporation would hold the tem- 
 perature several degrees below room temperature. But suppose the room 
 temperature was 94° from 8 in the morning until midnight. Milk does not 
 keep unless its temperature is held below 55°. A wet cloth wrapped around 
 the bottle will not keep the temperature so low. 
 
 The answer is that you would feed your baby on condensed milk, milk 
 powder, or some form of baby food. The statisticians tell us that the heaviest 
 mortality is among babies fed this way. The baby doctors tell us that babies 
 should have "liquid milk," mother's milk, or, that failing, cow's milk. They 
 are right, of course, but being without ice is a condition, not a theory, to bor- 
 row the phrase made popular by Cleveland. 
 
 If there is no ice, cow's milk for the city baby is ruled out. This is true 
 whether it is certified milk, pasteurized milk, or plain milk. Put yourself in 
 that position. Would you forget all about the better foods, now out of reach, 
 and try to form a decision between what was left? 
 
 As you could not have good cold milk to mix with the food, you would 
 select one that required no milk. You would select one that did not contain 
 too much sugar, but above all, you would select one that kept well. You 
 would get the best advice you could on these points, but you would insist that 
 your adviser stick to the points asked and not run off at a tangent and advise 
 you to use what you could not get. 
 
 FEEDING AND GROWTH OF BABIES 
 
 A baby should weigh seven and a half pounds at birth. It should lose 
 from four to eight ounces the first week of its life and gain every week there- 
 after during the first year. During the first six months it should gain from 
 four to eight ounces a week and during the second six months two to four. 
 At three months it should weigh twelve to thirteen pounds; at five months, 
 double its weight at birth; at six months, fifteen to sixteen pounds; at nine 
 months, seventeen to eighteen pounds, and at twelve months, three times its 
 weight at birth. The baby should be weighed every week until it is 1 year 
 old and every two weeks when between 2 and 3 years old. 
 
 The mother who prides herself on the weight of her baby and its weekly 
 gain is pursuing the right policy in the winter. In the summer she should go 
 slow. In hot weather fat babies are in special danger and feeding to increase 
 weight is risky. 
 
 If a mother cannot nurse her baby she is in an unfortunate position. It 
 makes work for her and endangers the life and health of her baby. Of the 
 
FEEDING AND GROWTH OF BABIES 
 
 801 
 
 Fig. 281. — The Relative Length of Trunk and Legs in a Baby, a Youth and an Adult. 
 
 artificial foods, cow's milk, properly diluted, is the best provided it is clean, 
 young, and has been kept cold. As between dirty, old, and warm milk and the 
 baby foods, the latter are 
 better. The best of all 
 cow's milk is that which 
 comes from a healthy 
 cow free from tubercu- 
 losis and kept in a clean 
 barn on the premises 
 ivli ere the baby is. Such 
 milk can be and should 
 be consumed before it is 
 twelve hours old. Next 
 comes certified milk; 
 next properly pasteurized 
 milk. No city or town 
 should allow its babies to 
 drink the ordinary raw 
 market milk or market 
 milk which is claimed to 
 be pasteurized and is not. 
 No mother should 
 feed any milk to her baby 
 that she has not investi- 
 gated. She should see 
 
 how clean, young, and cold the milk is; how clean are the bottles; how clean 
 is the milk depot, the farm, and the milkers. If the milk is sold as pas- 
 teurized, is it? Some of this information is available at the health depart- 
 
 of E age 2 4 6 8 10 12 14 16 18 20 22 24 26 
 
 17 
 
 16 
 
 15 
 
 14 
 
 13 
 
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 Dl 1 
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 Fig. 282. — Rate of Growth of Babies. 
 
802 
 
 THE BABY 
 
 of E age 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 60 52 
 
 23 
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 21 
 20 
 19 
 18 
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 13 
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 Fig. 283. — Rate of Growth of Children. 
 
 ment. No mother should feed milk to her baby unless she has got all the 
 information which the health department has and as much additional as is 
 within her reach. 
 
 FRESH AIR FOR THE BABY 
 
 Small babies are not "catchers." It is rarely that they have smallpox, 
 diphtheria, and scarlet fever. Part of this good fortune is theirs because 
 mothers are usually wise enough to keep small babies away from such dis- 
 eases. They are not taken into crowds or on street cars, and they cannot run 
 out on the street or mix with half cured children in schools. But these saving 
 graces do not serve to protect them against measles and whooping cough — the 
 two great causes of contagious illness in babies. 
 
 Babies do not catch cold easily and this is luckiest of all. The habit of 
 catching cold is acquired by wrong living. Babies have not had time to ac- 
 quire the habit. As a general rule, they are not coddled so much as grown 
 people ; they are seldom brought in contact with cases of "cold," and they have 
 not had occasion to become chronic carriers of the germs of colds. 
 
 If the baby is kept in a clean, well ventilated nursery, his chance of 
 keeping free of cold will increase. The following rules should be followed : 
 
 The nursery should be kept at 68°. Until the baby is 3 months old the 
 night temperature should not go below 65°. When the baby is 3 to 12 months 
 old the nursery temperature should go to 55°, and after that age 45° is 
 proper. The nursery should be aired twice a day. The baby over a month old 
 should have a daily airing in the room. After 3 months old he should have 
 an airing outside in all except the worst weather. To sleep outside for a while 
 
DANGEK SIGN WITH BABIES 803 
 
 each day gives the youngster a new impulse to live, grow, and become resistant 
 and strong. 
 
 The best use to make of physicians is to employ their services to direct 
 the methods of living that there may be no illness or that right living may 
 earn a cure for the disease brought about by wrong living. This plan is 
 frequently followed in the treatment of consumption and certain nervous dis- 
 eases. There is a growing disposition to use the services of physicians in this 
 way in the rearing of babies. It is to be hoped that the reading of articles 
 such as these and of books such as Holt's "Care and Feeding of Children" may 
 induce people to follow the right rather than the wrong method. The present 
 method is to pick up from advertisements, grannies, and neighbors, methods 
 of care which are wrong about as often as they are right, and then to rush 
 off to the doctor to have him rescue the baby from the position where wrong 
 methods have put him. 
 
 DANGER SIGN WITH BABIES 
 
 Perhaps the time will come when it will be the custom to consult one's 
 physician once or twice a year for direction as to keeping well. That is a long 
 way off. Perhaps the time will soon come when a mother will take her well 
 baby to the physician once a month during its first year that it may keep 
 well. 
 
 In summer it should be the custom to see the physician when babies' 
 bowels get loose. _ Kilmer advises that all food be stopped, a dose of castor 
 oil be given, and the doctor sent for. 
 
 A baby may have loose bowels and be in good spirits, no more irritable 
 and no more upset physically than a thoroughly well baby. Nevertheless, the 
 mother has a harder time judging the right course to follow when the bowels 
 are not just right. She will make fewer mistakes, if she will take counsel 
 promptly. 
 
 If the stools are green as well as loose, the hazard becomes greater. The 
 baby may still pull through all right, in fact usually does; but it is quite 
 risky for the mother to rely only on her own judgment as to what to do. 
 
 If the stools contain mucus, either with or without green, the mother is 
 certainly at a point where she needs help. Some mothers work it out success- 
 fully without help, but the risk is too great. If there is blood, or if the baby 
 has fever, or is exceedingly irritable, or is nauseated, it is imperative that 
 counsel be obtained. 
 
 Let us make clear these gradations : 
 
 Any baby with diarrhea should be seen by a physician. In simple diar- 
 rheas the risk in disregarding this advice may not be great. 
 
 If there is blood in the stools, or the baby has fever, the risk in disregard- 
 ing the advice is extremely great. 
 
 As Kilmer says, as soon as loose bowels appear, food should be stopped 
 and a dose of oil given. Water will usually satisfy for a while. 
 
 Too much food in hot weather is almost as bad as bad food. After the 
 system has rebelled against too much food, it will continue its rebellion against 
 any food for a while. 
 
804 
 
 THE BABY 
 
 The diarrhea usually has an object, although it accomplishes that object 
 in a harmful way. The object is to rid the digestive apparatus of something 
 that is troublesome, and that is why the advice is to give a dose of oil to begin 
 with. 
 
 Neglected diarrheas are responsible for the heavy baby death rate. For a 
 while after the diarrhea starts, the baby is not much disturbed. The condition 
 is not serious. 
 
 If neglected, the child slowly drifts downstream, and presently is caught 
 in rapids from which there is no escape. 
 
 It is the mild, neglected conditions of early summer that result in the 
 severe, hopeless conditions of midsummer. Therefore the advice to the mother 
 is not to try to manage the ship without help after things have begun to go 
 wrong. 
 
 BABY'S CRY 
 
 There are several situations in which it is desirable that the baby cry. 
 When first born the lungs are collapsed. A good cry is needed to expand 
 them. If not expanded properly they may not get right for days; in fact, 
 
 may never get entirely right. 
 
 Therefore if the baby does 
 
 not cry of his own accord, 
 
 he should be made to cry, 
 
 and the harder the better. 
 If, later in life, baby is 
 
 in a shock, or the feet are 
 
 cold, nothing warms him up 
 
 quick or better than a good 
 
 hard cry. 
 
 In some conditions of 
 
 tension a good skin-warm- 
 ing cry is good for baby. 
 On the other hand in 
 
 the great majority of in- 
 stances the question is: 
 
 What is the meaning of a 
 
 cry and how can it be 
 avoided? Kilmer gives a number of conditions which cause a baby to cry. 
 They are: 
 
 1. He is hungry. 
 
 2. He is thirsty. 
 
 3. He is in pain. 
 
 4. He wants attention. 
 
 5. He is sleepy. 
 
 6. His napkins are wet. 
 
 7. He is tired of lying in one position. 
 
 8. He is frightened. 
 
 9. He is exhausted. 
 
 10. He is crying from temper. 
 
 Fig. 284. — Correct 
 Method of Hold- 
 ing a Baby. (Kil- 
 mer.) 
 
 Fig. 285. — Incorrect 
 Method of Holding a 
 Baby. (Kilmer.) 
 
THE BABY'S NERVES 805 
 
 The cry of hunger is continuous and the baby sucks ravenously at his 
 fingers or anything else that gets in his mouth. After he begins to eat he may 
 interrupt his meal to cry once or twice, but shortly he quiets down. 
 
 A thirst cry is of about the same type as a hunger cry. It yields to a few 
 drams of water. 
 
 The colic cry is intermitting. When the pain is on the yelling is violent. 
 Generally the limbs draw up more than in other cries. 
 
 A cry from a pin prick is continuous and sharp. 
 ■ He wants attention. Kilmer's page on the folly of spoiling a baby is 
 worth the price of the book. If a baby is not born with a rupture, crying will 
 not develop one, Kilmer says. A mother will save herself trouble when the 
 cry is because the baby wants attention by letting him cry it out. She will 
 save the baby trouble. A crying baby heats his skin, cools his digestive ap- 
 paratus, and invites summer complaint. A spoiled baby is the first link in a 
 chain of spoiled beings — baby, child, youth, adult. 
 
 A sleepy cry is to be diagnosed by the time since sleeping and the con- 
 duct of the child. 
 
 No cry is more trying than the feeble moan and fretful outcry of a baby 
 exhausted by illness. The cry is an almost continuous, low call with occasional 
 sharper sounds. 
 
 Kilmer tells us that tears do not necessarily mean that the baby is crying 
 from pain. Not infrequently a youngster will cry so hard from temper that 
 the tears will flow. 
 
 THE BABY'S NERVES 
 
 A baby is born with an enormous brain and soon acquires an enormous 
 appetite. This is about all there is to start with. The size of his brain as 
 compared with his body is greater than it will ever be again. 
 
 James Lane Allen in "Aftermath" makes Adam say of his newborn son: 
 
 "If I could put forth one protecting prayer that would cover all his years 
 it would be that through life he continue as wise as the day he was born." 
 
 Parents should watch over the baby's digestion with even more care than 
 they have been accustomed to, but nothing warrants them in leaving the 
 nervous system untrained or training it improperly. The young baby seems 
 to have so little mentality that there is great temptation to begin teaching 
 him things, and then, when a little spark of intelligence is shown, the tempta- 
 tion to build further and faster is almost irresistible. His brain is in the 
 rough and needs to be properly trained just as his method of taking food and 
 air is new to him and needs training. 
 
 The foundation of much of the nervous instability of adult life is laid in 
 the self-centering, nerve-racking methods frequently employed with babies. 
 Holt says : "Babies under 6 months old should never be played with and the 
 less of it at any time the better." 
 
 When a baby has been nursed -he should be put down on the bed and 
 allowed to go to sleep without rocking, patting, or attention of any sort. He 
 should not be given pacifiers or soothing syrups. He should not be allowed to 
 form the habit of sucking his thumb. He should be trained to lie quietly, 
 unheld and unnoticed, when awake. He should be trained to sleep through the 
 
806 
 
 THE BABY 
 
 night with waking times prearranged according to age. If, at other times, he 
 awakes and cries, he should be allowed to cry it out. 
 
 At the worst only two or three nights are required to reestablish proper 
 routine. He can be trained to proper bowel habits very early in life. He 
 should not be stimulated to "take notice" or sit up or crawl or walk. If he 
 is healthy he will get these things as soon as he is ready. He will walk when 
 his legs are strong enough. It harms him to walk before. 
 
 Distinctly from the standpoint of impressions, babies should be left alone. 
 As it is, their brains are all out of proportion to their physical qualities .and 
 the need is to go slow on nerves so that muscles and frame may grow to some- 
 where near a balance. 
 
 It is easy enough to tell a nervous baby. If the mother is at all observant 
 she can diagnose the condition as well as the doctor. He knows more and 
 has seen more babies, but she is on the job all the time 
 and he is observing for brief periods. 
 
 Nervous babies cry frequently or overhard or 
 overlong. If old enough to laugh the laugh is ner- 
 vous or excessive. The child wakes easily, jumps at 
 noises, and seems on edge. A little excitement may 
 cause vomiting. As nervous babies respond to being 
 walked or jogged or other forms of attention they are 
 apt to be spoiled. The nervous baby is apt to grow 
 into the nervous child, and he in turn into the neuras- 
 thenic or neurotic adult. 
 
 What is to be done about it? Above all else 
 these babies must be trained to regular habits. Feed- 
 ing must be at regular intervals — four hours in the 
 day and six at night. They must go to sleep at regular 
 hours. They must not be handled, admired, or trotted, walked, or put to sleep. 
 They must not be entertained. They must live in the open air. 
 
 The diet must be carefully watched. As they do not digest sugars and 
 fats well the diet must not have too much of these. As they stand starch well 
 they can have a good deal of gruel. Nervous children over a year old do well 
 on vegetables and cereals. Meat, eggs, and large quantities of milk are not 
 well borne. 
 
 Somewhat allied to the nervous babies are those with a tendency toward 
 convulsions — general spasms or spasms of groups of muscles. The children 
 who are very prone to croup belong to this group. 
 
 Physicians who have had training in this work can test the nerves with 
 an electric machine, and in this way tell which babies belong in the tendency 
 to convulsions group and which do not. Even though the child is thriving, 
 growing, and seemingly well poised, this test shows a nervous instability 
 out of which some form of spasm is liable to result from any strain. 
 
 This spasm tendency rarely develops in babies under six months of age. 
 It rarely develops in breast-fed babies, showing another way in which a mother 
 may spare herself trouble and her baby danger by continuing breast feeding. 
 What is to be done for these babies? They must be kept in the open air. 
 They must get a nap in the outside air every day that the weather is fit. 
 They must be kept clean. 
 
 Fig. 286. — Bones of a 
 Baby's Skull Show- 
 ing "Soft Spot." 
 
 a, anterior fontanelle; 
 p, posterior fontanelle; 
 
 b, b, parietal eminences. 
 
FAT BABIES 807 
 
 These children bear starches very well. This may be taken advantage 
 of in feeding them. Dr. Grulee's book on infant feeding recommends milk 
 curds suspended in arrowroot water. But the method of feeding to cure a 
 tendency to spasm is too complicated for a mother to work out by herself. 
 It is not wise for her to try it. She should leave it to a physician or nurse who 
 has had training in this kind of feeding. 
 
 It is a diathesis which is quite amenable to dietetic treatment. To limit 
 what one tries to do to controlling the spasm is not enough. An effort must 
 be made to feed the child out of the tendency. 
 
 FAT BABIES 
 
 What use has fat? There are two uses. When life was simple, animals, 
 including man, ate a great excess of food in the season of plenty, laying up 
 the excess as fat. In the season of little food the animal pieced out by using 
 up the stored fat. We still see wild animals begin the winter round and 
 sleek, and come out in the spring poor and scrawny. 
 
 Fat is a poor conductor of heat. Fat animals suffer less from the cold 
 than do lean animals. To assist in keeping the body warm in winter is then 
 the second use of fat. 
 
 Well, now let's see how that fits the baby case. No mother intends to get 
 her baby through next winter without plenty of food. That, as a reason for 
 fattening baby, does not work. 
 
 In the hot weather the problem is to keep baby cool, not warm. The 
 second use of fat as a reason for fattening baby does not work. 
 
 There must be some reason that so many mothers want their babies to 
 be fat. 
 
 The reason is this : Most sick babies are thin ; therefore, as sickness and 
 thinness go hand in hand, fatness and wellness must go hand in hand, reasons 
 the mother. 
 
 The fatness of her baby is proof of its wellness, and naturally every 
 mother is proud to show her fat baby, because it m'eans that it is a well 
 baby. 
 
 This third use of fat — to serve as a measure of health, like a thermometer 
 or barometer — works fairly well from October to June, but between July and 
 October the mother had better substitute some other way of proving to the 
 neighbors that she treats her baby wisely and well. 
 
 In exceedingly hot weather fat babies suffer more than lean ones. In 
 consequence they cry and fret more and thus make more heat. Heat makes 
 them cry, and crying makes heat — a vicious circle. 
 
 They are more subject to summer complaint. Milk that is just a little 
 spoiled will make a fat baby sick, but will not harm a lean but healthy baby. 
 
 The fact that a baby gets fat is proof that its digestion or its diet or 
 both run to fat making, and that means to heat making. When things go 
 wrong with fat babies they wilt quickly. They seem to have little resistance. 
 
 The conclusion to draw is that a mother should slightly underfeed her 
 baby from July to October. The weekly rate of growth in weight should be 
 about half that of the winter. ; 
 
808 
 
 THE BABY 
 
 It will be well if the increase in weight is due to growth in length, 
 baby will be safe if the dimples gradually disappear. 
 
 The 
 
 COUNTRY BABY DEATH RATE 
 
 Fig. 287. — Hand-I-Hold Mitts to Pre- 
 vent Thumb Sucking. (Courtesy of 
 R. M. Clark & Co., Boston, Mass.) 
 
 Country babies are not getting a square deal. The city babies are being 
 safeguarded, and they are healthier in consequence. The census bulletin for 
 1911 shows that every large city is taking better care of its babies than of 
 yore. 
 
 The decrease in the death rate is about 50 per cent in New York, Atlanta, 
 and Los Angeles. The average was around 30 per cent. 
 
 The only cities showing an apparent increase were Minneapolis, St. 
 
 Paul, Syracuse, Rochester, and Port- 
 land, and this apparent falling back is 
 due to a change in the method of re- 
 cording. 
 
 In the few states where registra- 
 tion is almost what it should be, the 
 decrease in baby death rate averaged 
 19 per cent. Michigan made the worst 
 showing with a gain of 8 per cent. 
 After allowance is made for the gain 
 in the larger cities, 16 per cent in 
 Detroit, the figures show that the rural 
 districts lost. 
 
 As the good things are being 
 passed around, the city baby empties the platter, and the country baby gets 
 none. Why is this? The mother in the country knows that her baby is safer 
 than the city baby. Therefore she says, "My baby is as safe as it can be." Of 
 course she is wrong. 
 
 In the first place, there is not much difference any more between the 
 safety of the city and country babies. There are a dozen cities in America 
 where babies are safer than in rural Illinois, Michigan, or Iowa. In the 
 second place, the country baby could be twice as safe as he is. 
 
 I have before me an excellent "save the babies" bulletin, issued by the 
 Iowa Board of Health. 
 
 The country baby can always get milk fresh from the cow. There is no 
 reason why milk more than ten hours from the cow should ever be given. 
 As the cow is close at hand, the mother can always see that things are clean. 
 On the other hand, flies are more abundant in the country. Doctors and 
 nurses being harder to get, there is a greater chance that a mild diarrhea 
 will be not attended to. 
 
 Baby, living in the country, has disadvantages as well as advantages. 
 The disadvantages are not so great as the advantages, and they can be sur- 
 mounted. The mother of the country baby can learn from simple pamphlets 
 such as the bulletin of the Iowa Board of Health, from simple books such as 
 Holt's, Kilmer's, or Smith's, how to surmount these difficulties. 
 
 It would be easily possible to cut the present rural baby death rate in half. 
 
HEAT KILLS BABIES 809 
 
 The first need is that the mothers become dissatisfied with the policy of "let 
 well enough alone." The second need is that the information "how to do" 
 be carried to the country homes. 
 
 HEAT KILLS BABIES 
 
 It is heat that kills the babies. First get that in your mind. Swing on 
 that as a definite fact, for, when we begin to make some modifications of the 
 statement, the original idea may slip away from you. 
 
 In a table of mean temperatures published by the Chicago health depart- 
 ment July is shown to be the hottest month both in average mean temperature 
 and in number of hot days. August is second in the list of bad months, June 
 is third, and September fourth. May is fifth and October sixth. 
 
 When it comes to death rate from diarrhea among babies, August is much 
 the worst month. September is second, July third, October fourth, June 
 fifth, and March sixth. The death rate curve is not parallel with the tempera- 
 ture curve. 
 
 What is the reason? There are several. Diarrhea is seldom rapidly 
 fatal. The rule is that the disease wears down the vitality for a month or 
 more and then kills. October has a high death rate when September is hot. 
 
 Baby may come through a hot July without getting sick; at the same 
 time he is not quite up to the standard. He has resisted the effect of the heat, 
 but he shows the strain. In August he gets sick from some cause which would 
 not have upset him earlier in the season. He dies in September. 
 
 We have already noted that the top of the death curve lags after the top 
 of the heat curve. The top of the sickness curve also lags somewhat. 
 
 The heat is in the house. The room air of a thin walled house is the 
 hottest air. Or when the baby has escaped the effects of room air made hot by 
 the sun, he may fail from the effects of room air made insufferably hot and 
 humid from a kitchen stove or laundry tub. 
 
 Therefore, we may come back to the opening statement. It is the heat 
 that kills babies. When it seems otherwise a closer analysis explains the ap- 
 parent discrepancy. 
 
 Sometimes the heat gets in its work on the milk. The remedy for this 
 situation is ice. A newspaper campaign for ice for the poor is a health cam- 
 paign. 
 
 Sometimes the heat gets in its work on the baby directly. The remedy 
 for this situation is to get the baby to a cool place. 
 
 Some hospitals take care of babies in summer with air artificially cooled. 
 Some sanitaria for the care of babies in summer are built over large bodies 
 of water; others high up in the mountains. 
 
 Each of these works on the principle that it is heat that kills the babies. 
 
 BABIES IN HOT WEATHER 
 
 The problem of keeping babies well in hot weather is, in part, a milk 
 problem. Hot weather spoils the milk. Spoiled milk spoils the babies. Hot 
 weather spoils the babies, even those who get unspoiled milk. 
 
810 
 
 THE BABY 
 
 But another part of the hot weather problem is the baby itself. In a 
 rough sort of way the baby's food is burned up into energy of four kinds: 
 first, that which is built up into tissue; second, that which is used up in ac- 
 tion; third, that which is piled up as fat; fourth, that which is made into 
 heat. I say roughly, because you cannot say of one food element, "This goes 
 into tissue/' and of another, "This goes to fat," and have the elements stay 
 where they were put. Within certain limits they swap around. A lamp 
 may make light or heat or smoke; it may burn oil or it may burn the wick. 
 
 Kansas State Bulletin. 
 
 Fig. 288. — How to Place Baby in His Bath. 
 
 The American Practitioner quotes Professor Abderhalden of Switzerland 
 as saying : "The cells of our bodies never learn what the character of the food 
 we eat really is." 
 
 In the winter time a baby needs to make considerable heat and also needs 
 bands and wraps to prevent its rapid radiation. In the summer time the 
 restless, kicking, active, healthy baby always makes heat in excess, and the 
 great problem is how he shall get rid of it. The air is nearly as hot as he is, 
 and, therefore, cannot take up much of his heat. 
 
 Not only is the baby made uncomfortable but often he is made sick by 
 excess of heat. Some of the best doctors think most of the cholera infantum 
 is heat stroke. What can be done about it? 
 
 In the first place, the amount of clothing can be cut down as much as the 
 law allows. A pickaninny clothed in a promise is pretty, near the proper 
 thing when the temperature is 100° and the wind is holding from the south- 
 west. I should say that all doctors are agreed that much of the summer sick- 
 ness in babies is because they make heat faster than they can well get rid 
 
SUMMER COMPLAINT 
 
 811 
 
 of it. A band over the abdomen is all right on the cool days in summer, but 
 it must be removed when the temperature in the shade goes over 80°. 
 
 In the second place, the food can be cut down, particularly the fat ele- 
 ments. Advise with the doctor about keeping the baby on buttermilk or 
 skimmed milk while the weather is very warm. While it is important that 
 the baby should not get much cream or butter during the extreme hot weather, 
 
 Kansas State Bulletin. 
 
 Fig. 289. — Screened Bed for Out-of-Doors Sleeping. 
 
 it is also desirable to reduce slightly the quantity of food taken. This can 
 usually be done if the baby is given plenty of clean water to drink. 
 
 Let the mother whose baby is thin forget her wish for a fat baby until 
 the cold weather comes. Let the mother who has a fat baby watch it care- 
 fully — for hot weather threatens the fat baby worse than ever hawk threatened 
 a chicken. And, in addition, the baby can be kept in the coolest part of the 
 house, or on the roof, or out of doors, or in the park. 
 
 SUMMER COMPLAINT 
 
 Summer complaint in babies has some resemblance to contagious diseases. 
 Many hold that it is caused by a germ. Where babies are crowded together, 
 as in a baby hospital, the sickness rate from summer complaint is fearfully 
 high. 
 
 There was some reason for holding that summer complaint, like some 
 other forms of contagion, is spread by flies. The New York Merchants' As- 
 sociation had proved summer complaint was at its worst near the wharves. 
 
812 
 
 THE BABY 
 
 where badly infected flies abounded. Levy had shown that in Eichmond a 
 
 fly campaign lessened the baby sickness rate. Nevertheless, exact evidence 
 Was lacking. 
 
 Last summer the bureau of public health of the New York Association 
 
 COWDKMJ0DK5 
 
 Is IbuR tar Happy In Hot Weather ? 
 
 not — you're to blame. 
 
 ' This little tot 15 . 
 
 COMFORTABLE AND HflFW 
 WHEN THE 3UW1ER MV5 flRE HOT 
 
 He b Dressed Right 
 
 TO STAND THE BEIT. 
 
 THl3 UNlttW LITTiE CODGER 
 15 ALL FUS5ED UP AND (15 d 
 RESULT HE 15 HOT 
 UNI) UNCOMFORTABLE 
 
 HE 15 DRE55ED WRONG 
 
 roifs hot mvs. 
 
 DoN'T DRESS y0UR BABY TO 
 MARE f\ GOOD 5H0U Of 
 Hkn-DRESSHMTO 
 KEERJIlff COMFORTABLE 
 s mv HrfPPV. 
 
 KSIRSSm USt 
 
 war— 
 
 -.W.TH. Cmcaho. 
 
 Chicago State Board of Health. 
 
 Fig. 290. 
 
DIARRHEA— ITS TREATMENT 813 
 
 for Improving the Condition of the Poor decided that it would try to get exact 
 evidence. Dr. Armstrong picked out two neighborhoods in the Bronx where 
 conditions were as nearly the same as it was possible to find. In each area 
 were 311 families. In the protected area there were 1,725 individuals; in the 
 other 1,744. The numbers of babies under one year were 100 and 98; under 
 two years, 175 and 160; one to five years, 262 and 298. 
 
 The* sickness in the two neighborhoods was closely watched. In the pro- 
 tected neighborhood Dr. Armstrong's forces screened the houses and provided 
 fly swatters, fly paper, and fly traps. They furnished covered garbage pails. 
 They kept the premises clean and saw to it that stable manure did not serve 
 as a breeding place. In the other area they did nothing except register all 
 illness. 
 
 They were able to reduce greatly the number of flies. They found that 
 the flies caught in the cleaned houses average 14,000 bacteria ; those from the 
 dirty houses, 1,100,000. 
 
 Two babies died in the protected area, six outside it. The possible fly- 
 borne illness oi the protected area amounted to 22 cases; of the unprotected 
 area, 65. The total days of baby sickness in the flyless area was 273 ; in the 
 fly area, 984. The cases of summer complaint in the flyless area were 20; 
 in the fly area, 57. 
 
 This experiment proves that flies are one of the factors in summer com- 
 plaint. There are others. But by attending to this one we can reduce the 
 amount of baby sickness materially. 
 
 Incidentally the following facts were found: It costs nine-tenths of a 
 cent per day per horse to treat stable manure with iron sulphate so as to make 
 it fly-proof. The stableman would not do the work, even when the iron 
 sulphate was furnished him. One per cent of the flies captured in this city 
 area were biting stable flies. 
 
 Screens did little good. When the weather was hot the people took them 
 out. Cleaning was more effective than screening. Efforts against breeding 
 places were most effective. 
 
 The house to house daily visits extended from July 21 to September 13. 
 When visiting was resumed on November 1 it was found that the customs 
 and habits of the people had gone back to the old basis. 
 
 DIARRHEA— ITS TREATMENT 
 
 Diarrhea is more prevalent during the summer months. It reaches its 
 maximum curve some time in August. This shows that it bears a relation 
 to temperature and other atmospheric and telluric conditions. In the treat- 
 ment of the disease it is necessary, therefore, to have in mind the season o:: 
 the year and the agencies which hasten or retard recovery. 
 
 Since food has much to do with the cause of diarrhea, in the treatment of* 
 the disease great care should be observed in preparing the food. If the 
 cause of the attack is located in the mother's milk, the baby is to be kept away 
 from the breast and fed artificial food. 
 
 The best of all artificial foods is cow's milk. Cow's milk easily undergoes 
 fermentative changes in itself and is often contaminated by specific poison. 
 
814 THE BABY 
 
 Before it is fed to the child it should be pasteurized. Where it is possible 
 to obtain it, certified milk is preferable. 
 
 As soon as it is discovered that the child has diarrhea, all food should be 
 withdrawn. It should be put to bed in a room where absolute quiet can be 
 maintained. A dose of castor oil should then be given, and, if there are signs 
 of fever, it should be given a sponge bath with tepid water. If the baby 
 does not show signs of improvement within twenty-four to thirty-six "hours, a 
 physician should be called. 
 
 Where the disease assumes a dysenteric nature, it may be several days 
 before the child takes a turn for the better. In this case it would be fortunate 
 if the treatment could be carried out under the supervision of a trained nurse. 
 The main thing in this type of diarrhea is the nursing, and unless one has 
 been trained in nursing, strict and accurate instruction from the attending 
 physician should be given in regard to each detail connected with the treat- 
 ment, all of which are to be rigidly carried out. 
 
 The child should be kept in bed except, in the case of a breast-fed child, 
 when it is taken up to be fed. The patient should not be handled, and walk- 
 ing the room with the child in the arms is especially forbidden. 
 
 The room should be kept cool, quiet, and provided with plenty of fresh 
 air. The bedding should be changed frequently. Cleanliness is especially 
 necessary. The napkins should be removed as soon as soiled and placed 
 in a sterilizing solution, then washed and boiled. After the napkin is removed, 
 the parts are to be carefully washed and thoroughly dried before redressing. 
 
 When it is necessary to resort to medicine in the treatment of these cases, 
 a careful physician must be called. 
 
 COLIC IN BABIES 
 i 
 
 Of course, colic is only a symptom, but when a mother has had to worry 
 with a colicky baby for a week or two she is not disposed to give much thought 
 to finely drawn divisions between diseases and symptoms. She wants to 
 know what to do. 
 
 The first thing for her to do is to be certain that the apparent colic is 
 the real thing. In a very young baby colicky pains are not due to gas in the 
 bowels as often as they are to gravel in the kidneys. The young baby is 
 apt to have plugs of uric acid crystals in the kidneys. These cause pain. 
 
 Older babies are sometimes thought to have colic when they are suffering 
 from congenital syphilis. When the cry results from syphilis, treatment for 
 that disease must be given. Sometimes a hunger cry is mistaken for colic ; or 
 the cry is due to anger — the child has been spoiled. 
 
 In some cases of colic, clearly gas is the cause of the pain. If the gas is 
 in the stomach, holding the baby upright or laying him on his stomach may 
 cause the gas to come up. If the gas is in the intestine, trotting or changing 
 position may give relief. An injection may cause the expulsion of gas. 
 
 However, every mother of a colicky baby knows that the importance of 
 gas as a cause of pain has been overrated. Sometimes the passage of gas stops 
 the pain; more frequently it does not. A turpentine stupe to the abdomen 
 or a hot bath will relieve the pain more often than measures to cause gas to 
 
DYSPEPSIA 
 
 815 
 
 pass. In some cases paregoric is necessary. Holt says a baby one month old 
 may take one minim ; one three months old, two minims ; one one year old, five 
 to ten minims. 
 
 Mothers, though, are even more interested in preventing colic. The 
 chance is that the colicky baby feeds too frequently. The 
 babies who are fed once every four hours during the day 
 and every six hours at night are not the colicky babies. 
 
 The most frequent cause of colic is taking food into 
 a stomach that has not had a resting spell. A baby's 
 stomach cannot digest a meal, empty, and rest in two hours. 
 
 If the baby is at the breast either he should be given 
 a little water just before feeding or else his time at the 
 breast should be limited to five minutes, or even three. 
 If the baby is on the bottle, the indication is to decrease 
 the richness of the food. 
 
 It may be advisable to put the baby on skimmed milk, 
 one and one-half ounces for each pound of the baby's 
 weight. To do this a little malt extract and sufficient 
 water is added. Gradually whole milk is substituted for 
 skimmed milk. The element in the milk which is most 
 at fault is fat. 
 
 Dr. Grulee tells us that in colic calomel does no good 
 and castor oil may do harm. 
 
 DYSPEPSIA 
 
 Fig. 291.— Feeding 
 
 Babies are subject to a form of mild indigestion called TURE baby. 
 dyspepsia by some physicians. It is characterized by 
 vomiting, diarrhea, distention of the abdomen, gas, and a mild fever. There 
 is a slight loss in weight. There is restlessness, nervousness, and peevish- 
 ness. The baby is not very sick, but if the condition is neglected it may 
 develop into a much graver condition. 
 
 The cause of the condition is overfeeding. Babies that are fed whenever 
 they cry are very apt to develop it. In older children injudicious feeding from 
 the table is a frequent cause. Cakes, bacon, gravy, vegetables, coffee, and 
 beer are often fed to young children, and in consequence dyspepsia develops. 
 
 In nursing babies, whether at the breast or the bottle, the condition may 
 come on because of an inability to digest sugar. Less frequently the trouble 
 is an inability to digest fat. The excessive amount of sugar in sweetened, 
 condensed milk, of milk sugar in evaporated milk, and malt sugar in many 
 of the baby foods is a frequent cause. 
 
 Bad milk is a very frequent cause. Grulee's book quotes Blum as having 
 seen some cases that resulted from feeding milk from cows that were using 
 green alfalfa hay. A Michigan physician once wrote me his reasons for think- 
 ing the condition due to weeds eaten by cows in the pasture. 
 
 In those cases where the cause is an inability to digest sugar a good 
 deal of gas forms in the intestines. There is belching, the abdomen is dis- 
 tended, colic is present, and the stocls are foamy. If malt sugar is to blame 
 
Qusste£aaJ2L 
 
 ■QrtWiH 
 
 ju*rtt& 
 
 Fig. 292. — A, Nipple with Proper Perforation; B, Nipple with Faulty Perforation, 
 Permitting Milk to Run Too Freely, 
 
 816 
 
EYE OE THE CHILD 817 
 
 the stools are usually brownish. If milk or cane sugar is to blame the 
 stools are grass green and contain mucus and curds. 
 
 If the trouble is with fat digestion there is less gas and the abdomen 
 is not much distended. The stools may be fatty, containing oil globules, 
 fat curds. There may be a history of fat constipation — the constipation so 
 frequently found in babies fed on milk too rich in fat. 
 
 What is to be done about it ? Cut off the food supply. G-ive plain water 
 or barley water sweetened with saccharin for a day, then begin feeding a 
 mixture of skim milk and water — one ounce of skim milk to each pound of 
 baby — as a day's ration. The amount of skim milk is increased until the 
 baby is getting one and one-half ounces per pound of weight per day. Then 
 whole milk is gradually substituted for skim milk. 
 
 It is important to decide whether the fault lies with the sugars or the 
 fats, since the food must contain one or the other when it cannot contain 
 both. It would not do to increase the fat in a case where fat was the 
 cause of the trouble and it would be equally harmful to increase the sugars 
 when they were the food element that was disagreeing. 
 
 EYE OF THE CHILD 
 
 Kittens are born blind. When seven days old they get their sight. Such^ 
 at least, is what I learned as a boy. One statement is an exaggeration. The 
 other is less than the truth. Kittens when born are nearly, though not 
 totally, blind. They have no caul over their eyes. Their eyes are merely 
 unseeing. Sight does not suddenly come to them at seven days. It comes 
 little by little. At the end of seven days they see poorly. 
 
 Bad as that seems, the case is worse with babies. They are born blind, or 
 practically so. Not that there is a caul for witchcraft to remove. The eye 
 as a piece of mechanism is as complete as it will ever be. Eays of light 
 enter it. Images are formed on its mirror. But no impulse travels from 
 the eye to the brain. 
 
 At the age of 3 months the brain and the eye have hooked up enough so 
 that the baby will watch a bright light. Not until the normal child is 7 
 years of age is the eye normally good. After that the sight may train on. 
 Apropos of this Dr. Shaw tells us that to Professor Lowell, whose sharp 
 vision permitted him to discover important details about the canals on Mars, 
 the ordinary man was telescopically blind. 
 
 There are some eyes which are perfect in appearance, and in which 
 careful examination shows no defect, which are incapable of good sight — at 
 least without special care. For some of these nothing can be done; for some 
 much can be done. If they could be picked out at the beginning of school life 
 and then taught with the development of sight in mind, they could become 
 efficient. 
 
 At the same meeting at which Dr. Shaw discussed this group of children 
 with poor sight Dr. Parke Lewis discussed the reasons for nearsightedness in 
 school children. The f arsighted eye is one that is too shallow ; the nearsighted 
 eye, too deep. 
 
 "The shape of the eye, as has been shown by careful measurements of the 
 
818 
 
 THE BABY 
 
 cranial bones, 
 inherited from 
 
 s~\ 
 
 / 
 
 id 
 
 \U 
 
 u 
 
 \ 
 
 is determined by the shape of the skull, and this in turn is 
 our ancestors." 
 
 Most babies are farsighted — their eyes are shallow. 
 If they try to look at near objects their eyes cross. It is 
 rare, however, for a baby's eyes to show the effects of 
 strain. They do not use them enough. By the time school 
 age is reached the bones of the face and head have deter- 
 mined the shape of the orbit. The eye is often found to 
 be too deep — nearsighted. 
 
 Whatever may be its variation from the normal — be 
 it nearsightedness, farsightedness, or astigmatism — the 
 strain of routine school work causes a "tugging at the 
 sensitive portion of the eyeball." Certain fibers begin to 
 stretch. Hence, as Dufour has said, "The number of 
 shortsighted pupils increases from class to class. The 
 degree of shortsightedness likewise increases." 
 
 The remedy for this proposed by Dr. Lewis is that 
 the sight of all children be examined at the beginning of 
 school life, and that those whose eyeballs show that they 
 are destined to shortsightedness be taught without books 
 or with little book work. 
 
 WEANING THE BABY 
 
 Sooner or later the nursing baby must be weaned. 
 It must learn to build its bones and muscles out of the 
 materials provided by nature. Sucking is very often cut 
 short, and, not infrequently, unduly prolonged for the 
 pleasure of the mother, This is wrong and injurious. 
 The good of the child should be the only consideration, 
 providing the mother is healthy. 
 
 When should a baby be weaned? Most nursing 
 mothers are careful not to wean their babies during the 
 hot summer months, which is a very good practice. Other 
 considerations which are of equal and perhaps greater 
 importance are little known and hardly ever taken into 
 account by the great majority of nursing mothers. 
 
 A healthy child should ordinarily be weaned between 
 the ninth and tenth months. About the sixth or seventh 
 month the front teeth appear — an indication that the 
 system of the child is getting ready to take care of other 
 food than the mother's milk. 
 
 In weakly, scrofulous children, the appearance of the 
 
 front teeth may be delayed for several months. There 
 
 also are hereditary instances of late teething. When the 
 
 baby shows its teeth it is a sign that it is preparing to take its seat around 
 
 nature's table. 
 
 Another important guide is the weight of the baby. If the baby goes on 
 
 Fig. 293.— Lactom- 
 eter for Test 
 inq Milk. 
 
WEANING THE BABY 
 
 819 
 
 increasing in weight, breast feeding can be continued till nine or ten months ; 
 if the weight becomes stationary, or, what is worse, begins to fail, the baby 
 should be weaned, irrespective of its age. 
 
 The point is that it is not a matter of age in terms of months — it is 
 rather a question of physiological advancement. Some children are as far 
 advanced at six months as others are at eight. The state of growth and 
 
 Pi 111 ft! 
 
 ilis 
 
 Fig. 294. — Simple Milk-Testing Appabatus. 
 
 ability to take care of other food are better guides than the mere age of the 
 child. 
 
 Ordinarily breast nursing should not be prolonged after the tenth month. 
 If the mother suffers from any serious illness, 
 acute or chronic, it is best to wean the child 
 earlier. Pregnancy also necessitates earlier 
 weaning. 
 
 As to the season, the best time to wean 
 a child, everything else being equal, is in early 
 spring or fall. Keeping the child out in the 
 open air is very soothing to its irritated ner- 
 vous system at the time of weaning. 
 
 A child should be weaned gradually. 
 Sudden weaning, much practiced in former 
 years, does much harm to mother and child. 
 
 When the first teeth appear, along in the 
 sixth or seventh months, a healthy child should 
 be given some other food besides the mother's 
 milk at stated intervals. Four ounces of milk, 
 with the addition of two ounces of barley 
 water, may be given. In about a week these 
 
 Fig. 295. — Chapin Dipper for Re- 
 moving Top Milk. 
 
820 THE BABY 
 
 feedings may regularly alternate with the nursings. After a while a little 
 chicken or beef broth may be added. 
 
 If the child is in this manner gradually accustomed to take other food, 
 it will sometimes voluntarily give up the breast. At any rate, the breast 
 will not be missed much when it is entirely withheld. The cases where the 
 child will refuse to take other food than its mother's milk are rare and require 
 expert management. Thus managed, there ought to be no evil results to the 
 child from weaning. 
 
 A frequent source of trouble and disease at this period is an oversolici- 
 tous mother, who thinks that the baby always is hungry and will give it too 
 much food. The more food the baby gets the more irritable it becomes, and 
 it cries, not of hunger but because of overfilling, pain, and discomfort. This 
 cry frequently is misinterpreted, and more food is given, and a vicious circle 
 is established. 
 
 The diet after weaning should consist of milk and barley or oatmeal 
 gruel, chicken or beef broth, some stewed fruit, orange juice, zwieback, and, 
 a little later, some soft-boiled eggs. 
 
 Last but not least, give the baby plenty of water to drink. 
 
 WEIGHT DISTURBANCE IN BABIES 
 
 The babies who come in the class suffering from so-called' weight disturb- 
 ance are artificially fed. Earely does the condition develop in the breast-fed. 
 Dr. Grulee says that this is a disease of babies of the well-to-do"and that it is 
 much more frequent in winter than in summer. 
 
 The reason for this is that it is in a certain sense a midway condition. 
 The babies are not right, but then they are not very ill. The same condition 
 developing in the baby of a poor person or developing in a baby in hot weather 
 would go on to a more serious form of trouble. 
 
 The two outstanding symptoms are constipation and fretfulness. Com- 
 monly, the mother tells of how her fat baby seemed to be thriving except 
 that he was constipated. A while back she thought he was doing extra well, 
 as his weight increased rapidly. Suddenly the increase in weight stopped. 
 Now for several weeks he has not gained, not even an ounce. 
 
 Oh, yes, she will say, he was fretful. Somehow she could not find out 
 what he was fretting about. Maybe it was gas, as a fair amount passed. 
 Latterly she has noticed that his urine smelled like ammonia. 
 
 Yes, there was some tendency to eruption. The urine was strong and 
 had chafed around the buttocks. Somehow dusting powders would not keep 
 the creases from getting sore. She could not see why he was not growing 
 and thriving, as his stomach was not upset, his food was agreeing, and he was 
 fat. 
 
 The trouble with this baby is that he is not digesting the fat in his milk. 
 In the intestines the undigested fat is being changed to fatty acids. These are 
 absorbing alkalies from the system. The peculiar looking stools are mostly 
 fatty soaps caused by undigested fat. The system, robbed of its alkali to 
 make these soaps, is overacid. That causes the ammonia in the urine. The 
 scientists call this overacidity — acidosis. 
 
FEEDING BABIES 
 
 821 
 
 What must be done is to give the baby less cream. Commonly they 
 start the baby on the proper amount of skimmed milk properly diluted. In a 
 few days a little whole milk, an ounce or two a day, is substituted for some 
 of the skimmed milk. The addition of whole milk to the diet must be done 
 very slowly. A little ought to be added and the result watched for a day or 
 two before it is tried again. If the stools show fatty or chalky masses the 
 whole milk must again be withdrawn. 
 
 But energy without fat is not possible unless something replaces it. The 
 first carbohydrate to be tried as a substitute for fat is malt extract, say half 
 an ounce a day. This can be increased for a few days, and then everything 
 going well malt food can be substituted. Barley water can be given in place 
 of plain water. 
 
 Older babies can have cereals or cereal gruels. The child must be kept in 
 the open air as much as the weather will permit. Good air is almost as neces- 
 sary as good food. Care should be taken to keep the skin clean. 
 
 FEEDING BABIES 
 
 There are those who hold that the methods of preparing milk for the ar- 
 tificially fed baby have been too complicated. On the one hand they have 
 been too complicated for the 
 best interest of the baby. On 
 the other hand, they have 
 seemed so difficult that many 
 mothers have given their 
 babies condensed milk and 
 baby foods. They had no 
 hope of being able to make 
 the more complex mixtures. 
 
 A simpler method is be,- 
 ing advocated by some of the 
 best medical men in the coun- 
 try — a method so simple that 
 no one need hesitate to under- 
 take it. This method is not 
 intended for mothers who 
 can nurse their babies. If a 
 mother can nurse her baby 
 she had better do so. It is 
 better for baby. It is less 
 trouble for the mother. 
 
 A good system and one 
 that is widely used consists 
 of a series of nine strengths. 
 No. 1 in the list consists of two ounces of 7 per cent milk, one ounce of milk 
 sugar, one ounce of limewater, and seventeen ounces of boiled water. No. 9 
 consists of ten ounces of 7 per cent milk, three-quarters of an ounce of milk 
 sugar, one ounce of limewater, and nine ounces of boiled water. 
 
 Chicago Health Dept. 
 
 Fig. 296. — Breast Pump in Use. 
 
822 
 
 THE BABY 
 
 Between these two extremes there are seven mixtures as the series pro- 
 gresses from one to nine. The quantity of milk increases one ounce a step and 
 the quantity of water drops correspondingly. 
 
 Seven per cent milk is milk containing 7 per cent fat. It can be 
 bought as 7 per cent milk or it can be roughly guessed at by taking 
 the top pint of a quart of ordinary milk or the upper twenty-two ounces of 
 Jersey milk. 
 
 Weighing, measuring for these mixtures, and changing them as the baby 
 gains in age, appears formidable. Possibly it is not so complicated, but at 
 least it appears so. To get away from this is one of the reasons for the simpler 
 system proposed. However, it is not the only reason. Its advocates claim 
 that the simpler mixtures are more easily digested and nourish better. 
 
 The Simpler System. — The basis 
 of the system is that in children 
 under a year of age one and a half 
 ounces of good, clean, fresh cow's 
 milk will furnish all of the food nec- 
 essary for growth, heat, and energy 
 for a pound of baby for twenty-four 
 hours. Then the first step is to weigh 
 the baby. The baby's weight in 
 pounds multiplied by one and a half 
 gives the number of ounces of milk 
 needed by the baby in twenty-four 
 hours. 
 
 As the result of very careful de- 
 terminations by scientific men, one of 
 whom is Rubner, the man who is re- 
 sponsible for the feeding standards in 
 use in the German empire during this 
 war period, it has been found that a 
 baby needs about forty-five calories in 
 a day for each pound of its weight. 
 One and a half ounces of good milk 
 with the cream on it is a little short 
 of the required number of calories. 
 Instead of using more milk the calo- 
 ries are gained by adding some sugar. 
 The reason that more milk is not used 
 is because one and a half ounces con- 
 tains enough protein, the food needed 
 for growth, and more than that 
 amount of milk would furnish more protein than the child needs. 
 
 Making Energy. — The necessary energy in younger babies may be fur- 
 nished in the shape of ordinary cane sugar, milk sugar, or malt sugar. Grulee 
 says the best of these is malt sugar, though various forms of starchy foods can 
 be given slowly to displace it at any time after the third month. 
 
 In babies over three months old the day's food can start with one-half 
 ounce of malt food and this, within two weeks, can be increased to one ounce. 
 
 Chicago Health Dept. 
 Fig. 297. — Diagram Showing Construction 
 of Breast Pump. 
 
FEEDING BABIES 
 
 823 
 
 We have, then, for a baby weighing ten pounds fifteen ounces of whole milk 
 to which has been added one ounce of malt food. 
 
 The next question is how much water should be added to it. To determine 
 this it is necessary to know how many ounces a baby should eat in a day. 
 How many times shall baby be fed and how much at a time? The capacity 
 of the stomach at different ages according to 
 Holt is as follows: 
 
 At birth, 1J to 2 ounces. 
 
 At three months, 4-| ounces. 
 
 At six months, 6 ounces. 
 
 At one year, 9 ounces 
 
 The next question to settle is the number 
 of times a baby should be fed. The authori- 
 ties are all in favor of long intervals between 
 feedings. Of course, the policy of feeding a 
 baby every time it cries or in order to put it 
 to sleep is not followed now by anybody who 
 is well informed. 
 
 The only people whom I have heard ad- 
 vocate it in recent years are a few women who 
 thought they knew because of practical experi- 
 ence. When asked what the practical experi- 
 ence was they said they had had large families, 
 some of them ten children. When asked how 
 many of their children had died teething they 
 answered, four, five, six, some of them nine 
 out of ten. 
 
 Intervals of Feeding. — The stomach must have plenty of time to digest 
 one feeding, empty itself, and rest before a new feeding is given. A baby's 
 stomach cannot finish the digestion of milk in two hours. Therefore when 
 a baby nurses within two hours of another nursing the fresh milk and the 
 
 Fig. 298. — Arnold Sterilizer. 
 
 Kansas State Bulletin. 
 
 Fig. 299. — Out-of-Door Pen. 
 
 partly digested milk are mixed, but what is of more consequence, the stomach 
 is kept continuously at work. Everything in nature rests at intervals or 
 breaks down. 
 
824 
 
 THE BABY 
 
 The interval agreed on by those who know best is four hours. If a newly 
 born baby is begun on this basis it is simple enough. It becomes his habit. 
 When one has started in on another habit the problem is somewhat more 
 difficult. The feeding hours are six o'clock, ten, two, six, and midnight. This 
 means a four-hour interval during the day and a six-hour interval at night. 
 After the baby is six months old the night feeding can be shifted to ten 
 o'clock, which makes an eight-hour interval at night. 
 
 The long interval between feedings gives the* stomach plenty of time to 
 complete digestion of the milk and to get a good rest before the next working 
 time. 
 
 The long interval plan is not new. It has been tried out for years in 
 
 Kansas State Bulletin. 
 
 Fig. 300.— The Right Way. 
 
 this country. Most of us have heard of the success of Australian and New 
 Zealand mothers with their babies. Only one out of every twenty-four of their 
 babies die. They use the four-hour plan. 
 
 With five as the number of feedings and the amount of each feeding for 
 each age known, it is very easy to calculate the amount of food required for 
 the twenty-four hours. In practice Dr. Grulee holds it advisable to give a 
 little more food at each period than is indicated by the size of the stomach 
 in the 'table by Dr. Holt. He gives to a baby three months old five ounces ; 
 six months old, seven ounces; nine months old, nine ounces. Children be- 
 tween these ages take a quantity between these measures. 
 
 Amount of Food. — Using these figures as a basis, it is easy to figure 
 the amount of food required. For instance, a baby six months old will 
 take five times seven, or thirty-five ounces of food in the twenty-four hours. 
 If the baby weighs fourteen pounds his daily food supply would consist of 
 twenty-one ounces of milk and one ounce of malt food. In order to bring this 
 
FEEDING BABIES 
 
 825 
 
 up to the quantity required, thirty-five ounces, it will be necessary to add 
 fourteen ounces of water. 
 
 A baby nine months old, weighing fourteen pounds, would take forty-five 
 ounces of food, consisting of one ounce of malt food, twenty-one ounces of 
 milk, and twenty-four ounces of water. 
 
 In the first place, this plan is simpler and easier from the standpoint 
 of the mother. In the second — and this does not appear on the surface — it 
 does away with the very elaborate calculations as to percentages of fat, pro- 
 tein, sugar in cow's milk and human milk, upon which the older formulas 
 were based. The foundation of the newer plan is simpler, as well as its super- 
 structure. 
 
 Not even age and weight are inflexible guides as to how much a baby can 
 
 Kansas State Bulletin. 
 
 Fig. 301.— The Wrong Way. 
 
 or should eat. If a baby fed on this plan does not gain in weight, has no bowel 
 trouble, and goes at his fists as if he was hungry, this mixture should contain 
 a little more milk and a little less water. If he gets too fat, or has colic, or 
 spits up his food, or gets an eczema, he should have a little less milk and a little 
 more water in his mixture. 
 
 Older Infants. — After the baby passes nine months of age the problem 
 of feeding becomes much simpler to the careful mother. To the careless one 
 the hazards are greater than when the babies were younger. 
 
 What is meant is this : An older baby has very much better digestion 
 than a younger one, but the advantage is often more than offset by permitting 
 the child to eat without regard to the digestibility of the foods eaten. 
 
 After the ninth month a thick starch gruel, consisting of one-half ounce 
 of barley flour, oatmeal, or flour ball to a pint of water may be added to the 
 diluted milk. After the tenth month a strained vegetable soup may be added. 
 
 A vegetable soup recommended by Grulee consists of a handful of spinach, 
 
826 
 
 THE BABY 
 
 a large beet, and two carrots in a quart of water, boiled two hours, strained 
 and diluted to a quart. About this time meat juice may be added. Orange 
 juice may be begun in babies as young as 3 months of age. 
 
 The proportion of milk to the weight of the baby should be allowed 
 gradually to decrease. The rule is to give one and a half ounces for each 
 pound of weight. In the latter part of the time the child is at the bottle it 
 is a good idea to decrease this proportion. For instance, when the child is 9 
 months old, to make it one and a third ounces in place of one and a half. 
 
 Later one and a quarter ounces is enough. 
 It is never advisable to give a young child 
 more than a quart of milk a day. 
 
 Second Summer. — The opinion is 
 general that the second summer is the time 
 of greatest hazard to the baby. It is a 
 period of great hazard, but it need not be 
 so. In the case of about half the babies, 
 those born in the spring and summer, the 
 first summer is not a teething period. The 
 second summer is a teething period for all 
 babies. 
 
 The food during the first summer is 
 entirely in the hands of the parents. That 
 of the second summer is sometimes contrib- 
 uted to by outsiders ; the child himself may 
 slip something unawares; the parents are 
 disposed to be less careful the second sum- 
 mer than they were the first. 
 
 During the second year milk should 
 continue to be the chief element of diet. 
 The first additions are usually fruit juices, 
 crackers, and cereals. At the fifteenth 
 month spinach, beets, carrots, and potatoes 
 may be given. Meat juice, thinner gravies, 
 and butter are given to advantage. At 
 about eighteen months chicken, meat, and 
 fish, finely chopped and well cooked, may 
 be added. The habit of giving the child 
 a bone to suck as a method of starting the 
 use of meat is a good one. 
 
 Under Three Months. — Feeding a 
 baby under three months of age will not. 
 concern many readers of this volume. In 
 the first place the great majority of mothers breast feed their babies for three 
 months. The milk generally holds out that long even in the mothers who 
 have a poor milk supply. In the second place the feeding of a baby under 
 three months of age is a matter of such skill and varies so much in the indi- 
 vidual case that most people are anxious to leave* it to skilled baby feeders. 
 
 There is some difference of opinion as to whether a baby should have 
 any food in the first twenty-four hours of its life. I think the majority are 
 
 Kansas State Bulletin. 
 
 Fig. 302. — Cuts Showing Deciduous 
 Teeth: 1, central incisors. Crown 
 calcified before birth, erupted 5-8 
 months after birth; 2, lateral incisors. 
 Crown calcified before birth, erupted 
 7-10 months after birth; 3, cuspid 
 (eye tooth). Crown calcified by 3 
 months after birth, tooth erupted 
 14-20 months after birth; 4, first 
 molar. Crown calcified by 6 months 
 after birth; tooth erupted 12-16 
 months after birth; 5, second molar. 
 Crown calcified by 6 months after 
 birth, tooth erupted 20-32 months 
 after birth. 
 
FEEDING BABIES 827 
 
 of the opinion that it should not. Plain water, unsweetened, is better than 
 sugar water. 
 
 During the remainder of the first week Dr. Grulee offers the baby three 
 ounces of a mixture half milk and half water. To a seven-days-old baby 
 weighing eight pounds he gives eighteen ounces of milk and water, half and 
 half, in six feedings. A fourteen-day-old baby weighing eight pounds gets the. 
 same mixture with the addition of one-quarter ounce of malt food. A two- 
 months-old baby weighing ten pounds gets milk, twelve ounces; water, ten 
 and one-half ounces; malt food, three-quarters of an ounce, in five feedings 
 of four and one-half ounces each. 
 
 FEEDING SICK BABIES 
 
 If it were possible to obtain an accurate record of baby sickness it would 
 be found that many babies get sick in June and the early part of July, though 
 the baby death rate does not begin to show much rise until after the middle 
 of the latter month. 
 
 The asylums, sanitaria, hospitals, and baby tents find that the children 
 who are severely sick in midsummer give a history of mild sickness in the 
 early summer. It is the old, old story of the "stitch in time saving nine/' 
 
 Loose bowels, green stools, mucus, and blood cannot be neglected with 
 any degree of safety after June 15 in this climate and June 1 in warmer 
 climates. The child may seem to be happy, not upset by the little indigestion, 
 and it may seem useless to worry about so trifling a matter. But, unless 
 these trifles are attended to, things will get worse as the weather gets hotter 
 and, presently, the baby is in a condition where no food seems to agree with 
 it and no doctor seems to help it. The mother must carry on her long, weary 
 fight to keep the poor, skinny baby alive until the nights get cool in October. 
 
 The first thing to do when the baby gets sick is to stop feeding it. Prob- 
 ably the milk is bad anyhow. But, whether it be good or bad, it will disagree 
 with a sick baby. In place of milk the baby should take clean water from a 
 clean bottle or a clean cup. If the trouble keeps up there are milk substitutes 
 which can be given until it is safe to give milk again. The physician or nurse 
 will demonstrate how these are made. 
 
 The next step, after stopping the food, is to empty the child's intestines 
 of all fermenting, decomposing food. The parent is justified in going as 
 far in this line as the use of oil by the mouth and of simple enemas by in- 
 jection. If relief does not come when these have acted the mother is not 
 justified in going further. She should get help from a physician or nurse. 
 Caring for a sick baby is so largely "doing and showing/' as contrasted with 
 "telling," that a nurse is needed more than would usually be the case. 
 
 As the child goes back on milk let it be watered milk or good butter- 
 milk. If the first feeding agrees, let the next be slightly less watered, and the 
 next still less, until within a few days the diet is one proper for the age and 
 season of the year. Occasionally a mother continues to give watery milk 
 after the acute trouble has subsided and the baby in a few weeks shows signs 
 of starvation. 
 
 Remember — a baby with indigestion can be starved by overfeeding. The 
 indigestion passed, it may be starved by underfeeding. 
 
828 
 
 THE BABY 
 
 SELECTION OF BABY FOOI5 
 
 Many thousand women cannot get ice with which to keep the hahfs 
 supply of cow's milk. They have no mother's milk. They cannot do the 
 best thing; they cannot do the next best thing; they must choose further 
 down the line. 
 
 WHAT KILLS THE BABIES 
 
 this 'diagram shows the chief causes of death among 
 
 Children Under Two Years of Ase and the Ratio 
 
 of Each Cause to the Total Deaths 1n This Age Division. 
 
 •In eoch 100 deaths among children under 2 years of age 37 are caused 
 fey diseases of the digestive system ; 23 by the iropure-air diseases t 19 by 
 defects and accidents at birth; 9 by acute contagious diseases* 3 by diseases 
 of the nervous sqstcm; 2 by, tuberculosis i 2 by, violence » I by venereal diseases t etc. 
 
 70 Percent of Such Deaths Cati 
 
 ^AVOIDED - 
 
 With Proper Care 
 
 
 Pebcent op 
 
 Tota 
 
 5 j 
 
 u r D£/ 
 
 . 2 
 
 iTHS I 
 5 ■ 
 
 MDER 
 
 
 ?Ybs. 
 
 5 4 
 
 
 
 j Chief causes of death a- 
 1 mono children under 1 
 1 years of age an& the propor- 
 tion each contributes to W 
 total at this age period. 
 
 DIARRHEAL DISEASES 
 and Other Diseases 
 of Disestivc System 
 
 1 
 
 
 
 
 
 
 
 Diarrheal Disease* sa.6% 
 Convulsions t(,% 
 Gastritis ••*% 
 Other Dis. of Digestive Sys. 1.47. 
 
 
 
 
 
 
 
 
 
 impure-Air Diseases 
 
 
 
 
 
 
 i 
 
 
 
 
 Pneumonia 16.47. 
 Bronchitis b£l 
 Influenza -0.47. 
 
 
 
 
 
 3^22 
 
 
 
 
 
 
 Congenital Defects 
 and Accidents 
 
 
 
 
 
 I9L2 
 
 
 
 
 
 Premature Birth 127. 
 Congenital Debility 407. 
 
 
 
 
 
 | Injuries el Birth IA% 
 1 Other Defects ot Birth 5.97. 
 
 Acute Contagious 
 diseases 
 
 
 
 7 
 
 
 
 
 
 
 | Diphtheria 2.77. 
 | Scarlet Fever 117. 
 
 
 
 
 
 
 Measles 1,1 7! 
 
 Diseases of NERVOUS 
 
 SYSTEM 
 
 ■3. 
 
 > 
 
 
 
 
 
 
 
 
 Meningitis (simple) 2.47; 
 Other Dis. Nervous Sys. «-77. 
 
 TUBERCULOSIS 
 
 ■ Z-2 
 
 
 
 
 
 
 
 
 
 Tubercu losi » - Lungs 0.7 7. 
 
 . Meninges. 1.07. 
 
 Abdominal , o.l-r 
 
 All Other a3 7. 
 
 VIOLENCE 
 
 ■•7- 
 
 
 
 
 
 
 
 
 
 Accidents- 1.27. 
 Suffocation 0.2T. 
 Burns and Scalds 0.57, 
 Falls ai% 
 
 Homicide a5% 
 
 VENEREAL DISEASES 
 
 „ 
 
 
 
 
 
 
 
 
 
 Syphilis 107. 
 Gonorrhea 0.17, 
 
 DISEASES op URINARY 
 SYSTEM 
 
 |0.6 
 
 
 
 
 
 
 
 
 
 Nephritis 0S7. 
 Other Dis. Unnory Sys. 0.1% 
 
 Rickets 
 
 |06 
 
 
 
 
 
 
 
 
 
 Rickets ®«7. 
 
 Diseases of heart 
 
 and BLOOD VESSELS 
 
 |05 
 
 
 
 
 
 
 
 
 
 Heart Diseases 03% 
 Other Circulatory DiS. 0.2^ 
 
 ERYSIPELAS 
 
 |0.4 
 
 
 
 
 
 
 
 
 
 Erysipelas 0*1 
 
 all Other Diseases 
 
 HM 
 
 
 
 
 
 
 
 
 
 Tetanus and Trismus «S% 
 Pyemia and Septicemia ft»% 
 AH other causes 19% 
 
 Department op Health, 
 
 Chicago. 
 Popular Education Series 
 No.5 
 
 Fig. 303. 
 
FEEDING BABIES 829 
 
 To help this large number of mothers much investigation has been going 
 on in recent years. Conclusions are far from being final, but they are point- 
 ing in certain directions. 
 
 A baby food must contain milk in some form. The investigations point 
 definitely that way. A recent study of four foods, made by research workers 
 at the University of Illinois, showed this quite well. They fed mice on 
 Horlick's malted milk and Nestle's food, which contain dried milk, and with 
 two other foods which contain no milk. 
 
 They observed the mice, as to whether they kept up their weight, grew 
 properly, and bore young capable in turn of bearing healthy young. Or, to 
 put it another way, they would divide a batch of young mice into two groups. 
 One group was fed on ordinary mixed food, the other on food under test. The 
 members of the two groups were weighed, measured, and closely observed at 
 regular intervals. The number of young and the conditions of the young 
 were noted. 
 
 As the second generation approached maturity the test young were divided 
 into two groups. One was fed on the test food, the other on ordinary food. 
 The number and condition of the third generation were counted and ob- 
 served. 
 
 In this way the research workers determined whether the test food pro- 
 duced fat, supported growth, made possible the breeding of sound progeny, 
 with sufficient vitality to grow up and themselves produce sound progeny. 
 
 The milk foods stood the test. The foods in the manufacture of which 
 no milk is used did not. 
 
 The teaching of this experiment is that where a mother is selecting a food 
 for her nursing baby she should read the label carefully and select one made 
 wholly or partly from milk. This refers to the use of milk in the manufacture 
 of the food. If the food must be mixed with milk at the time of use it has 
 no advantage over the use of milk. 
 
 A baby food which is a dry powder will keep better than one that is 
 liquid or nearly so. After a can of evaporated milk is opened it spoils rapidly. 
 It is not safe, therefore, to use evaporated milk unless it can be kept as cool 
 as tap water will keep it. It must be kept clean. After a can of condensed 
 milk is opened it spoils slowly. It must be kept cool and clean. A dry, 
 powdered food is much easier to keep. 
 
 MERIT OF BABY FOODS 
 
 • 
 
 Most babies get mother's milk until they are eight months old. Many 
 babies are not so fortunate, however. There is a very large group, composed 
 in part of babies under eight months and in part of the older babies, which 
 must depend on cow's milk and other baby foods. 
 
 In this group there are two smaller groups that do not thrive on cow's 
 milk. These are: (1) babies who can get nothing but ordinary city raw milk 
 and (2) babies in whose homes there are no facilities for keeping the milk 
 cold. It matters not whether the milk be certified, pasteurized or raw, it will 
 not keep unless it be cold. 
 
 Some of these families can be provided with ice. Where ice is not avail- 
 able, then what? Evaporated milk, condensed milk, or some baby food. 
 
& 
 
 01 
 
 
 O -P! . 
 
 n^ C: 9 ^ 
 
 *> O X. 
 
 fc c^ a. 
 
 •Sll^o" 
 
 tC.S ^ vn > 
 
 I 
 
 ^ a. 
 
 *CS ^ CJ ^-S *> 
 
 OCl^Cl OQ. c^ 2^ ^ o 
 
 S o § S3 
 
 k. "V-jt 
 
 "a3J.VM 
 
 
 r\tU 
 
 85 
 
 VDlU 
 <*« 
 
 ^£ 
 o-iu 
 
 KcQ 
 
 830 
 
FEEDING BABIES 
 
 831 
 
 Whenever we study statistics relating to baby welfare we find a dispro- 
 portionate sickness rate among the babies fed on these foods. Bnt we must 
 remember that these comparisons are between the babies on mother's milk, 
 iced milk, and uniced condensed milk. A fairer study would be between 
 
 WHY, OH NHY PASTEURIZE 
 IF YOU DON'T SWAT THE FLIES! 
 
 COME. OK IN, 
 FELLOWS, ITS 
 STERI 1_»21EE>. 
 
 CHICAGO HERALD 
 
 S£^ 
 
 Fig. 305. 
 
 babies fed on uniced raw milk and babies fed on uniced condensed milk and 
 uniced baby foods. But no baby doctor would dare feed a baby on raw cow's 
 milk kept uniced. It would be too risky. 
 
 It all comes back to this : In those homes where the choice lies between 
 warm milk and baby foods, the lesser evil is the condensed or evaporated 
 
832 THE BABY 
 
 milk and the baby foods. Or to put it differently, if a mother cannot get ice 
 to keep the milk during the hot days she had better give her baby some form 
 of canned food. 
 
 As between the two kinds of milk, evaporated or condensed, some will 
 prefer the one, some the other. Condensed milk is evaporated at a low tem- 
 perature. Not all bacteria are killed. The milk is then preserved by adding 
 to it 40 per cent of its volume of cane sugar. The few feeble bacteria present 
 are restrained by the sugar. Evaporated milk is evaporated at a higher tem- 
 perature in a vacuum pan. No sugar or other preservative is added. It must 
 be sterile, else it is not marketable. 
 
 Soft Spot on Head. — I. N. 0. writes: "How and whence comes the 
 small soft spot on the uppermost part of babies' heads? How long does it 
 take before it is completely hardened? What is its purpose, and is there 
 any danger in injuring or breaking it?" 
 
 Reply. — 1. The bones of a child's head begin as ordinary membranes. 
 These membranes begin to be converted into bone at centers. The centers 
 are located near the middle of the patches of membrane. The conversion 
 of membrane into bone proceeds from the middle toward the edge. By the 
 time the child is eighteen months of age the bony plates growing from the 
 different centers have met, been knitted together, and form a solid bony 
 brain box. At the time of birth this change of membrane has not been 
 completed. There are soft areas. The location of the largest of these is 
 known to every parent. The next in size is at the back of the head near 
 where the neck joins it. 
 
 2. Usually eighteen months. The range is from fourteen to twenty- 
 four months. 
 
 3. The purpose is twofold — to make being born easier and to allow for 
 rapid growth of the head after birth. To perforate the fontanelle is dan- 
 gerous, of course. However, it is not easily perforated. The membrane is 
 nearly as tough as young bone. 
 
 Shape of Baby's Head. — L. T. H. writes: "Our baby's head seems to 
 be getting fiat on the back. Will you please tell us whether it will grow 
 round again, when she sits up? She is six months old and weighs ten 
 pounds, double her weight at birth. She is perfectly well, but does not hold 
 herself up like some larger babies of the same age. Her food is cow's milk 
 and barley water." 
 
 Reply. — The head has a remarkable capacity for righting after being 
 pressed out of shape. Nevertheless, it is easy to shift the baby's position 
 frequently. • 
 
 She should not sit up for another month. Do not stimulate her to sit 
 up before she is ready. As she started small she may be a little slow in 
 sitting up. 
 
 Mouse Story Untrue. — A. J. writes: "My wife saw a mouse twice 
 on the first day she felt life within her, and the second time she saw it she 
 put her hand to her mouth to prevent an outcry. Do you think that the 
 child is likely to be marked?" 
 
 Reply. — No. Two hundred years ago it was proved that no such effect 
 was possible. Have her forget her worries. 
 
FEEDING BABIES 833 
 
 Measurements for Baby. — Mrs. M. K. writes: "I wish data in regard 
 to perfect baby 2 1 /k years old." 
 
 Reply. — The following are measurements for an average baby of 32 
 months : 
 
 Weight, 29 pounds; height, 35 inches; circumference of head, 19V2 
 inches; circumference of chest, 20 1 /£ inches; circumference of abdomen, 
 19V2 inches. 
 
 Watch out for a baby contest in your neighborhood. If you learn of 
 one where the babies are to be marked on a score card, such as that devised 
 by Dr. Clark of Waterloo, enter your baby. You will learn much, and 
 your baby may get a prize. 
 
 Broken Tooth. — Mrs. B. writes: "A baby 18 months old had an acci- 
 dent and broke one of her upper teeth. Should the root be pulled out or 
 will the second teeth push it out?" 
 
 Reply. — Leave it there. It is needed to hold the dental arch in place. 
 When the time comes the tooth below will dislodge the root unless it has 
 been absorbed in the meantime. The X-ray will show the conditions there 
 if it seems advisable to use it. 
 
 Nursing the Baby. — Mrs. C. G. writes: "1. I have not sufficient milk for 
 my baby (two months old). My health is excellent, and I eat plenty of 
 wholesome food, drink two quarts of milk a day, and plenty of water. 
 My mental condition is good, and I get sufficient rest and exercise. 2. Can 
 you give an opinion on Reed & Carnrick's Soluble Food? I use a little 
 of it every day for the baby. Is cow's milk better?" 
 
 Reply. — The German experiments show that nearly every mother can 
 be made to give enough milk for her baby. Experiments both with cows 
 and women show that no particular article of food is a milk producer. 
 Observation shows that, among people in fair circumstances, overeating, 
 by producing indigestion, makes against rather than for a full milk supply. 
 The German experiences show that the best results follow attention to 
 details, such as plenty of sleep, freedom from anxiety (for instance, lest 
 they will not give milk enough), regular and proper emptying of the 
 breasts. Are you not worrying that you may not be able to nurse your 
 baby? 
 
 2. Modified cow's milk is better. Have you Holt's, or Kilmer's, or 
 Slemons' books on baby feeding? 
 
 Let the Baby Sleep. — Young Mother writes: "Should a baby about 
 three months old be permitted to sleep six or seven hours at night without 
 nursing? Does a combined alcohol and sweet oil rubbing after each night's 
 bath do any good to the child? What rubbing do you recommend, if any?" 
 
 Reply. — 1. Let the baby sleep as long as he will. If he will go seven 
 hours at night between feedings at three months old, by all means allow 
 him to do so. 
 
 2. Do not use alcohol and sweet oil. Bathe with water and soap. If 
 there is a tendency to chafe, use a dusting powder, otherwise not. 
 
 Good Place for Babies. — E. L. R. writes: "Will you please let me know 
 what effect, if any, the climate, water, and general conditions of southern 
 California would have on a family, including a year-and-a-half-old baby, 
 moving out there from Chicago?" 
 
834 
 
 THE BABY 
 
 B 
 
 Fig. 306. — Tape Worm. A, Magnified 
 Head; B, Segments; C, Egg. 
 
 Reply. — It would be a good place for you. Babies thrive in southern 
 California. The baby death rate in that section is low. 
 
 Child Is Cross-Eyed. — Mrs. B. writes: "About two months ago my 
 two-year-old baby fell down and injured her right optic nerve. Will she 
 outgrow it? I am dreadfully worried about her. I have been bathing her 
 
 eyes frequently, and put a piece of 
 black sticking plaster at the side of 
 the eye, hoping {he color would help 
 attract the eye toward its proper 
 position again." 
 
 Reply. — The optic nerve runs 
 from the brain to the back of the 
 eyeball. It is so deeply placed that 
 falls do not hurt it. You need not 
 feel ashamed of your mistake, since 
 the myriad-minded Kipling made 
 the same mistake in his novel, "The 
 Light That Failed." 
 
 I judge your baby is cross-eyed. 
 If so, it is because the muscle which turns the eye toward the nose is too 
 strong for the one which turns it toward the cheek. Bathing will not help. 
 Sticking plaster will not help. Have the child play in the open air and 
 the trouble may get right by itself. If not, glasses may correct it. If 
 not, a simple operation will. 
 
 Cause of Worms. — Mrs. H. A. writes: 
 "What is the cause of worms in children? What 
 is the best way to get rid of them? What do 
 you think of Pape's diapepsin for indigestion? 
 Is it harmful when used regularly?" 
 
 Reply. — 1. Worms hatch from worm eggs. 
 The eggs are swallowed. One child with worms 
 is liable to infect a group. 
 
 2. For round worms nothing is more effec- 
 tive than santonin powders (two to five grains). 
 Ordinary worm medicine is effective. Other 
 kinds of worms require other treatment. 
 
 3. Let it alone. 
 
 May Do Baby Harm. — Mrs. P. M. is giving 
 her one-month-old baby three-quarters of a grain 
 of saccharin a day. Is it wise? Is the passing 
 of undigested food by a baby reason for alarm? 
 
 Reply. — 1. The government experts have re- 
 ported adversely to saccharin. There is a good 
 deal of literature published in the last few years 
 on the harm done by milk sugar in baby feeding. 
 
 I can see no reason why you should give your baby saccharin, and I can 
 see where it might do harm. 
 
 2. Undigested food is not of great consequence if the baby is gaining in 
 weight and is comfortable. Nevertheless, in raising a bottle-fed baby it is> 
 wise to take counsel with your physician periodically- 
 
 Fig. 307.— Round Worm 
 Greatly Magnified. 
 a, worm; b, head; c, 
 eggs. 
 
FEEDING BABIES 
 
 835 
 
 Left-Handed Baby. — R. H. D. writes: "Our baby boy, five months old, 
 uses his left hand a great deal in picking up his toys. Is there any way 
 to prevent him from becoming left-handedf" 
 
 Eeply. — It depends on the way the brain cells are hooked up. Inherit- 
 ance is a factor in it. You can train a child to use his right hand by 
 keeping a mitt on the left. This 
 must be persisted in to be suc- 
 cessful. When persisted in it 
 generally results in ambidexter- 
 ity, which is highly desirable. 
 
 Let Baby Sleep Out of Doors. 
 
 — C. C. K. writes: "My baby 
 was born in May and has been 
 out of doors every day during 
 the summer and fall, except when 
 it has rained. Is it advisable to 
 let him have his daily nap out 
 of doors during the winterf" 
 
 Eeply. — It is. Babies six 
 months old are good heat makers 
 and should have lots of exposure 
 to cold. The ability to catch 
 cold from exposure to cold, from 
 cold feet, wet feet, et cetera, is 
 acquired as the result of cod- 
 dling. It is frequently found in adults. 
 It, of itself, is an abnormality. 
 
 u 
 
 Fig. 308.- 
 male; 
 
 -Pinworms: a, head; b, female; c, 
 1, eggs; e, pinworms, natural size. 
 
 It is seldom found in babies. 
 
 Not Robbed of Vitality. — X. Y. Z. writes: "Kindly inform me if it 
 is in any way harmful for an infant or young child to sleep with a healthy 
 and clean grandmother?" 
 
 Eeply. — Sometimes grown people roll on infants. Many deaths are 
 caused in this way. Babies are liable to catch colds from adult bedfellows, 
 even though the adults are not sick themselves. These are about the only 
 objections. Weigh them in your case as against the advantages in a 
 domestic way. The idea that the baby is robbed of magnetism, or elec- 
 tricity, or vitality has no foundation in fact. 
 
 Avoid Use of Drugs. — Mrs. B. R. writes: "My baby, one year old, is 
 troubled with constipation. We have used maltine with cascara sagrada 
 for him. He does not seem to be improving. For breakfast I generally 
 give him a cereal and for other meals he has cream on bread and some- 
 times a white sauce on bread. What do you advise me to do about 
 himr 
 
 Eeply. — Do not give the baby cascara sagrada or any other drug habit- 
 ually. A one-year-old baby should be able to take enough water, fruit 
 juice, and oatmeal gruel to relieve constipation. Dilute the milk more. 
 Give more oatmeal gruel ; give more water, more orange juice, prune juice, 
 or scraped apple. If something must be used, use enemas and soap 
 sticks. 
 
836 THE BABY 
 
 Baby with the Colic. — Young Mother writes: "Kindly tell me what to 
 do for my baby for colic. He is now three weeks old, and has colic some 
 time of every day and night" 
 
 Reply. — Your milk is probably too rich in solids. Give the baby some 
 water just before it nurses. You should eat less food and exercise more. 
 If the condition does not improve, you had better have your doctor help 
 you to work it out. 
 
 Dandruff on Baby's Head.— J. M. writes: "What can I do for scaly 
 dandruff on three-months-old baby's head? Have used olive oil and white 
 vaselin with no avail/' 
 
 Reply. — To keep the baby's scalp oiled and cleaned helps, but it does 
 not go to the root of the trouble. A baby with head eczema needs a change 
 in its diet. Generally the food is too rich. The only treatment which 
 avails is to change the feeding and overcome constipation, and even that 
 sometimes gives results slowly. 
 
 Baby's Second Summer. — H. J. M. writes: "I notice reference in your 
 column to a baby's second summer being a hazardous period. Is it any 
 more so than any other summer, and, if so, why? Would you recommend 
 any special food?" 
 
 Reply. — It is especially difficult to hold a child to a simple diet during 
 the second summer. During the second summer a child should have fiye 
 meals between seven in the morning and seven in the evening. The diet 
 lists should be made up from milk, dry toast, crackers, cereal, rice, eggs, 
 a little meat, orange juice and other fruit juices, butter, soups, and a 
 few vegetables, such as spinach, asparagus, new peas and potatoes. 
 
 Feeding the Baby. — Mother writes: "1. Should I feed my eight- 
 months-old baby anything aside from breast milk? 2. Are Graham crack- 
 ers good? 3. (a) Will it hurt this baby to cry itself to sleep at night? (b) 
 As this seems the only method, how long should I let the baby cry? J/.. How 
 can I break the baby from nursing three or four times a night? 5. Is 
 water out of the faucet all right for the baby to drink? 6. How many 
 teeth should a baby eight months old have? 7. Does it hurt this baby to 
 stand on its feet, as it insists upon doing?" 
 
 Reply. — 1. If the baby is thriving do not feed anything beside breast 
 milk. If the baby is not growing or is hungry a good part of the time, 
 dilute cow's milk and add it to the feedings. Many mothers give milk 
 enough when baby is eight months old; some do not. 
 
 2. They will be good when the baby is a little older. 
 
 3. (a) No. (b) Until it goes to sleep. 
 
 4. Give some water, but no food, at the old times. If the baby has been 
 nursing every two hours during the night run for awhile on a four-hour 
 interval. At the end of two months it can be made to go without food for 
 six to eight hours at night. Evidently you began to train your baby wrong. 
 To teach proper sleeping and eating methods will be more troublesome now 
 than it would have been at the beginning, but it will be less trouble now 
 than if you put it off longer. 
 
 5. Yes. 
 
 6. One to four. 
 
FEEDING BABIES 837 
 
 7. If the baby is healthy and strong it will not, provided it tries to 
 stand as it wants, not as the parent wants. 
 
 Baby Improperly Fed. — Mrs. T. C. writes that her baby is a year old, 
 weighs thirty pounds and has six teeth. Lately the baby has been vomiting 
 a good deal. She gets oatmeal and milk in equal quantities (amounts not 
 stated). The baby pulls at the mothers breasts, but there is not much 
 milk — at least the mother thinks not. She is jive months pregnant. She 
 asks : 
 
 1. Is the baby's indigestion due to teething f 
 
 2. Is the food right? 
 
 3. Does allowing the baby to nurse hurt the unborn babe? 
 
 Reply. — 1. Indigestion is not due to teething. Indigestion is due to 
 faulty feeding. 
 
 2. You are overfeeding — especially starch. Your baby is too large for 
 good health. She will be certain to get in serious trouble when hot weather 
 comes unless you decrease the amount of starchy food. 
 
 3. If you keep well nourished and strong it will do the new baby no 
 harm. If you are not, it will. Remember you are feeding yourself, your 
 unborn babe, and your one-year old. If you are equal to it, as shown by 
 your own condition, keep it up. If you are thin or run down, tire easily, 
 cut off the only one you can — the one-year old. 
 
 "When the Milk Fails. — Mrs. H. E. 0. writes that she has a boy faur 
 months old. Her milk has failed. She gave boiled milk, and the baby 
 became constipated. The baby is nervous. 
 
 Reply. — When mother's milk fails, the best food is fresh cow's milk. 
 This should be either certified or pasteurized. It should be diluted accord- 
 ing to the age of the child. 
 
 It is not a bad idea to use malted milk, condensed milk, and baby 
 foods during the hot weather. Particularly is this true if you are not 
 certain that your cow's milk is clean, cold, and fresh. But such foods are 
 not well enough balanced for feeding continued over a long time. 
 
 The constipation should be corrected by orange juice, two or three table- 
 spoonfuls a day. Water should be given. 
 
 Do Not Boil It. — Mrs. S. B. writes: "Should one boil certified milk 
 for a baby five to six months old? At what age can a baby sit up in a high 
 chair?" 
 
 Reply. — 1. If you are certain the certifying is not a fake, do not 
 heat the milk at all. If you are not certain, pasteurize it, but do not 
 boil it. 
 
 2. Seven months. 
 
 More Fruit for Baby.— F. G. T. writes: "My baby, 11 months old, is 
 troubled with constipation. I feed him soft boiled egg, Graham crackers, 
 oatmeal, bread, orange and prune juice, and milk. He drinks one quart of 
 milk a day. Can you advise as to any change in his diet to overcome this? 
 Otherwise he has always been healthy, and is growing splendidly." 
 
 Reply. — Make no radical changes. Give him water several times a day. 
 Try a baked apple. Give more fruit, beef juice, meat and bread. You 
 may have to give him less milk to get him to eat more of the bulkier 
 foods. 
 
838 THE BABY 
 
 Mother's Milk.— R. T. E. writes: "I am a mother of a baby three and 
 one-half months old. My supply of milk is scant. I would like to know 
 what the simple things are to make milk." 
 
 Keply. — First, freedom from worry and anxiety, above all, fear that 
 the milk will dry up. Second, regular sleep and plenty of rest. Third, 
 plenty of plain, wholesome, nutritious food. No one kind of food is ma- 
 terially better than any other. Fourth, regular nursing at intervals of less 
 than six hours. 
 
 Feed Baby Now. — Anxious writes: "I have a baby girl sixteen months 
 old. I fully intended weaning her at the year, but friends advised not to 
 do so until she had her stomach teeth. Thinking she would have them 
 before the warm weather came, I kept on nursing her. As she hasn't got 
 them yet, I am at a loss to know whether I should wean her or nurse her 
 through the summer. She has the four upper and lower, also her three 
 double teeth, and the fourth is just about through. She has had no trouble 
 with her teething, and she has been well ever since she came." 
 
 Keply. — She will be twenty-two months old by cold weather. You will 
 hardly have milk that long. You had therefore better start feeding her now. 
 
 Feeds Baby Too Much. — H. C. writes: "My baby weighed eight pounds 
 at birth. He weighs thirteen pounds at four months. Per gleanings from 
 your 'How to Keep Well' articles, I am supplementing the breast by three 
 ounces of Horlick's malted milk, a teaspoonful at a time. The baby has 
 eczema on face and scalp in three places that do not yield to Cuticura. 
 Could he be fed beef broth to supplement?" 
 
 Keply. — You are feeding too much. The gain in weight and the 
 eczema both prove it. The baby is too young to be taking so much carbo- 
 hydrates. Why supplement with anything? If necessary to use anything 
 give one cow's milk feeding properly diluted. 
 
 Weaning the Baby. — Mrs. H. writes : "My baby boy is eight and one- 
 half months old and I nurse him. Now I find myself pregnant again. 
 1. Is it necessary for me to wean baby? 2. If so, what shall I feed him?" 
 
 Reply. — 1. Decide this question by whether the baby is thriving or not 
 and whether you keep in good condition. You probably will have to wean 
 him before cool weather anyhow, and you might as well start now. 
 
 2. Diluted pasteurized milk. 
 
 Nothing to Do with the Moon. — Mrs. F. K. writes: "I wish it might 
 be possible if you see fit to have an article on 'Weaning a baby by the sign 
 of the moon,' as I know from my experience there is everything in it. I 
 weaned my baby the seventh of September and never had one bit of 
 trouble. A friend weaned hers the week after, and the poor little thing 
 cried for a day and night." 
 
 Keply. — There is nothing in it. The moon is not mixing up with 
 babies and babies are not mixing up with the moon. The mother who is 
 weaning her baby should watch the baby closely and let the moon go hang, 
 for a baby whose food and habits are being radically changed needs close 
 attention. 
 
 Conclusions drawn from one or two experiences are usually misleading. 
 
 Why one of these babies did well and the- other poorly I do not know. 
 
FEEDING BABIES 839 
 
 Maybe one naturally had a better digestion than the other. Maybe one 
 got cleaner, fresher cow's milk than the other. Maybe one was more in- 
 telligently handled than the other. 
 
 The apparent relation to the moon was coincidence rather than cause 
 and effect. It is not the first time, by long odds, that coincidence has 
 been confused with cause. We should always be careful not to draw con- 
 clusions from too few observations. It makes trouble for us. 
 
 January Good Weaning Time. — Mrs. C. R. F. writes : "I wish to wean 
 my 9y2-months-old boy, who is in the best of health, and would thank you 
 to advise me what food would be best for him and whether he should be 
 fed at regular intervals or whenever he is hungry." 
 
 Reply. — January is a good weaning time, though 9% months is a little 
 early. Use 13 ounces of milk, % ounce milk sugar, 1 ounce lime water, 
 6 ounces gruel. Give orange or prune juice every day. Feed at regular 
 intervals of four hours. Do not feed from 10 o'clock p. M. to 6 o'clock a. m. 
 If he does not thrive, get medical counsel. 
 
 Bowlegs in Babies. — Mrs. E. G. H. writes: "Would you kindly inform 
 me if there is a cure for bowleg gedness in a child of two years? What 
 causes it? Will it correct itself if left alone, or would you advise braces?" 
 
 Reply. — Bowlegs result from putting weight on legs the bones of which 
 are not yet firm enough. The weight and the pull of the muscles cause the 
 legs to bow out, bowlegs, or bend in, knock knees. Why are the bones too 
 soft? Because of rickets. A mother who notices that her baby sweats 
 around the head, does not hold his head up well, does not sit up straight 
 as children do at his age, should suspect rickets. If his head is overlarge, 
 or his legs are not developing well, or his teeth are much delayed, she 
 should strongly suspect this condition. 
 
 Rickets should always be discovered and cured before the legs begin to 
 bow. If the legs have bowed, can anything be done ? Yes. The food must 
 be richer. Cream and butter should be added. Meat and vegetables must 
 be given. It is well to feed the milk raw. Cod liver oil can be given 
 whenever enough milk and butter cannot be taken. Life in the open air is 
 essential. The child should be kept off his feet as much as possible until 
 the rickets has been remedied. 
 
 A certain amount of bowing of the legs tends to remedy itself when 
 the rickety condition is remedied. The bones of children are not com- 
 pletely ossified and the tendency of the muscles is to pull a slightly bowed 
 bone to its normal shape. If the deformity is bad, nothing but operation 
 will cure. I do not think braces will help. 
 
 Baby Carriages. — H. 8. B. writes: "In a discussion regarding 
 baby carriages for children under two years of age, an agreed opinion could 
 not be reached in regard to the so-called baskets. It was the opinion of 
 several that the construction was such as to cause permanent injury for 
 the reason that it did not have the proper springs to prevent jarring. 1. In 
 view of your valuable advice in regard to babies, I will appreciate it if you 
 will give me your opinion on this point. 2. Also, what is the proper quan- 
 tity of certified milk for one feeding where a siob-months-old child is fed 
 every four hours?" 
 
 Reply. — 1. Will not cause permanent injury. 
 
 2. An average baby six months old should be fed in twenty-four hours 
 thirty-three to forty-two ounces of prepared milk containing eleven ounces 
 of whole milk. This should be divided among the feedings. 
 
840 THE BABY 
 
 Cause of Sty. — H. M. writes: "Will you please reply to the following 
 questions ? 
 
 "Our bahy, eight months old, seems in perfect health and weighs seven- 
 teen and a half pounds, but she has already had three sties, or gatherings, 
 on her eyelids and is getting a fourth. Can you tell me the cause of them 
 and how I can prevent their coming? What is the best thing to do after 
 they have started to gather?" 
 
 Reply. — Keep the eyelids very clean by washing them in a saturated 
 solution of boracic acid. A sty is due to bacteria infecting the lid after 
 traveling from the surface down the lash. Therefore, sometimes a sty can 
 be absorbed by pulling out the lash or lashes whose roots are infected. 
 Other than that, the child's nutrition is probably out of balance. Probably 
 she is being overfed. When bacteria travel down hairs, there is usually 
 some such constitutional reason. 
 
 No Remedy Known. — W . L. D. writes: "My boy, aged three, grits his 
 teeth at night dreadfully ; in fact he wakes me up every night, sometimes 
 several times. He eats only what a child of his age should, and for supper 
 he gets only milk or some cereal. How am I to stop the habit? I am 
 afraid he will hurt his teeth, for he grinds them together with an awful 
 force and can be heard in any of the adjoining rooms." 
 
 Reply. — If I could help you I would. Many letters asking for help 
 along this line come to this department. 
 
 I have not read or heard of anything promising. 
 
 Break Lad of Habit. — Worried Mother writes: "Is thumb sucking a 
 bad habit? My boy is nearly five years old, and has sucked his thumb since 
 babyhood. It seems impossible to break him of the habit. Does it enlarge 
 the adenoids? When not sucking the thumb his mouth is open most of the 
 time, which gives him almost a dumb expression." 
 
 Reply. — Your letter answers itself. Your child keeps his mouth open 
 most of the time and has almost a dumb expression. Break him of the 
 habit, or break a leg, else he will break your heart. 
 
CHAPTER XLV 
 
 Children 
 
 WHY IS YOUR CHILD "IT"? 
 
 Of the backward children Dr. L. B. Ayres of the Russell Sage Founda- 
 tion says: "We know them in school as the children who are always a little 
 behind physically, a little behind intellectually, and a little behind in the 
 power to do. Such a child is the one who is always f it' in the competitive 
 games of childhood.-" 
 
 He further says that when a child fails to keep up in work, study or play 
 he is being educated to consider himself not the equal of his fellows; finally 
 he becomes thoroughly trained in failure and is destined to a life of failure. 
 Even if Thomas Jefferson's fine phrases in the Declaration of Independence 
 that "all men are created equal" were true a few years on the playground 
 and in the schoolroom would make them unequal. 
 
 When a child is the "it" of a group there's a reason. It may be that 
 the cause cannot be remedied. If it can be remedied it should be. What 
 of the parent who permits his child to train for failure because of some cause 
 that can be remedied? What of the school board which permits it? or the 
 school teacher? 
 
 One of the causes is poor vision. One group of investigators has exam- 
 ined the eyes of backward children. Another group has investigated the 
 school standing of children with eye defects. The conclusions of the two 
 groups are in a general way the same. The conclusion of each group sustains 
 the conclusion of the other. A very large proportion of the backward chil- 
 dren have poor vision. A very large proportion of the children with poor 
 vision are backward. 
 
 Tens of thousands of children have been investigated. The investiga- 
 tions have been made in Europe and in many parts of the United States. 
 Some of the investigators were eye specialists, some school teachers in ordinary 
 everyday schools, and some were associated with reform schools. There is 
 no possibility that by any accident the cases were not typical. We can be 
 certain that the proportions found are about the proportions existing in the 
 schools of our town. 
 
 Dr. Shaw said before the last International Congress on School Hygiene 
 [1913] that in his experience 66 per cent of the backward children who were 
 not subnormal mentally had ocular defects. Some were nearsighted, some far- 
 sighted, some astigmatic and some had cross eyes. When the eyes were prop- 
 erly cared for the children ceased to train for failure. They ceased to be 
 the "its." 
 
 He made a special plea that something be done for the cross-eyed children. 
 
 841 
 
842 CHILDKEN 
 
 Most people believe that children outgrow cross eyes. They do not. Behind 
 the cross eyes is trouble with the vision. Generally cross-eyed children are 
 farsighted. In their straining to see in spite of their infirmity the eyes are 
 pulled out of line, sometimes one, sometimes both. 
 
 Generally the eye which is most farsighted is pulled in. As that eye 
 looks in one direction it forms one picture. The eye looking forward forms 
 another. The cross-eyed person endeavors to see two pictures at once. But 
 however capable the two eyes may be of seeing two pictures at the same time 
 the brain can register only one. 
 
 In the early days of cross eyes there is a struggle between these two 
 pictures for supremacy in the brain register. Confusion results — vision con- 
 fusion and then brain confusion. A way out must be found. The way is 
 blindness in the crossed eye. A cross-eyed man sees with the eye that is 
 looking at the object his mind is on. What the other eye sees the man does 
 not see. The result is that the crossed eye passes from usefulness through 
 incapacity into degeneration. 
 
 Dr. Shaw thinks cross eyes should be discovered when they first begin 
 to cross. To do this properly every child should have an examination of the 
 eyes before starting the first grade followed by occasional examinations 
 throughout school life. 
 
 When there are no school physicians the teacher can catch many cases 
 of squint in the very early stage by following a simple test. The pupil looks 
 intently at a sentence on the blackboard twenty feet away. The teacher covers 
 first one and then the other of the student's eyes. When the hand is sud- 
 denly removed from in front of a badly defective eye it will be noticed that 
 the eye is slightly crossed and that it will quickly jump back into line. Such 
 children should go to the eye specialist for a more careful examination. 
 
 Aside from the use of this method the teacher is in a very good position 
 to judge of the sight of the student. Dr. Baker even went so far as to say 
 "the teachers are in a better position to diagnose eye strain than the inspector 
 or nurse, not from the fact that the child cannot read the test card but from 
 the symptoms shown in the classroom during the usual period of school 
 hours." 
 
 As one can infer from the above statement by Dr. Baker there are simple 
 test cards available everywhere by the use of which a teacher can form a 
 fair idea of the vision. In addition to using these an observant teacher can 
 strongly suspect eye strain from such signs as frequent sties, redness of the 
 lids, excess of tears, intolerance of light, squinting, habitual blinking, 
 wrinkling of the brows, "crow's feet" at the outer side of the eyes, holding the 
 head sideways, bending over the work or frequent shifting of position. 
 
 Dr. Shaw told of a boy whom one teacher reported spending the long 
 school hours practically unemplo}'ed, twisting and turning about on his seat and 
 making strange grimaces. The trouble with the boy was that he had opacities 
 on his cornea. "Sitting through the school session without any intelligent 
 idea of what was going on about him, the child was simply amusing himself 
 getting glimpses of the light which streamed into the room from the various 
 windows." 
 
 Dr. Fulkerson studied the proportion of children having poor vision 
 among a lot of backward children. He found that 53 per cent of them were 
 
WHY IS YOUB CHILD "IT"? 843 
 
 deficient because their sight was bad. By remedying the defects the children 
 were able to train away from failure. He quoted others as having found 
 from 42 to 45 per cent of such children with eye defects. 
 
 Wessels says 25 per cent of school children have defective sight. The 
 percentage of children with defective sight among the backward is more than 
 double that among all children. He says that it costs $35 a year to teach 
 each pupil. It costs $280 to carry each pupil to the eighth grade. If by 
 reason of poor vision the child is backward it costs the community $280 to 
 carry him to the fourth. 
 
 On the basis of 7,814 children examined in a Philadelphia series Wessels 
 figures a composite loss of $414,685. The extra expense to which Philadelphia 
 is put to educate backward children of poor vision he places at $87,000 
 a year. 
 
 The reports from those who are in charge of reformatories and prisons 
 show that the proportion of those with poor sight is even larger. Dr. Case 
 found that of 400 boys in the Elmira reformatory 223 needed glasses in 
 order to do near work without suffering. In the New Jersey reformatory 
 83 per cent of the boys need to wear glasses. Dr. William Eichards said : 
 
 "Some time ago I became impressed with the idea that the criminals I 
 knew also were the most incompetent people I knew, and thought there might 
 be some relation between these two facts. I therefore made a physical exami- 
 nation of a good many criminals and found that they were all of them suffer- 
 ing from some form of physical defect." 
 
 William Evers, formerly guard on "murderers' row" in the Tombs, is 
 quoted by Dr. Eichards as follows : 
 
 "I have been dealing with criminals for twenty-nine years; perhaps I 
 have seen more murderers than any man in the United States, possibly in 
 the world, and I have never seen a criminal who did not have some physical 
 defect which in my opinion was the cause of his being where he was." 
 
 Stimulated by his experience with criminals in the prisons in New York 
 state and convinced that he was working at the wrong end of the line, Dr. 
 Eichards and his associates for several years have been successfully handling 
 groups of incorrigibles in the New York school by attending to their physical 
 defects and especially their visual defects. 
 
 The children cared for fell into three groups. 
 
 1. The ungraded, or those too backward for regular classes. This group 
 formed half the total. 
 
 2. Backward children who had to take more than one term to a grade. 
 
 3. Delinquent children, truants, and those who kicked and bit and 
 screamed every now and then and with whom nothing could be done in a 
 disciplinary way. 
 
 A great many people not especially interested in child welfare will be 
 interested in one general position taken by Dr. Eichards — that there are a few 
 great causes of disease which can be grouped under two general heads, "faults 
 of habit" and "faults of structure." These make a favorable soil for the 
 exciting causes of disease to act upon. 
 
 Dr. Wessels investigated the proportion of backward children among 
 those with poor vision. In his Philadelphia city hall clinic he examined 
 9,167 school children. He found faulty vision in 7,319. The examinations 
 
844 CHILDBEN 
 
 were carefully made after the eyes had been prepared by the use of drops. 
 Of the 7,319 children with poor vision he found upon investigation that 5,211, 
 or 72 per cent, were backward. The proportion of backward children in- 
 creased as the age of the children increased. Only 29 per cent of the 8 year 
 old children were backward. Of the 14 year old children with poor sight 
 95 per cent were backward. 
 
 Professor Dufour laid down the following rules: 
 
 1. In all schools the number of shortsighted pupils increases from class 
 to class. 
 
 2. The average degree of shortsightedness increases from class to class. 
 
 3. The number of shortsighted pupils increases with the increase in the 
 school demands. 
 
 In other words, school work is a strain on the eyes. The longer it lasts 
 the more eyes give way under it, and the greater the degree of giving 
 way and the harder the work, the greater the number of eyes which give 
 way. 
 
 Dr. Cohn found that in the Breslau schools 6.7 per cent of the children 
 in the elementary schools were nearsighted; in the academy grade, 19.7 per 
 cent; in the university, 59.5 per cent. 
 
 Dr. Eislay found in the Philadelphia schools that 4.27 per cent of the 
 lower grade children were nearsighted. The percentage for the academy 
 grades was 19.33. Drs. Posey and McKenzie reported that 19.75 per cent 
 of the students in the University of Pennsylvania were nearsighted. 
 
 Dr. Parke Lewis advocated changing the educational method where it 
 was evident that the eye was going down under the strain. Some of these 
 cases can be adequately cared for by properly fitted glasses. Some can be 
 relieved by changing the light or the position of the desk or some other detail. 
 However, there remain cases in which the eye strain is too great in spite of 
 what is done. For these Dr. Lewis suggests that there be less reading and 
 more instruction by other means. 
 
 Eousseau wrote : "The child who reads does not think ; he does nothing 
 but read; he gets no instruction; he learns words." With a good part of 
 this Dr. Lewis agrees. When a child reads he first gets the words from the 
 printed page. He then forms a mental image of the thoughts contained in 
 the words. 
 
 Dr. Lewis says this is a roundabout process. The mind may stop midway 
 of the process, whereupon the printed words mean nothing. To show a 
 child an orange, to permit him to handle it as he is told about oranges, is 
 a better pedagogic method. By teaching the science through the art we teach 
 better and we spare the eyes. 
 
 Eeturning to the starting point, the "it" child is being trained to 
 timidity, self-effacement, lack of courage and an acceptance of inequality. 
 A very large proportion of the backward children can be made normally 
 capable. A very large part of the trouble is due to poor sight. The figures 
 show that children with poor eyes are backward and also that backward 
 children have poor eyes. 
 
 Many of the sight defects can he corrected by the use of glasses or by 
 changing the lighting. By modification of the methods of instruction it is 
 'possible to spare the eyes. 
 
EVIDENCE OF NORMALITY 845 
 
 EVIDENCE OF NORMALITY 
 
 A child of three years of age should be able to : 
 
 1. Touch his nose, eyes, mouth, and pictures of these when directed. 
 
 2. Eepeat easy sentences of six syllables with no error. 
 
 3. Enumerate familiar objects in pictures. 
 
 4. Give family name. 
 
 Four years: 
 
 1. Know own sex. 
 
 2. Recognize key, knife, penny. 
 
 3. Eepeat three numerals in order when heard once. 
 
 4. Eearrange a rectangular card cut differing by half an inch. 
 
 Five years : 
 
 1. Discriminate weights of 45 grains and 180 grains. 
 
 2. Draw after copy a square that can be recognized as such. 
 
 3. Count four pennies. 
 
 4. Rearrange a rectangular card cut diagonally into two triangles. 
 
 Six years : 
 
 1. Know whether it is forenoon or afternoon. 
 
 2. Define in terms of use the words fork, table, chair, horse, mamma. 
 
 3. Perform three commissions given simultaneously. 
 
 4. Distinguish pretty from distinctly ugly or deformed faces in pictures, 
 
 Seven years: 
 
 1. Describe pictures shown him. 
 
 2. Note omission of eyes, nose, mouth, or arms from four pictures. 
 
 3. Draw diamond shape from copy so that it can be recognized. 
 
 4. Pick out red, green, blue, yellow. 
 
 Eight years : 
 
 1. State difference between paper and cloth, butterfly and fly, wood and 
 
 glass in two minutes. Two satisfactorily. 
 
 2. Count from twenty-one to one in twenty seconds without more than 
 
 one error. 
 
 3. Name days of week in order in ten seconds. 
 
 4. Count value of six stamps, three ones and three twos, in less than 
 
 fifteen seconds. 
 
 Nine years: 
 
 1. Give correct change from 20 cents (two dimes) paid for an article 
 
 costing 4 cents. 
 
 2. Name the day, month, day of month, year, allowing error of three 
 
 days either way on day of month. 
 
 3. Name the months in order, allowing one omission or inversion in 
 
 fifteen seconds. 
 
846 CHILDREN 
 
 4. Arrange in order of weight boxes of same size weighing 90, 180, 225, 
 and 270 grains in three minutes. Two out of three trials. 
 
 Ten years: 
 
 1. Name a penny, nickel, dime, quarter, half dollar, two, five, and ten 
 
 dollar bills in forty seconds. 
 
 2. Copy design after ten seconds' exposure. 
 
 3. Tell what one should do in various emergencies and answer difficult 
 
 questions. 
 
 4. Use three given words in two sentences. 
 
 Eleven years: 
 
 1. Detect nonsense in three out of five statements in about two minutes. 
 
 2. Name three words that rhyme with obey in one minute. 
 
 3. Use three given words in one sentence. 
 
 4. Rearrange shuffled words of eight word sentences, two out of three with 
 
 one minute for each. 
 
 Fifteen years: 
 
 1. Imagine clock hands interchanged for hour 6:20 and for hour 2:56, 
 
 telling the time. 
 
 2. Write correctly the opposite of seventeen out of twenty-seven words. 
 
 TRAINING THE CHILD 
 
 One of the first, if not the first, score cards devised to value scientifically 
 the physical charms of the contestants in baby shows was worked out by the 
 Drs. Clark of Waterloo, la. Judging the entries in a baby show by this 
 method has just about displaced the old hair pulling, jealousy exciting method, 
 or lack of method, formerly employed. 
 
 Now the Drs. Clark are out with a plan for the orderly training of 
 babies. In their opinion lying, stealing, prostitution, cruelty and destructive- 
 negs develop upon idleness, disorderliness, and selfishness which in turn result 
 from bad training during the first sixty months of life. They propose that 
 the character qualifications and mentality of every child over eighteen months 
 of age be tested not less often than once every three months. 
 
 For the purpose of valuing these qualities in children and teachers they 
 have devised two score cards. One is for children between eighteen and forty- 
 eight months of age. The other is for children over four years and for adults. 
 
 The score card for young children contains four points : 
 
 1. Expression of the face and eyes, nervous stability, control of the 
 emotions. 
 
 2. Helpfulness to family. 
 
 3. Readiness to care for self. 
 
 4. Self-control as to eating. 
 
 The score card for older children and for adults covers the four points 
 covered in the first card and six new points besides. A well trained, normal 
 child should score 85 on the score card. 
 
FIVE CHILDKEN DEAD 847 
 
 Accompanying the score cards are schedules of games arranged according 
 to ages. At nine months the child should "pat-a-cake" and find his own teeth 
 and tongue; at eighteen months he should help clear off the table and paste 
 paper to form squares and crosses; at twenty-four months he should string 
 beads, select the colors of beads with accuracy and voluntarily pick up broken 
 beads and put them into waste baskets; at thirty-six months he should brush 
 his teeth, build houses with blocks, cut out and paste pictures and draw crude 
 pictures of houses. 
 
 The teaching of a child should be through play. In the training of a 
 child no use should be made of commanding, imploring, threatening or 
 buying as a means of securing obedience. They are even more pernicious 
 than when used with adults. 
 
 "Don't" should not be used until all other methods of accomplishing 
 a purpose have been exhausted. Generally a child bent on mischief can be 
 diverted by engaging his attention with some helpful or at least harmless 
 act of greater interest to him. The Drs. Clark define mischief as a small 
 crime. 
 
 In the main a child can be taught anything desired by encouraging him 
 to imitate his parents, his teachers and his companions. Orderliness, cleanli- 
 ness and industry can be taught by providing toy brooms, dust brushes and 
 cloths and permitting the child to imitate the work of putting the . house 
 in order. 
 
 FIVE CHILDREN DEAD 
 
 At least once every day I receive some letter intended for the health 
 commissioner of Chicago. I have just read one such. It is a birth report. 
 A midwife reports the birth of a girl baby with the name E. S., let us say. 
 From the certificate as it lies before me I gather the following information : 
 
 The father, Henry S., is a workingman, forty-four years of age. As his 
 employment is one that is unionized it is fair to assume that he belongs to 
 a union. This means that he gets wages that are at least fair. He is not 
 trying to maintain his family on the wages paid to unskilled laborers. They 
 live in a part of town where the residences are two story frame cottages set 
 on ordinary city lots. 
 
 His wife, Mary S., is thirty-nine years of age. This is the twelfth child 
 born to Mr. and Mrs. S. Of these seven are living and five are dead. The 
 certificate does not give the ages of these children but they are necessarily 
 young. Probably the oldest is less than twenty years of age and perhaps two 
 or three are under five. It is a safe guess that of the twelve less than half 
 will reach fourteen years of age. 
 
 It is not fair to a hard working woman that she should bear twelve 
 children and lose half of them at ages when they are still dependent on her. 
 Thirty-nine years old, twelve children ! Ever since she put on long dresses 
 she has been caring for babies. Most of the time she has been bearing 
 one and caring for another and more often two. Outside of her children 
 precious little time has Mary had for any pleasure except pleasure in her 
 children. To the mother who loses more than half of her babies in baby- 
 hood pleasure in her children is mixed with pain. 
 
848 CHILDEEN 
 
 Is it necessary that half of the babies of the Marys should die? There 
 are places where the Marys raise eleven out of their family of twelve babies. 
 Eight here in town with Mary, not five miles away from her, there are Marys 
 who have raised some nine and some even ten of their twelve children. Then 
 why not Mary? 
 
 She has been very busy. Probably she has never heard of the way those 
 more fortunate mothers have preserved the health of their children. Nobody 
 went to her with that information and she did not have time to go out in 
 search of it. The only people to tell her how were neighbors who had lost 
 their six or ten babies. 
 
 Maybe her babies had to live on dirty milk. Mary got the best she 
 could but the best was not good enough to save her babies. Maybe her house 
 was small, and she had to wash and cook in the room Avhere the baby slept. 
 
 Whatever the cause, is it fair to have Mary bear twelve children and 
 lose half of them in babyhood? 
 
 WHAT THE MOTHER OF A CRIPPLED CHILD OUGHT TO KNOW 
 
 It is estimated that there are over 200,000 crippled children in the 
 United States. To the mother of a crippled child this statement means that 
 there are hospitals and schools for the proper care of such children. Of 
 these 80,000 are crippled as the result of tuberculosis. 
 
 Tuberculosis in bones and joints results in the main from eating food 
 containing tubercle bacilli. The food which spreads more tuberculosis than 
 all other foods combined is milk from tubercular cows. 
 
 The mother of a crippled child should know how she may protect the 
 other children in the family as well as the one that has been and perhaps is 
 still being infected. 
 
 She should know that the pain in tubercular disease of bones and joints 
 is usually felt in some portion of the body remote from the diseased area. 
 For instance, a persisting pain in the pit of the stomach in a child who holds 
 his back stiff and who cries when jolted is apt to mean tuberculosis of the 
 spine. A child with a persisting pain in the knee is apt to be suffering from 
 hip joint disease. 
 
 The mother of a child crippled from tuberculosis of the bones and joints 
 should know that a great deal can be accomplished by treatment. The disease 
 can be arrested. By discovering the disease early a great deal of the deformity 
 can be prevented. 
 
 In a certain sense the responsibility for early diagnosis is up to the doc- 
 tor. But how is the doctor to diagnose it early unless the parents first get 
 suspicious and have the symptoms investigated? To a limited extent the 
 deformities which follow the acute stages of the disease can be repaired. In 
 some cases it is possible to insert new bone in place of the lost bones. Stiff- 
 ened joints can be made movable again. Surgery offers much to some of the 
 cases in this group. It is important that the mother know that crippled 
 children frequently suffer from neglect — neglect of which the parents do 
 not know. 
 
 The disease is in a bone or a joint. The muscles are sound, but they 
 
WHAT MOTHEE OF A CRIPPLED CHILD OUGHT TO KNOW 849 
 
 are liable to shrink from disuse. It is important that the muscles be kept 
 in good health during the acute stages of the disease. This can be done by 
 rubbing and manipulating, by passive exercise, massage, and electricity. 
 
 When the acute symptoms have subsided, the bones or joints have healed 
 and the child can get around, the mother should stimulate the child to play. 
 Play keeps the muscles healthy and the joints movable. 
 
 It renders another service which is just as valuable. It keeps the child 
 in touch with other children, develops his mind, and prevents him from 
 becoming sensitive and morbid. 
 
 Sugar Good for Children. — A. B. C. writes: "How about sugar for chil- 
 dren 1 ? Is its moderate use (accent on moderate, please) advisable? My 
 boys, ages 9 and 10, like it on their oatmeal of a morning. Some pronounce 
 that 'combination harmful. They say it conduces to colds, etc." 
 
 Reply. — Sugar is an excellent food for children. It is burned into 
 energy and children use that commodity by the wholesale. There is much 
 danger of their overdoing it. When they are first allowed candy and sweets 
 without stint they overdo, but after a short while they become satiated. 
 A good part of the overdesire for sweets is due to an undersupply. Desire 
 shrinks a little when we know we can get what we want. There are some 
 exceptions. I should say let the children have plenty of sugar on their 
 oatmeal. 
 
 Candy Good for Children. — W. 0. writes: "1. When a person has a 
 
 'sweet tooth' that is, takes lots of sugar in both drink and food, has that a 
 tendency to produce bad effects (blood turning into sugar, etc.) later in 
 life? 2. Children as a rule are great for sugar and sweets. Is it good or 
 lad for them?" 
 
 Reply. — 1. Yes. Eating of sugar and starches carried beyond the burn- 
 ing power of the system causes one form of what is called diabetes. How- 
 ever, it is the mildest form and easiest kept under control. It affects grown 
 people. 
 
 2. Children should have all the sugar and sweets they want. It is a good 
 idea to keep clean, wholesome and especially home made, candy where the 
 children can take it whenever they want it. Candy is a good heat maker 
 and a fine energy producer. 
 
 Bad for Child. — Mrs. B. writes: "Kindly inform me what the effect of 
 continued crying is on a young child? We have been letting our baby girl 
 cry herself to sleep since birth, and, while no evil consequences have been 
 observed, we have wondered if such a practice would not have a harmful 
 effect on the child's nervous system in time." 
 
 Reply. — Ordinarily a week is long enough to establish the habit of 
 going to sleep without rocking. If your child cries herself to sleep after 
 months of effort properly to train her I suspect the reason is that you are 
 not firm in your control of her, that you start out to control her but weaken. 
 To cry herself to sleep is bad for the child but for her to grow up uncon- 
 trolled is worse. 
 
 Kernels in the Neck. — L. P. B. writes: "In reply to 'Subscriber you 
 say the kernels that form in a child's neck are easily cured. 1. Please tell 
 me how they are cured. 2. How can one tell whether they have any con- 
 nection with tuberculosis or not?" 
 
850 CHILDEEN" 
 
 Keply. — 1. Give the child plenty of nutritious food. Let him play out 
 of doors all the time. Have his tonsils and teeth put in good condition. 
 If absorption is occurring through the nose have that put in shape. Most 
 cases of enlarged glands that have not suppurated will get well under such 
 treatment. Tuberculin will help. 
 
 2. A tuberculin test. 
 
 Aid for Weak Ankles. — 0. S. says he has a boy, 3 years of age, with 
 weak ankles, inclined inward. A physician informed him this would cause 
 fiatfootedness unless corrected. The doctor did not know what to do, and 
 G. S. asks a remedy. 
 
 Keply. — If the condition is bad have an orthopedic surgeon work out 
 the proper plan for relief. If it is only a matter of giving the ankle 
 a different tilt an intelligent shoemaker will succeed. If the condition is 
 less marked let him go barefooted in the summer time. Encourage him to 
 exercise his leg and foot muscles. 
 
 Bath Not Harmful. — H. B. A. writes: "Is a daily ~bath ever too much 
 for a normally robust, sturdy little girl aged 5?" 
 
 Keply. — No ; the custom is to discontinue the daily bath about the third 
 or fourth year, but that is to save trouble. 
 
 Have Children Exercise. — Mrs. J. 0. K. writes: "I have adopted two 
 children, a girl of k and a boy of 2, both of them being thin after a spell 
 of measles and the mumps. I wish to know what to feed to them, as I want 
 them to get robust. What should we eat to overcome constipation? What 
 should a person who is anemic eat to become stout?" 
 
 Keply. — 1. Plenty of vegetables, fruit, bread, milk and some meat. 
 Have them exercise in the open air above everything. 
 
 2. Fruit, vegetables and bran. 
 
 3. Milk, bread, meat, vegetables and fruits. There are no special blood 
 foods, or flesh foods or strength foods. Any food which is good, nutritious 
 and wholesome is a blood food. 
 
 Keep Room Cooler. — C. L. Z. writes: "What is the cause of a boy of 
 5 years having night sweats? He seems apparently well." 
 
 Keply. — It is of no consequence. Keep his room cooler and he will not 
 sweat. 
 
 Do Not Use a Brace. — T. J. S. writes: "What is the best way to get a 
 6-year-old girl who is round-shouldered to hold her shoulders back as she 
 should? She is a light eater. Her hair is dry and comes out a good deal 
 when combed. We have been using crude petroleum oil on her head, which 
 has helped. We put the oil on in the morning and wash the head in the 
 evening. Is there anything else that could be done to benefit the hair? She 
 seems perfectly well; runs and plays all day, and sleeps soundly about ten 
 hours each night. For the shoulders do you recommend exercising or a 
 brace? If the former, what exercises, and if the latter, what make or 
 kind?" 
 
 Reply. — Do not use a brace. Her shoulders are round because of one 
 or both of two defects. Her chest is too narow, the curves in her spine are 
 not as they should be, or both. In any event, the posture of her shoulders 
 is an effect and you must go after the cause. 
 
CHILDREN 851 
 
 Boy Fitful Sleeper. — R. M. H. writes: "My boy, aged P-fa, is a rest- 
 less and fitful sleeper, waking frequently, and crying out. His health is 
 excellent and his evening meal not unduly heavy. He has been fretful at 
 night since birth. He sleeps alone. What is the trouble*?" 
 
 Reply. — Ten years ago you would have given this boy worm medicine. 
 When no worms came you would have said the medicine was no good. You 
 have covered almost every point except two. Is the boy a mouth breather, 
 waking when his mouth gets dry? What is his inheritance as regards 
 sleeping ? If the trouble is due to mouth breathing the remedy is removal 
 of adenoids or tonsils. If it is inheritance you must do the best you can 
 to make his sleeping environment quiet. 
 
 Night Terror. — J. II. C. writes: "Kindly let us know what you would 
 advise in the case of our girl, J/, years of age, who recently has awakened 
 at night with marked symptoms of hysteria. For some minutes she would 
 toss on the bed, sticking at the air as well as beating her head. She seemed 
 incapable of speech, although she talks excellently when fully awake. Her 
 inability to recognize her mother at such stages is one of the distressing 
 features of the case. She is naturally of a highly sensitive disposition and, 
 accordingly, her training has been along the lines of persuasion and sug- 
 gestion. Her food at all times has been carefully chosen and it is within 
 the last six months that she has been given meat at all. She never drinks 
 tea or coffee or partakes of any condiments whatever. Both mentally and 
 physically her development has been normal." 
 
 Reply. — The trouble with your child is night terror and not hysteria. 
 Do everything to promote her physical health. If she has adenoids, en- 
 larged tonsils or bad eyes have them attended to. Be careful as to her 
 diet at supper. 
 
 Underlying night terror is a supersensitive nervous system. Send to the 
 National Committee for Mental Hygiene, 50 Union Square, New York, for 
 its pamphlets on training children. 
 
 Nervous While Asleep. — V. C. writes that her boy is twelve years old. 
 When he is asleep the muscles of arms and legs twitch and jerk — a sort of 
 tremor every few minutes. She asks what would cause this condition as 
 he is apparently in good health and large for his age. 
 
 Reply. — He is dreaming and mentally tense. He should have less 
 nervous excitement, particularly toward bedtime. He should have plenty 
 of exercise; he should eat but little meat; he should be taught to relax 
 mentally. There is no radical difference between nervous tension when 
 asleep and when awake. 
 
 Little Lad Dreams. — M. G. writes: "My little son, 1± years old, when 
 asleep twitches and jerks his legs, arms, and quite frequently even his face 
 twitches, sometimes to the extent of awakening him. This has continued 
 since he was 2 years old. He is apparently in good health and is happy 
 and bright. He also at times complains of cramps in the calves of his 
 legs." 
 
 Reply. — He is dreaming and his muscle twitching is associated with 
 his dreams. To dream during sleep is as natural as to think while awake. 
 Nevertheless, dreaming which is associated with twitchings and cramps is 
 not so restful as sleep should be. 
 
 The probability is that the child's digestion is below par. Give him 
 
852 CHILDREN 
 
 a very little simple evening meal — not much bread, rice or sugar, or food 
 Of that character. Examine his stools repeatedly for worms, especially for 
 pinworms. Do not allow him to play after supper, or to stay up late, or to 
 get excited in any way. See that his bed is comfortable and his room well 
 ventilated. 
 
 Your physician may find that he has adenoids. 
 
 Treatment for Children's Colds. — L. E. F. writes: "What do you con- 
 sider the best home treatment for ordinary colds in children? I am inex- 
 perienced, need the knowledge, and confess a fear to lasting results from 
 colds." 
 
 Reply. — A purge, light diet, quiet in bed until the aching stage has 
 passed. To keep them from having colds — keep them away from people 
 with colds and out of warm, stuffy rooms. Read "Cause and Cure of 
 Colds" by Sadler. 
 
 Mouth Breathing. — Parent writes: "My daughter, 9 years old, grinds 
 her teeth when asleep, breathes through her mouth, and tosses around in 
 bed all night. Sometimes she sleeps on her arms and knees, but still 
 grinds her teeth. None of the other children can sleep with her. What 
 would you advise?" 
 
 Reply. — Have the school physician or your family physician examine 
 her for adenoids and enlarged tonsils. Probably she is thrashing around 
 because instinctively she wants to breathe through her nose but is forced to 
 breathe through her mouth. 
 
 Diseases of Children. — F. L. B. writes: "The real reason why most 
 parents are not so averse as they might be expected to be to their children 
 having measles, scarlatina, and mumps is that these diseases, which are 
 rarely fatal to children when properly treated, are far more severe in their 
 effects upon adults. Parents, knowing there is small chance of their chil- 
 dren escaping these diseases all their lives, prefer that they should have 
 them when they are small, when chances of fatal effects are so much less. 
 As to scarlet fever (the real article) and diphtheria, I have never known 
 any parents so foolish as to desire their children to have these deadly dis- 
 eases. They are dangerous in the extreme to all — young and adults alike." 
 
 Reply. — The mistake under which you labor is so widely believed in 
 that it should be corrected. In neither smallpox, scarlet fever, diphtheria, 
 measles nor mumps is the disease more severe in grown people than in 
 children. You cite three: scarlatina, measles and mumps. Scarlatina is 
 nothing but scarlet fever and what is presently said of scarlet fever ap- 
 plies to it. 
 
 Mortality Statistics Bulletin 109, United States Census Bureau, ana- 
 lyzes 800,000 deaths in the registration area of the United States in 1910. 
 There were 6,598 deaths from measles distributed as follows: Under 1 
 year of age, 1,540 ; 1 to 2, 2,027 ; 2 to 3, 1,002. Total under 5, 5,338, leaving 
 1,260 for all the years of later life. Of this number 852 deaths occurred in 
 children of what is termed the school age, 406 were divided among the 
 people between twenty and eighty-five. These statistics cover 54,000,000 
 people. For purposes of illustration, of all people forty-five years of age 
 among this 54,000,000 only 7 died of measles. 
 
 Scarlet fever figures differ only in that the death rate is lower among 
 babies and higher among school children. Age forty-five shows even bet- 
 
CHILDREN 853 
 
 ter with 2.6. Contagious diseases do not run a milder course in children 
 than in adults. Clinical experience confirms the figures of the census 
 bureau. 
 
 Condition Not Dangerous. — Mrs. M. G. writes: "A boy of 8 is pro- 
 nounced by a doctor abroad to have a heart which has nothing wrong with 
 it, but is not strong aciioned. 1. Is this condition at all dangerous? 2, 
 Should any special precautions be taken with regard to games, running, 
 etc., at school? 3. Is there jany treatment which will strengthen a weak- 
 actioned heart? Jj.. Would it be inadvisable to take a child or person with 
 a not strong -actioned heart to live or stay for any length of time at a high 
 altitude? The place I have in mind in asking is 6,000 feet above sea level." 
 
 Reply. — 1. No. 
 
 2 and 3. A weak heart muscle in a boy of eight merely means that all 
 his muscles are weak. What is good for his leg muscles is good for his 
 heart muscle. See that he plays in the open air up to the limit of his ca- 
 pacity. If you can arrange it so that in school or on the playground he 
 can have some group play under a playmaster so much the better. 
 
 4. No. 
 
 Children's Diseases. — W. P. writes: "Please write an article telling 
 people how unnecessary it is for children to have measles, scarlet fever, 
 and diphtheria. I know a few people who believe it a good thing for chil- 
 dren to have the diseases in order to 'rid their systems of impurities,' etc., 
 and because 'all children have it, you know.' 1. Doesn't the board of health 
 quarantine against measles? 2. Isn't a man who permits his children to 
 suffer with measles without a physician s attention letting them take 'a 
 chance' even if they are 'given purgatives and hot water baths'? 3. Does a 
 child's physical organization suffer any consequences from an attack of 
 measles?" 
 
 Reply. — Having a contagious disease gets nothing out of the system. 
 The system of a person that has had a contagious disease is in no better 
 condition and sometimes is in a much worse condition for having had the 
 disease. In this day of enlightenment almost no children have smallpox ; 
 but a small minority have diphtheria, less than half have scarlet fever and 
 not much over half have measles. Therefore, a mother who exposes her 
 children to infections throws away a good chance of escaping them. 
 
 1. Yes. 
 
 2. Yes. 
 
 3. Usually the child is not violently ill. Recovery is usually complete. 
 However, many children die. More nursing babies die of measles than of 
 scarlet fever. Many children get pneumonia as a complication, some get 
 Bright's disease, some suffer such changes that for years thereafter they 
 are frail and delicate. 
 
 Feeding the Little Ones. — P. A. E. writes: "I am the mother of two- 
 children under 7, whom I try to care for in the best possible way open to 
 me, but in the last few months I have been led to wonder if I am finicky 
 and fussy on points where I had thought I was only reasonably sensible. 
 1. Is dinner at 6:30 p. m. as good as at noon? I have always prepared din- 
 ner for the children at noon, even though I have to prepare another din- 
 ner for their father and myself at night. 2. Are fried potatoes, doughnuts, 
 and pie suitable food to be served frequently (almost daily) to children? 
 
854 CHILDREN 
 
 3. Is it worth the effort of a mother who also has the work of the house to 
 do to provide especial foods for children, such as baked or creamed potatoes 
 instead of fried, and custards, rice puddings, etc., for desserts? 4. Is it 
 justifiable economy to cut down the butter that goes into the cream sauce, 
 the egg that goes into the muffins, etc., for young, growing children? I 
 am assuming actual poverty does not make it necessary. I hunt for places 
 to add to the butter and egg allowances/' 
 
 Keply. — 1. No. 
 
 2. Children can digest these articles much better than adults. Fed 
 occasionally or somewhat oftener they are good enough. 
 
 3. No. 
 
 4. Do not economize on the children's food. You can well do so on that 
 of the adults. In hot weather feed the children as little fat as possible. 
 Give them bread, meat, sweets, fruits and candies. 
 
 Change Boy's Diet. — Mrs. B. H. J. writes: "My son is 6 years old, 
 about the right size, strong, rather thin, and active. Every month or two 
 he has trouble, called by the doctors a bilious attack. There are high fever, 
 a coated tongue, and bad breath. He has been doped with calomel time 
 and again \one and one-quarter grains\, which brings away great quan- 
 tities of dark green mucus. Then he gets well. He has puffs under the 
 eyes a great deal, but examination of the urine shoivs a nearly normal con- 
 dition. He has always been troubled with constipation, which is hard to 
 regulate by diet, as he cares for few vegetables or cereals. Bran bread 
 seems to irritate the bowels and bring on attacks. Please advise me what 
 to do to prevent these attacks." 
 
 Reply. — The dark green passages after calomel, usually held to be proof 
 of the good done, is no proof at all. In the first place much of the green 
 color is due to a mercury salt. In the second place the place for green 
 bile is the liver, liver ducts, gall-bladder and upper intestines. In those 
 locations it does good work. Whenever it passes beyond the zone things 
 are not right. Therefore, green bile in the stools is a sign that the medicine 
 is doing something that should not be done. 
 
 Do not dope the boy with calomel. If he needs to be depleted from 
 time to time do it with something that will not produce so unnatural a 
 result as green stools. 
 
 However, the proper plan is to change his diet. Train him to eat vege- 
 tables and fruit in quantity and to drink plenty of water. That may be 
 somewhat troublesome but it is less troublesome than a bilious attack 
 and a course of calomel once a month. 
 
 Growing Pains of Children. — Mrs. T. B. H. writes: "Physiology says 
 children sometimes have what are called growing pains in their arms and 
 legs. Our little girl complains of some in her legs some mornings. Shall 
 I consult a physician?" 
 
 Reply. — Yes. Growing pains are rheumatic and gouty. Infection 
 through the throat must be thought of when the trouble is present in a 
 child. 
 
 Child in Need of Treatment. — F. C. writes: "I have a boy 4 years old 
 who is in the habit of sniffling. Two or three months ago, as a result of 
 this habit, a channel to his ear became affected, and his ear drum was 
 operated on by one of our best specialists. It seems impossible for us to 
 
CHILDREN" 855 
 
 teach him to blow his nose, and we are fearful this habit will give him 
 chronic catarrh. Have you any suggestions to offer as to the cure of this 
 habit?" 
 
 Reply. — Your child should be examined and treated. There is some- 
 thing behind a "habit of sniffling" which "blowing the nose" cannot remedy. 
 
 Promiscuous Feeding. — E. T. A. writes: "Can you say something to 
 help make promiscuous feeding of other people's children as bad form as 
 promiscuous kissing? My children have been offered every kind of dainties 
 at any time of the day, and I believe I am the judge of what and when 
 they may eat. Do say something concerning a mother s responsibility as 
 the sole guardian of young stomachs, please." 
 
 Reply. — Promiscuous feeding is even more important than promiscuous 
 kissing. Making food into tissue is the child's daily task. Promiscuous 
 feeding of children by promiscuous people is like the promiscuous use by 
 promiscuous people of a monkey wrench on an engine. 
 
 Bananas Good for Child. — Mrs. G. E. N. writes: "Bo you consider 
 the daily use of bananas either as a breakfast fruit or dinner dessert desir- 
 able, they being the cheapest and most easily obtained fruit? Do you con- 
 sider a dish of sliced bananas with sugar and cream, eaten with several 
 slices of bread and butter, a dish of cereal, and a glass of milk a proper 
 summer breakfast for a healthy child of 9 years?" 
 
 Reply. — Yes, one or two of them. Bananas should be chewed. When 
 bolted the stomach juices cannot get in well. 
 
 Take Child to Specialist. — J. L. W. writes: "What is the common sense 
 way to treat earache in children? My little girl, 6 years old, is a sufferer 
 from earache; not chronic, but there appears a tendency to trouble at times 
 when she has played outdoors in the wind, or got her feet wet." 
 
 Reply. — To relieve the pain a hot water bag should be placed against 
 the ear. A general hot bath will be of service. If absolutely needed pare- 
 goric may be given. So much for that part. 
 
 Earache is due to infection which travels from the throat to the ear. 
 To treat earache properly the throat must be treated. She should be taken 
 to a throat specialist. Most of the deafness of middle life is due to just 
 the condition described by you. 
 
 Have Child Examined. — M. G. C. writes : "A healthy child of 5 is fre- 
 quently chafed and irritated. Is the cause urine, or could there be a dis- 
 charge from the vagina that causes the itching and smarting? What course 
 should be pursued?" 
 
 Reply. — The cause might be thread worms. It might be a gonococcal 
 infection. Have an examination to discover what is the cause. 
 
 Food for Young Child. — M. A. R. writes: "Will you kindly advise the 
 best combination of foods to be given to a healthy, normal, female child of 
 three and a half years to four years of age?" 
 
 Reply. — At the age of four years a child may share the general table 
 diet providing it is plain and varied. Fried and highly seasoned foods 
 should not be given. 
 
856 CHILDREN 
 
 As to quantity a healthy child should be permitted to satisfy her appe- 
 tite if she eats slowly and masticates thoroughly. Breakfast should consist 
 of milk, a cereal and cream and bread and butter. An egg, fresh fish 
 or chicken may be added. For dinner give soup, meat, bread and butter 
 and some light vegetables. Junket, or pudding, milk, toasted bread and 
 butter and stewed fruit will do for the evening meal. Fresh fruits may be 
 given before or after meals. 
 
 Tea, coffee and alcoholic beverages are not for the use of children. 
 Make meat prominent in the diet. • 
 
 Celluloid Toys. — L. 8. writes: "Are celluloid toys dangerous for habies 
 as to explosion on catching fire? Are they dangerous only when exposed 
 to open fire, or will striking cause them to explode?" 
 
 Reply. — They are dangerous. An open fire or a high degree of heat 
 can ignite them. I have never heard of a spark from a blow exploding a 
 celluloid toy. 
 
 Sleep for the Child. — Mrs. F. C. H. writes: "My son, 2 years and 5 
 months old, has always been accustomed to long afternoon naps. As he 
 grows older he is less inclined to go to sleep, sometimes requiring stories 
 and urging for more than an hour. When he wakens it is too dark for him 
 to go out again, and he then cannot be made to go to sleep before 8:30 
 p. m. We have always had him out every possible moment, and it seems 
 too bad these beautiful fall days for him to spend so much time in the 
 house. Would it be detrimental to him to discontinue or omit the afternoon 
 nap and put him to bed at 6 o'clock? He is normal in every way except he 
 has to be urged to eat practically every mouthful." 
 
 Reply. — I would hesitate to advise you to discontinue the boy's naps 
 but you can shorten the time to advantage. Wake him at the end of two 
 hours and maybe one. It he rests quietly for some time before dropping 
 off to sleep count that out of his sleeping time on the basis of sixty min- 
 utes of rest in bed while quiet but awake equaling about thirty minutes of 
 sleep. If he is a fitful eater encourage him to play actively since play gives 
 him muscular exercise.. 
 
 Baby Likes to Eat Mud. — Mrs. J. F. writes from Green Bay, Wisconsin: 
 "My son, 2 years 8 months old, seems perfectly normal except for strange 
 appetites. He will eat mud, mortar, or coal unless watched, and seems to be 
 hungry for such things. When put to bed he rolls from side to side, singing 
 himself to sleep. He wakes up in same manner. His diet is carefully 
 watched. He seems sturdy, and is fat, but at times he is quite pale. Kindly 
 advise me as to method, other than punishing, of curing these morbid 
 habits." 
 
 Reply. — The child should be studied, not punished. The probability is 
 that he has a mild case of scurvy or rickets. If this is the trouble the 
 remedy is to feed him plenty of fresh meat, fruits and vegetables. He may 
 have a nervous trouble. It may be that the need is for companionship 
 with children mentally more normal; if so, kindergarten will cure him. 
 The family physician and the mother should carefully study the child to 
 find the reason and correct it. 
 
 Starch Craving Unnatural. — M. C. K. writes: "I have often heard of 
 people craving starch. My small daughter eats laundry starch whenever 
 
CHILDREN 857 
 
 she can get it, and I watch her continually, fearing that it is injurious. 
 Does this habit grow? Is it harmful? What causes it?" 
 
 Reply. — She cannot digest raw starch. It ferments in her intestines. 
 Both children and adnlts are liable to starch indigestion. 
 
 I suggest that yon see your physician. The craving is unnatural. 
 Such cravings may indicate chlorosis, or intestinal catarrh. 
 
 Feeding Year-Old Child. — D. F. writes: "May I trouble you to let me 
 know what you consider a proper diet for a baby 1 year old, just weaned 
 and perfectly healthy? She has a good appetite and does not find milk 
 sufficient." 
 
 Reply. — 1. Feed regularly. 
 
 2. Milk with one-fourth its quantity of barley or oatmeal water should 
 form the basis of the diet. Six to eight ounces of this mixture may be given 
 at a feeding. 
 
 3. A little stale bread, potato and butter, zwieback, beef soup, white of 
 an egg, prune or orange juice may be given alternately. 
 
 4. Rich foods should not be given at this period; solid food not until 
 the child is able to chew it. 
 
 5. Watch the child closely for evidence of indigestion. Be guided by 
 your physician in changing the food and feeding habits as soon as trouble 
 shows. 
 
 Feeding the Baby Potatoes. — G. F. M. writes: "Kindly inform me 
 whether mashed potatoes with butter or meat gravies in moderate quan- 
 tities given to babies more than a year old cause constipation or are in any 
 way harmful to them." 
 
 Reply. — If given in moderation potatoes with gravy and butter will be 
 all right. It will not cause constipation. Begin with a small portion and 
 gradually increase the allowance. However, the quantity given can be 
 easily overdone. 
 
 Nodding Spasm. — C. E. W. writes: "My baby girl, Ik months old, has 
 been since birth a healthy, normal child. She is heavy for her age, weigh- 
 ing So pounds; she talks and walks and eats heartily of milk, eggs, cereal, 
 fruits, and soups. At the age of a year she began to develop a shaking of 
 the head. Her head moves constantly, and the shaking from side to side is 
 in appearance like an aggravated case of palsy. Except for this condition 
 the child seems to be in perfect health. What could cause it? What 
 treatment would you advise? Is it curable?" 
 
 Reply. — Your child has what is usually known as nodding spasm or 
 Henoch's spasm of the head. Have you noticed that the eyeballs are moved 
 almost constantly (nystagmus) I The condition develops sometimes in 
 teething children. Rickets is the cause in many cases. 
 
 It generally responds to a regulated diet, life in the open air and the 
 use of some preparation of phosphorus. The outlook for cure is good. You 
 should have your physician see her. 
 
 Cleft Palate. — M. M. L. writes: ''Is there any cure or remedy for a 
 'split' palate, antedating the birth of the child, who has now reached the 
 age of 16, without any lessening of the impediment in speech caused ' 
 thereby? Is there any artificial appliance made which would prove of 
 benefit in a case of this kind?" 
 
858 CHILDREN 
 
 Reply. — In the development of a child the growing in of a membrane 
 to divide the nose from the mouth takes place rather late. The membrane 
 (both the hard and soft palate) grows as a plate coming down from each 
 side, finally growing together in the middle. This is the way it hap- 
 pens in the mouth. The lips follow a somewhat different plan. It some- 
 times happens that halves do not completely unite — then we have cleft or 
 split palate. It should be operated on. The earlier the better because the 
 child must learn to use the muscles differently in talking. 
 
 Stature. — A. R. writes: "I have a son 12 years old who is no taller 
 than boys 9 years old, and I am afraid he always will be small. My hus- 
 band is 5 feet 10 inches tall and I am 5 feet 6 inches. Both are strong 
 and healthy. The two other children (girls) are of proper height. He is 
 the second child. Some time ago I read that a British physician prescribed 
 thyroid extract for a boy 18 years old and the boy gained seven inches in 
 six months. Can you give me information about it?" 
 
 Reply. — In determining stature three factors must be considered — in- 
 heritance (of great importance), ductless glands and nutrition. In decid- 
 ing whether inheritance is the cause it is necessary to consider the family 
 tree as far back as the four grandparents at least. One short grandparent 
 is most likely the explanation of the shorter stature of your son. It has 
 been demonstrated that plenty of exercise leading to good muscular develop- 
 ment and an abundance of food helps. As to whether the use of ductless 
 glands taken by the mouth will help or not I hesitate to express an opinion. 
 The matter is being investigated in many different quarters and informa- 
 tion sufficient for guidance should be forthcoming before long. Do not 
 give your boy thyroid except under medical guidance. The drug is too 
 powerful to be otherwise taken. 
 
 Harelip Can Be Cured. — Mrs. A. C. writes: "A child was born here 
 with a bad case of harelip and cleft palate. What is the cause of that? 
 „ Had the baby lain in such a condition before birth as to prevent proper 
 development? Some old people say it is a birthmark, caused by the mother 
 being frightened. Is that so? If it is properly attended to from the start, 
 can it be cured? This child was immediately taken to a specialist, who 
 put a few stitches in the palate. That seemed to help enough so a little 
 food could be taken through his mouth. Two weeks after a wire was placed 
 so as to draw the two parts together. This has been done about three times. 
 The last time the jaw bone ivas split on the opposite side. It has helped 
 some, but during the last couple of months nothing has been done, and that 
 deep gash in his jaw looks anything but promising. Please state your 
 opinion of such a case. He is 7 months old." 
 
 Reply. — The mother being frightened and the position of the child 
 have nothing to do with the case. As the child is being formed the upper 
 lip develops from four centers. If the four separate pieces fail to grow 
 together just right a harelip results. The reason for harelip is so easily 
 understood by studying the development of the mouth that it is hard to see 
 how all the foolish ideas got started as that about birthmarks, mother 
 being frightened, position of child, and the like. 
 
 Harelip can be cured. As your physician does not seem to be doing 
 well get him to direct you to a specialist in operations on harelip. 
 
 Will you not also write to the Eugenics Laboratory, Cold Spring Harbor, 
 N. Y., if you know of other cases of harelip in this family ? 
 
CHAPTER XLVI 
 
 First Aid 
 
 Not to know what to do in minor emergencies is somewhat of a disgrace 
 now. First aid is being taught by scores of agencies and nearly everybody 
 is being reached. The American Eed Cross is teaching it by a number of 
 approved methods. The national and state governments are covering some 
 part of the field. 
 
 First aid is a larse part of the program of the Boy Scouts and the 
 Camp Fire Girls. The Y. M. C. A. 
 teaches it to its members. The large 
 employers keep first aid posters con- 
 spicuously displayed and some provide 
 
 Fig. 309. — Method by Which One 
 Man Can Carry a Wounded 
 Man. 
 
 Fig. 310. — Another Method by 
 Which One Man Can Carry a 
 Wounded Man. 
 
 systematic care in first aid. The boys who have been trained in the army, 
 navy and militia know what to do and what not to do. 
 
 Books on first aid, clear and simple in text and well illustrated, are sold 
 for a few cents. Among these none is better than the series written for the 
 Eed Cross by Major Charles Lynch of the United States army. From the 
 Manual of Instructions most of the following is taken. 
 
 859 
 
860 
 
 FIKST AID 
 
 The materials for first aid are given as bandages, compresses, splints, 
 tourniquets, stimulants and emetics. The surgical instrument houses sell first 
 aid packages containing material often needed. Simple pocket first aid pack- 
 ages constitute one form; another form is a portable case and a third, more 
 fully equipped, is intended for use in an emergency hospital. 
 
 No person should be near a patient but those actually needed for help. 
 The injured person needs air. Furthermore, he should be spared the mental 
 shock of seeing a mob of strange people crowding around him. 
 
 The best position for the patient is lying fiat. If the face is flushed 
 it is safe to raise the head enough to put a pillow under it. If the face is 
 
 pale the head must not be 
 raised from the floor. If 
 the patient is vomiting the 
 body should be turned on 
 the side and the head 
 turned so that the vomit 
 runs out of the mouth. 
 Beyond this no lifting of 
 the head is justified. To 
 raise the head straight up 
 is greatly to increase the 
 danger that the vomit will 
 go by gravity into the wind- 
 pipe. 
 
 No water or stimulant 
 should be given. Unless 
 consciousness has fully re- 
 turned the liquid is apt to 
 go into the windpipe. On 
 account of the tendency to 
 nausea from shock the 
 liquid, whatever it may be, 
 is liable to cause vomiting. 
 Whisky does more harm than good and brandy has no advantage over 
 whisky. 
 
 A distinguished woman physician was once hauled from hospital to 
 hospital when suffering from the shock of an apoplectic attack because some- 
 one had given her whisky when she became faint and the hospital attend- 
 ants, smelling whisky, thought she was drunk. 
 
 A prominent woman was carried to a police station and neglected for 
 several hours though suffering from concussion as a result of a fall because 
 some busybody tried to pour some whisky down her throat as she lay half 
 conscious. 
 
 As a general rule, after a few minutes of unconsciousness the rested 
 heart again becomes equal to its task and no stimulant is needed. Generally 
 speaking, any consciousness that returns after a stimulant would have re- 
 turned without the stimulant and those cases in which consciousness does 
 not return spontaneously are harmed by stimulants. 
 
 If a person who has been unconscious would like a bracer give him 
 
 Fig. 311. — A Short Stretcher Made with Two Rifles. 
 
FIKST AID 
 
 861 
 
 half a teaspoonful of aromatic spirits of ammonia in a fourth of a glass 
 of water. 
 
 A person recovering from a hurt generally wants water. This is be- 
 cause shock has paralyzed the salivary glands and not because he needs water. 
 If he insists give him a few sips, but see that he sips it ; or give him a piece 
 of ice to hold in his mouth or gum to chew. 
 
 Loosen the collar and all tight clothing. If there is profound shock — 
 
 Fig. 312. — Method by Which Two Men Can Carry a Wounded Man. 
 
 Cover the body well with blankets. 
 
 Put hot bricks to the extremities. 
 
 Rub the limbs briskly. 
 
 Place flannels wrung out of hot water or towels over the abdomen. 
 
 Put ammonia or smelling salts to the nose. 
 
 Give hot coffee or aromatic spirits of ammonia. 
 
 Introduce two fingers into the rectum and stretch the sphincter muscle. 
 
 After severe injuries it may be advisable to move the patient. Do not 
 do so until search has been made for fractures. 
 
 If there is a fracture of the arm above the elbow or leg above the knee 
 or if both bones of the lower leg are broken the patient must not be moved 
 until the broken limb is splinted. 
 
862 
 
 FIEST AID 
 
 For this any sort of a board or rod or broom handle will do. To this 
 the injured limb must be securely tied in several places. 
 
 Fig. 313. — Compress the Carotid Artery for Severe Hemorrhage about 
 
 the Head and Neck. 
 
 The patient generally knows when a bone is broken. Works on first aid 
 give signs by which one may know when there is a fracture. Such are 
 deformity, crepitus, and the like. The person hurt will generally tell you 
 
 Fig. 314. — Digital Compression of Subclavian Artery. 
 
 offhand of the fracture and where it is, and probably the inexperienced helper 
 had better accept the diagnosis and proceed accordingly. 
 
 if there is a compound fracture, that is, if the broken bone sticks through 
 
Fig. 315. — Diagram Showing Position of Important Arteries. The arteries shown in 
 heavy cross-bars are superficial and ean'be compressed at points in area shown. Arteries 
 shown in dots are deep. 
 
864 
 
 FIRST AID 
 
 the skin or if there is a wound extending down to the break the wound 
 must be covered by the compress found in the first aid packet and then the 
 limb must be splinted to something solid and firm. 
 
 In treating the wound the fingers must not touch the bone or the wound. 
 It is highly desirable that the wound should not become infected and to 
 inspect it or handle it is to invite infection. 
 
 When the fracture is of the backbone or of the neck the warning against 
 reckless handling of the patient must be emphasized. It may be better to 
 leave him where he is until the doctor comes. 
 
 If he is to be moved it must not be done until the back and neck are 
 
 Fig. 316. — Digital Compression of 
 the Femoral Artery. 
 
 Fig. 317. — Tourniquet 
 to Control Hem- 
 morrhage in the 
 Forearm or Hand. 
 
 rigidly splinted; otherwise the broken bone may tear the spinal cord and do 
 irreparable harm. 
 
 Whenever wounds break the skin the part must be protected to prevent 
 germs from getting in. The few that are driven in by the agent producing 
 the wound stand a good chance to be destroyed if no more are carried in. 
 
 It is well to encourage wounds to bleed and ooze up to a certain point. 
 Bleeding and oozing constitute the best sort of washing. It is much better 
 to put nothing on a wound than to put on any unclean thing. In fact, it is 
 better to put nothing on than to put on anything about which you are not 
 certain. 
 
 At the present time there is a decided movement toward the open treat- 
 ment of wounds. When one has a first aid packet he should open up the 
 wrapping and apply the compress and do it without washing the wound. 
 Leave that for the doctor. 
 
 In case the hemorrhage from the wound is excessive, the treatment of 
 the hemorrhage takes precedence over treatment of the wound. If the hemor- 
 
NOSE BLEED 
 
 865 
 
 rhage comes in spurts it is from an artery. If it is a steady flow it is probably 
 from a vein especially if it is dark. 
 
 If the blood is spurting deep pressure should be made on the skin be- 
 tween the bleeding point and the heart. If the blood is from a vein the 
 pressure should be on the other side of the wound. 
 
 Pressure in the wound is often 
 ineffective because the cut vessels may 
 contract until it is out of the wound. 
 It is so liable to infect that it is rarely 
 justified. 
 
 Often in arterial hemorrhage 
 some near-by artery between the cut 
 and the heart can be seen throbbing 
 and pressure upon it will speedily 
 show whether it or its branch is the 
 vessel injured. 
 
 If the bleeding wound is in a 
 limb the tourniquet can be applied. 
 For this no special anatomical knowl- 
 edge is required. Students taking first 
 aid courses are always taught some 
 score or more points at which impor- 
 tant blood vessels can be reached, 
 for example, just in front of the ear, 
 where the lower jaw can be felt work- 
 ing in its socket; over the throbbing 
 artery in the temple; in the neck at 
 the front border of the heavy muscle 
 
 running from the breastbone to a point just behind the ear; deep in the 
 hollow behind the collar bone; at the inner border of the big muscle of the 
 front of the arm — the biceps; at the middle of the groin. 
 
 Fig. 318. — Compressing the Femoral Artery 
 with Tourniquet and Pad for Severe 
 Hemorrhage in Leg. 
 
 INTERNAL HEMORRHAGE 
 
 In internal hemorrhage have the patient lie flat. Apply cold over the 
 organ where the bleeding is located. Put hot bricks to the feet. Do not give 
 stimulants. 
 
 NOSE BLEED 
 
 If mild, do nothing. When severe grasp the two nostrils with the finger 
 and thumb. Press the soft wings against the septum. Have the patient 
 lean forward. The purpose is to allow the nose to fill with blood and to give 
 this blood time to clot. Apply a cold cloth wrung out of ice water to the 
 back of the neck or place a piece of ice under the upper lip between that and 
 the gum. Press on the lip. 
 
 Cold water or ice on the back of the neck or over the bridge of the nose. 
 A towel wrung out of cold water and placed around the neck with one end 
 
866 
 
 FIRST AID 
 
 over the bridge of the nose. Pinch the nostrils together. If bleeding per- 
 sists, plug with a piece of cotton. Tie a thread around a piece of cotton as 
 large as the end of the thumb ; soak in strong tea or lemon juice ; push gently 
 up into the nostril. After the bleeding has stopped for about a half hour pull 
 the cotton out gently by the thread. 
 
 DISLOCATIONS 
 
 A man giving first aid should never try to replace a dislocated joint 
 except in two locations — ringers and jaws. To try will generally mean to 
 
 fail and the hauling and pulling may harm 
 important structures. It has happened that 
 large blood vessels have been torn and impor- 
 tant nerves have been paralyzed. In case of 
 dislocation the injured limb should be snugly 
 wrapped and made as comfortable as possible 
 while help is being secured. 
 
 DISLOCATION OF THE LOWER JAW 
 
 Tear a handkerchief in two. Wrap one 
 piece around each thumb. Place the thumbs 
 in the mouth pressing against the crowns of 
 the teeth on each side. With the fingers seize 
 the lower jaw on each side. Press down and 
 backward. As the head of the bone slips into 
 its socket the molars will clamp the thumbs 
 unless they are quickly slid toward the tongue. 
 
 Fig. 319. — Compressing Bra- 
 chial Artery for Severe 
 Hemorrhage in the Elbow, 
 Forearm and Hand. 
 
 DISLOCATION OF A FINGER 
 
 By grasping the finger with one hand above 
 the dislocated joint and with the other below 
 it and making gentle traction the joint will slide into place. A little gentle 
 flexion and extension will be of service. 
 
 RESCUE OF PERSONS AT FIRES 
 
 Lynch, after advising that persons going into a burning building tie a 
 wet handkerchief around the nose and mouth, says : "Kemember that the air 
 within six inches of the floor is free from smoke; so when unable to breathe 
 crawl along the floor with the head low, dragging anyone you have rescued 
 behind you. Crawl backward in the same way down a staircase or any 
 slope." 
 
 TREATMENT OF A BURN 
 
 Exclude air by a thin paste made with water and cooking soda, starch 
 or flour. Smear on a cloth and cover the injured surface. If these are not 
 
ELECTEIC SHOCK 
 
 867 
 
 at hand use vaselin, lard, cream or any grease. In using grease use the 
 cleanest possible. Do not use old grease or dirty grease. Do not use car- 
 bolized grease. If time will permit heat the grease and then cool it before 
 
 Fig. 320. — Artificial Respiration, Inspiration, Pressure Off. 
 
 using it. To boil is not necessary. A place where burns are frequent should 
 always carry a picric acid compress or picric acid bandages. When these are 
 available they should be used instead of the soda paste. 
 
 Fig. 321. — Artificial Respiration, Expiration, Pressure On. 
 
 Burns with acid should be treated with lime wash made of lime scraped 
 from the wall and thrown into water, soapsuds or milk of magnesia. 
 
 Alkali burns should be washed in vinegar, lemon juice or hard cider. 
 
 ELECTRIC SHOCK 
 
 The safest means of rescue when it is possible is to short circuit the 
 current before it reaches the persons shocked. This can be done by dropping 
 a metal bar or rod or a wet stick or rope on the side between the power 
 and the person. If the live wire is on the ground and the person is on 
 it it will be safe to roll him off with the hands. If the live wire is on the 
 prostrate person it will be safe to fleck it off with a dry stick if the hands 
 are dry. Of course it is much safer to handle the wire with a glass rod or 
 
868 
 
 FIRST AID 
 
 with hands covered with rubber gloves. If neither of these is at hand covering 
 the hands with a mackintosh is fairly safe. 
 
 The patient is to be covered with warm wraps. Artificial respiration 
 
 Fig. 322. — Blanket Stretcher. 
 
 is to be done if breathing has stopped. In some cases respiration having 
 started up will stop again. In that event artificial respiration must be 
 resumed. 
 
 Fig. 323. — A Pillow Used as a Temporary Splint in Fracture of the Leg. 
 
 The household emergency box should contain the following, according 
 to Lynch: • 
 
 Alcohol. 
 
 Aromatic spirits of ammonia. 
 Castor oil. 
 Epsom salts. 
 Powdered mustard. 
 Lime water. 
 Bicarbonate of soda. 
 Sirup of ginger. 
 
 Fig. 324. — Gun Used as a Temporary Splint in Fracture of the Femur. 
 
SOME MINOR AILMENTS 
 
 869 
 
 Sirup of ipecac. 
 
 Witch hazel. 
 
 One-tenth grain calomel tablets. 
 
 Carbolized vaselin. 
 
 Five grain bismuth tablets. 
 
 One dram oil of cloves. 
 
 Soda mint tablets. 
 
 Talcum powder. 
 
 One package antiseptic gauze. 
 
 One-half pound absorbent cotton. 
 
 Six gauze roller bandages. 
 
 Two Bed Cross First Aid outfits. 
 
 One roll oiled silk. 
 
 One small bottle collodion. 
 
 One box tooth wax. 
 
 One box tooth plasters. 
 
 One pair scissors. 
 
 One sharp knife. 
 
 Pins. 
 
 SOME MINOR AILMENTS 
 
 COLIO AND CRAMPS 
 
 Fig. 325. — Sling Made From 
 Coat. 
 
 Appendicitis starts with colic. Fever comes 
 after. 
 
 Gall stones cause a colic, but the pain is 
 liable to be so severe that it is referred to as 
 "stabbing." The shock with gall stones is 
 usually severe. 
 
 Kidney stones cause a colic. The pain shoots into the genital organs. 
 
 Then there is the ordinary abdominal colic known as cramp or colic. 
 It is caused by spasm of the muscles of the intestinal wall. When much 
 shock is present look for a cause. If fever follows the colic look for a cause. 
 
 Fig. 326. — First Aid in Fracture of Leg. Strapping legs together. 
 
 Treatment — Put a hot water bottle over the seat of pain. Take essence 
 of peppermint or sirup of ginger in warm water or take soda mint tablets. 
 Take a purge. Produce vomiting where indicated. 
 
8*0 
 
 FIRST AID 
 
 TRANSIENT DIARRHEAS 
 
 Give a laxative — sirup of rhubarb, castor oil or A. S. & B. pills. A 
 dose of salts or purgative water acts more quickly. To ease the cramping 
 give sirup of ginger, a teaspoonful in water after each passage; or paregoric 
 in teaspoonful doses, repeated when needed at four hour intervals ; or Squibbs' 
 
 Fig. 327. — First Aid Treatment of Fracture of Both Bones of Leg. 
 
 cholera mixture. Cholera mixtures and paregoric contain opium and there- 
 fore should be taken cautiously. Stop all food except boiled milk. If the 
 diarrhea persists see a physician. 
 
 Diarrhea in babies is a more serious matter and it is taking chances 
 
 Fig. 328. — Fracture of 
 Nose. 
 
 Fig. 329. — Fracture of Finger. 
 Wooden Splint Applied to 
 Palm Surface. 
 
 to doctor it at home. When a baby gets diarrhea give a dose of castor oil 
 and watch the food closely. When the oil acts and the diarrhea does not stop, 
 see a physician. 
 
 NAUSEA AND VOMITING 
 
 Nausea may be due to some food which has disagreed. In that event 
 home treatment is all that is needed. It will save trouble to empty the 
 stomach. Two glasses of lukewarm salt or mustard water may be given. 
 It may be necessary to put the finger in the throat or to tickle the throat 
 with a feather. After this use a little cold water and a soda mint tablet. 
 
SOME MINOK AILMENTS 871 
 
 Many forms of severe infection [scarlet fever] begin with vomiting. In 
 certain diseases poisons in the blood are excreted by the stomach and nausea 
 results. Therefore the field for home treatment of vomiting is somewhat 
 limited. 
 
 HICCOUGH 
 
 Between the chest and the abdomen is a great muscle called the dia- 
 
 Fig. 330. — Break of Bone in Back of Hand. Corresponding to Right Middle Fin- 
 ger. Corrected by Bending Hand Over a Bandage Held in the Palm with Adhe- 
 sive Plaster Reaching from Back of Hand to Front Part of Wrist. 
 
 phragm. Hiccough is due to spasmodic contraction of this muscle. Transient 
 hiccough can be relieved by holding the breath just as long as possible, or 
 by intently trying to bring the two index fingers close together without touch- 
 ing them, or by throwing a glass of cold water on the face, or by any one 
 of a half dozen tricks. 
 
 If these do not bring relief vomiting should be induced. If the hic- 
 cough is disturbing enough to warrant nervous chills apply warm applica- 
 
 Fig. 331. — Fracture of Wrist. Colles Fracture. 
 
 tions and give a cup of hot tea. If there is much shock give twenty drops of 
 aromatic spirits of ammonia. 
 
 Stop up both ears with the fingers of each hand and drink water slowly 
 from a cup held by someone else. Produce sneezing. Pull tongue out and 
 put a piece of sugar or soda on it. Hold out for a few minutes. 
 
 NEURALGIA 
 
 Apply hot applications or rub with a menthol pencil or with some good, 
 warm, aromatic liniment. 
 
872 
 
 FIEST AID 
 
 EMERGENCIES 
 
 The following suggestions are for the mothers who may or may not have 
 a first aid kit handy. Children especially are prone to fall down and skin 
 their knees. Bumps are of everyday occurrence. Children are constantly 
 getting into mischief resulting in emergencies for which few mothers are 
 prepared. 
 
 BLACK EYE 
 
 Bathe the eye immediately with hot water and rub it very gently. 
 
 FOREIGN BODIES IN NOSE 
 
 Children are much inclined to push corn, beans and other small objects up 
 into their noses. The first thing to do is to tickle the nostril with a thread 
 or feather until the child sneezes. Do not push anything into the nose as 
 
 Fig. 332. — Dislocation of Both Bones of the Forearm Backward, Showing Position 
 of the Ends of the Dislocated Bones, Deformity of Elbow, and Position of 
 Forearm. 
 
 it may push the objects up farther. Have the child blow the nose. If these 
 simple procedures fail call a doctor. 
 
 See page 865. 
 
 NOSE BLEED 
 
 CHOKING 
 
 Slap on the back between the shoulders. Eaise the child's arms as high 
 as possible above the head. If the object is small let it go through the body. 
 Have the child eat bread or potatoes. Do not give castor oil or other 
 laxative. 
 
 HICCOUGH 
 
 See page 871. 
 
EMERGENCIES 
 BITES OF INSECTS 
 
 873 
 
 For the relief of bee stings, mosquito, fly, spider, bug and other insect 
 bites applications of damp baking soda or ammonia water will afford relief. 
 
 RUSTY NAIL WOUND 
 
 Wash the foot and wound with warm water and soap. Thoroughly cleanse 
 the wound with peroxid, then with alcohol, and paint with several coats of 
 tincture of iodin. 
 
 Fig. 333. — Artificial Respiration, Sylvester Method. Expiration. 
 
 See page 866. 
 
 BURNS 
 
 BRUISES 
 
 When the skin is not broken apply cloths wrung out of hot water; then 
 apply witch-hazel. If the skin is broken cleanse the wound with castile soap 
 and warm water; then use boracic acid solution and apply zinc oxid. 
 
 Fig. 334. — Artificial Respiration, Sylvester Method. Inspiration. 
 
 CUTS 
 
 Cuts should be washed and cleansed with peroxid, a piece of gauze dipped 
 in boracic acid solution should be applied and then the cut bandaged. If the 
 cut is deep make a pad of many thicknesses of the gauze and bandage tightly. 
 If the cut is large and requires stitches call a doctor. 
 
874 
 
 FIRST AID 
 
 ARTIFICIAL RESPIRATION 
 
 This procedure is simple. A certain sort of artificial respiration con- 
 sists in expelling the air by pressure on the chest sixteen times a minute. 
 As soon as the pressure is relieved air will flow into the lungs. On this 
 
 Fig. 335. — One Method of Resuscitation After Drowning. Can be Employed bt One 
 Man. Drains the Lungs; Lifting, Especially with Arms Under Body, Expels Air 
 from the Lungs; Normal Expansion Draws in Air. To be Repeated Fourteen Times 
 to the Minute. 
 
AETIFICIAL EESPIKATION 875 
 
 simple procedure the different artificial methods of respiration are built. 
 No one of them is difficult to carry out. A Boy Scout or a Camp Fire Girl 
 can carry them out just as well as can a physician. 
 
 Sylvester Method. — Clean all water and dirt out of the nose and mouth. 
 Roll the person on his back. Elevate the shoulders about two inches by put- 
 ting his coat under them. Have someone pull the tongue out slightly and 
 hold its tip just outside the lips. Place a watch where the operator can see 
 it. Unless checked by the watch the respiratory movements will be gone 
 through with too rapidly. 
 
 Kneel just above the person's head facing towards him. Catch both his 
 arms just below the elbows. Draw the arms outward and upward until they 
 
 CM- 
 
 Fig. 336. — Artificial Respiration. Hall Method. 
 
 are pointing toward your abdomen. Hold in this position two seconds. This 
 moving pulls the chest upward. As it moves upward the ribs move outward. 
 Thus a partial vacuum is created in the bronchial tubes and air rushes in 
 to fill it. 
 
 Carry the arms back to the side and front of the chest following the 
 track through which they were lifted. Complete this movement by firm 
 pressure on the lower part of the chest exerted through the person's elbows. 
 This second movement compresses the chest, drives out the air and places 
 the structures of the chest in such condition that the spring back when the 
 pressure is relieved will pull air deep into the chest. 
 
 This is a respiratory cycle. It should not be gone through oftener than 
 sixteen times a minute. If artificial respiration is worth doing at all in a 
 given case it is worth keeping up for two hours. 
 
 Laborde has suggested an addition which can be carried out by some care- 
 ful person while artificial respiration is going on. More care is required for 
 the Laborde procedure than for artificial respiration. 
 
 The suggestion is that every time the hands are carried above the head 
 the person holding the tongue shall draw on that member. The tongue is 
 allowed to go back into the mouth as the arms are carried to the chest. 
 Traction on the tongue must not be too strenuous. 
 
 While artificial respiration is going on the body must be wrapped in 
 
876 
 
 FIEST AID 
 
 blankets and hot bricks put to the feet. If the person has been in the water 
 the wet clothing must be removed, the body dried and warmly wrapped. 
 Sometimes a nervous shock will start the breathing apparatus; such would 
 be ammonia to the nose, anal stretching and rectal injections of warm 
 coffee. 
 
 FIRST SUNSTROKE TREATMENT 
 
 Fig. 337. — Triangular Bandage. A, base; B, apex; 
 C, D, basal ends. 
 
 The elevated roads of Chicago furnish each of their employees with a 
 
 vest pocket manual of first aid in emergency accident cases from which I 
 
 extract the following instructions for cases of sunstroke and heat prostration : 
 
 "Carry patient quickly to shaded spot out of the direct rays of the sun 
 
 and get all the fresh air pos- 
 sible for him. Place patient 
 upon his back and remove all 
 clothing from neck, chest, and 
 waist. Put ice to the head and 
 temples and pieces of ice over 
 the body and arms. With a 
 large piece of ice gently rub 
 up and down along the spine. 
 Do not be rough in rubbing 
 the patient. 
 
 "If a hose and water are 
 close at hand, turn a stream of water over the entire body and keep it running 
 over him continuously. Do not give any liquids by mouth. Place a hand- 
 kerchief or piece of gauze, saturated in spirits of ammonia, near the patient's 
 nose. If an oxygen tank is handy, place the oxygen tank on one side of the 
 patient's nose and turn on a fine spray of oxygen. 
 
 "Keep up a brisk massage of the legs ^ 
 
 and arms to stimulate the circulation. ^** x x 
 
 These cases are hospital cases; so follow _ y \^ 
 
 the above rules until a physician or am- 
 bulance arrives." 
 
 The reason for the insistence that 
 sunstroke cases are hospital cases is that 
 there are different affections due to heat. 
 Heat cramps, heat prostration and some 
 cases of heatstroke yield readily to the 
 simple treatment indicated. Sunstroke of 
 the more violent kind, especially of the 
 asphyxial type, is a severe condition call- 
 ing for a high degree of medical skill. 
 
 In addition to the immediate effects of heatstroke and sunstroke there 
 are later effects. Osier tells of a man who subsequent to a sunstroke could 
 never stand a temperature of over 75°. He lived in a cellar for a summer or 
 two and then moved to Alaska. Some are made so sensitive to heat that in 
 summer they get severe headaches, they have ugly tempers and they may 
 become delirious or insane. 
 
 z\ 
 
 Fig. 338. — Triangular Bandage 
 Folded Once and Twice. 
 
FIEST AID REQUIREMENTS 
 
 877 
 
 In every case of violent sunstroke there remains behind some men- 
 ingitis. In some cases there follows a violent form of progressive chronic 
 meningitis. 
 
 FIRST AID REQUIREMENTS 
 
 The article telling of the first aid packet required by ordinance in 
 Arlington, Massachusetts, stimulated a correspondent to inform us that the 
 
 Fig. 339. — Method of Rolling a Bandage. 
 
 Massachusetts law, chapter 557, acts of 1914, require every factory to keep & 
 first aid package at hand. Acting under this law the state Board of Labor 
 requires the following articles in first aid packages: 
 
 Fig. 340. — Triangle Bandage for Head. The base A is placed downward over the brow, 
 and the apex B at the nape of the neck. The basal ends C and D are carried backward 
 over the ears and crossed over the apex below the external occipital protuberance, the 
 "bump" on the back of the head. This prevents the bandage from slipping upward. The 
 basal ends are then returned to the front and tied, the apex being turned upward and 
 pinned to the body of the bandage. 
 
 One two ounce bottle of aromatic spirits of ammonia (to be renewed 
 every three months). 
 
 One two ounce bottle of 4 per cent boric acid solution. 
 One two ounce bottle of alcoholic iodin. 
 
Fig. 341.— Four-tailed Bandage for Fracture of Lower Jaw. 
 
 Fig. 342. — Four-tailed Bandage for Chin. Place the center of the bandage (see Fig. 341) 
 against the chin with the wide tails below, when the latter are turned upward and tied on 
 top of the head. The upper or narrow tails are carried backward and tied at the nape of 
 the neck. 
 
 Fig. 343. — Double-Headed, Knotted Bandage. The double-headed knotted bandage is 
 made of a strip of muslin about eight yards long and two inches wide, and rolled into two 
 heads or cylinders. The knotted bandage is generally used to arrest hemorrhage] from the 
 scalp by making pressure upon the temporal artery, which is situated just in front of the ear 
 and extending upward into the scalp. The pulsation of this vessel can easily be felt. Before 
 applying the bandage, a firm compress should be placed over the artery at a level with the 
 upper border of the ear. A piece of cork, for example, about half an inch thick and the diameter 
 of a silver half-dollar, should be enveloped in a piece of soft muslin and applied over the 
 artery. The operator then, holding a roller in each hand, places the outside of the bandage 
 against the compress and carries one roller around the head just above the eyes in front, and 
 the other below the occipital protuberance or "bump" on the back of the head, and to the 
 opposite temple; at this point the hands of the operator change rollers and return them to 
 the compress, over which they form a knot by twisting and changing their direction, one roller 
 being carried over the top of the head and the other beneath the chin, and then meeting at the 
 opposite side. At this point the rollers are again changed and returned to the compress, over 
 which a second knot or twist is made in the same manner; two or three knots over the com- 
 press are usually sufficient to arrest the hemorrhage. 
 
 878 
 
FIRST AID REQUIREMENTS 
 
 879 
 
 Two three ounce tubes of 3 per cent bicarbonate of soda in petrolatum. 
 
 One three inch by ten yards roll of gauze bandage. 
 
 One two inch by ten yards roll of gauze bandage. 
 
 Two one inch by ten yards rolls of gauze bandage. 
 
 One medicine glass. 
 
 Three drinking cups (paper), to be used once only. 
 
 One teaspoon. 
 
 One eye dropper. 
 
 One pair 4^2 inch scissors. 
 
 One dozen assorted safety pins. 
 
 One one ounce jar of green soap, to cleanse hands. 
 
 One basin, enameled, or nonrustable metal. 
 
 One-half pint of grain alcohol. 
 
 Fig. 344. — Figure of Eight of the Hand. 
 dicates route taken by bandage roll. 
 
 Arrow in- 
 
 Fig. 345. — Cravat Bandage 
 for Hand. 
 
 Six paraffin envelopes, each containing 6 x 36 inches of sterilized 
 gauze, dressings for wounds, burns, etc. 
 
 One yard of 24 inch canton flannel, to make triangular slings. 
 
 One one inch by five yards spool of adhesive plaster. 
 
 One rubber tourniquet, 24 x y 2 inch, or of webbing about 24 x 1 
 to control hemorrhage. 
 
 Two splints, 30 x 4 x 3-16 inch, whitewood, and one wire gauze splint, 
 about 30 x 4 inches, for fractures. 
 
 The National Founders' Association, 20 
 counseling with other manufacturers, has 
 standard package : 
 
 One tourniquet. 
 
 One pair of nickel plated scissors. 
 
 One pair of nickel plated tweezers. 
 
 One triangular sling. 
 
 One wire gauze splint. 
 
 Twelve assorted safety pins. 
 
 inch, 
 
 South La Salle Street, Chicago, 
 adopted the following for its 
 
880 FIEST AID 
 
 One two ounce bottle of castor oil. 
 
 Two three ounce tubes of burn ointment. 
 
 One two ounce bottle of 3 per cent alcoholic iodin. 
 
 One two ounce bottle of white wine vinegar. 
 
 One two ounce bottle of 4 per cent aqueous boric acid. 
 
 One two ounce bottle of aromatic spirits of ammonia. 
 
 One two ounce bottle of Jamaica ginger (or substitute), 
 
 One piece of flannel, 24 x 36 inches. 
 
 Fig. 346. — Adhesive Plaster for Sprain of the Thumb. 
 
 One roll of absorbent cotton (1.5 ounce). 
 
 One roll three inch by ten yards of gauze bandage. 
 
 One roll two inch by ten yards of gauze bandage. 
 
 One spool one inch by five yards of adhesive plaster. 
 
 Six packages 6 x 36 inches of sterile gauze. 
 
 One teaspoon. 
 
 One metal cup. 
 
 Two medicine droppers. 
 
 Three paper drinking cups. 
 
 First aid record cards. 
 
 FIRST AID OUTFITS 
 
 Arlington, Massachusetts, now requires that every shop or factory where 
 machinery is used for manufacturing purposes be equipped with a first aid 
 outfit. In that city the Board of Health has the power to fix requirements of 
 this character and their rules shall have the same standing as do ordinances 
 by city councils. 
 
 The rule is as follows: Every person, firm, or corporation operating a 
 factory or shop in which machinery is used for any manufacturing purpose, 
 or for any other purpose except for elevators, or for heating, or hoisting ap- 
 paratus, shall at all times keep and maintain free of expense to the employees 
 a full set of the following articles, the same to be kept in a suitable dust- 
 proof case : 
 
 Adhesive plaster, 1 inch roll and 2 inch roll. 
 
 Bandages, 2 dozen assorted, sizes 1 to 4 inches. 
 
 Absorbent cotton, 1 pound. 
 
FIEST AID OUTFITS 
 
 881 
 
 Gauze, 1 package of ten yards. 
 
 Elastic tourniquet, 24 inches. 
 
 Safety pins, 2 dozen. 
 
 Splint material, 4 white wood strips, 30 x 4 x 3-15. 
 
 Fig. 347. — Bandaging Wrist and Hand. Numbers indicate route of bandage. 
 
 Scissors, straight, 3 inch blade. 
 
 Basin, enamel. 
 
 Tablets, corrosive sublimate and citric acid, 100. 
 
 Carron oil, 1 quart. 
 
 Aromatic spirits of ammonia, 4 ounces. 
 
 There are many first aid outfits now on the market. This would be a good 
 
 Fig. 34.8. — Spiral Reverse Bandage. 
 
 one. The New York health department would modify it by omitting the 
 carron oil and specifying that the gauze and cotton should be in small 
 
 Carron oil is a poor dressing for burns. It is dirty, it is apt to spread 
 infection; it should be omitted. 
 
Fig. 349. — Bandaging Elbow. 
 
 Fig. 350. — Triangular Bandage Applied to Shoulder, Hand and Elbow. Shoulder: 
 The triangle should be applied to the shoulder by placing the base A downward across 
 the middle of the arm, the apex B being turned upward against the neck. The basal 
 ends C and D are carried to the inner side of the arm, crossed and returned to the outside 
 and fastened. The apex B is tied or pinned to a cravat or sling placed round the neck. 
 Hand: In injury to the posterior part, or dorsum, the hand may be bandaged by placing 
 the base of the triangle A upward at the back part of the wrist, the hand lying on the bandage; 
 the apex B is turned over the fingers upon the palm and carried to the wrist ; the basal ends 
 C and D are then carried to the front and crossed, and returned to the back of the wrist 
 and tied, or crossed again, and tied in front. In injury to the palmar surface of the hand, 
 the base should be first applied to the front of the wrist. Chest: The triangular band- 
 age is applied by placing the base A downward across the lower border of the chest, with 
 the apex B over the shoulder of the affected side, the basal ends C and D being carried 
 around the sides of the back, and tied together in such a manner that one end of the 
 knot is longer than the other. The long end is then tied to the apex, which has been carried 
 over the shoulder. 
 
 882 
 
POISONS AND ANTIDOTES 
 
 8S3 
 
 The object in specifying that the gauze and cotton be divided among 
 small packages is that the entire amount may not be soiled when first used. 
 
 In addition to the first aid cabinet a factor)' equipment could very well 
 include a few simple remedies. Massachusetts requires this. Moreover, there 
 are laws requiring that certain industries in which the workers are exposed to 
 certain poisons shall carry the antidotes for those poisons in convenient 
 accessible cases. 
 
 A medicine chest should in- 
 clude at least the following: 
 
 Medicine glass — two ounces. 
 
 Droppers — two. 
 
 Aromatic spirits of ammonia — 
 four ounces. 
 
 Salts — one pound. 
 
 Cathartic pills — one hundred. 
 
 Vaselin — one dozen boxes. 
 
 Laudanum — two ounces. 
 
 Diarrhea, mixture — four ounces. 
 
 Oil of cloves — one ounce (for 
 toothache). 
 
 Sirup of ipecac — two ounces. 
 
 Limewater — one quart. 
 
 Mustard — one pound. 
 
 Bicarbonate of soda — half 
 pound. 
 
 POISONS AND ANTIDOTES 
 
 Fig. 351. — Triangular Bandage Used for 
 Arm Sling. The base is placed vertically 
 along the outer border of the right side of 
 the chest, with the basal end thrown over 
 the right shoulder, and the apex is placed 
 behind the left elbow, the left arm being 
 bent at a right angle and held in front of 
 the bandage. The other basal end is now 
 carried around the forearm and over the 
 left shoulder, and tied to the first basal end 
 at the back of the neck. The apex is then 
 carried around the elbow and pinned to the 
 bandage in front. 
 
 In a case of poisoning the need 
 is for quick action. A physician 
 should be summoned at once; but 
 to wait for his coming before get- 
 ting into action might be a fatal mistake. 
 
 The first procedure whenever the poison has been taken into the stomach 
 is to produce vomiting. Frequently a lot of time is lost in hunting up emetics. 
 Vomiting should be stimulated by tickling the throat. If a feather or straw 
 is handy use that; if not, use the finger. 
 
 In the meanwhile someone should be preparing some lukewarm salt water 
 or mustard water. No time should be wasted on accurate dosage, as the water 
 is to come up again anyhow. 
 
 When the physician comes he will give apomorphia hypodermically, and 
 in most cases he will use the stomach pump. In some cases a stomach pump 
 will be available before the doctor comes. The most satisfactory stomach 
 pump is the simple kind consisting of a tube and a funnel. 
 
 To operate a stomach pump the end of the tube is introduced into the 
 mouth, pushed to the fauces, and the patient is told to swallow. As he swal- 
 lows the tube is pushed gently. The patient swallows the tube just as he 
 swallows food. Pushing on the tube may help or it may interfere. The 
 
884 
 
 FIBST AID 
 
 Fig. 352. — Triangular Bandages Used for Arm Slings. The bandage is to be applied in a 
 manner similar to Fig. 351, with this exception — instead of the second basal end being 
 carried over the left shoulder, it is carried under the left arm, then upward across the back, 
 and tied to the first basal end over the right shoulder. If the right shoulder or clavicular 
 region be injured as well as the left arm, the latter can be placed in a sling, leaving the affected 
 shoulder (the right) uncovered by laying the first basal end over the left shoulder, the base 
 being carried from above obliquely downward and to the right, the apex of the bandage and 
 the arm being in the same position as in the slings just enumerated. The second basal end 
 is now carried under the left arm and upward over the back, and tied to the first basal end at 
 the left shoulder. 
 
 essential part of the proceeding is the swallowing, not the pushing. The 
 head must be bent forward slightly else the tube cannot be swallowed. 
 
 Fig. 353. — Triangular 
 Bandage for Collar- 
 bone Fracture. 
 
 Fig. 354. — Dressing for 
 Fracture. 
 
 Collar-bonb 
 
 The tube having been swallowed, the salt water is poured into the funnel. 
 After a fair quantity has been run in the funnel should be rapidly lowered 
 
POISONS AND ANTIDOTES 
 
 885 
 
 and the stomach contents siphoned out. This should be repeated several 
 times. 
 
 il %/ 
 
 Fig. 355. — Triangular Bandage of Breast. 
 
 Acetanilid, Antipyrin, Antifebrin (Headache Medicines). — Antago- 
 nists: heat externally; coffee; aromatic spirits of ammonia — teaspoonful in 
 half a glass of water. 
 
 Fig. 356. — Figure-of-Eight Spica Bandaoe of Shoulder. Numbers indicate 
 
 route of bandage. 
 
886 
 
 FIEST AID 
 
 Acetic Acid. — Antidotes: whitewash from the wall; soap; chalk; lime- 
 water; magnesia. 
 
 Fig. 357. — Temporary Dress- 
 ing for Fracture of Clav- 
 icle 
 
 Fig. 358. — Strapping with Adhesive Plaster for 
 Broken Rib. 
 
 Arsenic. — Antidote: hydrated oxid of iron with magnesia. 
 
 Alkalies (Such as Lye, Washing Powders, Etc.). — Antidotes: vine- 
 
 Fig. 359. — Cravat Bandage 
 for Knee. 
 
 Fig. 360. — Spiral Reverse Bandage of Thigh Showing In- 
 troduction of the First Reverse. 
 
 gar; lemon juice; albumin; milk; gelatin; oils. (Potter says never use the 
 stomach pump.) 
 
 Alkaloids (General). — (Morphin, atropin, strychnin, quinin are illus- 
 
POISOXS AXD ANTIDOTES 
 
 88? 
 
 trations of alkaloids.) Antidotes: tannin, half a teaspoonful in water; 
 potassium permanganate, fire grains in water, freshly mixed: borax in milk, 
 twenty-five grains to the ounce; charcoal — empty the stomach immediately. 
 Wash it out after the antidote has been given. 
 
 Fig. 361. — Spiral Reverse Bandage of Thigh Completed. 
 
 Ammonia (Smelling Salts, Hartshorn). — Antidotes: vinegar; lemon 
 juice; orange juice. 
 
 Bichlorid of Mercury. — Antidotes: white of egg, one white for each 
 four grains of poison. Stomach should be emptied at once as the albuminate 
 
 Fig. 362. — Bandaging Hip and Abdomen. Numbers indicate route of bandage. 
 
 of mercury is soluble in the alkaline content of the stomach. An excess of 
 albumin puts the mercury back into solution. Iodid of potassium should 
 be given carefully for several days after the poison as it assists the kidneys 
 in getting rid of the mercury. 
 
888 FIRST AID 
 
 When other means are not available or practical in cases of poisoning 
 drug or nourishment is given by rectal injection. In these cases the solution 
 should be warmed and at least one-third more given than when taken by 
 the mouth. The ordinary household syringe should be used and care should 
 
 Fig. 363. — Triangle Bandage on Hip. The triangular bandage at this portion of the 
 body is applied in very much the same way as at the shoulder. The center of the base A 
 is placed downward across the middle of the thigh, the apex B being carried upward above 
 the crest or upper border of the pelvis or haunch-bone, the basal ends (C and D) 
 are carried around the thigh, and fastened at the outside. The apex \B is attached above 
 to a cravat around the waist. 
 
 be taken that the air in the syringe is expelled before the pipe is introduced. 
 
 In the absence of a stomach pump the rubber tube of an ordinary foun- 
 tain syringe can be used by cutting off the rubber or metal end. The bag 
 takes the place of the funnel of the regulation stomach pump. 
 
 When corrosives have been taken a stomach pump should not be used as 
 the membrane is usually swollen. 
 
 Cannabis Indica — Hashish.— Antidote: lemon juice from time to time. 
 There is no record of death from hashish poisoning. 
 
 Carbolic Acid. — Antidotes: wash out the stomach with equal parts 
 of alcohol and water. Leave about half a pint of the mixture in the stomach 
 for a few minutes, then wash out with warm water. If the case is first seen 
 some time after the poison has been taken give an ounce of Epsom salts 
 or half an ounce of Glauber's salts. Vinegar; soapsuds. 
 
 Chloral Hydrate. — Antidote: two teaspoonfuls of the official solution of 
 hydroxid of potash to be taken well diluted every hour for several hours. 
 
 Chloroform (Internally). — Antidotes: sodium carbonate, half a tea- 
 spoonful in plenty of water; pint of coffee by rectal injection; hot water 
 bottle to the extremities. 
 
 Coal Oil (Kerosene, Gasoline).— Antidote: wash out the stomach with 
 warm milk. If a stomach pump is not at hand give a quart of milk and 
 then produce vomiting. 
 
POISONS AND ANTIDOTES 
 
 889 
 
 Cocain. — Antidotes: if the drug has been swallowed give a fresh solu- 
 tion of permanganate of potash. If it has been taken hypodermically give 
 morphin or chloral. Stimulate. 
 
 Cyanid of Potassium. — Antidotes: where factories use cyanid of potash 
 they should keep the following stock solutions on hand : solution of ferrous 
 sulphate, 3 per cent, one ounce; solution of potassium hydroxid, 5 per cent, 
 one ounce. Keep these solutions in separate bottles. To use, mix, add 
 two or three grains of calcined magnesia and a pint of water. Give the 
 mixture, wait ten minutes and then wash out the stomach. Other antidotes: 
 cobaltous nitrate ; hyposulphite of soda ; bleaching powder in weak solution 
 in water. 
 
 Formaldehyd. — Antidote: ammonia. In case the gas is objectionable 
 sprinkle ammonia around. When the gas has been inhaled heat some water 
 
 Fig. 364. — Good Method of 
 Strapping a Sprained An- 
 kle with Adhesive Plas- 
 
 Fig. 365. — Bandaging Leg. Spiral Reverse. 
 
 of ammonia diluted with two parts of water and inhale the steam cautiously. 
 If the formalin has been taken internally give aromatic spirits of ammonia, a 
 teaspoonful in a glass of water. 
 
 Gas, Illuminating. — Antidotes: inhalations of a spray of chlorin water; 
 oxygen by inhalation; artificial respiration should be kept up several hours 
 if necessary. 
 
 Headache Medicines (See Acetanilid). 
 
 Hypochlorite (Bleaching Powder). — Antidote: hyposulphite of soda, 
 fifteen grains in water every hour for several doses. 
 
 Iodin. — Antidote: starch, teaspoonful washed down with water. 
 
 Lead Salts. — Antidote: Epsom salts, teaspoonful in water. Eepeat in 
 an hour. Produce vomiting. 
 
890 
 
 FIEST AID 
 
 Lead Colic. — To a pint of boiling milk add ninety grains of alum. Give 
 a wineglassful every hour or two. 
 Matches (See Phosphorus). 
 Mineral Acids (Muriatic, Nitric, Sulphuric, and Some Others). — 
 
 Antidotes: whitewash; wall plaster; chalk; soapsuds; magnesia; cooking soda. 
 (Potter advises against the use of the stomach pump because of the liability 
 of puncturing the stomach.) 
 
 Morphin (See Opium). 
 
 Mushrooms, Poisonous. — Antidote: give atropin sulphate. Do not 
 give more than one dose of 1/100 of a grain before the physician takes charge. 
 
 Fig. 367. — Tkiangle Bandage on Foot. 
 The foot should be placed on the triangle 
 with the base A backward, and laid behind 
 the ankle, the apex being carried upward 
 over the dorsum or top of the foot. The 
 basal ends C and D are brought forward, 
 crossed, then carried around the foot, and 
 tied on top. 
 
 Fig. 366. — Figure-of-Eight 
 Bandage of the Ankle 
 and Foot. Numbers in- 
 dicate route taken by band- 
 
 Fig. 368.— Reef Knot. 
 
 Opium (Morphin).— Antidotes: a third of a spoonful of tannin dissolved 
 in water, or wash out the stomach with a 1 per cent solution of potassium 
 permanganate. Leave some in the stomach. Borax (5 per cent) in milk. 
 Coffee by the rectum. 
 
 Oxalic Acid (Salts of Lemon, Ink Eradicator). — Antidotes: wall plas- 
 ter; whitewash; limewater; chalk; ink; magnesia. (Potter, from whose 
 therapeutics most of this information is drawn, says: "Avoid cooking soda, 
 since it forms compounds as toxic as the acid itself. Never use the stomach 
 pump.") 
 
POISONS AND ANTIDOTES 801 
 
 Prussic Acid. — Antidotes: cobalt nitrite; hyposulphate of soda; give 
 inhalation of ammonia. 
 
 Phosphorus (Matches; Some Rat Pastes). — Antidotes: wash out the 
 stomach with a 1 per cent solution of permanganate of potash. Leave some 
 in the stomach. Limewater; charcoal; hydrated magnesia. 
 
 A poison case should contain the following substances properly labeled: 
 
 Borax; bicarbonate of soda; limewater; charcoal; common salt; calcined 
 magnesia; permanganate of potash; hyposulphite of soda; starch; sulphate of 
 magnesia; tannin; solution of ferric sulphate, 600 grains in 4 ounces of 
 water ; magnesia, 150 grains in a pint and a half of water ; nitrate ; hypodermic 
 syringe and pellets of apomorphin muriate ; strychnin and morphin sulphates ; 
 stomach pump. 
 
 Martindale's antidote bag: dialyzed iron; sirup of chloral; chloroform; 
 spirits of chloroform; magnesia; spirits of ammonia aromatic; oil of turpen- 
 
 Fig. 369. — Grannie Knots. 
 
 tine ; acetic acid ; tincture of digitalis ; tannic acid ; amyl nitrite ; zinc sulphate ; 
 Ipecac ; bromid of potash ; permanganate of potash ; solution of ferric sulphite, 
 40 cc. in 125 cc. of water; magnesia in solution, 10 grains in 750 cc. water in 
 a bottle 1,000 cc. capacity; mix and make official antidote for arsenic. Hypo- 
 dermic syringe and morphin, atropin, apomorphin, pilocarpin and strychnin. 
 
 Poison Oak Treatment. — B. H. M. writes : "What is the test remedy for 
 poison oak? Why does it break out again every year about the same timef 
 
 Reply. — One attack of poison oak'dermatitis makes the skin more sensi- 
 tive to the poison. The poison does not stay in the system between attacks. 
 There is a contact with the vine before every attack. Bathe the poisoned 
 parts with hot water, and dry carefully. Spread ichthyol ointment [10 per 
 cent] on sterilized gauze and bandage loosely or strap with adhesive plas- 
 ter. Dressing should be changed twice daily. If the face is poisoned make 
 a mask of gauze, cutting holes for the eyes, nose and mouth. 
 
 Alcohol and Snake Bite. — Mrs. W. F. V. writes : "Is an alcoholic stimu- 
 lant the best remedy for snake biteV 
 
 Reply. — It is not. If a stimulant is needed aromatic spirits of am- 
 monia is a better one. 
 
 Snake bite is rarely fatal. But few snakes are poisonous. Of the 
 poisonous snakes few are capable of killing a grown person. 
 
 Alcohol has got the credit for curing a great many people who would 
 
892 FIRST AID 
 
 have become well without it and indeed have become well in spite of it. 
 When a man has been bitten and is scared stiff alcohol gives him some 
 Dutch courage. For this purpose morphin and hyoscin would be better. 
 
 Treatment of Wounds. — S. B. C. writes: "We are being told on every 
 side that we must not wash a wound with soap and water or antiseptic 
 solutions lest the tissues be injured. You say iodin should be in the emer- 
 gency hit, but you do not say how it should be used" 
 
 Reply. — If a wound is greasy and dirty (shop wound) wash it out with 
 gasoline. If the wound is through ordinarily clean skin wash around the 
 wound with soap and water and follow with alcohol. 
 
 The iodin may be poured into the wound, or it may be applied to the 
 wound with an applicator made with a toothpick and a bit of absorbent 
 cotton. If the iodin runs over the sound skin that excess should be washed 
 off with alcohol. Then cover the wound with a small amount of gauze. 
 Hold the gauze in place by a light bandage. Do not seal out the air with 
 collodion. 
 
 Where wounds are stinking, suppurating with decomposing secretions, 
 such as are the neglected wounds of the European war, the best treat- 
 ment is to clean with peroxid of hydrogen and to apply very light open 
 gauze dressings. Such wounds need oxygen and air. 
 
 Toxemia. — F. L. B. writes: "1. What would produce toxemia in a child? 
 2. What would cause toxemic poisoning? 3. With proper care would the 
 prognosis be favorable? 4- Should a relapse or second attack of poisoning 
 be feared, if so from what cause?" 
 
 Reply. — Toxemia merely means that there is a poisonous substance in 
 the blood. What would cause it, whether a given case would get well and 
 whether it will recur depend on what the nature of the poison is and some 
 other factors. For instance, a child eats spoiled food. Some of the harm- 
 ful substance is absorbed, some goes to the brain and causes fever, some to 
 the skin and causes a rash. If the child vomits and purges before much 
 poison has been absorbed it should get well. The toxemia will not return 
 unless the child again eats spoiled food. 
 
CHAPTER XLVII 
 
 Occupational Diseases 
 
 When human slavery was abolished employers became careless of work- 
 ers. Any sort of a hole would do for a servant's room ; employees were worked 
 until they fell; accidents were inevitable; lead poisoning was unfortunate 
 but unavoidable and consumption was a visitation of Providence. Now we 
 recognize industry as social. It is no longer the business of the employer 
 alone. 
 
 First, the government came around sticking its nose into interstate com- 
 merce. There was a great outcry from the railroads but the measures stuck. 
 Then came regulation of public and semi-public utilities. Then came the 
 government sticking its nose into private business looking for combinations 
 m restraint of trade, for unfair competition, for dishonesty of many sorts 
 including cheating by substituting fakes or impurities for food and by lying 
 labels. Finally, the socializing process is extending to movements for the 
 prevention of accidents, trade poisoning and occupational disease. 
 
 This preventive movement is being fairly well received by legislative 
 bodies, employers and employees. Each complains a little but as I see it 
 there is no great amount of justification for it. Probably the reason is 
 that the educational work has been well done. John Calder said: 
 
 "Legal obligation to safeguard thoroughly has only succeeded where per- 
 suasion and enlightenment have accompanied it/' 
 
 The American Eed Cross from time to time issues pamphlets telling how 
 to prevent injurious industrial conditions. It distributes wall cards telling 
 what to do in case of accident or poisoning. There are several organizations 
 doing similar work. In consequence many places of business now contain 
 first aid cabinets distributed at convenient points around the factory. Some 
 have first aid corps that have a certain amount of training in the accidents 
 liable to occur in the various factories. 
 
 Some have emergency hospitals. I know of a few large plants with a 
 large amount of floor space under cover where there are complete motorcycle 
 ambulance systems. But the majority of the plants have not developed any- 
 thing of this character. They are not large enough to warrant the necessary 
 organization. These should at least have cards of instruction prominently 
 displayed and first aid cabinets containing antidotes for poisons and surgical 
 dressings. 
 
 The Illinois Commission on Occupational Diseases found in Illinois 
 seventy industrial processes which are productive of lead poisoning. Sixty- 
 three out of 89 brass foundries were acknowledged centers of trade sickness. 
 Of 187 men examined 161/. were found to be suffering from brass poisoning. 
 Out of 1,760 men examined only 17 were over fifty years of age and only 180 
 were over forty. 
 
894 OCCUPATIONAL DISEASES 
 
 The commission examined 240 men employed in steel mills and subjected 
 to carbon monoxid gas. Practically all of them were in bad physical condi- 
 tion but the commission found it difficult to say whether the cause was carbon 
 monoxid in the works or factors outside. Among other things they noticed 
 a loss in muscular power and a sluggish mentality. The relation of carbon 
 monoxid poisoning to these changes should be investigated. 
 
 Few people understand how many industries make use of poisonous 
 metals and therefore subject their workers to poisoning. Some of those using 
 lead are: painting, enameling, glass making, file making, kitchen tinware, 
 pottery, india rubber, plumbing, milk bottle covers, electric cables, storage 
 batteries, dry sandpapering of lead paint and those processes which make 
 use of phosphorus. 
 
 I would suggest reading of Dr. Alice Hamilton's address as printed 
 in Human Engineering for 1911 if for no other reason than it shows how 
 little employers know about the conditions of their men. I have reference 
 not so much to the philanthropic side as to the premature senility, loss of 
 muscular strength and mental tone, incapacity from illness in their workers 
 ■ — expenses which the employer unconsciously carries in part. 
 
 Acid Burns 
 
 A manufacturer wrote me a short time ago about hydrofluoric acid burns 
 in his factory. His letter has prompted this article. Hydrofluoric acid is used 
 for cutting glass. The fumes irritate the breathing apparatus and the eyes. 
 When the solutions of acid get on the hands they make deep burns which 
 heal slowly. A milder effect is a chronic inflammation of the skin — a 
 dermatitis. 
 
 For the removal of the fumes hoods should be placed over all vats and 
 ventilating fans should draw the fumes into these hoods under strong draft. 
 The eyes should be protected by celluloid goggles, the hands by rubber gloves. 
 These are the recommendations of the Illinois Commission on Industrial 
 Diseases. If the worker gets a dermatitis from rubber gloves, as some do, 
 he can keep his hands covered with grease and then wear a pair of well 
 greased cotton gloves. 
 
 A factory using hydrofluoric acid should have easily available facilities 
 for hand washing. When acid splashes on the skin it should be washed off 
 with plain water and then silicon or sand should be applied. This should be 
 washed off later and the burn treated like any other burn. 
 
 With other forms of mineral acid poisoning, wherever in the process 
 fumes are given off (including those processes where liquids are so heated 
 as to cause steam to rise) the fumes should be collected by hoods from which 
 the air is drawn by fans. If this does not suffice the men should be provided 
 with respirators. Goggles should be used to protect the eyes. When acid gets 
 on the skin it should be quickly washed off with water. Alkali, such as baking 
 soda, should be at hand and some of this should be dusted on as soon as the 
 excess of acid is washed off. The burns should then be treated as are other 
 burns. 
 
 In trades where alkali is used the fumes must be carried away. When 
 alkali has got on the skin it should be washed off with plain water and then 
 
PHOSPHORUS POISONING 895 
 
 with a weak acid. Watery solution of mineral acids should be kept at hand 
 but in their absence vinegar can be used. 
 
 Workers with chromic acid and bichromate not infrequently suffer from 
 poisoning of the skin with these substances. Sometimes the acid is strong 
 and deep burns resulting in chronic ulcers develop. To prevent this facili- 
 ties for washing with soap and water should be provided. 
 
 More frequently the effect is a chronic eczema. To prevent this the hands 
 should be Washed with an aluminum sulphate solution (8 per cent), one 
 ounce in one pint of water. They should then be greased with a fresh cold 
 cream or with fresh lard. While at work rubber gloves should be worn. 
 
 PHOSPHORUS POISONING 
 
 One of the most interesting papers read at the International Congress 
 on Hygiene was one by Sir Thomas Oliver on industrial diseases. In the 
 course of his lecture he complimented the United States upon the passage 
 of the bill to prevent the use of poisonous forms of phosphorus in the 
 manufacture of matches. 
 
 According to Sir Thomas, when students of occupational diseases dis- 
 covered the horrible effects of phosphorus upon the matchmakers they recom- 
 mended sanitary shop regulations thinking in this way to prevent phosphorus 
 poisoning. Many governments embodied such regulations in their laws and 
 many factories installed such provisions as a part of their shop practice. 
 Nevertheless phosphorus poisoning was about as frequent and as horrible 
 as before the regulations were enforced. 
 
 Sir Thomas showed many lantern slides illustrating horrible deformity 
 amongst match workers. One poor fellow lost half of his upper jaw and then, 
 instead of taking up farming, he went back into the factory, was again poi- 
 soned and lost his entire lower jaw. 
 
 In 1872 Finland prohibited the use of poisonous kinds of phosphorus 
 in matches. In 1874 Denmark likewise prohibited the manufacture of matches 
 with dangerous kinds of phosphorus. In 1906 the International Association 
 for Labor Legislation meeting at Berne proposed an international treaty 
 agreement for the prevention of the use of white phosphorus in making 
 matches. Certain manufacturers opposed the change saying the cost of manu- 
 facture would be prohibitively high, the matches would not keep, the matches 
 would not be as good — the change was not feasible commercially. 
 
 As soon as the recommendation was made by the congress Denmark 
 signed the treaty, France signed in 1906, so did Switzerland, Holland, Luxem- 
 burg, Italy and Germany. Austria complied in 1908 and England in 1910. 
 
 Contrary to the opinion of the objectors Sir Thomas Oliver said the law 
 had not been found objectionable from any business standpoint and it has 
 done away with phosphorus poisoning among the workmen. 
 
 When the bill came up in Congress it was proved that phosphorus poison- 
 ing in this country was frequent and severe. The Diamond Match Company 
 came forward with an offer to give the method of manufacture of harmless 
 phosphorus to whomever wanted it. The law gave plenty of time for every- 
 body to adjust his business to the new requirement. There remained not 
 
896 OCCUPATIONAL DISEASES 
 
 a single business objection, while, on the other hand, there was the offer of 
 safety for the workingman. Finally the bill was pried out of the pigeonhole 
 and passed. The president signed it and before many months this republic 
 was protecting matchmaker citizens as well as most European countries do. 
 
 ACCIDENTS AND DISEASES OF IRONWORKERS 
 
 Such was the title of a paper by Dr. Eopke of Solingen, Germany. Iron- 
 workers, especially workers in raw iron, have a great many accidents and 
 contrary to what one would think mechanical accidents are more frequent 
 than scalds and burns. Their disease rates are also higher than normal. 
 
 In raw iron work the men are poisoned by the gases, vapors and dust. 
 When air passes over red hot iron it has a burnt odor and it does harm. That 
 we have noticed in houses heated with stoves and hot air furnaces. Part of 
 the cause is the charring of dust and bacteria; part of it is carbon monoxid 
 gas. If the structures are inclosed enough to allow it to accumulate this gas 
 abounds in foundries and rolling mills. 
 
 In what he terms the small iron industry the harm, in the main, is from dust. 
 
 1. Blacksmiths suffer from coal dust, coal vapor, from sudden changes 
 in temperature and from overwork. The reader will note the distinction 
 between the effects of coal dust and smoke and vapor — a distinction usually 
 lost sight of by our anti-smoke nuisance friends. 
 
 2. The locksmith trade is not a dusty one. The workmen develop curva- 
 ture of the spine from sitting in bad positions for long stretches. 
 
 3. File cutters also develop stoops and postures from working at badly 
 placed benches. They suffer from lead poisoning occasionally. Their con- 
 sumption rate is rather excessive. 
 
 4. The grinders suffer heavily from the dust diseases. They lead the list 
 of consumptives. Eopke found that ironworkers had more than their share 
 of eczema and boils. 
 
 Galvanizers were especially subject to eczema. They were nearly always 
 deaf after working one year in a noisy shop. They had an excessive amount 
 of consumption. Though pneumonia and colds were frequent their rise did 
 not keep pace with that in consumption. 
 
 The author lays this down as a basic proposition : "The state, the commu- 
 nity, and the employer all have the same interest at heart — to keep the iron- 
 worker in good health/' Nor does he neglect to emphasize the obligation of 
 the ironworker to keep in good health. A part of the protection is properly 
 the duty of the employer. A part of it is the duty of the employee. 
 
 The basic principle of the method laid down is : "Dust and gases must be 
 rendered innocuous at the place of their origin." And, again, the almost 
 universal note of optimism: "The mortality rate among metal grinders at 
 Solingen is much lower than in the good old days." 
 
 REMEDY FOR THE "GASSED" 
 
 One of the least suspected sources of poison is the fumes of wood alcohol. 
 Wood alcohol is used to cut shellac and other varnishes. It is used in some 
 
LEAD POISONING 897 
 
 rapid drying paints. It forms the basis of liniments and is used to cut 
 oils. The alcohol vaporizes readily and the air of closed rooms becomes 
 saturated with it. When a man has soaked up much of it he is liable to die 
 suddenly in coma. 
 
 If he recovers from the first effects he may become pale and anemic, 
 develop crops of boils, and in time go blind. The blindness from wood alcohol 
 poisoning is hopeless because the nerve of sight is destroyed. 
 
 The preventive is good ventilation. If a few electric fans were properly 
 distributed around the beer vats which are being varnished the poisoning would 
 be negligible. The remedy is to take the stricken person into the fresh air. 
 
 Workers at vulcanizing of rubber get jagged from the fumes of the hy- 
 drogen sulphid inhaled. An acute insanity with destructive tendencies, even 
 with a tendency to self-destruction, sometimes develops. In chronic poisoning 
 a peripheral neuritis is developed. Some of the nerves become chronically 
 inflamed and after months of pain the muscles supplied by the painful nerve 
 begin to shrivel. 
 
 The remedy is to provide the workshop with good ventilation, with hoods 
 and exhaust fans to draw the gases as directly as possible. The best of bath- 
 ing facilities should be provided. The workers should be provided with 
 working clothes that their street clothes may not be saturated with the foul 
 odors of the work place. Outside eating rooms should be provided. Young 
 persons should not work at this trade. The hours of work should be short. 
 
 When a person is "gassed" the remedy is inhalation of oxygen. 
 
 A frequent form of gas poisoning is that due to carbon monoxid. Blast 
 gas contains 26 per cent and producer gas 23 per cent of this highly poison- 
 ous gas. It is found around steel mills, gas plants and coke ovens. It is even 
 present in such places as rooms heated by stoves and tailor shops with their 
 coke fires and irons. 
 
 The workers get into an intoxicated condition which they speak of as 
 being "gassed." Later effects are insanity and anemia. A striking result 
 is a loss of power in the muscles. 
 
 The remedy for the acute condition is oxygen gas. 
 
 To prevent the condition the places should be well ventilated. Drinkers 
 should not be allowed to work around blast furnaces, rolling mills or gas 
 works. Oxygen should be kept at hand. 
 
 LEAD POISONING 
 
 A mother expects her baby under two years old to have diarrhea occasion- 
 ally but when her older children get it she wonders why. She is pretty 
 certain to accuse them of eating green fruit or spoiled fruit or something else 
 forbidden. Every now and then the children get such attacks and occasionally 
 the cramping is so great that a physician is called in. If he be a bright, quick 
 witted chap he is likely to suspect lead poisoning. If he turns about a bit 
 he will find several ways in which children can get hold of lead without 
 knowing it — for instance, from soda water and pop. Every "kid" likes them. 
 
 Soda water and pop are mixtures of plain water and carbonic acid. Car- 
 bonic acid dissolves lead wherever it touches it. Lead pipes make the best 
 
898 
 
 OCCUPATIONAL DISEASES 
 
 and also the cheapest connections for soda fountains and pop machines. Block 
 tin pipes or chemically pure lead pipes are much more expensive and less well 
 adapted to bottled water work than those made of ordinary everyday lead. 
 
 Pop or soda water that touches ordinary lead gets a small charge of 
 lead, not enough so that one bottle of pop or one glass of soda will kill a 
 child but just enough to give a child who drinks two or three glasses of soda 
 or two or three bottles of pop a week spells of diarrhea and frequent cramps 
 in the legs, arms and belly in a few weeks. If the poisoning is worse the child 
 may be having convulsions or be pale or have a blue line along the gums — 
 occasionally paralysis of a leg or arm will develop. 
 
 The preventive remedy is simple. Allow the child to drink no soda water 
 except from fountains which advertise "No lead 
 in our soda" ; to drink no pop unless "No lead 
 in this water" is blown in the bottle. 
 
 Lots of grown people are suffering from 
 lead poisoning. They do not know it, which 
 only makes it worse. The report of the Illinois 
 Commission on Industrial Diseases proves that 
 many suffer from lead poisoning and also that 
 most sufferers wonder what the trouble is. The 
 symptoms of lead poisoning in grown people are 
 much the same as in children. 
 
 When a grown person has a persisting diar- 
 rhea there is a reason and the reason may be lead 
 poisoning. However, in grown people, as you 
 would expect, diarrhea is not so prominent a 
 symptom as in children. The cramps, the 
 paralysis, the pallor, the blue gum line become 
 more important signs. 
 Of course, every painter knows he is in danger but there are many other 
 trades in which some lead as dust or smear gets on the hands; the worker 
 fails to wash his hands before taking a chew of tobacco or eating his meals, 
 or drinking water or beer or doing any one of a dozen acts that everyone 
 does almost unconsciously but which serve to carry just a little lead to the 
 mouth. If the amount carried was great enough to knock the man right down 
 he would not repeat the thoughtless act, but it is mighty hard to see the 
 importance of a thing which does not show its importance until it has been 
 kept up for half a year. 
 
 Among other workers who get lead poisoning are glaziers, plumbers, 
 miners, workers in lead, file makers, gun polishers, tinware makers, weavers, 
 typesetters and typemakers, rubber goods makers, structural iron workers, 
 brass workers and lace-makers. Eather an extended assortment. 
 
 370. — Wrist Drop Due to 
 Lead Poisoning. 
 
 PREVENTING LEAD POISONING 
 
 Dr. Francis D. Patterson, having declared that industrial plumbism 
 was preventable, gave the following twelve requirements by which a factory 
 could prevent it: 
 
 "1. Taking care to make the processes as dust free as possible. 
 
LEAD POISONING 899 
 
 "2. As it has been found difficult to enforce the use of the ordinary type 
 of respirators, we are using with success a respirator which I designed and 
 have had manufactured by Johnson & Johnson. It is made of five thicknesses 
 of gauze and they are issued clean to the men each day. 
 
 "3. But a slight amount of the lead dust which enters the mouth and nose 
 passes into the lungs. Fully three-fourths of it lodges in the mouth and nose, 
 where it becomes mixed with saliva and mucus and is unconsciously swal- 
 lowed. In order to obviate this as much as possible it is our practice to 
 require our employees before taking their dinner and when cleaning up after 
 the day's work to thoroughly wash out the nares with warm water and to 
 gargle the throat and wash the mouth thoroughly with a 0.2 per cent solution 
 of sulphite of soda. 
 
 "4. Each factory should have a room, preferably in a separate building, 
 where the employees eat, and no food should be allowed to be carried into 
 any other room in the factory. Care should also be taken to see that the 
 employees wash properly before eating their dinner. 
 
 "5. Milk being a valuable preventive, it should be provided at the com- 
 pany's expense and the employees urged to drink it freely. 
 
 "6. All employees should be provided with clean overalls each week at 
 the company's expense. 
 
 "7. Ample facilities for bathing with soap and towels should be provided. 
 
 "8. The carrying and the chewing of tobacco at work should be prohibited. 
 
 "9. Too much stress cannot be laid upon the importance of the employ- 
 ment of a competent physician, who will make a physical examination of all 
 applicants for employment and reexamine the employees at a weekly interval. 
 We do not employ any men under the age of 21 years, nor those who present 
 the physical evidences or history of alcoholism, kidney disease, syphilis, rheu- 
 matism, or any chronic digestive disturbance. 
 
 "10. Each employee receives a thorough physical examination each week, 
 so as to determine those who present the evidences of being in a condition 
 of "lead store." The recognition of this in its incipiency and the adminis- 
 tration of the proper treatment insure the relief of the condition before it 
 has time to progress. 
 
 "11. All employees are given free medical treatment; they are encouraged 
 to consult me for any ailment, no matter how trivial, and this further insures 
 the early recognition of any cases of poisoning. 
 
 "12. In each room in the factory is a notice which tells the employees 
 of the precautions which they should take in assisting in preventing lead poi- 
 soning among them/' 
 
 RECOGNIZING LEAD POISONING 
 
 A great many people suffer from lead poisoning. Some recognize the 
 condition readily. Some suffer for a long time without knowing it. The 
 Illinois state factory inspector reports the following as the more important 
 symptoms found in the poisoned workers coming under the observation of his 
 department: ■ ., ..-..-.... 
 
 The most, frequent notation is "blue line on gums," "lead line." The 
 second .most frequent . notation is "colic," "umbilical cramps," "pain in the 
 region of the umbilicus," "abdominal tenderness," "abdominal -pain," "nau- 
 
900 OCCUPATIONAL DISEASES 
 
 sea," "pallor." Next comes tremor. Other less frequent symptoms are paralysis, 
 wrist drop, muscular weakness, dermatitis, constipation, headache and sore 
 eyes. 
 
 These are the more immediate effects of lead poisoning. The report does 
 not refer to such delayed effects as high blood pressure, apoplexy, Bright's 
 disease and premature senility. 
 
 The occupations in which there is especial tendency to poisoning from 
 lead are several. The most dangerous of all trades from the standpoint of 
 lead poisoning is painting. Among the employees of white lead manufactories 
 the lead poisoning rate was about four per one thousand. 
 
 In the smelting and refining of lead conditions are improving rapidly. 
 The lead poisoning rate among employees in 1914 was three per one thousand. 
 In the paint and dry color factories there was considerable hazard. In the 
 former it was found that the men would often eat without washing their 
 hands. In the latter the danger from soiled by lead hands was augmented by 
 the danger from lead dust. 
 
 Among workers in battery factories the number of cases of lead poi- 
 soning was high, about six per one thousand. The worst rate of all was in the 
 tinware establishments. The lead sickness was eleven per one thousand. 
 
 Other dangerous trades are manufacturing car seals, electrotyping, enam- 
 eling, brass foundry work, litho transfers, decalcomania work and galvanizing. 
 In some of these trades the care taken is reducing the hazards to reasonable 
 limits of safety. In some processes lead sulphate is being substituted for 
 other forms of lead because of an opinion that lead sulphate is not poisonous. 
 The Illinois officials found lead sulphate about as poisonous as other forms 
 of the metal. 
 
 Painters using different forms of rapid dryers are subject to another 
 form of poisoning. The evaporating solvent in these rapid dryers is either 
 benzin or wood alcohol. Painters who use them are subject to vertigo, head- 
 ache, nausea, and ringing in the ears. These symptoms are the same as are 
 found often in garages and dry cleaning establishments. They are due to 
 the fumes of benzin, petrol or wood alcohol. 
 
 To prevent lead poisoning it is necessary (1) to have ample washing 
 facilities, (2) to require that the lunch be eaten outside the factories and that 
 before eating the face and hands be washed, (3) to wear respirators in dusty 
 places, (4) to use hoods and artificial ventilation wherever needed. 
 
 MERCURY POISONING 
 
 Both Professor Teleky of Vienna and Professor Tylecote of Manchester 
 told the hygiene congress that acute mercury poisoning as a trade disease 
 was becoming less but that there was an increase in chronic poisoning with 
 mercury. ' 
 
 The use of mercury to gild mirrors has materially decreased. Euro- 
 pean mercury mining has been made safer. Fire gilding has been replaced 
 by galvanic gilding. These industries caused the more acute forms of mercury 
 poisoning. On the other hand, chronic mercury poisoning among hatmakers 
 is on the increase. 
 
ARSENIC AND BENZIN POISONING PREVENTION 901 
 
 The symptom which makes the hatmaker think there is something wrong 
 is a fine tremor first appearing in the hands and then spreading to the 
 body entire. The hand does not jerk so coarsely as it does in paralysis 
 agitans or in disseminated sclerosis. It is a coarser jerk than the very fine 
 tremor of goiter. Later it affects the speech and gait. The teeth turn black 
 and some of them loosen and drop out though this symptom is not nearly 
 so great as it is in the salivation from calomel which the older people re- 
 member. 
 
 Felt plankers' hands are cracked and calloused but this is from the acid 
 in the bath more than from the mercury. 
 
 Tobacco chewers suffer more than men who do not chew. They get mer- 
 cury on their hands, then on their tobacco and then into their mouths. 
 
 There is no special susceptibility to consumption. 
 
 The methods of prevention proposed applied, in the main, to hat facto- 
 ries, felt factories, and the places where pelts and fur were handled, cleaned, 
 dyed, and worked. Workmen in such places should receive a monthly medical 
 examination. No hat work should be done at home. Women and children 
 should not be allowed to do hand planking. In fact, hand planking should 
 be done away with. The factory should be spacious and well ventilated. The 
 workers should have an average of 800 cubic feet of space each. The room 
 must be frequently sprinkled. Every machine must be provided with a hood 
 and a dust exhaust. Government inspectors must make periodic examinations 
 of the air to keep down the amount of dust, and particularly mercury dust, 
 it contains. As far as possible all hand processes must be supplanted by 
 machines so as to keep the hands away from the mercury mixtures as much 
 as possible and to keep the dust down to the minimum. There should be 
 ample toilet facilities conveniently located and appealing to the esthetic sense. 
 
 ARSENIC AND BENZIN POISONING PREVENTION 
 
 Men who work in making and cleaning wallpaper, those who manufacture 
 dyes and some workers at the manufacture of chemicals, suffer at times from 
 arsenic poisoning. Chronic arsenic poisoning causes the hair and nails to 
 fall off and produces shin eruptions, bronchitis, bleeding gums, neuritis and 
 Bright' s disease. Acute arsenic poisoning causes violent vomiting and purging. 
 
 To prevent chronic poisoning the general ventilation should be of the 
 best. Where hoods and exhaust fans can produce results they should 'be made 
 use of. Sometimes respirators should be used, and ample washing facilities 
 must be provided. 
 
 As an antidote for acute poisoning with arsenic take white of egg, then 
 produce vomiting; after that take milk. 
 
 People who work at the manufacture of celluloid articles develop cough, 
 bring up bloody sputum and in time become asthmatic. The principal neces- 
 sity is that there should be provision against fire. Fire apparatus, and espe- 
 cially fire smothering cloths and sand for the same purpose, should be kept 
 at hand. The factory should be well ventilated. 
 
 Cleaners, dyers, and all others who work with benzin or similar substances 
 are greatly hazarded by their occupation. To prevent explosions add a small 
 
902 
 
 OCCUPATIONAL DISEASES 
 
 quantity of oil soap to the benzin (1/10 to 1/100 of 1 per cent). Such soaps 
 are on the market. 
 
 Oliver gives the following as the method of manufacture of an oil soap : 
 One part of caustic soda or caustic potash is mixed with four parts of alcohol. 
 To this mixture there is added oleic acid in the proportion of one and three- 
 fourths parts of the acid to one part of the alcohol-alkali solution. The mix- 
 ture is heated and to it is added benzin or benzol in the proportion of two 
 and one-half parts of benzin to one part of the mixture. This forms the oil 
 soap which is added to the benzin. 
 
 Those who work in an atmosphere of benzin get benzin drunks. They 
 
 later develop headaches and gid- 
 diness, and then they vomit and 
 become stuporous. The meas- 
 ure of prevention is fresh air. 
 Hoods and exhaust fans should 
 be used, and the body of the 
 room must be well ventilated. 
 Separate lunchrooms must be 
 provided. 
 
 Benzin affects women more 
 than men. Anemic girls should 
 not be allowed to work at trades 
 in which much benzin is 
 used. 
 
 To sober the jag nothing 
 is so good as plenty of cold fresh 
 air. A glass of milk internally 
 helps some. 
 
 CAISSON DISEASE 
 
 In some engineering proj- 
 ects to prevent walls from fall- 
 ing or water from flowing in, 
 the workman must work in air 
 compressed chambers called cais- 
 sons. This is all right for the 
 work but it is hard on the 
 worker. A man entering a com- 
 pression chamber has in his 
 blood the amount of gas proper 
 when the atmospheric pressure 
 is normal. Compressed air drives into his blood an excessive amount of 
 gas. This does no harm so long as the pressure is kept up but when the 
 man gets out of the high pressure air the extra gas tries to get out of his 
 blood. It goes out of solution and accumulates in the blood vessels as bubbles 
 of nitrogen gas. 
 
 Caissons are usually badly ventilated; they are too hot and too humid, 
 
 Fig. 371. — Drager Oxygen Apparatus for Use 
 in Mines. (Report of Illinois State Commission 
 of Occupational Diseases, Jan., 1916.) 
 
DUSTY TRADES 903 
 
 and for this reason a man in a caisson can only do half a mans work. 
 
 But the great harm comes when the man goes from the bad air of the 
 caisson into the good air of the outside. The bad air of the caisson eats into 
 the employer's pocketbook but the attempt of the worker s body to readjust 
 itself rapidly to outside conditions after working in the caisson causes com- 
 pressed air to eat into his life. 
 
 When the Hudson River tunnels were being dug Moir's air locks were put 
 in and thus the death rate from caisson disease was reduced from 25 per cent 
 to 1 per cent. In the New York river tunnels the rate fell to 1/5 of 1 per 
 cent. 
 
 Schroetter recommended that where men work under one and one-half 
 atmospheres they should work in eight-hour shifts and after work they should 
 pass through the decompression chamber in less than fifteen minutes.* Where 
 they work under three atmospheres they cannot work in shifts of longer than 
 four hours and a longer time must be consumed in decompression. 
 
 Haldane has shown that decompression should be accomplished with a 
 rapid drop at the beginning, followed by a slow, gradual fall, and that if dur- 
 ing the process bubbles begin to form in his blood and the man gets into 
 trouble the air pressure should be run up again until the bubbles go back 
 into solution, whereupon decompression should again be undertaken with 
 watchfulness and care. 
 
 An oxygen tank is kept handy and ready for use. When gas bubbles 
 form in the blood the hemoglobin works at low efficiency. Inhalation of 
 oxygen for a few minutes will keep the patient going until the bubbles are 
 got rid of and the difference between inside and outside pressure is adjusted. 
 Working in a caisson and diving are dangerous occupations but the degree 
 of danger is determined by the degree of obedience to proper rules and reg- 
 ulations. This presupposes an equipment to make life safe. 
 
 DUSTY TRADES 
 
 Men who are at work need air which is neither too hot nor too cold, too 
 wet nor too dry, and which moves in currents strong enough to be felt. 
 
 There is another quality of great importance and that is that it should 
 be fairly free from dust. A good deal depends on the kind of dust. The dust 
 from a country road on a hot, sunshiny July day is much less harmful than 
 street dust in a large city and is almost harmless as compared with the dust 
 of a metal polishing establishment. The most harmful of all dust is that 
 containing large numbers of live disease-producing bacteria. 
 
 Next comes inorganic dust such as stone, metal and glass dust. Of less 
 importance is organic dust such as that of starch and flour mills. The report 
 of the Department of Commerce and Labor on the baking industry states that 
 flour dust is more harmful than starch dust because there is more gluten in 
 the former. These are illustrations of gradations of the harm done by dif- 
 ferent kinds of dust. 
 
 It is advisable for the manufacturer to ascertain the quality and the 
 kinds of dust in his factory. Breathing large quantities of dust gradually 
 impairs the efficiency of the workers. Haldane, Martin and Thomas report- 
 
904 
 
 OCCUPATIONAL DISEASES 
 
 Fig. 372. — Respirator. (From Rauch und 
 Staub, III, 9, June, 1913.) 
 
 ing to the Secretary of State for the Home Department of the British govern- 
 ment in 1904 said: 
 
 "So far as the Cornish miners are concerned, it seems evident enough 
 that the stone dust they inhale produces permanent injury of the lungs — ■ 
 gradually in the case of ordinary miners and rapidly in the case of machine 
 
 drill men — and that this injury, while 
 it is apparently capable of gradually 
 producing by itself great impairment 
 of the respiratory functions, and, in- 
 directly, of the general health, also pre- 
 disposes enormously to tuberculosis of 
 the lungs/' 
 
 The thirty-fifth annual report of 
 the Local Government Board of Eng- 
 land says: 
 
 "The behavior of consumption 
 toward dust-producing occupations 
 lends support to the theory of predis- 
 position to infection by some induced 
 alteration of the lung substance." 
 
 It is the opinion of those inves- 
 tigators that, aside from the disease 
 caused, dust causes inefficiency. 
 
 The manufacturer can have a de- 
 termination made of the character and quantity of dust in his factory. How- 
 ever, he can get a pretty good line on it by a careful study continued suffi- 
 ciently long of the consumption rate of his men. The study should be careful 
 enough not to mislead. The number of men who have fooled themselves on 
 this point by shallow observation would fill a book. 
 
 The above cited report gives figures for consumption among English 
 workers. Using farmers at 100 as 
 the base they report as follows: 
 
 "Ironstone miners, 133; carpen- 
 ters, 148; coal miners, 166; corn 
 millers, 166; bakers and confection- 
 ers, 177; blacksmiths, 177; lock- 
 smiths, 194; wool workers, 202; tin 
 workers, 204 ; carpetbag makers, 213 
 bricklayers, 215; ropemakers, 220 
 coopers, 238; cotton spinners, 244 
 lead workers, 247 ; brass workers, 250 
 stone quarriers, 261; iron workers, 292; copper miners, 307; copper workers, 
 317; lead miners, 319; glass workers, 335; filemakers, 373; cutlers, 407; 
 earthenware workers, 453." 
 
 Miss Brandt's table for the United States places marble and stone cutters, 
 cigar makers, plasterers and printers even higher than cutlers. 
 
 The relation between consumption and dust is easily seen. A manu- 
 facturer by careful study of the bad air diseases among his men can get a 
 fair idea of the harm his factory is doing. 
 
 Fig. 373. — Showing the Choking with 
 Soot of a Breathing Pore of a Leaf of 
 a Silver Fir Tree. (Arthur C. Ruston, 
 University of Leeds.) 
 
DUSTY TEADES 
 
 905 
 
 DUST IN SHOE FACTORIES 
 
 Such statistics as we have show that shoemakers have an undue propor- 
 tion of lung and throat disease. Their consumption rates are high. In part, 
 this is due to contagion, for the chance of catching consumption is high in a 
 trade where the man at the next bench is exceptionally liable to be a 
 consumptive. 
 
 Another reason is the dustiness of the air in a shoe shop. Sir Thomas 
 Oliver says dust causes colds and pneumonia as well as consumption. There- 
 fore, we are prepared to believe 
 that shoemakers frequently are 
 laid up with colds or, having a 
 cold and needing the pay, they 
 stay at the bench and get through 
 the day without making much for 
 themselves or their employers. 
 
 Drs. Hansen and Wolcott, 
 having studied the boot and shoe 
 industry in Massachusetts, made 
 a report on existing conditions 
 and recommended certain meth- 
 ods in a paper distributed in 
 the" exhibit of the Massachusetts 
 health department at Washington. 
 
 To estimate the amount of 
 dust, they exposed slips of paper, 
 
 sometimes dark paper, sometimes light, at the point usually occupied by the 
 workman's head. A piece of heavy gummed paper, 10 by 7, was painted with 
 a mixture of thirty parts glycerin and seventy parts water. This was ex- 
 posed while moist in the position usually occupied by the workman's head. 
 
 The exposure was for a definite time while the machine run by the 
 operator was doing its regular work in the regular way. The cardboard was 
 then covered by a thin rice paper ruled into one-inch squares or else by a 
 gelatin film. The preparations for microscopic examination were made by 
 treating glass in the same way and then exposing it as in the case of the 
 paper. 
 
 The amount and the type of dust having been determined the experi- 
 menters proceeded to calculate the size of the hood, its location and the size 
 of the ducts leading from it. Next they calculated the amount of negative 
 pressure needed to lift the shoe dust and therefrom the size and speed of the 
 fan required. And finally the results were checked by an examination of the 
 dustiness of the air at the breathing zone. 
 
 Shoemaking should not make men inefficient. The factories in Massa- 
 chusetts were generally well lighted and fairly well ventilated. The advan- 
 tage of good lighting is so great that most of the factories are surrounded 
 by yards and most of the machines except the stitchers are close to win- 
 dows. The only poisonous fume is that from naphtha and that is easily 
 controlled. An effective control of dust should make shoemaking in factories 
 a healthy trade and its workers men of high efficiency. 
 
 Fig. 374. — Cabinet for Sand Blasting. The 
 operation directs the blast against the casting 
 (b), a current of air driven by a fan (t) carries 
 the dust into a duct through which it is sucked 
 by the fan shown at the right. (From Ranch 
 und Staub, II, 5, Feb., 1912.) 
 
906 OCCUPATIONAL DISEASES 
 
 MEN WHO WORK IN WET AIR 
 
 There are certain trades where the workers are kept in moist air and 
 are thereby made uncomfortable, inefficient and sometimes ill. Dr. 
 Graham Rogers investigated 215 workrooms in New York State. In 18 per 
 cent the humidity was over 70 per cent saturation. The worst offenders 
 are pearl button factories, bakeries, clothing manufacturers, cigarmakers, 
 printers and laundries. The British parliamentary commission found humid- 
 ities high among cotton spinners and weavers. Cooks, greenhouse workers, 
 tunnel diggers are among a long list of workers who are subjected to air which 
 is too wet. 
 
 Fluegge in Germany and Haldane in England have shown that when 
 the temperature rises to 80° with moderate humidity or much above 70° with 
 high humidity depression, headache and dizziness come on. When the air 
 reaches 78° temperature and 100° humidity Haldane found that men begin 
 to get fever. Those who work in warm, moist air suffer from heat more than 
 any other group. They get headaches and presently fall over from heat 
 stroke. They are subject to rheumatism, asthma, colds and all kinds of 
 infections. 
 
 That is to say, if one hundred men as nearly alike as possible were divided 
 into two groups and one was put to work in a warm, damp bakery and the 
 other in a well ventilated room with a temperature of 68° and a humidity of 
 60°, more of the first group would develop inflammatory rheumatism than of 
 the second. If a group of women were similarly divided and one half put 
 to work in laundries and the other half in places with a proper humidity and 
 temperature the latter group would be freer from colds. 
 
 Winslow in his address before the National Educational Association on 
 July 14, 1911, said: 
 
 "We have thus the somewhat paradoxical condition that excessive moisture 
 increases the bad effect of either heat or cold." 
 
 The man who works in wet air cannot do a full day's work in either winter 
 or summer. This the "traffic must bear." He is sick or otherwise knocked 
 out more than the average. This also the traffic must bear. 
 
 SANITATION IN THE CLOAK INDUSTRY 
 
 [From the Bulletin of the Joint Board of Sanitary Control in the Cloak, 
 
 Suit, and Skirt Industry] 
 
 Human Engineering for 1911 quotes as follows: 
 
 ''Workmen in safe and sanitary shops are not only more healthy; they 
 are more efficient. Efficiency is the very soul of industry. Ours is the first 
 attempt in the history of industry in this and other countries of a trade to 
 control its own destiny. This is the first common ground upon which or- 
 ganized labor and organized capital may peacefully meet, and consists in safe 
 and sanitary shops/' 
 
 Proceeding on these basic principles the Joint Board of Sanitary Control 
 
WHAT THE WORKINGMAN SHOULD DO 907 
 
 of the Cloak, Suit, and Skirt Industry conducted "a shop to shop sanitary 
 inspection of the cloak making industry in Greater New York." 
 
 The board consisted of two inspectors, one office secretary and one mes- 
 senger. They made a total of 1,693 inspections, appointed twenty-five shop 
 committees, gave twenty-four noon lectures, and distributed 58,500 bulletins 
 and cards. They circulated this notice: 
 
 "To Shop Owners: Our sanitary certificates are ready. All owners of 
 shops which conform to the following standards are entitled to a certificate, 
 which will be granted upon application and inspection. The possession of our 
 sanitary certificate will be a positive indication that your shop is safe and 
 sanitary." 
 
 There follow twenty-eight sanitary requirements. Among them are 
 such as: 
 
 "No shops to be allowed in a cellar. 
 
 "Sufficient window space to be provided so that all parts of the shop will 
 be well lighted from 9 a. m. to 4 p.m. 
 
 "At least 400 cubic feet of space, exclusive of bulky furniture and mate- 
 rials, should be provided for every person within the shop. 
 
 "The shop should be thoroughly aired before and after working hours, and 
 during lunch hours, by opening windows and doors. 
 
 "All seats to have backs." 
 
 Some of the remaining twenty-three requirements are quite as important 
 as these which have been cited. Some requirements of great consequence 
 are not found; but the leaven is there and it will continue to work until 
 things become as they should be. When that time comes Ghetto consumption 
 will rapidly diminish and the workers, relieved of this great burden, will be 
 more contented and happier. Inevitably business will be more secure. 
 
 The movement is emphatically right. No better business policy could 
 be conceived than for manufacturers engaged in other lines to follow this 
 example. Workingmen have a right to demand safe and sanitary shops. Em- 
 ployers have a right to demand of workingmen personal cleanliness, help in 
 keeping the shop clean and good home hygiene. 
 
 WHAT THE WORKINGMAN SHOULD DO 
 
 Some of the unions are assuming their duties. The cigarmakers, printers 
 and bakers are doing well; others are taking up their duties in a less satis- 
 factory way. The unskilled laborer is the point where the line of progress 
 lags — the wandering laborer who lives in lodging houses, the newly arrived 
 immigrant, the country boy newly come to town, the average negro. 
 
 The first obligation of the employee is to go to work in the morning in 
 the best possible physical condition. This means good food, good air and 
 good sleep at home. His home should be the most sanitary that his means 
 will afford, his foods the most nutritious that his wages will allow. Several 
 things are needed for a sanitary home some of which are expensive while< 
 many cost effort only. 
 
 If the employee works at a dusty trade he can contribute his part toward 
 keeping the dust down as much as possible. He can keep from infecting the 
 
908 OCCUPATIONAL DISEASES 
 
 dust by not spitting on the floor. If he works at a poisonous trade he can 
 wash his hands with frequency. He can wash especially well before eating. 
 He can wear gloves in certain processes. He can be careful of dangerous ma- 
 chinery. He can help in the maintenance of standards by a proper use of 
 the toilet facilities. He can stand with those who insist on fresh, cool air 
 in the working room. He can do his part to prevent the spread of venereal 
 diseases, smallpox, consumption, diphtheria and colds among the workers. 
 
 The employee can block the wisest efforts to improve that an employer 
 can make. On the other hand he can lend his support to plans for improve- 
 ments and thus double their efficiency. 
 
 Regarding Matches. — 0. L. S. writes : "Can you advise me whether there 
 is any way by which the consumer can distinguish the poisonous white 
 phosphorus matches from the red phosphorus or the sesquisulphid matches? 
 Do the so-called 'Swedish' or 'safety' matches belong to any one of these 
 processes of manufacture?" 
 
 Reply. — From the standpoint of the consumer white phosphorus 
 matches are about as harmless as those of red phosphorus. The object 
 of the Esch bill was to help the workers in match factories. They were 
 the sufferers from phosphorus poisonings. Consumers were asked to use red 
 phosphorus matches in order to help the workers in the factories. The 
 law has passed and the white phosphorus match industry is at an end in 
 this country. I understand that Swedish matches do not contain white 
 phosphorus — neither do American matches now. 
 
 Brass Chills. — Foundry Worker writes: "I am a brass foundry worker 
 and am often subjected to so-called 'brass chills/ which are due to the in- 
 haling of zinc fumes when smelting yellow brass. Is there any way to pre- 
 vent it?" 
 
 Reply. — Brass chills result from inhaling the fumes from the pots. The 
 poison, probably zinc, causes the red blood cells to become stippled. Under 
 the microscope the blood cells look as they do in malaria and the symp- 
 toms are a little like those of malaria. Of course there is no relation be- 
 tween the two diseases. Dr. Hayhurst of the Illinois Commission on Occu- 
 pational Diseases advises (a) isolated furnace rooms, (b) hoods over fur- 
 naces and pouring places, (c) ceiling ventilators with suction fans, (d) 
 ample space, adequate light, wet cleansing, frequent whitewashing, (e) 
 eliminating boys, women, anemic and tubercular men and alcoholics. As to 
 what you should do, by all means ask the state factory inspector to see to 
 it that your working place is made safe for you. 
 
 Danger from Dust. — H. K. writes that he works in a grain elevator 
 and has a racking cough. The room is dusty and smoky. He breathes a 
 great deal of dust and smoke. He has had this cough for six months and 
 wants to know if the breathing of dust and dirt can turn into consump- 
 tion. 
 
 Reply. — Nothing more frequently turns into consumption than breath- 
 ing dust and smoke from working in a dusty place. By all means be care- 
 fully examined and without delay. 
 
 Writer's Cramp. — W. E. E. writes : "I am a commercial artist and have 
 been considerably worried on different occasions by a dull, throbbing ache 
 
OCCUPATIONAL DISEASES 909 
 
 in my working hand. This ache extends as far as the elbow. I would 
 like to know what the symptoms are, and what precautions, if any, may 
 be taken to avoid writer s cramp." 
 
 Reply. — Writer's cramp is a paralysis from overuse. It means that 
 the pitcher has been to the well too often. There is no cure except to "let 
 up" before it is too late. Sometimes methods of using the hands so as to 
 spare the overused muscles and nerves can be devised. You should see a 
 nerve specialist. 
 
 Protecting Workers from Heat. — E. D. D. writes that he has a factory 
 with an occupied basement. In one corner the boilers are located. The re- 
 mainder of the basement and the floors above are occupied as workrooms. 
 The men complain that the rooms, are too hot; that they get heated and 
 the cold air rushing in chills them. In the summer they are much too 
 warm. Can anything be done about it? 
 
 Reply. — In the dairy husbandry building of Cornell University they 
 have a large workroom in the middle of which is a sterilizing room. The 
 milk cans are run into the sterilizing room, the doors shut tight, and the 
 steam is turned on. The temperature of the sterilizing room gets to 200°. 
 The large workroom is not heated by it. How is it done? 
 
 The walls of the sterilizing room are made of hollow tile. The doors 
 are heavy and double walled, with insulation between. Try it. You will 
 get more work from your men. They will have less pneumonia and be 
 generally healthier. 
 
 Telegrapher's Palsy. — S. writes: "I am now middle aged. During all 
 my working life my occupation has been office work, telegraph operator, 
 bookkeeper, clerk, etc. I am right-handed. For several years my right arm 
 has been losing its activity and willingness to do its work. It is only with 
 great effort that I am able to use it. The effort to make it work causes 
 me mental pain and distress. It wants to cling to my side; when idle it 
 squirms and twists around towards my body; when I attempt to write I 
 cannot hold it down to the desk; it wants to fly up or drop down and hug 
 my side. I cannot write in a straight line — the finish of a line will be con- 
 siderably higher than the commencement ; there is a dull pain in the upper 
 arm and shoulder, also in my right side directly under and in front of the 
 arm; there is no swelling. Is there any way I can restore my arm to its 
 activity and usefulness?" 
 
 Reply. — The dull ache and the pain described by you suggest that you 
 have telegraphers' palsy. The tendency "to cling to your side, squirm and 
 twist toward your body, to fly up or drop down and hug your side" sug- 
 gests a mind cause. Perhaps it is partly due to each. If you have teleg- 
 raphers' palsy get into the best hands possible and follow directions. If 
 you are going to tinker with yourself you had better quit telegraphy and 
 take up something where your telegrapher's hand is not important. As 
 it is, your hand is your tool. Give it the best attention possible. 
 
 Case of a Painter.— C. W. H. writes: "Early in the spring in part of my 
 right hand would come and go a peculiar sensation as if it were asleep and 
 partly numbed. It gradually got worse and reached to the elbow. Some- 
 times during an attack I could not use the hand. Two months ago I placed 
 myself under treatment by a doctor who says it is a touch of paralysis 
 brought on by lead poisoning. I am a painter. The treatment seemed to 
 
910 OCCUPATIONAL DISEASES 
 
 benefit me at first, but later the attacks were more severe and more fre- 
 quent. My general health is good. Will massaging and electricity help 
 meV 
 
 Reply. — Lead poisoning is much more frequent than generally sup- 
 posed. As your disease is not of long standing or far advanced you should 
 get well. Massage and electricity will help you after your disease has 
 ceased to progress. In other words, when the disease has subsided they 
 help you to regain the use of the muscles and nerves. Keep in the open air 
 and keep your bowels open. Lead poisoning brings on premature old age 
 and heart and kidney disease. After you get well change your trade or else 
 be much more careful about keeping your hands clean than you have 
 been. 
 
 Cause of Lead Poisoning. — 0. L. writes: "When you speak of a disease 
 as 'lead poisoning' what do you mean ? What causes it?" 
 
 Reply. — A disease affecting the nerves and blood, and, in some meas- 
 ure, all of the tissues. It results from prolonged drinking or swallowing 
 of lead. It is found most frequently in painters and is then known as 
 "painter's colic" or "lead colic." With them it results from white lead 
 which gets into their food from their hands, though some absorbs through 
 the skin. It sometimes results from the use of bottled or charged waters 
 which have been allowed to become contaminated with lead. An ulti- 
 mate effect is premature senility. This results from thickening of the 
 arteries. 
 
 Too Long a Workday. — N. L. writes: "I am a man about 20 years of 
 age. I have been working in an office for six years. Since the first of this 
 year I have been given a position which keeps me sitting most of the day. 
 I naturally have to bend over the desk somewhat, as I have to write a 
 good deal. I have been troubled with backache almost every afternoon for 
 the last few weeks. Otherwise I am feeling pretty well, considering that 
 I am working almost twelve hours daily. I have tried exercising, but it 
 does not seem to help me any." 
 
 Reply. — You are bending over too long, working too many hours. 
 Backache means nerve tire with you as with nearly everybody else when- 
 ever the work is too hard. There is a backache work line. Neurasthenics 
 get to it quickly. The well balanced get to it more slowly. But twelve 
 hours at a desk would give it to a truck horse. The cure is shorter hours, 
 fresher, cooler air in the office, and exercise, preferably play, after work. 
 
 Quit Working There. — Reader writes: "7 have been working in a dark 
 basement for one year and five months where I consider the conditions 
 insanitary. Could I continue to work there without harm? The place, 
 being a corner, has three wet walls covered with slime, which smells like 
 mushrooms. Water comes in constantly, decays, and smells bad. Mold 
 forms on everything. It is poorly ventilated." 
 
 Reply. — You cannot continue to work there without harm. A dark 
 basement is bad enough but one with damp walls covered with slime and 
 where mold forms on everything is intolerable. If you stay there long you 
 will get rheumatism, consumption, blastomycosis, or some other sort of 
 bacterial disease. 
 
CHAPTER XL VIII 
 
 Hot Weather Advice 
 
 Coming north on an Illinois Central train I read a booklet got out by the 
 immigration department of that road. The write-ups of Mississippi towns in- 
 variably stated, "We have no sunstroke." These statements I know to be 
 substantially correct. What is the solution ? 
 
 First, the place of atmospheric heat in causing death is subject to a 
 good deal of interpretation. Cities anxious to refute the charge that heat 
 causes deaths amongst its people are careful to see that old age, heart disease, 
 Bright's disease and baby complaint get their deserts. Towns that do not care 
 call every death in hot weather where heat can be dragged in a death from 
 heat. 
 
 After proper allowance has been made for these considerations there 
 still remains the fact that summer resort Chicago has more heatstroke than 
 Mississippi. Why ? 
 
 There is an art in bearing heat and many people in Chicago have not 
 learned it. The suffering is greater in the beginning of the season than later 
 on, because experience teaches the art to some. 
 
 1. The first item of the art to master is in dressing. The clothes should 
 be as few as the law allows and as light and porous as possible. Coming 
 in today I met some boys wearing two garments. If they were suffering they 
 did not show it. Our intermittent warm and cool weather makes us more 
 susceptible to heat than others and it is one of the reasons which makes us 
 wear hot clothes in hot weather. 
 
 2. The second is eating. Fruits, salads, vegetables, buttermilk, cereals, 
 bread and lean meat (and not over much of the last two) are proper. The 
 most important item to control is quantity. Next are fats and greases — 
 cream, butter, gravy, salad dressings, olive oil, fat meat and nuts — a tropical 
 diet for tropical weather. One-half of the usual diet will suffice when the 
 temperature goes over 90°. A part of every man's boiler capacity is used to 
 make work-steam, the remainder is a heating plant. For comfort's sake 
 shut down the heating plant when the air sizzles. 
 
 3. Drinking. Avoid beer and every sort of cooling drink containing wine. 
 Alcohol burns with a quick, hot flame that blisters the boilers and then dies 
 down. Heatstroke is a blistered boiler. 
 
 4. Bathing. Promote sweating by baths, internally and externally. 
 By baths internally is meant drinking plenty of water. 
 
 5. Elimination. Keep the excretory organs working. 
 
 6. Crowding. Keep out of the crowds. Why burden yourself with the 
 other man's heat? 
 
 7. Drafts. Keep away from still air. Keep close to a draft. 
 
 911 
 
912 HOT WEATHER ADVICE 
 
 8. Sleeping. Sleep cool. Eooms were invented for winter necessities. 
 Some can sleep under the trees, some on porches, some on roofs. Three hours 
 after sundown the roof is cooler than the room and the pavement is cooler 
 than the porch. 
 
 9. Worry. Never mind the weather. To think hot is to feel hot. Deserve 
 to be cool and then forget what you can't help. 
 
 WORK IN HOT WEATHER 
 
 The human stove has two major and several minor fires going. The 
 fires go all the time, night and day, sleeping and waking, still and moving, 
 so long as life lasts and for a short time after. But the more the fires 
 are fed the more heat the stove makes. It is not within our power, com- 
 patible with life, to end the fires, but it rests with us to make more or less 
 heat. 
 
 The most important fire, and one that can be turned up or down, is that 
 fed by food. The next most important contributor to the sum total of heat is 
 muscular movement. 
 
 Every act of the body is attended by the production of heat. The 
 digestion of food is a pretty good heat producer. The liver cells, albeit well 
 oiled, work so as to produce considerable heat. The flow of blood in the 
 vessels, the coursing of air in respiration and the oxidation of blood in 
 the lungs — each of these is a heat producer. 
 
 The great heat making organs are the muscles; and the amount of heat 
 produced by them is under considerable control. Thompson in his "Dietetics" 
 computes the number of calories required when a man is working hard as 
 4,150, with 2,700 for a man at rest. 
 
 By calory is meant the amount of heat forming substance in a given 
 amount of food. When fifteen grams of fuel burned give off enough heat to 
 raise the temperature of 2.2 pounds of water 1.8 degrees we say it gives 
 one calory. A man at hard work, then, needs about one and a half times 
 as much food measured in heat units as when at rest. 
 
 Scientists have had a way of checking such conclusions as these. By using 
 an instrument called a calorimeter they are able to measure the amount of heat 
 made by a man at work as compared with the same man at rest. 
 
 The human stove has an engine attached. These scientists have found the 
 engine a most efficient machine. They find that a man at work makes more 
 heat than a man at rest and the difference almost exactly equals the added 
 number of calories required as food. 
 
 The practical application is that all unnecessary muscular labor be cut 
 out during hot weather, at least during the torrid part of the day. 
 
 The people in Eome shut up their stores and rest from twelve to two. The 
 people of the southern states do a good deal of their work during July, 
 August, and September at night when the moon is shining, and in the early 
 morning and late afternoon at other seasons. 
 
 During the long days of summer an eight-hour day can easily be managed 
 without making use of the heat of the day. 
 
DISEASE IX HOT WEATHER 913 
 
 DISEASE IN HOT WEATHER 
 
 When hot weather comes on some of our disease enemies get less active 
 and some more so. The ordinary contagions diseases become much less 
 harmful. Smallpox almost disappears. Whenever a community carries a 
 smallpox epidemic over into hot weather it is certain there is something wrong. 
 Either the government is weak and ineffective or else the cranks are unusually 
 numerous and active. 
 
 A large city in this part of the United States is certain to have some 
 smallpox poured into it in the winter and spring. It cannot be blamed 
 for that. It may spread a little in the spring months — it cannot be blamed 
 for that. But when the smallpox cases continue to bob up during sizzling 
 weather somebody should be punished. 
 
 Diphtheria, scarlet fever and measles can also be expected to let up. 
 Pneumonia runs to less than a half of the February rate. In the parts 
 of the country where pneumonia, contagion and colds are the principal 
 diseases the physicians take their vacations in summer. On the other hand 
 certain diseases are more abundant and some of them more hazardous in 
 summer. 
 
 First on the list is summer complaint in babies and next in importance 
 comes malaria. Typhoid is of more importance in summer than in winter, 
 though autumn is the typhoid season. During the hot months typhoid 
 seems to be laying the foundation for its fall work. The people who are 
 having typhoid are infecting wells and milk supplies. The flies that are 
 to carry it later are multiplying. The amount of pellagra increases, and 
 so do the less important intestinal disorders. 
 
 The heat of the sun's rays is too great for bacterial prosperity. Certain 
 parts of a ray of sunlight are actively bactericidal. Then why is it that in the 
 season when the sun's rays are hottest some bacterial diseases are at their 
 worst ? 
 
 There are two reasons. Enough of certain germs escape the great heat 
 and the bright light to effect their part of the harm; in the second place, the 
 effects of spoiling are greatest in hot weather. 
 
 In summer complaint in babies a very important factor is spoiled milk — 
 not badly spoiled milk, not milk that is offensive to the smell or is even off 
 in taste but which is spoiled so far as baby feeding is concerned. There 
 are those who claim that pellagra is due to spoiled meal. The minor digestive 
 disorders are also due to spoiled food. 
 
 To prevent these disorders ice is required. The heat of summer is bad 
 enough on the baby but it is worse on his food. It is not feasible to keep the 
 baby on ice. It is feasible to keep the baby's milk on ice and, though not so 
 important, the food of the grown up should also be kept on ice — and some 
 very great authorities think this injunction should apply also to meal in 
 summer. 
 
914 HOT WEATHER ADVICE 
 
 THE LIVER IN HOT WEATHER 
 
 Ordinarily the liver comes down as low as the edge of the ribs, about three 
 inches to the right of the median line. Therefore whenever it swells it must 
 push downwardly for it cannot bulge upward. 
 
 The volume of the liver changes constantly. It is a great Mood reservoir 
 and its volume is changed by change in the amount of blood within it. Its 
 own cells increase and decrease in size according to the work they do and this 
 changes the size of the liver. 
 
 The liver is a favorite place for the storage of surplus food. Man is a 
 provident animal. Socially he hoards his treasure in savings banks, ware- 
 house bins and cold storage houses. But what he learned in a social way 
 as he emerged from savagery his body cells had always practiced. This 
 statement is true of almost every principle of community life. For example : 
 When a man eats more than he needs the surplus is converted into easily 
 burned fat and stored in the liver tissues toward the possibility of a "rainy 
 day." The liver is one of the most elastic and most serviceable of these great 
 warehouses. 
 
 As the liver enlarges trained fingers can easily feel it pushing down- 
 ward below the ribs and under the softer muscles. Amongst people in hot 
 climates the liver nearly always swells in August and September. It comes a 
 half inch farther below the ribs than in cold weather. This condition of hot 
 weather liver enlargement is almost the rule in the people of the Gulf 
 states and is frequent even as far north as Chicago. 
 
 The question comes up, Is this the result of the heat? If not, to what 
 is it due? The answer is, It is not due to the atmospheric temperature but 
 is due to eating too much. 
 
 The engineer of an office building runs his fires so as to make steam 
 for the elevators and heat for the radiators. In summer time he uses less 
 coal and carries less steam because the radiators are not in use. When the 
 thermometer is over 85° a man needs little steam in his radiators. If he 
 continues to eat cold weather rations the surplus piles up somewhere. The 
 favorite somewhere is the liver. 
 
 When, in August and September, a man finds his liver swollen — or his 
 physician finds it for him — he commonly takes a course of calomel "to 
 touch his liver." A wiser course would be to stop eating until he has burned 
 up his surplus, in the meantime taking milder laxatives. Of course, the 
 really wise plan is to cut down his food beginning June 1 and thus prevent 
 his liver from swelling in August. 
 
 Now, everybody knows that the desire for food lessens in hot weather. 
 People who eat ravenously are willing to nibble in hot weather. Many people 
 know that heavy eating makes the heat worse — increases the discomfort from 
 the heat. 
 
 But the habit of eating is so strong that many people eat too much in 
 spite of these two considerations. It may help some of these to control them- 
 selves to know that the swollen livers of hot weather are due to overeating 
 and that a large liver persisted in means eventual organic or functional 
 disease, 
 
CROWDS IN HOT PLACES 915 
 
 CROWDS IN HOT PLACES 
 
 A Chicago theater carries this advertisement: 
 
 Temperature in this theater, 70°. 
 Temperature in the" street, 90°. 
 
 I do not vouch for the accuracy of this advertisement. I do not know 
 anything about it one way or the other but the advertisement of itself stimu- 
 lates a demand for a cool theater and it is certain that that demand will bring 
 about cool theaters. 
 
 We have faith enough in the good of it to advertise the advertisement. 
 I do not know but I presume the theater chills the air with which it ventilates. 
 This method is used in restaurants in the basements of two Chicago hotels. It 
 may be true of others. If it is not it should be. 
 
 When a thousand people are together you are dealing with a thousand 
 stoves. In the winter such a crowd would make heat enough to heat them- 
 selves and the walls of the room but not enough to heat the needed fresh air. 
 In the summer they make enough heat to make life a burden wherever there 
 is no proper effort to control it. 
 
 The excess heat can be removed if air enough is used, but it is easier done 
 (and in some places it can only be done) by chilled air. Cooling a room with 
 air at 90° does not get very far. Great crowds and very artificial conditions 
 demand very artificial remedies. 
 
 When a man says our grandfathers never had chilled air and therefore 
 why should we, the answer is — 15,000 of our grandfathers never crowded 
 into one room located on ground worth a million and a half an acre. We 
 can quit crowding at one end of the line when they quit crowding at the 
 other. 
 
 Whenever we have congestion of occupation we get congestion of heat 
 making. Now, when a man makes heat he must pass it on or he gets a self- 
 made heatstroke, sometimes called sunstroke. If the air around him is cool or 
 moving fast he can dump his load of heat with ease. If the air is warm, or 
 stagnant, or wet, or all combined, he becomes uncomfortable and is soon over- 
 come. Whether it be summer or winter the man is the hottest thing in the 
 room. The next hottest is the air which is next him. 
 
 It is all right for the restaurant keeper to tell the man to wear loose 
 open clothes, dark underwear and white top wear and to keep his own fan 
 going. But has not the man a right to demand that the room temperature 
 be kept as low as 70° and the humidity as low as 50 — the first that he may 
 radiate heat directly; the second that he may lose it by evaporating sweat? 
 
 How many places in town could advertise a cool dining room and make 
 good? 
 
 How many could advertise a cool kitchen and make good? Food pre- 
 pared by hot cooks in hot kitchens is liable to have something in it which 
 is not nice to think about. 
 
 How many men refuse to patronize a hot theater or restaurant? Heat 
 kills many people; cold but few. 
 
916 HOT WEATHEB ADVICE 
 
 SLEEPING IN HOT WEATHER 
 
 Sleeping in the hot weather is a difficult proposition for some people. 
 The night hours are short ; the streets are noisier ; Morpheus, the god of sleep, 
 has difficulty in getting his orders obeyed. 
 
 In summer time, when the rising sun is about to catch up with the 
 setting sun, when the birds are singing, the sparrows chattering, the rooster 
 crowing, the milk cans rattling, and the neighbors gossiping — all in the open 
 air and in the . heart of the sleeptime of the early morning ; and when 
 the thermometer keeps above 85° all night long Morpheus' job is liable to give 
 the old man nervous prostration. We can do a good deal to help him out. 
 
 We can scarcely claim much flexibility in our sleeping customs. The 
 house is no place in which to sleep in hot weather. More than half the liv- 
 ing places will permit of sleeping on a porch. In case there is no porch in 
 some instances a fire escape may be made use of. In other cases the roof 
 is available. 
 
 Many have the idea that a roof is always hot because they know that 
 rooms just underneath the roof are generally so. 
 
 The contrary is true. On the roof it is always cooler than on the pave- 
 ment and once the sun has gone down on the roof it shortly becomes a com- 
 fortable spot. The moving air can reach it far better than it can reach the 
 pavement. 
 
 This factor, the ability of moving air to reach the sleeper, is the deter- 
 mining factor in an under-the-roof room. If such a room is so arranged 
 that the side walls can be dropped or lifted and the air allowed to blow 
 through it will not be a hot sleeping place. 
 
 For some of those not able to sleep on roof or porch yard space may be 
 available. Where none of these is to be had, why not sleep in the parks 
 and squares? Many men of small earning capacity have to choose between 
 sleeping in the park and sleeping in a room the walls of which feed heat to 
 the room all night long as well as keep out the air. 
 
 Would it not be advisable for park boards to take note of this and then 
 extend invitations to the people to sleep in the parks? 
 
 The added expense for policing would not be great but the gain in work- 
 ing capacity as well as in health would be enormous. 
 
CHAPTER XLIX 
 
 Insects 
 
 PARASITICAL PESTS 
 
 RED BUGS 
 
 As a rule red bugs do not bore into the skin. They remain on the 
 surface and suck through the skin. They sometimes get into the ducts of 
 sweat glands and occasionally get well into the skin. Herrick describes one 
 case in a chicken in which there was a berrylike cluster of them below the 
 surface of the skin. 
 
 Both Herrick and Eiley advise that to keep them off the body the stock- 
 ings and underwear be dusted with flower of sulphur. Chittenden advises that 
 the underwear be dusted with powdered naphthalene. Sulphur ointment, car- 
 bolized vaselin or salted butter 
 will kill the parasites on the 
 skin. To allay the irritation 
 bathe the itching patches with 
 a saturated solution of soda in 
 water. 
 
 STRAW ITCH 
 
 Men who work around 
 straw or who sleep on fresh 
 straw are liable to develop an 
 acute eruption as the result of 
 bites by a straw parasite. The FlG - 375.— A Harvest Mite. (Ealand.) 
 
 name of this disease is derma- 
 titis Shamberge. The name is worse than the disease. 
 
 There are no parasites in old straw. The man who must work in fresh 
 straw can protect himself by the use of powdered sulphur or naphthalene. 
 Goldberger recommends greasing the body with lard. The best wash is soda 
 water. Salt water and dilute ammonia water are good. The best local applica- 
 tion is sulphur ointment. 
 
 ITCH PARASITES 
 
 Fifty years ago the skin disease now known as itch went by the name 
 of the seven-year itch. Now we know that the cause is a mite which burrows 
 in the deeper layers of the skin, and acting on this knowledge, we know how 
 to cure it in a week. Seven-day itch is a better name than seven-year itch. 
 
 Stiles' method of cure is as follows: 
 
 917 
 
918 
 
 INSECTS 
 
 1. Eub the entire body except the face with green soap and water for 
 twenty minutes. 
 
 2. Stay in a warm bath for thirty minutes. Eub with green soap while 
 in the bath. 
 
 3. Eub sulphur ointment into the skin for twenty minutes. Leave the 
 ointments on for five hours. 
 
 4. Wash off the ointment with soap and water. 
 
 5. Sterilize the clothing, especially the underclothing, with heat. As 
 this does not kill the eggs, five days later repeat in order to kill the parasites 
 which have hatched meanwhile. Thin-skinned persons should modify the 
 
 above plan. 
 
 LICE 
 
 There are three varieties of lice which regularly live as human parasites — 
 the head louse, the body louse and the crab louse. It has been proved that lice 
 
 transmit typhus fever. Furthermore, it has been 
 proved that a mild form of typhus fever known 
 as Brill's disease is present in many portions of 
 the United States. 
 
 We learn that the European soldiers in the 
 trenches pull off their clothes and leave them on 
 ant heaps as a means of ridding themselves of 
 lice. This may work with body lice. It will not 
 work with the other two varieties. 
 
 For the body lice the clothes must be baked, 
 steamed, or washed in gasoline. Two treatments 
 at intervals of a week are required. 
 
 For head lice several washes are effective. 
 Kerosene, 2 per cent carbolic acid and a tincture 
 of cocculus indicus are good. The treatment must 
 be repeated as nits are not easily killed. Mer- 
 curial ointment applied will kill crab lice. 
 
 Fig. 376. — Louse and Nit, 
 
 BEDBUGS 
 
 From the standpoint of disease, bedbugs are not important. They have 
 been known to spread plague, kala-azar, trypanosoma, relapsing fever, Aleppo 
 boil, typhoid fever, tuberculosis, and syphilis. All but the last three of these 
 diseases are of little importance in this portion of the world. It is not thought 
 that bedbugs are important factors in the spread of any of them. 
 
 Bedbug eggs hatch in six to ten days. If the bug gets plenty of food 
 it reaches the adult size in thirty-five days. If poorly fed, one hundred and 
 fifty days may be required. A bedbug can live without food for more than 
 a year. 
 
 While they prefer to bite human beings they do not hesitate to feed 
 on cats, dogs, rats, mice, swallows, canaries, sparrows or any other acces- 
 sible warm-blooded animals. 
 
 Much the most efficient method of destroying bedbugs is by the use of hy- 
 drocyanic gas. This method is too. dangerous to be used except by persons who 
 have had experience with it. 
 
STINGING PESTS 
 
 919 
 
 The burning of sulphur is not satisfactory. Herrick thinks probably 
 this has been because not enough was burned and the exposure was not for 
 long enough. He suggests that the cracks be thoroughly stripped; that two 
 pounds of sulphur for each 1,000 cubic feet of air be burned ; that everything 
 be dry; and that the gas be allowed to act for eight hours. 
 
 As local applications kerosene, gasoline, boiling water, and a mixture of 
 alcohol one pint, spirits of turpentine one- 
 fourth of a pint, and corrosive sublimate one 
 ounce are all effective. Whichever of these 
 is used to get results treatment must be 
 thorough and it must be repeated at least 
 four times at intervals of four days. 
 
 FLEAS 
 
 Fleas certainly spread plague. Possibly 
 they also spread leprosy at times. They may 
 spread one form of tapeworm. They may 
 spread trypanosoma. 
 
 Eiley recommends lotions of carbolic 
 acid, 3 per cent, or camphor and carbolated 
 vaselin to relieve the irritation of a flea bite. 
 
 The best fumigation against fleas is that by hydrocyanic gas. The best 
 single measure against fleas is to get rid of the nits, especially in the cats 
 and dogs. Riley tells of a woman who held a half-grown kitten in her lap 
 for a short while and then gathered up a teaspoonful of flea eggs which had 
 fallen from the kitten to her dress. 
 
 Perhaps the second best single procedure is to get rid of the rugs and 
 carpets and to keep the bare floors clean. Dr. Skinner scatters five pounds 
 of flaked naphthalene on the floor of a room, closes the doors and windows 
 and leaves things for twenty-four hours. He then sweeps up the powder 
 and sprinkles it on the next room. Riley quotes him as saying, a The flea 
 question is solved." 
 
 TICKS 
 
 In the Rocky Mountains a form of spotted fever is spread to human 
 beings by ticks. The Public Health Service rids an infected mountain side 
 of ticks by grazing it with sheep. Grazing is begun in the valley and the sheep 
 are slowly worked up the mountain side. 
 
 Fig. 377. — Bedbug. 
 
 STINGING PESTS 
 
 Spiders do not deserve their bad reputation. None of them will bite 
 if escape without biting is possible. Most of them are harmless when they 
 do bite. Only two varieties are dangerous to life — the tarantulas and the hour- 
 glass spiders — and these are only dangerous under most exceptional circum- 
 stances. On the other hand they are efficient insect destroyers. 
 
920 INSECTS 
 
 Spider webs do not soil a wall. They show up a dirty wall as such — that 
 is all. 
 
 A solution of cooking soda in water should be applied to the bite. If 
 there is need of it thirty drops of aromatic spirits of ammonia in a wine- 
 glass of water may be given. 
 
 SCORPIONS 
 
 The bite of a scorpion less than two inches in length is no more irritat- 
 ing than a bee sting. Large scorpions may carry a dose of poison capable 
 of producing a good deal of local irritation and causing some disturbance of 
 the system. Strong soda water should be applied locally. Aromatic spirits 
 of ammonia may be given internally if the face is pale. 
 
 CENTIPEDES 
 
 The centipedes of the United States do not carry enough poison to 
 endanger human beings. The treatment of centipede bites is the same as 
 that of tarantulas. 
 
 BEES, HORNETS, WASPS AND YELLOW JACKETS 
 
 The stinging apparatus of these insects is a tube barbed at the farther 
 end. This stinger is a part of the apparatus for depositing eggs. Therefore 
 only the female can sting. 
 
 As the barbs hold the stinger in the wounds the insect stings but once 
 in a lifetime. At the base of the egg depositor are two glands. The secretion 
 of one of these is acid; of the other, alkaline. The poison does not become 
 poisonous until the secretions mix. 
 
 For a sting there is no better application than wet soda or strong soda 
 solution. 
 
 Hornets, wasps and yellow jackets do not make bad neighbors. Her- 
 rick quotes an English entomologist, Westwood, who visited us in 1840, as 
 having written the folks back home : "The Americans, aware of the service of 
 hornets in destroying flies, sometimes suspend a hornet's nest in their parlors." 
 
 To destroy a yellow jacket's nest pour carbon bisulphid into the opening. 
 If you are prudent you will do this at night. To destroy a hornet's nest 
 plug the opening and pour kerosene on the nest. 
 
 BLACK FLIES 
 
 Probably the most annoying and most dangerous of all American biting 
 insects per se is the black fly. The studies of Dr. Stokes suggest that the 
 best applications to make to black fly bites is a solution of muriatic acid in 
 water (1 to 200). Perhaps a solution of pancreatin and baking soda in water 
 would answer the purpose. 
 
 To destroy the larvae in the breeding places Conradi recommends phinotas 
 oil. He used half a gallon on a body of water five feet wide by twenty 
 feet long, as a repellant. Forbes recommends a mixture of oil and tar. Eiley 
 recommends that equal parts of kerosene and oil of pennyroyal be applied 
 to the face and hands. 
 
 
 
PANTEY PESTS 
 
 921 
 
 PANTRY PESTS 
 
 From the standpoint of public health the insects which infest meal, 
 flour, and other foods are of no importance. Nobody wants to eat food 
 infested with bugs or worms, and that is objection enough; but the question is 
 one of taste rather than of health. 
 
 INSECTS INJURIOUS TO CEREALS 
 
 The darker mealworm and the yellow mealworm eat meal, flour, bread, 
 cakes, and cereals. The confused flour beetle and the rust red flour beetle, 
 infest meal, flour, and cereals. The chief source of annoyance is from the 
 presence of the larvae of worms in the cereal. 
 
 Fig. 378. — Trap for 
 Cockroaches. 
 
 Fig. 379. — Cockroach. 
 
 Fig. 380. — Larder 
 Beetle. (Herrick 
 Sanitary Science 
 Series No. 3, Cornell 
 Reading Course, 
 Oct. 1, 1913.) 
 
 The Mediterranean flour moth, the Indian meal moth, and the meal 
 mout moth also eat meal, flour, bread, cakes, and cereals. The chief source 
 of objection to the members of this group is that they web up in the cereal. 
 
 The insects which show a liking for grain rather than the products of 
 grain are the cadelle, the saw toothed grain beetle, the angoumois grain moth, 
 the granary weevil, and the rice weevil. 
 
 The body of the granary weevil contains an irritating poison somewhat 
 similar to cantharidin obtained from Spanish fly. It was used as a substitute 
 for Spanish flies in the southern states during the war. Herrick suggests that 
 if granary beetles are ground up in flour the mixture might prove seriously 
 injurious to persons eating it. 
 
 Other pests capable of infesting pantries are the pea weevil, the bean 
 weevil, the broadhorned flour beetle, the coffee bean weevil and a fruit fly 
 which attacks dried, canned, and pickled fruits. 
 
 The insects injurious to meats, cheese, and condiments are several. 
 Among them are the larder beetle, the red legged ham beetle, the cheese and 
 ham mites, the cheese and meat skipper, and the drug store beetle. 
 
922 
 
 INSECTS 
 
 METHODS OF CONTROL 
 
 The most efficient method of killing insects is with hydrocyanic gas. This 
 gas is produced by mixing pure cyanid of potassium, commercial sulphuric 
 acid and water. A portable apparatus for fumigating with this gas is now 
 
 available. Its use is safe enough for those 
 accustomed to it, but others dare not risk it. 
 Perhaps before long men making a vocation of 
 fumigating with cyanid will be accessible. 
 
 The second best fumigating agent is car- 
 bon bisulphid. The chief objection to carbon 
 bisulphid is that it is highly inflammable. An- 
 other objection is its odor, but this is not last- 
 ing. Flour exposed to carbon bisulphid does 
 not bake quite so well as flour not exposed. 
 
 To fumigate with it 
 stop all cracks, vaporize 
 three pounds for each 1,000 
 cubic feet of air and leave 
 the fumigated space closed 
 for twenty-four hours. This 
 gas kills grown parasites 
 satisfactorily. It is not very 
 efficient against larvae and 
 eggs. Therefore it is usually 
 necessary to repeat the fu- 
 migation one or more times. 
 Thorough cleansing of 
 all flour bins and meal and cereal boxes is necessary. These should be emptied, 
 brushed out with a stiff brush, and in proper cases washed. The infected food 
 might as well be fed to poultry and hogs. 
 
 Fig. 381. — Larva of Larder 
 Beetle. (Herrick Sanitary 
 Science Series No. 3, Cornell 
 Reading Course, Oct. 1, 1913.) 
 
 Fig. 382. — Croton 
 Bug Carrying 
 Egg Capsule. 
 Natural Size. 
 
 BROWN-TAILED MOTH 
 
 BROWN TAIL RASH 
 
 Children are instinctively afraid of caterpillars. Mothers try to con- 
 vince them that these loathsome worms are harmless. In the main the 
 mothers are right. The great horned tomato worm and others of his species 
 are harmless. In fact, not one of the butterfly moths can poison by its 
 bite or sting with its tail or with its horns. 
 
 Herrick tells us that of the six thousand species of caterpillar in the 
 United States only twenty are poisonous. These twenty poison not by biting 
 but through the hairs. 
 
 Very much the worst offender is the brown-tailed moth. In the Middle 
 West but little is known of this form of caterpillar but Eiley tells us that, 
 introduced into this country from Europe twenty years ago, it has spread 
 Over New England and New York and "there is every prospect that the pest 
 
BROWS-TAILED MOTH 
 
 923 
 
 will continue to spread throughout the eastern United States and Canada, 
 
 and wherever it goes it will prove a direct pest to man, and to his plants." 
 The poisoning effect from the brown-tailed moth results from chemical 
 
 substances contained in the shaft 
 
 of the long barbed hairs carried 
 
 on the abdomen and back. These 
 
 hairs can be carried by the wind 
 
 and can produce the rash in 
 
 people who have not been in con- 
 tact with the caterpillar. 
 
 The ordinary effect is rash 
 
 similar to hives, the brown tail 
 
 rash. The usual site is the skin 
 
 of exposed portions of the body — 
 
 the neck, face, and hands. 
 
 The rash may be similar in appearance to hives ; or it may be like eczema ; 
 
 or there may be oozing bumps; or there may be small boils or pustules. 
 
 The hairs may get into the nose and bron- 
 chial tubes causing colds and coughs that may be 
 mistaken for consumption. They may get into 
 the eyes causing small lumps like proud flesh. 
 Sometimes these lumps have been diagnosed as 
 granular lids and sometimes as tuberculosis. 
 
 Fig. 383. — Case-making Clothes Moth (en- 
 larged) (Herrick Sanitary Science Series No. 3, 
 Cornell Reading Course, Oct. 1, 1913.) 
 
 Fig. 385. — Black Carpet 
 Beetle. (Herrick Sanitary 
 Science Series No. 3, Cor- 
 nell Reading Course, Oct. 
 1, 1913.) 
 
 Fig. 384. — Webbing Clothes Moth (enlarged). 
 (Herrick Sanitary Science Series No. 3, Cor- 
 nell Reading Course, Oct. 1, 1913.) 
 
 Eiley studied some small eye granulations under the microscope. In the 
 center he found a caterpillar hair. Around the center the tissue had an 
 arrangement very like that of tuberculosis. Of course none of the lesions was 
 tubercular. Xone was caused by tubercle bacillus. 
 
 Tyzzer found that the poison from the brown-tailed caterpillar hair caused 
 great changes in the red blood corpuscles. Herrick recommends that the 
 ordinary hives eruption be washed with a solution of baking soda in water. 
 For brown tail rash he uses menthol, ten grains; zinc oxid, two drams; lime 
 water, eight ounces, and carbolic acid, fifteen drops. 
 
 Eiley says that the patches must not be scratched. Sometimes soda 
 water is the only wash required. In other cases he advises washing with soda 
 water and then applying a 10 per cent ichthyol ointment. A weak solution 
 of creolin, one teaspoonful to a quart of water, is also recommended. 
 
924 
 
 INSECTS 
 
 FLIES 
 
 FLIES AND TYPHOID FEVER 
 
 In 1898 our army preparing for Cuba was disabled by typhoid fever 
 and diarrhea, and the commission appointed to investigate (Drs. Vaughan, 
 Reed, and Shakespeare) reported that flies were responsible. 
 
 Evidently as recently as the beginning of 
 this century our antagonism to flies had no great 
 grip on public opinion. Perhaps those of us who 
 are now the Pauls in this crusade are the more 
 Pauls because so recently we were Sauls. 
 
 In a study of typhoid fever in Jacksonville, 
 Florida, Terry proves that flies are largely re- 
 sponsible. Surface closets, 8,500 in number, were 
 
 used by 25,000 (41 per cent) 
 .. -sJmmJy of the population. As the 
 
 closets are widely scattered 
 
 throughout the city 75 per cent 
 
 of the population live within 
 
 three blocks of dry closets. 
 
 Sixty per cent of Jacksonville's 
 
 typhoid was amongst the 41 
 
 per cent of the people using 
 
 dry closets. 
 
 The 95 per cent enforce- 
 ment of an ordinance requir- 
 ing that closets be properly fly 
 
 screened was attended by a 
 
 drop of 56 per cent in the 
 
 typhoid rate, the drop being 
 
 especially marked amongst 
 
 the people who used dry 
 
 closets. 
 
 Terry also investigated the 
 
 possibility of keeping down the 
 
 flies on a garbage dump by 
 
 covering the waste with eight 
 inches of sand. He inoculated bread with germs, allowed flies to blow it, 
 and then buried it in the ground. The flies were crawling out of the ground 
 in a week. Along in November, when the ground in Florida was getting 
 cold, it took sixteen days for the eggs to hatch and the flies to get to the 
 top. Four feet of ground was not enough to stop them. Stiles had pre- 
 viously found that six feet would not suffice. When the eggs hatched the 
 young ate the germs on the bread. Bacteria were grown from the fly specks. 
 A German who tried inoculating bread with typhoid bacilli found them in 
 the fly specks after the flies had been out of the ground twenty-three days. 
 Terry's conclusion was that dumps would breed flies however much dirt 
 
 Fig. 386.— Larva of 
 the Black Car- 
 pet Beetle. 
 
 Fig. 387. — Fish Moth (en- 
 larged). (Herrick Sanitary 
 Science Series No. 3, Cornell 
 Reading Course, Oct. 1, 1913.) 
 
Wire DO TO 
 
 Where you <2at offen determines whar you eat 
 
 A Dirty Kitcme^ CamotTum OutClea/i foot) 
 
 An underground Kiich<zn undermines heaJfh off he worker* 
 
 A CLEA/S KlTC/iEAi 15 A/1 APPETIZI/16 A55ET 
 
 A Kifchgn &bgvg grougd is n?ore likely ts be &bovg jtbgicion 
 
 A PUBLIC KlTCflEfl 3/10ULD BE OPEfl TO PUBLIC VIEW 
 
 Chicago Mc+JtA Depart)-****, educational fosi*j-*f/° /&g 
 
 Fig. 388. 
 
926 
 
 INSECTS 
 
 was used to cover them. The policy of covering a dump with some clean waste 
 or even clean sand does not keep down flies. 
 
 FOOD AND FLIES 
 
 Flies are of no consequence except as they affect the food. They do not 
 
 start any diseases. They serve to carry them from one place to another. 
 
 Water flows from place to place, there- 
 fore typhoid germs that get in at 
 Quincy may sicken the people of St. 
 Louis. One farmer may get typhoid 
 in his milk and then spread typhoid 
 to a hundred farmers' milk by empty- 
 ing it into a common vat. From this 
 common vat five hundred consumers 
 may obtain their milk. Thus typhoid 
 may be spread all over a town. But 
 about the only chance for solid food 
 like bread, meat, and sugar to spread 
 typhoid is through the help of flies. 
 A man's water faucet taps the 
 same pipe as that of another man, a 
 man's milk bottle is filled from the 
 same can as another's — but the only 
 link between two men's bread is our 
 enemy, the fly. If the one has a com- 
 municable disease the fly, forgetting 
 all about quarantine, travels with his 
 saddle bags loaded with germs from 
 
 him who hath to him who hath not. 
 
 And on top of this there is the esthetic side. Is it not inconsistent 
 
 to have bathtubs and clean linen and all such refinements and eat fly-befouled 
 
 food? 
 
 Eead what Hurty of the Indiana State Board of Health says about it : 
 
 Fig. 389.— The Hodge Fly Trap on a Gar- 
 bage Can. 
 
 Fig. 390. — Parasite Ticks on the Body of a House Fly. 
 
FLIES 
 
 JOURNAL OF A FEMALE HOUSE FLY 
 
 927 
 
 Thursday, Nov. 2, 1911 — Went into winter quarters. Barely lived through 
 the long, hard winter. 
 
 April 20, 1912 — Came out of winter quarters and laid my first batch of eggs — 
 120 in number — in a manure heap. 
 
 April 21, 1912— My first 120 eggs 
 have hatched. 
 
 April 22, 1912 — Larvae have under- 
 gone first molt. 
 
 April 23, 1912 — Larvae have under- 
 gone second molt. 
 
 April 26, 1912 — Larvae transformed 
 into pupae. 
 
 May 1, 1912 — One hundred and 
 twenty full-grown flies, sixty of which 
 are females. 
 
 May 3, 1912 — Laid my second batch 
 — 120 eggs. 
 
 May 13, 1912— One hundred and 
 twenty flies came from my second batch 
 of eggs. Laid my third batch in a kind 
 neighbor's garbage can. 
 
 May 20, 1912 — The city has offered a prize to the school child who will kill 
 the largest number of flies. The boy at the house where I live is killing flies 
 right and left. And to think — we have all been eating at the same table with him. 
 
 May 21, 1912 — Laid my fourth batch of eggs. Left alone and unhindered, 
 by Sept. 10, 1912, my descendants will number 5,598,720,000,000. 
 
 Fig. 391. 
 
 Iowa Health Bulletin. 
 Flies — Milk. 
 
 FLY CATECHISM 
 
 Where is the fly born? In manure and filth. 
 
 Where does the fly live? In all kinds of filth and he carries filth on his feet 
 and wings. 
 
 Where does the fly go when he leaves the manure pile and the spittoon ? He 
 goes into the kitchen, the dining room, and the store. 
 
 What does the fly do there? He walks on the bread, fruit, and vegetables; 
 he wipes his feet on the butter and he bathes in the milk. 
 
 Does the fly visit patients sick with consumption, typhoid fever, and cholera 
 infantum? He does and he may call on you next carrying the infection of 
 these diseases. 
 
 What diseases does the fly carry? Typhoid fever, consumption, diarrheal 
 diseases, diphtheria, scarlet fever, and, in fact, any communicable disease. 
 
 How can the fly be prevented? By destroying all the filth about your prem- 
 ises ; screen the privy vault, cover the manure bin, burn all waste matter, destroy 
 your garbage, screen your house. 
 
 Either man must kill the fly or the fly will kill man. Prevent the fly. 
 
 FLY FAMILY DESCRIBED 
 
 The Connecticut experiment station has made some tests to determine 
 how thickly populated with germs are flies from different places. To begin 
 with, our old enemy, the blue bottle fly, is not much of an enemy after all. 
 
928 INSECTS 
 
 In addition to being so shy as to be harmless he is not thickly populated. 
 He only carries 300,000 germ passengers. Swill barrel flies average about 
 3,000,000, pig pen flies about 1,000,000 and dwelling house flies nearly 
 900,000. 
 
 Swill barrel flies, pig pen flies, and dwelling house flies are the same 
 species of insect. The only difference is in the degree of dirtiness. It is the 
 difference between a man before and after his bath. 
 
 Flies engaged in eating in a pig pen or swill barrel are working at a dirty 
 trade. When the fly travels the swill barrel course to the house to finish his 
 dinner with dessert taken from the table he is working at a cleaning trade, 
 and for his desire to top his meal and incidentally to clean himself, Mr. 
 Fly cannot be blamed. The blame rests with the people who are willing to 
 drink the fly's bath water. 
 
 The fly is a most voracious eater. We have heard that he is a most 
 appalling breeder but his gastronomic ability has not had much notice. A 
 satiated housefly, preening himself ou a piece of pie, weighs nearly twice as 
 much as when he began to eat. When fed plenty of moist food he deposits a 
 fly speck every five minutes. 
 
 Anything is grist that comes to his mill. He will eat anything as well as 
 everything. Because sputum, is from a case of consumption or secretions are 
 from a case of typhoid is no reason why they do not appeal to the fly's palate. 
 
 Being fond of filth as well as of clean food and being fond also 'of dirty 
 places naturally they have many germ diseases of their own. 
 
 There are epidemics affecting flies as well as epidemics affected by flies. 
 But what matters it if a few millions are killed by germs when so many 
 millions can quickly breed? Nothing with the feeding and breeding power 
 of a fly is at any great disadvantage from germs. It is the human being 
 that expects to produce but a few of its kind that must fight off the enemies 
 to keep the race alive. 
 
 In fighting flies it is most important to concentrate attention on fly breed- 
 ing places. Next in importance come fly feeding places. Flies require such an 
 enormous volume of food that we can accomplish something by keeping things 
 free from fly food. Most important is care of the garbage — no garbage on the 
 ground, a clean can well covered and frequent removal. 
 
 But efforts toward diminishing fly food should not stop at garbage. Ex- 
 posure of foods to the flies in stores must be stopped. Confectionery, fruits, 
 vegetables, meats and general bulk groceries must not be exposed. In some 
 states, laws covering this point are enforced. In others they are a dead letter. 
 What's the use of fly posters and widely heralded fly campaigns if the law re- 
 lating to fly food is not enforced ? 
 
 OPEN SEASON FOR FLIES 
 
 A female fly begins to lay eggs when ten to fourteen days old and it 
 takes the young nine or ten days to pass through the various stages from 
 egg to house fly. It takes about three weeks therefore to complete a genera- 
 tion — from egg laying to egg laying. 
 
 In order to spread typhoid bacilli flies must have access to the excre- 
 tion of those having typhoid fever or carriers of typhoid bacilli. Therefore 
 
I 
 
 § «j § 5 § $ 
 
 929 
 
930 
 
FLIES 
 
 931 
 
 the number of chances for flies to pick up infection increases as the season 
 goes on. 
 
 A typhoid laden fly does no harm so long as he stays out in the grass, 
 but when the cold night season arrives the house fly fits his name. For 
 these reasons there should be no let up on the fly campaign. Another reason 
 for continuing the effort is to lessen the number to be carried over into each 
 succeeding year. There should be fewer flies hatched each year. Every one 
 killed, therefore, represents a decrease in the supply. 
 
 PREVENTING FLY BREEDING 
 
 The fight against flies began with the slogan "Swat the fly." Fly swat- 
 ters, fly paper, fly poison, and fly screens are in general use. It was soon seen 
 that something else was needed. The next step was the general use of 
 fly traps in places not well adapted to 
 screens, fly paper, and fly swatting. 
 
 As I go around the country I find 
 that the use of fly traps in the vi- 
 cinity of fruit and vegetable stands, 
 around milkhouses and some other 
 places widespread. As one walks 
 along the business streets in small 
 cities two or three fly traps are found 
 on each block. 
 
 Redlands, California, has gone a 
 step further. It has appointed a spe- 
 cial officer whose duty it is to look 
 
 Iowa State Board of Health. 
 
 Fig. 394.— Fly Food. 
 
 Virginia Health Bulletin. 
 Fig. 395. — Giant Fly Trap. 
 
 after the fly traps, to keep them baited, cleaned, and generally in order. 
 
 We are just beginning to work out methods to prevent flies from breed- 
 ing. Some ordinances requiring that manure boxes be made flyproof have 
 proved a disappointment. Just now special stress is being put on treatment 
 of manure in the box to prevent flies from breeding in it. 
 
 The Department of Agriculture has just promulgated the following 
 method. Powdered borax is sprinkled over the manure at intervals of five 
 
932 
 
 INSECTS 
 
 days. The quantity used is .62 of a pound to eight bushels of manure. 
 
 Forbes recommends the use of a solution of iron sulphate two pounds 
 to one gallon of water per horse per day. The University of Wisconsin 
 recommends the use of arsenic. 
 
 In Bulletin No. 14, Bureau of Entomology, Department of Agriculture, 
 Hutchinson says that when manure is so spread out that it rapidly dries out 
 
 Fig. 396. 
 
 Chicago Health Department 
 
 flies will not use it as a place in which to deposit eggs. The department rec- 
 ommends that manure be scattered on the fields and thus be rapidly dried out. 
 This is even more effective than treating it in boxes with borax, iron sulphate, 
 or Paris green. 
 
 Hutchinson found that fly eggs were found in the moister part of the 
 pile; that the larvae there hatched but that after a while the larvae sought 
 drier areas to change to pupae; that neither larvae nor pupae would remain 
 in a light place ; that they could not stand heat ; that they avoided the moldy 
 parts of the manure pile. It was these qualities that made it impossible for flies 
 to hatch out of manure that had been scattered on the ground. 
 
FLIES 933 
 
 DEFENSE AGAINST FLIES 
 
 Sometimes it is not possible to do the best thing nor even the second 
 best thing; whereupon it becomes increasingly necessary to do the third best 
 thing. 
 
 The best fly preventive is to prevent fly breeding. The second best is to 
 keep things so clean as to prevent fly feeding. The third best thing is to 
 defend oneself against the flies that have come. Sometimes it will be possible 
 to screen them away. This works well enough with dwellings. The few 
 flies that get into a well screened house can be swatted, or caught with paper, 
 or killed with poison. 
 
 Where the doors are opening constantly screens are sometimes of little 
 service and sometimes none at all. Under these circumstances what is 
 to be done? 
 
 Usually it will be possible to protect the food supply with cases, screens, 
 or mosquito bar. Anything kept in the icebox will be protected. Flies sud- 
 denly entering an atmosphere of 60° will escape if they can. If not, they 
 slow up. At about 48° they lose their ability to fly. At 27°, five degrees below 
 freezing, most of them die. 
 
 The best method of ridding a dairy barn, milk house, or store, of flies will 
 depend on the number present and on other considerations. When flies are 
 abundant the use of fly traps is the most effective method. 
 
 Sticky fly paper has some advantages and some disadvantages. A few 
 saucers containing a mixture of one pint of water, one tablespoonful of 
 formaldehyd (commonly known as formalin), and one tablespoonful of 
 sugar will be efficacious, if not much water is exposed in the room. 
 
 The proposers recommend that pieces of bread saturated with this solu- 
 tion be placed in plates and these exposed in places inaccessible to children 
 and domestic animals. 
 
 When the place is not being used it should be darkened whereupon fly 
 paper, fly traps, or fly poison, placed near an undarkened window, will be 
 doubly effective. 
 
 WHY HAVANA IS FLYLESS 
 
 There are no flies in Havana. The temperature does not go below 54°. 
 Therefore flies could multiply all winter long. The people eat in the open. 
 Therefore there should be plenty of fly food. The smaller towns have flies 
 in abundance., Nature has done its share to provide flies for Havana. Why, 
 then, is Havana flyless? Because man has done enough to protect himself. 
 Obviously what Havana has done any American community can do. 
 
 What has been done? The city has been made clean. The streets are 
 clean. The homes are clean. Nothing is thrown on the ground in Havana. 
 The courtyards as well as the floors are kept immaculate. The manure of livery 
 stables is deposited without delay in a cart. 
 
 At 10 o'clock each night all wastes are hauled out by the city. This in- 
 cludes stable manure, garbage, street sweepings, and rubbish. At 12 o'clock 
 begins the sweeping and washing of the streets. The street cleaning is not done 
 until after the manure wagons and garbage wagons have passed on. 
 
 Wlien there recently I went into the poorer parts of the city looking 
 
934 INSECTS 
 
 for dirty streets. They were not to be found. I investigated the floors of 
 homes and the nagging of interior courts and found that cleanliness prevailed. 
 I thought surely the stables would be found below standard. So I went 
 there and found the same observance of sanitary law. 
 
 No doubt railroad trains and vehicles bring flies into Havana. And an 
 occasional fly is seen. But none breeds in the city and those that are brought 
 in die. 
 
 The most important factor in this result is the perfect care of manure 
 and garbage on the premises and their daily removal. The next factor in 
 importance is the cleanliness of the streets and homes. 
 
 STABLES AND FLIES 
 
 The object of this article is to call attention to two important phases 
 of a fly prevention campaign, to wit: a campaign against fly food — in other 
 words, a campaign for clean houses and premises; and a campaign against 
 fly breeding places — in other words, a campaign against bad stable conditions. 
 
 Drs. Porter and Byrd of Florida have reported the result of a study 
 of one hundred and thirteen stables in Jacksonville. They found that chickens 
 around a stable were a help. They ate fly eggs and grubs. 
 
 If the stable floor was not perfect they always found eggs or larvae. A 
 well dressed cement floor without cracks was the ideal. Practically all of 
 the wooden floors were breeding places. Either the female would get through 
 a crack and lay her eggs in the dark space below or else bits of flyblown 
 manure would fall through the crack. Cement floors were also liable to 
 crack but the liability that flies will find them a breeding place is small com- 
 pared with wooden floors. 
 
 Worst of all was the record of the earthen floors. When the ground of 
 the stable floor was hard and dry throughout no larvae were found ; but where 
 a part of the earth floor was soft and moist, larvae were found in those parts 
 of the stall floor that were dry and hard as well as in the soft parts. The exam- 
 ination was made by digging up and examining the top six inches of the 
 ground. 
 
 It is next to impossible to prevent flies from breeding in a stable unless 
 the floor is tight, dry, well drained and properly constructed. Taking care 
 of the manure pile is easy though even more important. It must be flyproof. 
 Furthermore, the manure box must be emptied once a week. It takes flies 
 ten days to develop from mother through eggs, larvae and pupae into flies. 
 To empty the manure box every week is to kill most of the young and to get 
 the balance away from your neighborhood though you may be harming the 
 neighborhood where you dump them. 
 
 FALL FLY DANGER 
 
 There are many women who advocate the double standard for their 
 homes — one for bugs and another for flies. There are other women who run 
 their homes on the single standard — no bedbugs and no more flies than bed- 
 bugs. Those single standard women boast of their homes during this summer 
 season. They worked on the theory that the flies came in the house for food. 
 They kept their homes so clean that the flies found more food outside than 
 
fig 
 
 s 
 
 I 
 
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 1 
 
 A 
 
 
 ^a 
 
936 INSECTS 
 
 in, and, therefore, did not try to find holes in the screens or to get in through 
 open doors. 
 
 As the weather begins to get cool they find that their plan does not work 
 so well. The reason is that the flies are now seeking the house for another 
 reason; they want to keep warm. A clean house is nearly as much sought 
 after as a dirty one. 
 
 When the temperature falls well below 70° flies suffer greatly. They be- 
 come stiff in wing and leg and they move slowly. When the temperature gets 
 about 50° they cannot move at all. 
 
 In controlling disease health officers try to push back the contagion little 
 by little until the foci of infection are few whereupon they redouble their 
 efforts and try to bring about its disappearance. 
 
 Flies in October have reached the stage where they could be made a dis- 
 appearing plague. The August effort to control, if duplicated in October, 
 would make them disappear. 
 
 Therefore the single standard housewife should get out her swatter and 
 her flypaper for October. 
 
 The double standard housekeeper has had hers out all summer. She prob- 
 ably notices fewer flies in her house now than in August. If she stops 
 swatting because the flies are fewer she will have to do more swatting next 
 year. 
 
 She should proceed upon the plan health officers have worked out for 
 contagion: To double the effort as the enemy decreases and success becomes 
 possible. 
 
 There is another reason for keeping flies out of the house in October. 
 Summer flies, living in the grass, are not so liable to be spreading typhoid 
 as fall flies. 
 
 Flies spread typhoid. They do not originate it. They can only spread it 
 when it is around. 
 
 Typhoid is a fall disease; therefore be doubly afraid of flies in the fall. 
 
 HOW TO AVERT FLY MENACE 
 
 Flies spread disease. So much has been said on this subject that every- 
 body knows it to be true. Flies do not abound in a clean house. If there are 
 many flies around it is certain that the house is not clean. These facts are 
 known by everybody and nothing is gained from discussing them further. 
 
 The fact next to be stated is that in order to prevent flies from multiply- 
 ing it is necessary properly to control the manure situation. Before many 
 years cities will remove stable manure as they now remove garbage. Havana is 
 a flyless city, likewise a healthy city, because it has adopted this as one 
 of the functions of the city government. 
 
 Next in importance to the prompt removal of stable manure is the treat- 
 ment of it with chemicals. In Bulletin No. 118 the Department of Agriculture 
 gives the advantages of the different chemicals used for destroying fly larvae in 
 stable manure. They recommend borax. The method is as follows: Use 
 ten ounces of borax for each ten cubic feet (eight bushels) of manure. Sift 
 it on the fresh manure with flour sifter and then sprinkle with two or three 
 gallons of water. 
 
FLIES 
 
 937 
 
 This will kill the larvae and eggs. It will not decrease the fertilizer 
 value. The cost will be 1 cent per horse per day. 
 
 They found that calcined colemanite ranked second. Colemanite is 
 the crude borax mined in California. This is heated to a white heat and the 
 product is known as cal- 
 cined colemanite. It is 
 used in the same manner 
 as borax but the quantity 
 required is somewhat 
 larger (twelve ounces to 
 ten square feet). The 
 cost is about one-quarter 
 of 1 cent per day per 
 horse. Colemanite does 
 not lessen the fertilizer 
 value of manure. 
 
 Calcium cyanamid 
 was found to be fairly 
 efficient. Twenty pounds 
 to eight bushels of ma- 
 nure killed 99 per cent 
 of the larvae. Four 
 
 pounds killed 40 per cent of them. Calcium cyanamid increased the fer- 
 tilizer value of the manure. 
 
 Sodium fluorid was somewhat efficient. Formaldehyd was moderately 
 effective. Paris green was fairly efficient. The fact that Paris green is a 
 poison was against it. Iron sulphate, salt, kerosene, pyroligneous acid, canal 
 larvacide, kainit, copper sulphate, lime-sulphur mixture, potassium cyanid 
 and ammoniacal gas liquor were tried and founcf ineffective. 
 
 Fig. 398.— Flies All Over Town. 
 
 HOUSEHOLD FLY TRAP 
 
 The United States Department of Agriculture, Bureau of Animal Indus- 
 try, gives these directions for a household fly trap six inches in diameter and 
 twelve inches high : 
 
 "Buy two sets of six inch embroidery hoops. I T se two of the small and 
 one large hoop for- the trap. Tack twenty inches of twelve inch wire screen- 
 ing on the inside of the smaller hoops. The cone requires twelve inches of 
 twelve inch wire screening cut in a half circle, with a six inch radius to the 
 circle. Lace the selvage edge of the screening together with wire or linen 
 thread. Tack the circular edge of the screening on the inside of the lower 
 cylinder hoop. Cut a hole one-half inch in diameter at the top of the cone. 
 Cover the cylinder with a piece of cloth held in place with the large em- 
 broidery hoop. Place trap over a bait of sugar and vinegar, high enough 
 from the table to allow flies to get underneath. Clean the trap by scalding 
 the flies, removing the cloth, and shaking the dead flies into the fire." 
 
938 INSECTS 
 
 A NEW FLY TRAP 
 
 Levy of Richmond found that, while fly eggs were laid in stable manure 
 whenever possible and there hatched, the maggots would crawl out of the ma- 
 nure and burrow in the ground to pass their pupa stage there. He conceived 
 the idea of adding a new trap to the list of fly traps, one to catch the larvae 
 as they sought to escape from the manure. 
 
 He got a whisky barrel, bored some holes in the bottom, set it on bricks 
 in a tub, and rilled it full of manure. 
 
 The next day larvae began to drop through the holes into the tub. After 
 about a week the manure was emptied from the barrel and carefully examined 
 for larvae. None was found. 
 
 Then an improvement was made. The end of the barrel was knocked 
 out and a piece of gauze with a quarter-inch mesh was substituted. This 
 worked better because the larvae could get out. 
 
 Levy's practical suggestion is that manure boxes be made with perforated 
 bottoms; that they be set in a tank containing an inch or more of some 
 poison, such as a solution of Paris green or of sulphate of iron, and that this 
 be covered by a close-mesh gauze or that it be kept oiled to keep the mosquitoes 
 away. 
 
 Levy says that flies lay in manure before it leaves the stalls. All fly ma- 
 nure must be regarded as fly borne; that where the manure box is set flat 
 on the ground or in the ground removal should be twice a week, because 
 from egg to larva — old enough to crawl — requires but three days and therefore 
 when the box is emptied the pupae will be left behind in the ground to 
 develop into flies in course of time. 
 
 Another point made is this: Not all of the larvae escape from manure. 
 The ordinary box does not lend itself perfectly to such escape. The farmers 
 sometimes object to manure from the cities because it increases the number 
 of flies and the flies trouble their stock. In fly time the horses get thin and 
 the cows give less milk. 
 
 Levy's suggestion is that if the box has a perforated bottom the larvae 
 will escape and the manure will not develop so many flies to plague the farmer's 
 stock. 
 
 This suggestion of Levy is not to replace fly traps, fly poison or swatters. 
 It is only an additional agent. 
 
 I am sure that the number of flies in the cities is getting materially less. 
 There is some improvement in the country. 
 
 The more recent movement directed against fly food and fly breeding 
 places is much better than the fly swatting with which the anti-fly movement 
 began. 
 
 DOOR FANS FOR FLIES 
 
 In De Kalb, Illinois, there is a saloon with a large wooden blade electric 
 fan outside the front door. It is suspended from the roof of the vestibule of 
 the open corner entrance. It serves a double purpose. Flies do not like a 
 windy place. As the outside of the screen doors is kept free from flies the 
 number finding entrance to the interior of the saloon is greatly reduced. 
 
 In the second place the cool, well fanned saloon is inviting in hot weather. 
 
FLIES 
 
 939 
 
 I had never seen or heard of this method until the July number of the 
 North Carolina Bulletin of Health came to hand. Some tarheel restaurant 
 keeper had beaten the De Kalb saloonkeeper. Dr. Booker writes that the 
 
 A'Day in the 
 
 HAVING HAD A GOOD NIGHTS 
 SLEEP IN AN OLD GARBAGE 
 CAN 1 BREAKFAST AND AWAY- 
 
 LIGHT ON A HORSES 
 FACE FOR A RIDE. 
 
 FIND A DOG ASLEEP 
 
 AND TEASE HIM 
 
 A WHILE 
 
 of a Fly 
 
 TO A BAKERY WHERE I 
 HAVE SOME DESSERT 
 
 GO FOR A WALK AROUND THE 
 EDGE OF A DRINKING GLASS 
 
 GO IN A WINDOW IN A 
 NICE LOOKING MOUSE 
 
 CRAWL AROUND THE 
 
 BABY'S FACE FIND 
 
 IT VERY SWEET 
 
 SEE AN OLD STABLE j£f 
 DOOR OPEN 
 
 /AND FIND TME TABLE 
 ALL READY FOR DINNER. 
 
 PASSING BY A 
 
 FEW DAYS LATER 
 
 NOTICE A WHITE 
 
 RIBBON ON THEIR 
 
 FRONT DOOR. 
 
 — COFFMAN IN NEW YORK AMERICAS* 
 
 Fro. 399. 
 
 number of flies in the dining room was reduced to almost none. The owner 
 had found that the arrangement keeps the flies out and serves as a first class 
 advertisement. 
 
 The bulletin says: "Grocers, butchers, bakers, confectioners, hotel and 
 restaurant keepers will undoubtedly find the advertising value of such an 
 
940 INSECTS 
 
 arrangement worth considering, and in a short while the general public will be 
 demanding such protection." 
 
 STABLE FLIES 
 
 When Rosenau discovered that stable flies could carry infantile paralysis 
 the interest in this fly increased materially. The farmers already knew of the 
 harm from this fly. In addition to spreading infantile paralysis Jennings 
 and King of the Bureau of Entomology say it may spread pellagra. The 
 diseases of domestic animals spread by it are anthrax, swamp fever, glanders, 
 septicemia, surra, souma and, maybe, round worm. 
 
 In addition, biting flies worry stock so much that they cannot work 
 efficiently. Animals get thin and milk cows sometimes go off 40 to 60 per cent 
 in the amount of milk produced. 
 
 F. C. Bishopp of the United States Bureau of Entomology tells in Bul- 
 letin 540 what he has learned about the stable fly. It breeds largely in straw. 
 Old strawstacks in the fields are the worst offenders. Bishopp's advice is to 
 burn these stacks or else to spread the straw and plow it in deep. When 
 a heavy rain falls on freshly thrashed straw conditions for fly breeding are at 
 their worst. Manure containing straw is another breeding place of importance. 
 
 To keep the flies off, Bishopp advises a mixture of fish oil (one gallon), 
 oil of pine tar (two ounces), oil of pennyroyal (two ounces), and kerosene 
 (one-half a pint). To keep the flies out of the stable he recommends the 
 Hodge window trap. 
 
 DO NOT REMOVE YOUR SCREEN 
 
 This is being written on November 1 in Chicago. We have had one 
 blinding snowstorm lasting for more than half an hour. Heavy killing frost 
 has occurred several times during the last month. During the first half 
 of the month there was a week of rather continuous cloudy cold weather 
 with several heavy rainstorms. The grass and weeds are dead. 
 
 The screens were removed October 29. Prior to that time whenever 
 a lone fly secured entrance to the house the scouts located him and the 
 cavalry speedily demolished him by. the swatter route. Today the rooms are 
 full of flies and swatting seems an endless job. 
 
 In spite of the most persistent effort some females will find warm recesses 
 in which they will remain until more propitious weather next spring. Had 
 the screens remained on another month all the outside flies within a few 
 hundred yards of the house would have been killed and our next fly fighting 
 job would have been far lighter. After fighting all summer we surrender a 
 considerable part of the vantage gained through one mistake. 
 
 I have not seen any mosquitoes lately nor heard of any. It is fair to 
 assume that the lady mosquitoes needed to perpetuate the species for next year 
 are now under cover in this latitude. Those mosquitoes not in out of the cold 
 are dead and are therefore good mosquitoes. 
 
 From the mosquito standpoint in the latitude of Chicago it is safe to 
 remove screens as early as November 1. South of the latitude of Memphis 
 screens should not be removed during the winter. While the temperature is 
 much of the time well below that at which flies are killed and far below 
 
FLIES 941 
 
 that at which mosquitoes are destroyed removal of screens is not ad- 
 visable. 
 
 Insects show a good deal of intelligence and forethought at least in ele- 
 mental things. Perhaps they intuit, and Bergson tells us that "intuits" "land 
 the goods" while "intellectuals" speculate and freeze. 
 
 A few flies (and perhaps a few mosquitoes) get into warm places on 
 warm walls, live through the frosty night and then, the day having warmed 
 the air, seek out a warm indoor place in which to hibernate. I have often 
 seen a fly infested Pullman running through a section of the country where 
 the ground was deeply . covered with snow. Even though all the flies and 
 mosquitoes of a given town had been killed off by cold railroad trains 
 loosen refugees that must get indoors or die. 
 
 Flies and mosquitoes do little harm in winter. But winter provisions 
 against them return many fold. It is easier to kill the one female in cold 
 weather than the millions of its descendants in warm weather. 
 
 WHO HAS A NEW FLY SLOGAN? 
 
 What is the matter with "Swat the fly" ? It is short, easy to say, slangy, 
 suggests action and furthermore it has been accepted. For a woman who 
 will have no flies in her house, who wants to protect her baby, who will not 
 stand for flies in the milk — for her "Swat the fly" is an ideal slogan. It is 
 possible for her to kill every fly that crawls through her screens. 
 
 However, the grocer, the butcher, and the dairyman cannot swat the fly 
 in their places. The best they can do is to limit the number. The ideal slogan 
 for them is "Trap the fly." 
 
 Flies have but few impulses. One is the impulse to eat ; the other is 
 to propagate. The spreading of disease by them is purely an incident. There 
 is no impulse about it. There is no intent, no malice. They go in search 
 of food and incidentally they become covered with filth. They move on 
 in continued search for food and incidentally they infect milk, butter and 
 bread with filth and disease. 
 
 Now the impulse to eat is a force to be reckoned with. Flies come around 
 because fly food is about. There is no more attractive fly food than garbage. 
 Any dirty place is a fair pasturage for flies. In a certain sense a better 
 slogan would be "Starve the fly." 
 
 None of these procedures, though, is sufficient; nor are all of them com- 
 bined. A woman can keep swatting the fly and keep her house flyless. A 
 grocer can trap the fly and keep his store clear enough of flies to attract 
 desirable customers. Careful, cleanly people can keep things clean enough to 
 starve the fly. 
 
 However, none of these nor all combined can make a flyless town. In 
 order to have a flyless town it is necessary to plan against that other great 
 impulse — the impulse to propagate. Years of experience prove that the only 
 fly campaign which can result in a flyless town is one which removes the fly 
 breeding places. 
 
 The fly situation can be controlled if one type of fly breeding place is 
 eliminated. That is horse manure. A daily removal of all horse manure has 
 made Havana a flyless town. Santiago de las Vegas, twenty miles away, 
 
942 INSECTS 
 
 has as many flies as Memphis, Tennessee. A weekly manure service 100 per 
 cent perfect in warm weather would solve the problem. 
 
 To get this done we must have laws. To have laws we must have public 
 sentiment. To have public sentiment we must get everybody to talking about 
 it. For this we need a slogan. Who has one? It must be short and easy to 
 say. It must tell enough but not too much. It must carry the essence of 
 the idea but not too much of it. It must suggest action. It must affirm. 
 If it is slangy, so much the better. Who has it ? 
 
 Case Against Flies Proved. — Mrs. E. H. S. writes : "If house flies are 
 transmitters of disease,, why were the periodical visits of cholera to the 
 United States distinguished by their absence, so much so that forecasts for 
 the coming of the dread disease were based on the presence or absence of 
 these insects?" 
 
 Reply. — House flies are transmitters of disease. That has been proved 
 by positive and incontestable evidence. I do not know why the epidemics 
 of cholera fifty years or more ago were preceded by absence of flies, if they 
 were. My opinion is that they were not. It is so easy for such loose state- 
 ments to start and when the facts are half a century in the past it is 
 impossible to run them down. 
 
 Plague of Small Flies. — Desperate writes: "Four years ago I moved 
 into a house where small flies collected around the sink and in the bathroom 
 and I have tried every means of getting rid of them without success. I had 
 diphtheria and the house was fumigated, but I still have the flies. Can 
 you tell me what is the cause? I never leave anything around that would 
 cause them to come, and I never have one of the ordinary flies, just those 
 water flies." 
 
 Reply. — Generally this kind of fly keeps away from food. Therefore, 
 they are not of importance as disease spreaders. Fumigation with formal- 
 dehyd does not kill insects. These flies breed in soggy wood. Burn pyre- 
 thrum powder (insect powder) around the sink and bathtub; spray the 
 woodwork of the sink and bathtub with Piatt's chlorids. Use an abun- 
 dance. 
 
 To Get Rid of Flies. — D. H. W. writes: "Can you tell me some method 
 of ridding a small community of flies? As the summer advances they 
 gather in clouds around the kitchen doors and stables. We have tried 
 every known device." 
 
 Reply. — 1. Enforce proper care of stables as breeding places by 
 (a) having manure boxes emptied once a week; (b) screening manure 
 boxes; (c) having proper floors in stables; (d) screening stables. 
 
 2. Enforce such cleanliness as deprives flies of food, (a) Through 
 garbage being wrapped in clean, covered cans ; (b) through keeping garbage 
 off the ground. 
 
 3. Keeping flies out of the house by (a) screens; (b) swatters; (c) 
 fly paper and fly poison. 
 
 4. Pay proper attention to butcher shops and creameries. 
 
 5. Regulate or prevent dumping. 
 
 6. Education by posters, fly campaigns, lectures, and by talking flies in- 
 stead of the weather. 
 
IXSECTS 943 
 
 Bothered By Flies. — Mrs. D. J. H. K. writes: "Please tell me how to 
 keep flies out of a screened porch, or get rid of them, as we are compelled 
 to leave the door open in order to run the washing machine on the inside 
 with a gasoline engine on the outside." 
 
 Reply. — Catch them in traps and on fly paper. Around a washing ma- 
 chine fly poison would not be of much service — the flies get plenty of un- 
 poisoned water. Fly repellants are of little service. 
 
 Smudge Plan to Kill Flies. — S. B. writes: "Kindly let me Tcnow if there 
 are any chemicals or other substances that can be mixed and burned, the 
 odor of which hills flies, mosquitoes, etc., and if there is such a preparation 
 that I can make or mix, will it be possible to have a pleasant odor and not 
 objectionable to people in my place of business?" 
 
 Reply. — Insect powder slowly burned after a smudge plan stupefies flies 
 and mosquitoes and they can be easily killed or swept up and burned. The 
 odor is not unpleasant. Sulphur burning makes fumes which kill insects ; 
 but the fumes are highly objectionable. Neither should be relied on. The 
 only way to keep out flies and mosquitoes is to screen them out. As to 
 flies, no fly food should be left around. As to flies and mosquitoes breeding 
 places must be abolished. Burning powders helps a little. 
 
 Try Burning Sulphur. — B. writes: "Will you kindly advise me how to 
 rid my basement of small flies? I have tried chlorid of lime and sticky 
 and poisonous flypaper without success. They are not the ordinary house 
 flies, but I believe have hatched out from eggs laid in cordwood which was 
 stored in my basement last winter." 
 
 Reply. — This small fly is found rather frequently around houses. Cen- 
 suses show that they make up from 5 to 15 per cent of the house flies. They 
 spread no disease so far as is known. They are not killed by ordinary fly 
 killing procedures. Try sulphur. Close all openings and burn five pounds 
 of sulphur for each 1,000 cubic feet of air space. At the end of eight hours 
 let the fumes out. Then clean up thoroughly or a new crop will breed 
 within a month. 
 
 How to Bar Flies. — J. A. S. writes: "1. What is the best way to dis- 
 pose of horse manure so that it will not breed flies? 2. Will sprinkling with 
 crude oil do any good?" 
 
 Reply. — 1. Keep the manure box screened so that flies cannot enter. A 
 female ready to lay will find a hole in an ordinary cover. Empty the box 
 once a week in warm weather. In early spring and late fall once every 
 two weeks is often enough. 
 
 2. The danger from fire is too great when oil is used. Forbes recom- 
 mends that manure be sprinkled with a solution of iron sulphate. He 
 advises two pounds dissolved in one gallon of water for each horse each day. 
 
 Iron Sulphate and Water. — H. F. writes: "Please give the formula for 
 a preparation to put on manure to prevent flies from breeding in it, but not 
 to destroy the fertilizing qualities. We keep two horses." 
 
 Reply. — Dissolve four pounds of iron sulphate in two gallons of water. 
 Sprinkle this over the manure and the floor of the stalls, if of dirt. The 
 above is the quantity required each day for a two-horse stable. 
 
944 INSECTS 
 
 To Get Rid of Ants. — G. A. C. writes: "Can you suggest any means 
 of getting rid of small ants? They have infested our refrigerator and 
 kitchen all of a sudden." 
 
 Reply. — The following are methods recommended by the Division of 
 Entomology, Department of Agriculture: 
 
 First, see that all food and especially sugar and sweets is in tightly 
 closed receptacles. Moisten sponges with sweetened water and place where 
 the ants are most numerous. Collect the sponges several times daily and 
 immerse them in boiling water, which will kill the ants. 
 
 Also use a sirup of boiling water with borax and sugar dissolved in it 
 
 The odor of camphor is distasteful to ants and gum camphor loosely 
 wrapped in paper will often drive them away. 
 
 Another method recommended is to fill a bottle (partly) with sweetened 
 water; make a hole in the cork large enough for the passage of a single 
 ant; run a thread moistened with the sweetened water from the floor 
 through the cork. When once within the bottle the ant is gorged with 
 food and cannot get out. 
 
 Bedbugs. — M. A. C. writes to know if anything can be done in a com- 
 munity way about bedbugs. He has found them frequently in newspapers 
 as delivered and in books as they come from the public library. 
 
 Reply. — Bedbugs are of no particular health importance though of 
 course they are highly objectionable. I don't know what department of the 
 city government would undertake to get rid of them. The public library 
 can do nothing. The bugs can get into the books and papers only from 
 the persons of the readers. 
 
 To Get Rid of Fleas. — Mrs. H. W. A. writes: "Three kittens deserted 
 by their mother before they were able to care for themselves acquired a 
 fine collection of fleas. As soon as the cause was discovered the survivor 
 was chloroformed. This was over two weeks ago, but the furnace room, the 
 only place they were in, seems to be still infected. There are no other 
 animals about the house, but the fleas appear to be spreading. What can 
 we do to be rid of them?" 
 
 Reply. — Old floors, mattings and carpets favor the development of the 
 flea. Places frequented by them should be thoroughly cleaned, using boiling 
 water or dusting with pyrethrum powder, especially in the crevices or 
 cracks. A decoction of one ounce of pyrethrum powder to one gallon of 
 water boiled for ten minutes filtered and strained and sprayed into the 
 infected places helps. Sprinkling with benzin is helpful but of course is 
 dangerous, as benzin is highly inflammable. 
 
 Fungus on Insect. — S. A. H. writes: "I killed a large fly in the house 
 recently. Noticing a lump formed on its body, I found it to be a mass of 
 little worms, just visible, when single, on glass. Was this part of the 
 generating process, as with ticks, or was it some parasite or foreign larvae?" 
 
 Reply. — I judge the mass was composed of a fungus — empusa. 
 This fungus destroys many flies during the latter part of the season. 
 
 To Get Rid of Mosquitoes. — E. K. writes: "Kindly tell me the best 
 way to get rid of mosquitoes. Our basement, although dry and sanitary, 
 harbors a flock of them all winter, and has for the last two or three years. 
 Even in the bedrooms and bathroom there are a few stragglers that hide in 
 
INSECTS 945 
 
 and around picture moldings and other out of the way places and come out 
 whenever we have a warm spell" 
 
 Reply. — Make a careful search of your house and you will find some- 
 where a bucket or pan of water in which mosquitoes are breeding. Upon 
 close examination you will find wiggletails. Such accumulations of water 
 must be emptied or else treated with a mixture of kerosene and crude oil, 
 half and half. The oil treatment must be repeated at two-week intervals. 
 
 The mosquitoes on your premises are too active for hibernators. To 
 kill the hibernators the best plan is to freeze them out. In any room 
 where the temperature remains at or below freezing for a few days, the 
 hibernators will be killed. 
 
 Where the freezing method cannot be applied use sulphur fumigation. 
 Close the room very tightly; stop all cracks; burn two pounds of sulphur 
 for each 1,000 cubic feet of air space. Allow the fumes to act. 
 
 Insects in Flour. — Mrs. S. R. writes: "Will you please tell me if it is 
 safe to use flour in which there are small brown insects, which in one stage 
 are tiny worms? Is there any way of destroying these insects?" 
 
 Reply. — I infer that you have got rid of most of the insects if not all 
 of them. I should say that you would be safe in using the flour. 
 
 When flour is riddled with them it might not be safe. Certainly it 
 would not be fastidious. 
 
 It is not an easy matter to get rid of flour weevils. The pantry and bins 
 must be thoroughly cleaned. Use scalding water freely. Carbon sulphid, 
 two pounds to each 1,000 cubic feet of air space, is recommended. The gas 
 is inflammable. Cyanid gas is better, but it is too dangerous for gen- 
 eral use. 
 
 Go to the public library and read up the subject in Herrick's "Insects 
 Injurious to the Household." 
 
 To Get Rid of Flour Bugs.— H. S. B. writes: "We believe that some 
 time ago you gave a remedy for the elimination of flour bugs, which 
 appear to thrive in flour bins and barrels. We are having trouble in this 
 direction in our flour bin in our kitchen cabinet." 
 
 Reply. — Much the most effective remedy is hydrocyanic acid gas. This 
 gas is so dangerous to human life that the method should not be used 
 except by experienced people. Where it can be used an effective method is 
 the use of carbon bisulphid. Stop all cracks, spray the floor, the bins, 
 sacks, walls, etc., with carbon bisulphid. Use two pounds for each 1,000 
 cubic feet of air space. The gas is inflammable. Beware of lights. After 
 some hours ventilate and then clean thoroughly. As the gas penetrates 
 poorly it is advisable to use up or otherwise dispose of the flour in the 
 bins before applying the gas. 
 
 When to Remove Fly Screens. — W. L. wants to know when fly screens 
 should be removed. Her neighbors have removed theirs. 
 
 Reply. — Fly screens should be removed when it is necessary to do so 
 to put in storm windows. Storm windows should not be put in until as late 
 in the winter as possible. Around Chicago, they should be put on about 
 Thanksgiving; around Indianapolis, about December 15; around Kansas 
 City, about Christmas. Around Memphis and from there to the Gulf the 
 fly screens should stay on all winter. 
 
946 INSECTS 
 
 This is written on November 16 on a Sante Fe train between Kansas 
 City and Chicago. Looking out of the window, the ground is seen to be 
 covered with snow and the ponds with ice. A fly is hovering around this 
 writing table. There were four in the washroom an hour ago. There 
 were fifteen flies in the washroom of the Baltimore Hotel in Kansas City 
 yesterday. The school superintendent's office in Gary was full of flies 
 two weeks ago. The flies which furnish the swarms of summer are those 
 which get into the warm places for winter. 
 
 The flies which are wintering with your neighbor may get out of doors 
 some warm day next week and later come into your house when the weather 
 turns cold. 
 
 Flyless Havana. — 0. R. M. writes: "Cannot you print what was done 
 in Havana by the United States government to make it a flyless city and a 
 cleaner one than any in the States?" 
 
 Reply. — I have the method. It is available for any health officer or 
 other city official who asks the Havana officials for it. Not all of it can be 
 given in this space but certain essentials can be referred to. 
 
 The first is that the city is thoroughly cleaned every night by the 
 authorities. There is a daily garbage removal service. The city removes 
 the stable manure every night. After the refuse removal has been com- 
 pleted between that and breakfast time the streets are swept and washed. 
 The daily removal of stable manure and garbage is the largest factor in the 
 city's wonderful freedom from flies. 
 
 It has a mosquito brigade. Accumulations of water are drained. Pools 
 and puddles that cannot be drained are kept oiled. The oiling brigade gets 
 into the field almost immediately following each rain. 
 
 Keep Screens Up. — Housekeeper writes: "The janitor of our building 
 insists on taking out the screens in our apartment now [fall]. Is it not too 
 early? Although I had no flies in the house all summer, I have two or three 
 now that seem to stay." 
 
 Reply. — Do not allow the janitor to remove the screens until the flies 
 have disappeared. Do not allow him to remove them now. The flies try 
 harder to get in the house in cool weather than in hot weather. Besides, 
 this is the typhoid season. 
 
 Moth Miller Trouble. — Mrs. H. J. C. writes: "We have a new, well 
 ventilated house. The sun shines in every room. Last summer we were 
 away for several months. This spring we are having trouble with small, 
 light colored flies. They are active, and hide in dark colored goods. They 
 are hard to catch. When we do catch one and mash it all that remains is 
 a mark of light colored dust. Are they moth millers? What harm will 
 they do and how shall we proceed to get rid of them? I think we have 
 aired about everything in the house." 
 
 Reply. — My guess is that you have moth millers. They are of no health 
 consequence. Clean everything you can with a vacuum cleaner if possible. 
 Pack woolens in moth balls. Use mothproof chests and mothproof bags. 
 
 Flies Like Electric Mixers. — L. A. writes: "If you want to give the fly a 
 large, healthy swat you can certainly do so by calling the attention of the 
 public to these little electric shakers or mixers that are found at practically 
 every soda fountain in Chicago. They are used principally in mixing sweet 
 
INSECTS 947 
 
 drinks, such as malted milk and frappes. Between drinks they stand ex- 
 posed to the air and are absolutely unprotected from flies. I have given 
 special notice to them almost every day for the last two weeks and I have 
 never watched one for over a couple of minutes when it was not in action 
 hut what there were at least a couple of flies roosting on it." 
 
 Reply. — I hope you did not buy. 
 
 Duty of the City. — J. A. suggests that a little pan he put under the fly 
 trap. He says: "Let us have a law to have a fly trap at every place 
 which attracts flies. Let the city operate them in puhlic places where 
 necessary." 
 
 Reply. — The type of trap which I would advise would not be any more 
 efficient with a tray or frying pan. 
 
 The suggestion to have a law requiring fly traps in all places where flies 
 abound and where screens do not suffice to keep them out is most excellent, 
 and should be adopted by the city council. The suggestion that the city 
 operate fly traps in public places where flies are abundant is a good one, 
 at least as far as dumps are concerned. 
 
 There are dumping grounds in the city on which a good deal of organic 
 matter is placed. They are owned by private parties but receive some part 
 of the public refuse. For years the city has used a fly repellant on these 
 dumps. Experiments have shown that this repellant is of no service. 
 
 To set out fly traps and keep them in order would cost much less money 
 than this repellant and would be infinitely more effective. 
 
 "Sewer Bug." — J. W. W. writes: "Is there such a thing as a sewer 
 hug, and if so, what does it look like? We occasionally find an ugly 
 looking hug — sometimes two inches long — crawling about the walls or 
 floors; it has numerous legs. Someone told me they were sewer hugs, and 
 as I once found one in a stationary washbowl, it occurs to me that this 
 may he correct." 
 
 Reply. — I know of no bug called a "sewer bug." Several bugs seem 
 to prefer sewers. None of them do any harm or make themselves objec- 
 tionable. When you catch another send it to Prof. S. A. Eorbes, State 
 Entomologist, Urbana, Illinois, and ask him to let you know what it is, 
 whether it does any harm and how you can get rid of that kind of bug. 
 
 Lice In Girl's Hair. — New York inquirer writes: "Will you kindly 
 advise a cure for lice in a hig girl's head — something drastic that would 
 clear it readily? She has never heen troubled like this before." 
 
 Reply. — Saturate the hair thoroughly with tincture of larkspur. 
 Rub in well. Be careful not to let the mixture get into the eyes or into 
 a scratch. Wrap the head in a bath towel. Leave on for six hours. Then 
 wash the head thoroughly. Take two quarts of hot water and add one tea- 
 spoonful of carbonate of soda. Wet the hair with this mixture. Soap 
 thoroughly with castile soap for ten minutes. Wash the soap out with 
 plenty of warm water. If nits are abundant, repeat the above several 
 times. 
 
 How to Remove "Nits."— Mrs. A. P. writes: "My little girl, age 5, as 
 a result of playing with unclean children, has become troubled with vermin 
 in the hair, which we seem to he unable to get rid of. We have had the 
 head washed several times and also have made frequent applications of 
 
948 INSECTS 
 
 tincture of larkspur and of coal oil. Still the vermin remain, as the daily 
 use of the fine comb discloses. Her hair shows a mass of 'nits' and the 
 child is becoming nervous from the constant itching. The hair is naturally 
 curly, and has been admired greatly. We naturally hesitate to sacrifice the 
 hair, if there is any remedy we could make use of to rid it of this condi- 
 tion. Will it be necessary to cut off the hair, or can you suggest some 
 remedy that will overcome this condition?" 
 
 Reply. — Use the following: Mix equal parts of kerosene oil and olive 
 oil. Rub the mixture well into scalp. Then cover the hair with a piece of 
 muslin and fasten it about the head avoiding contact with a lighted gas 
 jet or name of any kind. The following morning the scalp should be 
 washed with soap, hot water and vinegar. A fine toothed comb wet in 
 vinegar should be used to remove "nits." Dry the hair thoroughly with a 
 towel. This treatment should be repeated three or four times. You have 
 probably failed by not being thorough enough. Follow each detail exactly. 
 
 Butter and Jiggers. — J. W. P. writes: "Red bugs, chigo, chigro, or 
 jiggers are a source of great annoyance in Alabama during summer and 
 fall. What preventive can be used? Also what eradicates them after the 
 bugs have become imbedded in the skin?" 
 
 Reply. — I do not know what will repel them. When I was a child the 
 custom was to grease with butter. This was supposed to kill them. 
 
 Butter Fatal to Chiggers. — W. F. P. writes: "How can I get rid of chig- 
 gers? How can I avoid them?" 
 
 Reply. — Grease the bites with butter; this will kill the chigger. 
 
 Seeks a Preventive. — Experience writes: "For the benefit of J. W. P., 
 I wish to state that spirits of camphor, applied once or twice, will relieve 
 permanently the pain and irritation due to jiggers, and time will cure 
 the marks." 
 
 Reply. — J. W. P. was especially interested in a preventive — something 
 to keep the bugs from biting. 
 
CHAPTEE L 
 
 Longevity 
 
 EFFORTS OF METCHNIKOFF 
 
 MetchnikofT had heard that there were many exceedingly old people in 
 Bulgaria. He also heard that the sour milk in Bulgaria was the sourest 
 ever heard of. 
 
 He grew some bacilli from this sour milk and he found that they 
 could produce about four times as much acid as the ordinary stable variety 
 and that when the milk became extremely sour, instead of curling up and 
 dying, they were just getting in good fighting trim. Therefore he recom- 
 mended Bulgarian bacilli as a preventive of senility. 
 
 x4t once everybody went to it. They gained no good from it. Why? 
 Because the manufacturer went out to the stable, scraped up any and every 
 old acid-producing germ and flooded the market with lactic acid cultures 
 that could scarcely sour milk, to say nothing of licking colon bacilli in 
 mortal combat. 
 
 The people who took them did not know what they were trying to 
 accomplish. They took lactic tablets as they were accustomed to taking 
 quinin pills or headache powders. 
 
 The object sought is to get lactic acid bacilli to growing and fighting in 
 one's large intestine, to make them at home there, to get oneself permanently 
 infected with this microbe — a result that cannot be measured by the same 
 standard as can quinin pills and headache powders. 
 
 MetchnikofT s first recommendation was that we consume a large number 
 of live, very active acid-producing bacilli of a certain species; that this large 
 dose be swallowed every day for a few days. The thought was that a few 
 out of each dose would survive the stomach juices and that in a few days 
 they would get a foothold in the large intestines and there would overgrow 
 and kill out other bacteria. This first method, Metchnikoff now tells us, 
 was imperfect. 
 
 BELIEF OF METCHNIKOFF 
 
 Professor Heinemann of Chicago does not think taking lactic acid 
 bacilli will postpone old age because in the intestines there are ounces of 
 lactic bacilli normally present. 
 
 To this the Metchnikoff school answers that the lactic acid bacilli 
 normally present are a weak-kneed lot capable of producing only extremely 
 small quantities of acid. Even when the Bulgarian takes enough of the strong 
 bacilli to make 150 grams of lactic acid a day the bowel movements are but 
 
 949 
 
950 LONGEVITY 
 
 feebly acid. The ordinary lactic acid germs do not make them acid at all. 
 
 When, as an argument for sour milk, Dr. Wiley was informed that 
 Marie Prion who died in 1838 at 158 years of age lived for the last ten years 
 of her life entirely on cheese and goat's milk, he replied: "That does not 
 prove much, as she lived for 148 years on an ordinary diet and thus had 
 already established a reputation for longevity ." 
 
 While men of scientific standing were breaking their lances against the 
 sour milk conclusions of Metchnikoff that great scientist went on perfecting 
 his methods. 
 
 We are liable to get an idea that MetchnikofFs plan for postponing old age 
 consists solely in the use of germs and soured milk. One who reads his 
 "Prolongation of Life" will not be of that opinion. 
 
 In Minot's introduction to the book he says of Metchnikoff: 
 
 "One suspects that cheerfulness and optimism are in Metchnikoff inborn 
 temperamental qualities, and, in the present volume, optimism is the domi- 
 nant note." 
 
 Metchnikoff died of heart disease at seventy-two. It is impossible for 
 him to escape being regarded as the final test of the truth of his theory. 
 
 Such a test, though, has in it the elements of unfairness. He was born in 
 Eussia where the average age at death is low. He worked his way up to a 
 professorship at Odessa; was dispossessed of his means of livelihood by one 
 of those peculiarly Eussian happenings; wandered around Europe as an 
 unattached scientist from 1882 to 1892 since which time he had a haven and 
 an opportunity at the Pasteur Institute. 
 
 He was nearly sixty when he began to investigate the Bulgarian bacillus, 
 and, at sixty, it is supposed that inheritance and experience have already 
 determined about how long a man will live barring death from infection or 
 other forms of accident. 
 
 Presumably for the last eight or ten years he made use of the sour milk 
 features of his method. 
 
 Inherently and therefore since youth we are told by Minot he made use 
 of Cheerfulness, serenity and optimism as another feature of his method. 
 Students at the Institute were accustomed to meeting him daily as he re- 
 turned from market carrying his supplies in a market basket. 
 
 He made use of simple, wholesome living. We are told by the editor 
 of "Prolongation of Life" that Metchnikoff believed in "the avoidance of 
 alcohol and the rigid exclusion from the diet of foods that favor putrefac- 
 tion, such as rich meats, and of raw or badly cooked substances." 
 
 In his book we see that he had studied everything in nature bearing 
 on the subject; that, searching for truth, he had analyzed the life of every his- 
 torical personage who attained exceeding great age, and that he contemplated 
 death at the proper time with serenity. 
 
 He believed that in a properly developed cosmos where everything happens 
 in its due season there will be a logical instinct of personal death replacing 
 the instinct of personal life. 
 
GROWING OLD GRADUALLY 951 
 
 GROWING OLD GRADUALLY 
 
 If a person is between forty-five and fifty-five his average chance of 
 dying is about 1 in 65 — a little higher than the average chance of people at 
 all ages. If between fifty-five and sixty-five his chance is abont 1 in 30; if 
 between .sixty-five and seventy-five about 1 in 15 ; if over seventy-five about 
 1 in 7. 
 
 In the last census period the chance of living to full years increased 
 materially. The total gain for men was 10.23 per cent, and for women, 
 15.15. The greatest gain was for girls between 5 and 9 years of age, 32.61. 
 The greatest gain on the male side was for boys of the same age, 27.66. The 
 gain for men was found in all groups before forty-five years of age and for 
 women in all groups below fifty-five. The greatest loss for women was between 
 sixty-five and seventy-five, 2% per cent. Verily, this is the woman's century. 
 
 Dr. Dublin of the Metropolitan Life, in discussing this question before 
 the American Public Health Association, said: 
 
 "The body at 50 is little more than what the preceding years have 
 made it. The hereditary factor is largely overshadowed by direct influences 
 of environment which have continuously modified the physique." 
 
 The first statement is pretty nearly true ; the second requires some modi- 
 fication. 
 
 Studies show that those who live to be eighty and over usually belong 
 to long-lived families. Not all the children born to long-lived families live 
 to exceeding old age but with some exceptions only members of long-lived 
 families are able to fight off the enemies and endure to ripe old age. 
 
 Dublin groups the reason for disease and death in old age under three 
 heads: Scarlet fever and other germ diseases in childhood and early adult 
 life; habits and modes of life; effects of occupation. 
 
 At the head of the diseases which trouble old people stands heart disease, 
 with kidney disease fairly close up and apoplexy third. These diseases are 
 largely the after effects of scarlet fever, diphtheria, measles and pneumonia. 
 
 Under habits and modes of life Dublin places the effects of venereal 
 disease and alcohol. 
 
 Dublin says that the most important contributor to middle age mortality 
 is the effects upon the body of the habits and conditions of work. The working 
 conditions of organized factory work is what he has especially in mind. 
 
 That men may live out the biblical command to stay three score years 
 and ten among men Dublin advises the following five procedures : 
 
 1. Communities must stop the epidemics among children in order 
 to reduce the heart and kidney disease among people in the fifties, sixties, 
 and seventies. 
 
 2. The movements against venereal disease and alcohol must be en- 
 couraged, aided and fostered. 
 
 3. We must bring about better working conditions. 
 
 4. Death certificates should be better recorded and more carefully studied 
 in order that we may better plan to improve conditions. 
 
 5. We must heartily encourage the movement for public education on 
 all topics connected with personal hygiene. 
 
952 LONGEVITY 
 
 The above has to do with the precautions necessary to attain old age. 
 Many are interested in knowing how old people should deport themselves in 
 order to continue to live and to get the maximum out of life. 
 
 To continue to live the old man should proceed on the supposition that his 
 old physique is pretty badly worn and that it requires looking over at stated 
 intervals. Once a year, or twice, he should have his urine examined, his 
 chest examined and his blood pressure taken. 
 
 His greatest hazard will be colds. When unfortunately he has con- 
 tracted a cold with aches and fever he must go to bed and stay there until 
 his cold has passed well beyond the fever and ache stage. 
 
 In order to get as much out of life as possible the following general plan 
 should be carried out: 
 
 Sleep. — Saundby, in his excellent book, "Old Age, Its Care and Treat- 
 ment," tells us that old people who sleep five or six hours a night get enough 
 sleep. Nature is automatically saving. When a man has burned "toward 
 the end of the string/' nature turns down the fire. 
 
 Old people can destroy their fatigue toxins in five hours. When they 
 wake up because they have destroyed the, previous day's stock of fatigue 
 poison the process is natural. If they want to get up at 3 or 4 o'clock, let 
 them get up. If they want to lie in bed reading or quietly resting let 
 them do so. 
 
 However, if the old person wakes up before the fatigue poisons have been 
 completely burned to waste, that is another matter. For instance, if two hours 
 after going to sleep he wakes and finds his stomach sour and the next day he 
 has a backache or his muscles are sore he may know that his insomnia was due 
 to poor digestion of his supper. To get relief he may take a dose of soda. 
 
 If, though, he' thinks that thereafter he can be reckless with his supper 
 because he can escape the consequences by taking soda he will have done him- 
 self harm when he took the first dose. 
 
 It is doubly essential that the old should go to bed with empty stomach 
 after a simple meal and properly poised mentally. 
 
 Exercise. — The old must get some exercise each day. If it is at all 
 possible, the exercise should be taken out of doors. Morning is the time 
 for exercise. 
 
 At Battle Creek it was noticed recently that a large portion of the people 
 in the gymnasium were elderly. An onlooker laughed derisively. As a 
 matter of fact the elderly persons taking exercise were wise. 
 
 Children can be left to get their exercise from play. Middle-aged people 
 must exercise to keep themselves supple. Otherwise their joints stiffen 
 and creak. The wisest of them recognize the absolute need of keeping them- 
 selves fit. 
 
 Old people need a daily "suppling" stunt just as much as do middle- 
 aged people. They do not need to do so much; but they need to take some 
 exercise each day. 
 
 Clothes.— Old people are poor heatmakers. Their blood vessels do not 
 carry so much or change size so readily as do those in the young. The blood 
 vessels of the skin in the feet and hands commonly do not carry enough 
 blood to keep the extremities warm on a decidedly cold day unless they are 
 warmly covered. 
 
GEOWIXG OLD GRADUALLY 953 
 
 Old people should wear woolen underwear, woolen stockings and woolen 
 gloves in cold weather. The old heavy red flannel underwear has no advan- 
 tages in warding off rheumatism but is a good heat-saver. 
 
 A cold skin saves heat but it is uncomfortable; and there is no reason 
 why an elderly person should suffer the discomfort. 
 
 The night clothes should be of wool or flannel. The old-fashioned night 
 cap was a good institution. 
 
 Bathing". — Old people should bathe for cleanliness. They have no busi- 
 ness using cold baths for stimulation or hot baths for sedatives. The old man 
 who has "broken the ice each morning to take his plunge" should discontinue 
 it. There is no reason for continuing it just to show his hardihood. 
 
 Turkish baths are not justified under any circumstances. The violent 
 sweating is too hard on his skin. One compound cathartic pill will cause him 
 to eliminate more waste than he could sweat out in a year's Turkish bathing. 
 
 On the other hand the heat and general strain is liable to stop his 
 heart or break one of his fragile blood vessels. 
 
 Care of the Skin. — The fat is apt to disappear from the deeper layers 
 of skin in old people. At the same time the skin loses some of its elasticity. 
 The fat disappears also from the tissues beneath the skin. Besides the changes 
 in the tissues from the disappearance of fat the organs actually shrink some- 
 what. This is the reason for wrinkles. 
 
 The skin of old people dries out. The dead layer thickens. There is a 
 great tendency to the growth of warts and other kinds of thickened areas. 
 These occasionally crack and bleed. The old need massage. They need 
 massage for the muscles. They need skin massage. 
 
 Their skin will be better off if some form of grease is rubbed into them 
 twice a day. A good ointment for the purpose is cold cream mixed with five 
 per cent boric acid. 
 
 On account of the tendency of the skin to tan and crack old people 
 will do well to keep out of dry living-rooms and offices. 
 
 Diet. — The old must be careful against overeating. Their teeth are 
 usually poor. 
 
 If they do the necessary chewing they should be twice as long eating 
 as in their younger years. Eating slowly makes light eating. 
 
 However, occasionally an older person gormandizes. Xow elderly people 
 require less food than young people. Von Xoorden says that between sixty 
 and seventv the amount of food should be reduced 10 per cent; between 
 seventy and eighty the reduction should be 20 per cent; over eighty, 30 
 per cent. This is on the basis of a good deal of exercise taken. When the 
 old person settles down to a quiet, inactive life he should eat a great deal 
 less. 
 
 Saundby gives the following as a fair diet for a person of seventy, weigh- 
 ing 130 pounds and not notably active : 
 
 BREAKFAST 
 
 Ounces Ounces 
 
 Milk S Bread 2 
 
 Sugar 2/3 Butter 1/6 
 
954 LONGEVITY 
 
 DINNEK 
 
 Ounces 
 
 Bread 3 Vegetables and fruit .... 2 ounces 
 
 Meat or fish 2 Beer y 2 pint 
 
 SUPPEB 
 
 Ounces Ounces 
 
 Bread 3 Light pudding 4 
 
 Eggs 2 Whisky 2V 2 
 
 If a person has been accustomed to beer and whisky with his meals, 
 he should be allowed to continue them when he gets to be old. At the 
 same time I do not think much of the man who allows himself to develop 
 the habit of whisky with his meals. 
 
 Generally speaking, no efforts should be made to change the habits of old 
 people. This is true of tea and coffee, of tobacco, of habits of sleeping, of 
 room ventilation, of habits of every sort. It holds true also of work habits. 
 It is a bad plan for an old man to discontinue the work that has come to 
 be a habit to him. 
 
 When old people are allowed to do things in their own way and at their 
 own speed they can do a lot without fatigue. In fact, they fatigue less 
 than younger people under the circumstances noted above. The reason is that 
 they worry and fret less. With them there is less lost motion. 
 
 It is another case of the fretful colt hitched with the seasoned work 
 horse. The former comes in at night hot, wet and tired ; the latter cool, quiet 
 and not overfatigued. This only holds true where the old man is allowed 
 to do his task in his own way and at his own speed. 
 
 Beturning to the question of diet — Saundby advises the free use of 
 soured milks by old people. The easiest secured of these is buttermilk. In 
 winter time the old person may need a good deal of heat, in which event 
 he can take a buttermilk made out of whole milk with a culture. In warm 
 weather ordinary skim milk buttermilk is better. Cottage cheese, clabber, 
 whey kumiss, and kefir are easily secured. 
 
 Saundby uses sour milk made after the following plan : Hand skimmed 
 milk is sterilized or thoroughly pasteurized to kill all the disease germs 
 and also all those of the ordinary barnyard kind. The milk is then heated 
 to 100° and put in a thermos bottle. Half a dozen yogurt tablets are crushed 
 and added to the warm milk. The mixture is then put aside for twenty-four 
 hours. The soured milk is sweetened and eaten. 
 
 Old people are apt to be troubled with constipation. A part of this is due 
 to errors in diet; but the greater part is due to change in the walls of the 
 large intestine. 
 
 In the first place, the walls lose some part of their sensitiveness and 
 therefore do not keep the intestinal content on the move as is normal. In 
 the second place, the muscle of the intestinal wall becomes flabby like the 
 general muscular system. 
 
 I have known of old people becoming so constipated that when the largely 
 
SOME PLAXS FOR A LOYG LIFE 955 
 
 dilated lower bowel was finally emptied it was found that the accumulation 
 amounted to many gallons. 
 
 Perhaps the accumulation had been gathering for years, a little each 
 day. At times during this period the bowels had been constipated; at other 
 times they had been normal; at still other times there had been diarrhea. 
 
 After a while the old person became sick with a low fever, then had some 
 delirium. The doctor had been sent for. 
 
 In his examination he felt a large peculiar tumor in the abdomen. He 
 diagnosed this as an accumulation of feces. When oil and enemas had 
 produced the desired result the fever disappeared and all the symptoms passed 
 away. 
 
 For constipation in the old soured milk is excellent. A pint of the 
 yogurt milk described above may be taken each day. In making yogurt 
 for daily use some of the soured milk of today may be used to sour the 
 milk for tomorrow. It is not necessary to use tablets each day. 
 
 SOME PLANS FOR A LONG LIFE 
 
 In the sixteenth century Cornaro wrote a book entitled "How to Eegain 
 Health and Live a Hundred Years." As he wrote the third edition of his 
 book in his ninety-fifth year and lived to be over a hundred his advice is 
 worth listening to. 
 
 He lived abstemiously and carefully avoided all extremes of heat and 
 cold, all extraordinary fatigue, all interruptions in his usual hours of rest 
 and all bad air. He avoided melancholy, hatred and other evil passions. 
 He laid especial stress upon eating a small quantity of food. At eighty he 
 ate four meals a day. His diet list included bread panada, yolk of eggs, 
 soup, kid mutton, poultry and fish. 
 
 Hippocrates advised good air, baths, friction and physical exercises. 
 
 Milton makes the Archangel Michael say of the way to reach old age: 
 
 "The rule of not too much by temperance taught 
 In what thou eatest and drinkest." 
 
 Lord Strathcona at ninety-two ate two meals a day. ate little or no 
 meat, took a great deal of exercise, slept six hours and did not smoke. 
 Frederick Harrison at eighty-one gave golden rules of health : 
 
 1. To abstain from tobacco, spirits, made dishes and all such terrible 
 things. 
 
 2. Eise from a meal with an appetite. 
 
 3. Walk every day for two hours. 
 
 4. Sleep eight hours. 
 
 5. Be content with what you have. 
 
 Tolstoi taught that the secret of long life is in fresh air day and night, 
 daily exercise, moderation in eating and drinking, a hot bath a week and a cold 
 one every day. 
 
 Yon Moltke at ninety said he maintained his health by great moderation in 
 all things and by regular outdoor exercise in all weathers. 
 
956 LONGEVITY 
 
 The Prussian historian, von Ranke, rose at eight, took a cup of tea, 
 worked unti) one, took a long walk in the park, ate a full afternoon dinner 
 of plain fooc including two glasses of wine, worked until seven, took tea with 
 his family worked or talked with his family until eleven and then went 
 to bed. 
 
 Sir Herman Ueber, when over eighty, lectured to the Royal College of 
 Surgeons on the means for the prolongation of life. He took a daily walk in 
 all weathers, went walking for four hours once a week, and once a year he 
 went on a walking holiday. He recommended mental occupation, gardening, 
 intellectual games and traveling. 
 
 He spent his winters on the Riviera. He took breathing exercises for 
 five to fifteen minutes each day. He slept six to seven hours and then arose to 
 a bath followed by friction of the skin. He especially advocated regular bowel 
 habits and simple, plain food. 
 
 He used no alcohol, stimulants, narcotics or soothing drugs. He advised 
 the cultivation of mental tranquillity and hopefulness, the avoidance of grief 
 and the control of the passions. 
 
 Goethe, after a youth of poor health, lived to be more than eighty. In his 
 old age he became an optimist. This helped him to live on in spite of enormous 
 portions of roast goose and bottles of red wine. He died of pneumonia. 
 Metchnikoff said of Goethe in his last illness: 
 
 "If he had not been a drinker of wine, he would have been able to with- 
 stand this attack and to live still longer." 
 
 The germs that produce acid live on sugar. The food sugars com- 
 monly absorb out of the intestines within fifteen feet of the stomach. 
 The fight against the germs which produce indols and phenols does not 
 begin until the food has traveled thirty feet down the intestine from the 
 stomach. 
 
 How to keep the sugars in the intestine for the lactic bacilli to feed 
 on in order to fight each other was the question. Metchnikoff concluded that 
 it could not be done, so he set himself to find a way to make sugar for the 
 germ to feed on. 
 
 He found some germs which could do that. He now recommended that 
 this germ be combined with the lactic acid producer: one to make sugar in 
 the intestines and the other to eat the sugar and make acid. 
 
 However, Metchnikoff said he was sure the method was not yet complete 
 and many changes would have to be made before the Methuselah type of man 
 was made universal. 
 
 That does not spell defeat, however. The automobile today is quite 
 different from the monstrosity that caused Ford's arrest in Detroit a quarter 
 of a century ago. Yet Ford going down the street that day was starting 
 something. The locomotive engine had to be shifted around a good deal to 
 travel from the Stephenson type to that of 1916. 
 
CHAPTEE LI 
 
 Cancer 
 
 Many are the theories as to the cause of cancer. The disease is so 
 palpable, so easily seen, and in its early behavior so different from the normal 
 that men assumed there must be a definite cause in the early stages of science 
 and, with a starting point established, speculation ran riot. 
 
 The disease was caused by eating meat and a case in some meat eater 
 was the proof. Then somebody bowled out that explanation by citing cancers 
 in vegetarian men and animals. The disease was due to eating tomatoes, 
 or cabbage, or some other vegetable. Then came the days of bacteriology 
 and its multitude of diseases with bacterial causes and surely cancer must 
 belong in the list- 
 As a natural corollary there arose the group of speculators who said : 
 "Since yellow fever has its stegomyia. malaria its anopheles, plague its flea, 
 and typhus its louse, cancer must have its host transmitter." And wasps, 
 earthworms, and itch mites have been accused. 
 
 In the meanwhile a group of microscopists was plugging away and from 
 them has come the evolution of a theory which is illuminating and through 
 which some material and practical advance may be made. 
 
 The theory of Bibbert is that cancer cells are anarchists ; that the cancer 
 state is a state of anarchy, and that cancer is anarchism. 
 
 Every cell in the body is an individual, lives its life and does its work as 
 an individual; but that work is thoroughly adjusted to the work of every 
 other cell. The human body is the community of cells. The laws of 
 physiology are the laws of the commune. 
 
 Normally each cell stays in its appointed place, lives out its life, does 
 its work, divides into new cells — each act being in relation to the need. 
 Sometimes a cell will get away from its proper place, will get into a wrong 
 area, will get away from its proper work, and will multiply and make 
 new cells. 
 
 To show how fast the cells multiply and grow Bashford says that you 
 could start with a cancer in a mouse and keep inoculating it, doing everything 
 possible to promote growth, and in three years all the tumor derived from 
 the small beginning in the mouse massed together would make a giant 
 mouse as large as a St. Bernard dog. 
 
 Ehrlich inoculated a mouse weighing one-half an ounce with cancer. In 
 a week the cancer weighed thirty grams, in three weeks forty-five grams, 
 and in two months the tumor weighed as much as the mouse. 
 
 The essential point is that the cancer cells do just what normal cells 
 do but they do it out of relation to need. The individual cell does its 
 individual stunt in its individual way but with entire forgetfulness of the 
 general good, and, though having more individual liberty than it ever had 
 
 957 
 
958 CANCEE 
 
 before, with fatal results to the community — and when the man dies the cancer 
 dies. Could there be a better illustration of anarchy ? 
 
 Many men have worked on the contributing causes of cancer. There 
 is some proof that cancer is contagious. Husbands have developed cancers 
 after nursing wives with cancer and vice versa. Seemingly a better proof 
 of contagiousness is the easily proved inoculability of cancer. 
 
 Every well equipped research laboratory now has some cancer mice, 
 and from time to time pieces of cancer from these are used to inoculate 
 new mice. Every domestic animal is subject to cancer and not infrequently 
 research students succeed in inoculating domestic animals of various sorts 
 with cancers derived from other animals. 
 
 Biologists say that this does not prove that cancer is due to a microbe 
 but that the explanation is easy on other lines. 
 
 Cancer houses, cancer streets and cancer towns are recognized. There 
 are damp walled, illy sunned and badly ventilated houses in which cancer 
 seems to thrive. 
 
 Burnett's "The Campaign Against Microbes" recites pages of illustrations 
 of cancer houses, cancer streets, cancer towns and cancer districts. His 
 theory ties it up with thick, impervious soils, bad town drainage, marshes, 
 and absence of sewers, bad house drainage, damp walls, wet floors, dark cellar 
 sleeping rooms and poor ventilation. 
 
 Some cities make cancer reportable and have cancer spot maps just as 
 they have scarlet fever spot maps. A Prussian sanitary ordinance passed 
 in 1797 required that cancer be reported like other contagion. The proof 
 seems conclusive that these are contributing factors of importance in cancer 
 though there is no evidence that they act through microbes. 
 
 Ten years ago a Chicago physician — Dr. Stofer — proved that blasto- 
 mycosis, a disease closely akin to cancer, was due to a microbe which grew 
 on moldy, wet bedroom walls but nobody has gotten any closer to cancer 
 in the intervening time. 
 
 There are those who think cancer is inherited. They do not think the 
 disease is inherited but that a weakness toward it is. 
 
 They are right. There are cancer families. As Davenport shows, if we 
 can compare the causes of death of people between forty-five and sixty-five in 
 certain families with the same data for others we find great variance among 
 them. 
 
 Of those dying during that period one-tenth should die from cancer 
 according to the law of averages. If a family has a larger proportion of 
 cancer deaths than ten per cent then that is a cancer family. But this, too, 
 is only a contributing factor. 
 
 However, if the body is a commune and individualism is subjected to 
 socialism there must be some machinery of regulation. What is it? There 
 is an automatic something which automatically terminates pregnancy at nine 
 months. The proof seems quite good that the something is the development 
 of chemicals similar to antitoxins or, maybe, vaccines. 
 
 This is about the most striking illustration that I could give. There 
 are scores of others going on inside the body incident to everyday life ac- 
 tivities, some of which are somewhat worked out and others of which are 
 pretty well thought out. Some of the men who are trying to cure cancer 
 
CANCER ACURABLE DISEASE 
 
 The hope of curing cancer lies in early 
 reco g nition and prompt surgical treatment 
 
 SURGERY IS SUCCESSFUL 
 
 ,N Percentage of Cures 
 
 Early Delayed 
 Operation Operation 
 
 Cancer of the Breast 807° 257° 
 
 Cancer of the Lip 951*607° 
 
 Cancer of the Tongue 307° 157° 
 
 Approximate estimates furnished 
 by the American Society for the Control of Cancer 
 
 Cancer causes 80000 deaths every year in the 
 United States. 
 
 At ages over 40 one death in ejght among women 
 and one in fourteen among men is due to Cancer. 
 
 Yet cancer is not a hopeless incurable disease and. very 
 many of these deaths are unnecessar y and preventable . 
 
 Cancer is at first a tocal disease beginning in a tiny spot. 
 
 At that time it can be easil y removed by the surgeon 
 and a cure is almost certain. 
 
 If neglected, it grows and is carried to other parts 
 of the body and rapidly gets beyond control. 
 
 New York State Board of Health. 
 
 Fig. 400. 
 
 959 
 
960 CANCER 
 
 are working along this line and what they are getting looks like pay 
 dirt. 
 
 The serum from animals cured of cancer will cure cancer in other 
 animals. No way to make it work in men has been found. On account 
 of a biologic resemblance between the young tissues of a fetus and the 
 young cells of a cancer the tissues of still births are being used for the pur- 
 pose of developing a vaccine. Pleuritic fluid, extracts of organs, various agents 
 of this type are being used by men trying to cure cancer. 
 
 Some of the reports of cases treated in this way are promising. Analysis 
 of cancer has shown that the cells are rich in glycogen. Glycogen is the 
 form in which sugar is handed out to tissues. Tts presence in quantity in 
 tissue is a sign that that tissue is working hard. 
 
 Other men have found that when Roentgen rays were turned on tissues 
 they pick out those rich in glycogen and shrivel them up while those poor 
 in glycogen are not touched. 
 
 At once the idea grew that X-rays would cure cancer. It does cure some 
 cancers pretty well but not all. In the first place, X-rays cannot penetrate 
 well and therefore they are good for skin cancers but not of much account 
 for deeper ones. Another limitation is that the rays are not selective enough. 
 They pick out cells rich in glycogen and all young working cells are rich 
 in glycogen. Therefore they get some good ones along with the bad ones. 
 All in all we need some agent which can pick out cancer cells better than 
 can X-rays. 
 
 The old arsenic and zinc paste cures were alleged to pick out the cancer 
 tissue and leave the other behind. The ads had pictures of the roots which 
 we were told were the roots of the cancer. 
 
 Unfortunately for the business of certain gentlemen it was easy to show 
 that cancer has no roots and that what is left behind by plaster was seen 
 under the microscope to have plenty of cancer tissue. What came away 
 and was called roots was nothing more than strings of gristle. 
 
 Drs. Loeb, McClung and Sweek of St. Louis tell us their partial suc- 
 cesses by injecting colloidal copper into the blood. Professor Leo Loeb is a 
 brother of Professor Jacques Loeb and a most careful, painstaking and 
 courageous investigator himself. For twenty years he has been working to 
 find a cancer cure. 
 
 Ten years ago he found that he could cure cancer in animals by injecting 
 cyanide of potash. But the dose required to cure the cancer was little short 
 of the dose required to kill the animal. You see he had to take another tack. 
 
 A dozen of the best men in Europe had been working on colloidal 
 selenium and eosin as a cure, and recently a report of a case of cancer of 
 the stomach treated by injections of selenium was made. In the meanwhile 
 Loeb and his associates had been working on copper injections into the 
 blood. They could cure cancer in animals — why not try it on men ? 
 
 A few months ago their courage got to the sticking point. They got 
 hold of some cases that had to die— they were hopeless. They had been 
 operated on sometimes more than once: the disease had returned; further 
 operation was impossible. It did not seem possible to make things worse. 
 Why not try to make them better? 
 
 They began injecting these men, throwing into the vein from one-fifth 
 
CANCER 
 
 961 
 
 of a pint to a pint of watery solution of colloidal copper. Many of the 
 symptoms improved under this treatment and the early reports are favorable 
 enough to warrant the experimenters in advising that the method be still 
 further tried out on cases where the diagnosis is certain and the cases are 
 in a hospital where they can be watched properly; otherwise not. 
 
 It hardly seems likely that copper would be able to seek out the cancer 
 cells to kill them off and leave the other cells alone. It probably has some 
 such action. But is it superior in this capacity to X-rays or radium or 
 the streptococcic serum? 
 
 The experimenters summed up as follows : 
 
 "We may state that we are now able to cause the gradual retrogression 
 
 DIAGRAM SHOWING RELATIVE IMPORTANCE OP CANCER 
 
 AS A CAUSE OF DEATHS IN MICHIGAN DURING 
 
 THE SEVEN YEARS 1901-1907. 
 
 HEART DISEASE 
 PNEUMONIA 
 TUBERCULOSIS 
 CANCER 
 APOPLEXY 
 BRIGHT f S DISEASE 
 OLD AGE 
 
 Michigan Public Health. Fig 401. 
 
 of human cancer, and furthermore that the treatment does not seem to be 
 limited to one kind of cancer, but is applicable in the effective treatment 
 of various kinds of cancer. A definite judgment on the ultimate outcome must 
 be suspended/' 
 
 They also announce that they have arrived at two other conclusions. 
 The first is that human cancer is more amenable to treatment than is mouse 
 cancer. 
 
 As mouse cancer is being cured right along this opinion is fraught with 
 hope. If the opinion be correct the little faults of procedure in curing human 
 cancer should not delay discovery of cure for long but of course experimen- 
 tation with men cannot go so far as experimentation with mice. 
 
 The second opinion is that there is no essential difference between mouse 
 cancer and human cancer. Scientists have been agreed for some time that 
 there was not a great fundamental and necessary difference between cancers 
 and sarcomas — epitheliomas, carcinomas and sarcomas. 
 
 A long time ago the elder Krebs described a kind of tumor as a sarco- 
 carcinoma because he could not say to which group it belonged. The little 
 pigmented moles that develop into violent cancers in man and on the tails 
 
962 CANCER 
 
 of gray horses into fatal sarcomas have always been a battleground between 
 the carcinoma and the sarcoma school. 
 
 Leo Loeb held views as to the cancers in the deeper layers of the skin 
 which were much contended over. Some of the tumors in dogs and other 
 lower animals were held by some microscopists to be sarcomas and by others 
 to be carcinomas. 
 
 The meaning of all these contentions was that the differences between 
 the varieties were superficial and changeable. For instance, Ehrlich inocu- 
 lated an animal with carcinoma. He took the carcinoma from this second 
 animal and inoculated a third. He kept this up for ten generations, when 
 the growth began to change to a sarcoma; by the fourteenth generation it 
 was a straight sarcoma. Burnett quotes Loeb as doing the same experiment 
 with the same result. 
 
 From another standpoint, it does not matter so much. For instance, 
 an epithelioma on the face is so mild as scarcely to be malignant at all but 
 an epithelioma on the womb is exceedingly malignant. A carcinoma in the 
 womb is mildly malignant; in the stomach it is violently malignant. 
 
 From certain curative standpoints there was a difference. For instance, 
 Coley's toxin was much more powerful as a remedy against sarcoma than 
 against carcinoma. X-rays did better with superficial epitheliomas than with 
 sarcomas. 
 
 In the light of all this the hope of Drs. Loeb, McClung and Sweek 
 that colloidal copper will be as useful against sarcoma as against carcinoma 
 (and vice versa) has some foundation in the kinship of the tumors and makes 
 unnecessary refinements in diagnosis on which some insistence is now put. 
 
 IMPORTANCE OF CANCER KNOWLEDGE 
 
 Lombroso held that criminals were marked by certain features which he 
 called "stigmata of degeneracy." His view was that an expert could pick out 
 criminals without any knowledge of the history of the men indicated. 
 
 When I first began examining specimens of tissue microscopically for 
 cancer the average doctor thought cancer cells could be picked out as 
 Lombroso picked criminals. For that matter it has not been long since 
 it was the custom for an ailing man to walk up to a physician, poke out his 
 tongue and say: "Doc, what's the matter?" If the physician began to ask 
 for a history the sick man would take in his tongue long enough to say: 
 "I came to get, not to give, information" whereupon he would stick out his 
 tongue again. 
 
 The physicians now know that there is no such thing as a cancer cell 
 and that as far as cancer roots are concerned nobody now believes in that 
 fake except the worst of the fakers such as Chamlee and that the only way 
 he can make it go is to follow the plan of the evil resort — split the money 
 with the cabby. 
 
 Lombroso was wrong. The idea that there is a cancer cell is wrong. 
 A cancer cell is an ordinary cell in the wrong place and doing the wrong 
 thing — that is all. 
 
 Yellow fever has disappeared from this country. So has cholera. 
 
IMPORTANCE OF CANCER KNOWLEDGE 963 
 
 Malaria is going. Twenty years from now all portions of the United States 
 will be free from this disease. Hookworm is in the way of being banished. 
 Consumption is on the run. Cancer and pneumonia are the next two 
 problems. 
 
 The way must be found. The way to find the way is to turn on the 
 light. 
 
 Hoffmann says that the number of deaths from cancer in the United 
 States in 1913 was 75,000. Of this number, 30,000 were from cancer of 
 the stomach and liver; 12,000 from cancer of the uterus and other organs 
 of generation of the female; 10,000 from cancer of the peritoneum, intes- 
 tines, and rectum; 7,000 from cancer of the breast and the remainder from 
 cancer among the other organs. 
 
 The cancer death rate in 1912 in New York State was 86 per 100,000 
 living; in Greater New York, 80.9. The average rates for the last five 
 years were: for Greater New York, 77; London, 94; Paris, 109; Berlin, 
 107; Chicago, 78; Philadelphia, 86; Boston, 107. 
 
 The rate for the old city of New York has increased in fifty years from 
 24 to 86. The principal increase has been in people over fifty-five years of age. 
 There has been an increase in the cancer of every organ but one — the skin. 
 Cancer of the skin has decreased. Note that fact, for presently it will be 
 referred to and used as the foundation for the one big point in this article. 
 
 There is no reason for pessimism over these figures. Fifty years ago 
 most of the people were dying far below the cancer age. The average age 
 of death was far below forty-five to sixty-five — the cancer age. Again, fifty 
 years ago microscopes were not in common use; everything was a guess and 
 the records were not well kept. 
 
 Rittenhouse tells us in "The Human Factor" that between 1880 and 
 1910 the cancer rate in Massachusetts and New Jersey rose from 42 to 85. 
 The statistics of Massachusetts and New Jersey were fairly well kept as long 
 ago as 1880. 
 
 In ten registration states the increase in cancer between 1901 and 1911 
 at the different age periods was as follows: Twenty to twenty-four years 
 of age, increase, 23 per cent; twenty-five to thirty-four years of age, increase, 
 4 per cent; thirty-five to forty-four, 1 per cent; forty-five to fifty-four, 14 
 per cent; fifty-five to sixty-four, 31 per cent; sixty-five to seventy-four, 35 
 per cent; seventy-five and over, 45 per cent. 
 
 The impression is general that the reason for the increase in the deaths 
 of people past fifty is because more people live beyond fifty than in olden 
 times. That is a part of the reason and a large part but for years Ritten- 
 house has been contending that it was not the whole reason. 
 
 To prove his point he has been using the statistics of New Jersey and 
 Massachusetts, states whose figures of thirty years ago are fairly dependable. 
 Rittenhouse proves that old people are having a harder time and showing 
 higher death rates than a generation ago. One of the important factors is 
 the increase in the deaths from cancer. 
 
 The second reason for writing about cancer is that a better way of 
 diagnosing it must be found. The microscope has told us everything that 
 it can about cancer. What it has told is not enough. 
 
 The biological chemists are now trying their hands. The old chemical 
 
964 CANCEE 
 
 methods failed. The methods now being tried are the much more delicate 
 methods of biological chemistry. 
 
 It may be that they, too, will fail but they have demonstrated enough 
 to show that they are entitled to a trial. Institutions in which such trial is 
 being made must have support. 
 
 However, the part of the diagnosing end now chiefly at fault is the 
 postponement of the effort at diagnosing until it is too late for our ineffective 
 methods to be of any service. The surgical method of treating cancer, while 
 the best we now have, is a poor one. In time it will give way to a better 
 method. 
 
 Most of the cancers are not diagnosed until surgery cannot cure. Dr. 
 William Mayo says the largest number of patients with cancer of the stomach 
 tell their physician of symptoms from which they have suffered from one 
 to three years. 
 
 In 1890 Dr. Agnew of Philadelphia, then a distinguished surgeon in 
 the evening of his life, said that he had never cured a patient of cancer 
 of the breast by operation. He had operated on thousands. Dr. Agnew 
 never operated until the signs of cancer of the breast were fully developed. 
 
 A few weeks ago Dr. Bloodgood examined a patient operated on by 
 Dr. Halsted in 1890. The cancer had not come back. The statistics show 
 that five years after operation, 47 per cent of the patients operated on at 
 Johns Hopkins for cancer of the breast have had no recurrence. 
 
 Those are not exceedingly good figures. They are less than half as good 
 as they should be. Some day a method will be found more than twice as 
 good. However, they are much better than Agnew's — 47 per cent of cures 
 as compared with nothing. 
 
 The difference between the Agnew and the Halsted methods is that 
 Halsted operates on suspicion : Agnew required "the signs of cancer to be 
 fully developed." 
 
 In the Halsted method the tumor is removed, frozen, and examined 
 microscopically, and what the microscope shows determines whether the 
 operation is limited to the removal of the knot or made to include much 
 beside. Furthermore, the microscopic sections of the tumor are made a part 
 of the permanent record of the case. 
 
 As to cancers in general, Bloodgood tells us that in Johns Hopkins, 
 where they have operated on suspicion 80 per cent of the cases have had 
 no return of the cancer five years after the operation. Where the diagnosis 
 of cancer was certain — from the looks of it and the way it acted — 25. per cent 
 of the cases have had no recurrence five years after. The one method cures 
 eight out of ten, and the other, one out of four. 
 
 To stop the scoffers let me repeat that every growth is examined micro- 
 scopically during the operation, or before, or after, and, if the microscope 
 does not show cancer, it does not get into the list. No non-cancer cases enter 
 into the statistics. 
 
 Hoffman tells us that in the last five years there has been a slight 
 decrease in the deaths from cancer of the skin. The reason runs to the main 
 point of this story. The skin is right before our eyes. We are constantly 
 examining it. If a blotch the size of a pinhead appears it attracts attention. 
 
 Information about things is getting general. When we notice some ulcer, 
 
IMPORTANCE OF CANCER KNOWLEDGE 965 
 
 knot, or growth on the skin, we give it care. The care is often foolish care. 
 Often we do the wrong thing. We do not do the wrong thing so often as 
 we did. The proof? The falling rate from skin cancer. 
 
 If the stomach could be put upon the surface cancer w T ould diminish 
 there. As that cannot be two things must happen — the people must know 
 more about their bodies, must get accurate information in place of the 
 foolish ideas, fears, and forebodings that now prevail; and the diagnosticians 
 must improve their methods. 
 
 Cancer is not a blood disease. It is not always a local disease. In the 
 later stages of certain cancers the cancer cells get into the blood but they 
 do not stay there. In less than a minute they are thrown out of the blood 
 and into some tissue, forming there a new growth called a metastasis. 
 
 In certain other cancers the cells try to get into the blood but they fail. 
 They get into the lymph but the lymph glands filter them out before they 
 reach the blood. 
 
 Cancer is not a blood disease nor even a disease present in tlie blood. 
 At the beginning it is local and at that limited to a space too small to see. 
 For a long time it grows only where it started. 
 
 Operated on at that time it is cured. As we have already said, at that 
 time the surgeon has suspicions; he cannot be certain. If he waits to be 
 certain the case is extremely apt to get beyond the range of cure. 
 
 Bloodgood tells us that in the state patients reach physicians from 25 
 to 50 per cent of them have passed into the hopeless stage. Many of these 
 will live longer without operation than with it. 
 
 It is plain that toe must have the cases come into view earlier than they 
 now do. It is plain that the people must know more about these earlier 
 stages than they now do. 
 
 In time a better method of treating cancer will be found. Many are 
 being tried. The copper salts may yet offer something. For sarcomas Coley 
 proposed an injection of streptococcus. At first they dared to inject more 
 virulent material and they got some results. Later they seemed afraid of 
 the pain, fever, and generalized infections and injected less virulent mate- 
 rial, which fell short of expectations. 
 
 The Neiv York Medical Journal has great faith in radium. In reporting 
 the meeting of the College of Surgeons in Philadelphia lately [they] say had 
 it not been that the speakers were men of the type of Howard Kelly and 
 Robert Abbe, the positiveness with which they urged that radium would 
 cure cancer when it could be placed in contact with it would have inspired 
 skepticism. Fortunately the results obtained by them are in keeping with 
 those of others, notably Louis Wickham of Paris. 
 
 The men taking part in the discussion were of the opinion that surgical 
 removal should be done whenever it was possible. Radium should not be 
 used just to stave off surgery. 
 
 Then, to summarize, the light must be turned on cancer because: 
 
 1. The disease is of great importance. 
 
 2. Our diagnosis is faulty, partly because the scientists do not know 
 enough and largely because the people do not know enough. 
 
 3. Our cures are faulty, partly because our scientists do not know enough, 
 and largely because the people do not know enough. 
 
966 CANCER 
 
 CANCER KNOWLEDGE NECESSARY 
 
 The New England states have been trying to discover whether cancer is 
 more prevalent with them than elsewhere in the country. 
 
 The Census Bureau reports that in 1913 the death rate from cancer 
 in the registration area was 78.9 per 100,000. The rate in Connecticut is 
 85.1; Rhode Island, 93.3; Massachusetts, 101.4; New Hampshire, 104.4; 
 Maine, 107.5; Vermont, 111.7. 
 
 Why talk about cancer? For one reason, the people want to know 
 about it. They know that it is a menace and that it is getting to be more so 
 year by year. For another reason, we have something to say. It is not neces- 
 sary to paint a grewsome story and stop. The way out is unfolding. 
 
 Miss Slye has told us that a person whose family are very subject to 
 cancer can mate with a person not of a cancer stock and be certain that his 
 children will not be in much danger from cancer. In three generations the 
 susceptibility to the disease will be negligible. 
 
 For another thing, protection of the different organs of the body from 
 prolonged nagging irritations will prevent cancer even in those of cancer 
 stock. The intelligent person, alert in the care of his body and understanding 
 something of his machine, can discover cancer or cause it to be discovered in 
 him at a stage so early that cure is possible. 
 
 CANCER OF THE BREAST 
 
 Cancer of the breast starts with a lump in the breast. Not all lumps 
 in the breast are cancerous. In the first place the normal breast has a lumpy 
 feel. A tumor, however, feels harder and better walled around than does a 
 lobe of the breast. 
 
 The most frequent tumor of the breast is fibroma. Fibroma is a hard, 
 fibrous tissue tumor. It is as harmless as a wart or a wen or nearly so. 
 Cysts of the breast are also frequently found. They, too, are harmless. 
 
 Caking of the breast results from infection with pus cocci. The infec- 
 tion travels from the skin up the milk tubes. The dairyman calls it garget. 
 Caking of the breast grows rapidly, develops quickly, and hurts from the 
 start. 
 
 At the other end of the line are fibromas and cysts which develop slowly, 
 grow at a snail's pace, and usually give no pain. Occasionally some rub 
 causes a tumor of this type to get a little sore, but the soreness is slight. 
 
 In between comes cancer. Pain is given as one of the earliest signs of 
 cancer. The pain is sharp and shooting. It is due to the destruction of 
 other tissues (microscopic, however, in extent) by the cancer cells. 
 
 Often this symptom is the first to direct the attention to the breast. 
 A woman having such a pain feels for the hurting point, and her fingers make 
 out a small hard lump. 
 
 If there is no lump the pain is probably a neuralgia but she had better 
 feel carefully before concluding that there is no lump. 
 
 Later the cancer grows from the milk gland into the skin. The skin no 
 
CANCER OF THE FACE 967 
 
 longer slides over the tumor. Still later the nipple retracts. Still later 
 the glands in the armpit enlarge. 
 
 Now, what is good judgment? To wait until the glands enlarge or 
 the nipple retracts is not good judgment. To wait a few weeks, say four 
 or maybe eight, after the growth is noticed or the first pain is felt may be 
 good judgment if the person watching the growth will do so in earnest. 
 A judgment is to be formed on the rate of growth and the amount of pain. 
 
 To wait until one is sure the growth is a cancer is not good judgment. 
 Statistics show that operations based on shrewd guesses when these guesses 
 are based on moderately extensive watching are good judgment. After the 
 skin is cut and the tumor can be felt and seen by the operator he can form a 
 much better opinion about it. He can even cut off a small piece and have 
 it under the microscope in fifteen minutes. 
 
 If he finds the growth to be a fibroma or a cyst he will remove it through 
 a small incision leaving little scarring. If he finds it to be a cancer he 
 should remove not only what he can see to be the growth but also all of 
 the tissues into which experience has taught that cancer of the breast 
 promptly spreads. 
 
 To remove what he can be certain is cancerous is not enough. He 
 must guess how far the cells have spread and remove accordingly. 
 
 Proceeding on this plan nearly half the breast cancers are cured; by using 
 plasters death results. 
 
 CANCER OF THE FACE 
 
 The mildest of cancers are those on the face. Some of them get well 
 without treatment, some with pastes, some with X-rays, some with operations. 
 As cancers are generally thought to be incurable (most of them are when 
 they are diagnosed) and as cancers of the face are so frequently cured they 
 constitute the stand-by of cancer cures. 
 
 A man will use a paste on a face cancer and the cancer will be cured; 
 whereupon the man will believe he can cure any cancer anywhere on anybody. 
 If he is a plausible rascal he may make a good deal of money before he is 
 found out. Amongst his list of cancers of the breast and elsewhere that 
 have not been cured will be enough cancers of the face and skin eruptions, 
 improperly called cancers, to keep him afloat for a number of years. If he 
 is an altruist and gives away his formula for a paste, accompanying it with 
 a statement of cures, he will do but a limited amount of harm. 
 
 It is the advertisement that makes the harm of cures possible. Unless 
 a good deal of money is spent on printer's ink cures do not spread. Even 
 those that have merit are but slightly contagious and unless at least 50 per 
 cent of the receipts go into advertising, there are but few takes. 
 
 Cancer of the lip is nearly always on the lower lip, the proportion being 
 20 to 1. Cancer of the lower lip is seven times as frequent in men as in 
 women. It is not often found on the upper lip, but the few cases found 
 are equally distributed between the sexes. 
 
 Why men have lip cancer more frequently than women is just a guess, 
 but the guess is that it is because men smoke. Women also smoke at times 
 but — there's the difference. Women smoke at times — some men smoke all 
 
968 CANCEK 
 
 the time. It is just those smokers who constantly irritate their lips with 
 a pipe or cigar that get lip cancers. 
 
 The surface of a lip cancer soon breaks and makes an ulcer. Around 
 this ulcer is a hard area. When a man gets a lip ulcer, how is -he going to 
 know it is a cancer? Pain will not tell him because any ulcer of the lip 
 is painful. Hardness is a fairly good sign but several ulcers on the lip 
 are hard. The glands under his chin will enlarge but that test is not of 
 much service because it is what is known as a late sign. Cancer spreads along 
 the lymph vessels to the lymph glands. The lymph glands that swell when 
 the lips are long out of order are those in the neck below the chin. 
 
 In cancer of the lip some of the cancer cells are easily broken loose by 
 the muscles of the lip, whereupon they are swept along the lymphatics to the 
 lymph glands under the chin. Therefore enlargement comes early as those 
 things go. Nevertheless enlargement of the lymph glands is a late sign. An 
 alert physician should be able to make a diagnosis before the sign appears. 
 
 Up to now we have not named any very good signs and there is no sign 
 by which a man who has an ulcer on his lip can judge finally. A more sensible 
 question is : What should make a man suspicious ? 
 
 CANCER OF THE MOUTH 
 
 Cancer in this location is rare in women of any age and men younger than 
 forty-five. But a man past forty-five, especially if he is a smoker who lets 
 an ulcerated tongue drift on, ought to have a guardian. The "Index of 
 Differential Diagnosis" says : "Any ulcer of the tongue occurring in a middle 
 aged man, and lasting for more than two or three weeks, should awaken 
 suspicion." 
 
 Cancer of the tongue rapidly develops into the ulcerated form. Therefore, 
 when cancer is in mind the feature to look for is an ulcer. But inflammations 
 of any sort when located in the tongue are apt to become infected and cause 
 ulcer. 
 
 In the list of ulcers are the aphthous stomatitis (bad mouth cankers) 
 and dyspeptic. Ulcers of these types should not last two weeks. If they show 
 any disposition to hold on a free purgative followed by two weeks of milk, 
 cheese, bread and fruit will cause them to disappear. 
 
 The above types of ulcer are too acute and too painful for cancer. 
 The dental ulcer is generally an acute ulcer. However, that is not a good 
 sign to go by. 
 
 The ulcer is the result of injury from a sharp tooth or a decayed one. 
 The way to tell about these ulcers is to have the dentist pull the tooth, fill it 
 or polish it, as the need may be. The dental ulcers disappear when the offend- 
 ing tooth is made unoffending. 
 
 The hardest of all the tasks is to distinguish the syphilitic ulcer. Time 
 was when mistakes on this point cost many lives and there was no remedy. 
 Now a microscopic examination of the secretion of a venereal ulcer will show 
 the germ. A Wassermann reaction will be positive and an injection of salvar- 
 san will cure the ulcer in a week. 
 
 The ulcers of cancer are liable to be on any part of the tongue though 
 
CANCER OF THE STOMACH 969 
 
 they are more frequent along the side. In addition to hurting and bleeding 
 the cancer ulcer causes a hardness in the tissues around the ulcer. 
 
 There are several conditions that cause hard, boardlike areas to appear 
 on the tongue. The name by which the doctors know these conditions is 
 leukoplakia. Leukoplakia is not cancer. It is not an acute condition. The 
 patches stay unchanged for years. 
 
 In time, however, cancer develops on leukoplakia patches. An ulcer 
 develops in the midst of the boardlike tissue. If, then, a man has had one 
 of these patches for some time and an ulcerated area develops on it he should 
 seek counsel at once. 
 
 It does not pay to temporize with cancer of the tongue. The growth 
 promptly spreads to the glands of the neck. A manana policy means in- 
 operable cancer. 
 
 CANCER OF THE STOMACH 
 
 The most frequent cancer is that of the stomach and liver. The two are 
 grouped because cancer of the liver is generally secondary to cancer else- 
 where and the stomach is the most frequent location. That cancer of the liver 
 is secondary is true even when the cancer of the liver is very large and the 
 other cancer is small. The liver is not a good starting place for cancer but 
 when it reaches there after starting elsewhere it finds growing conditions 
 good. 
 
 The leaflet of the Chicago Medical Society on "Early Signs of Cancer" 
 gives the following early signs of cancer of the stomach : "Indigestion, slight 
 distress or pain in the stomach, and general weakness and loss of flesh." 
 
 Of all cancers our methods in cancer of the stomach are about the most 
 unsatisfactory. This is true both of methods of cure and of diagnosis. When 
 a tumor can be felt or a knot appears in the neck diagnosis is easier; but 
 what is the use of knowing when nothing can be done? 
 
 "The Index of Diagnosis" gives the following suspicious signs: Indiges- 
 tion beginning abruptly in a patient above the age of 40 and not yielding 
 to diet or treatment — a mild gnawing pain coming several times a day. 
 (This pain is much less severe than the sharp neuralgic pain of too much * 
 acid. It is less violent than the pain of ulcer.) Loss of appetite in a person 
 of cancer age and without any good cause, especially a loss of appetite for 
 meat; vomiting, not violent, but a little disposition that way nearly every 
 day. (One case out of five will vomit a little blood.) A steady loss in weight, 
 for which no cause can be found. Seven cases out of ten occur in persons 
 between 40 and 60. 
 
 These are the suspicious signals. Any one who guesses that he has cancer 
 because he has any one of these afflictions is not wise. Any person who has 
 several of them and fails to have a careful examination made is not wise. 
 
 A careful physician after inquiring into the above points will start 
 his examination. He will give test meals, empty the stomach of its contents 
 and then analyze the material pumped up. He will carefully examine both the 
 stomach contents ancl the bowel movements for occult blood — that is minute 
 traces of blood. He will illuminate the stomach, fill it with bismuth and 
 X-ray it, and probably will try some of the new biological tests for cancer 
 
970 CANCER 
 
 recently proposed by the German scientists and now being tried out in hos- 
 pitals and laboratories the world over. 
 
 He will make an examination of the blood. Cancer of the stomach 
 destroys blood cells all out of proportion to its general destructive work, just 
 as it interferes with nutrition and causes a great loss of flesh even before it 
 has reached any great size. 
 
 LAY DIAGNOSIS OF CANCER OF THE STOMACH 
 
 Is there any one sign by which a person can tell that he has cancer of 
 the stomach in a stage in which anything of importance can be done? The 
 answer is in the negative. Cancer causes a tumor. Unless the tumor is on 
 the back portion of the stomach it can be felt through the abdominal wall. 
 But that symptom is not worth much, since it means a late not an early stage. 
 
 Rapid loss of weight with stomach symptoms is a good sign, but it means 
 late not early cancer. Vomiting of blood, anemia, and loss of appetite, espe- 
 cially for meat, are good signs, but they come too late to be of much service. 
 Pain in the stomach is the best of this group of symptoms, but there are 
 several other causes of pain. 
 
 Are there any feelings which should cause a person to suspect cancer of 
 the stomach and, acting upon the suspicion, to have a careful examination 
 made; I mean feelings which should put a man on guard when the disease 
 is in its beginning? I think this question can be answered in the affirmative. 
 
 If a person past 30, man or woman, has a pain in the pit of the stomach 
 for a week or two or has indigestion for that length of time he should eat very 
 lightly for three or four days. He should eat one slice of bread or toast and 
 one cup of coffee, tea, beef tea or warm water three times a day for that length 
 of time. It is well to begin the period of fasting by taking a mild purge. 
 
 If the pain and discomfort, nausea, indigestion or vomiting continue 
 after the stomach has had a chance to rest and recuperate (say if it continues 
 beyond the first day) the person is justified in going to a skilled diagnostician 
 for an examination of the stomach contents for blood, acid and other ingre- 
 dients ; of the feces for minute traces of blood ; of a drop of blood for general 
 traces of the disease; and for a physical and X-ray examination. 
 
 The examination to be of any value must be painstaking and thorough. 
 Superficial examination will not "find" cancer at a stage when anything is 
 gained from having the information. 
 
 Cancer of the stomach belongs to the cancers which spread slowly. The 
 growth does not spread to the glands until it has been present for months. 
 The seriousness of cancer is dependent upon the degree of spreading to the 
 near-by glands. All of these considerations make us believe that operation 
 on very early cancer of the stomach should give good results. 
 
 Smithies tells us that at the present time only one of seven people oper- 
 ated on for cancer of the stomach dies from the operation. 
 
 One great need is for some certain sign of early cancer of the stomach. 
 
CANCER OF THE SKIN 971 
 
 CANCER OF THE SKIN 
 
 Cancer is a local disease. At the beginning it is limited to one spot or 
 location. After a while some of the cells are carried to new locations. It 
 then is still a local disease but it is growing in more than one locality. In 
 no proper sense is it ever a blood disease. Blood impurities, so-called, never 
 have anything to do with cancer. 
 
 Cancer, then, being a local disease and a disease occupying in the early 
 stages little space in a single locality the most important of all questions is 
 how to know it. 
 
 When we came to know about consumption (by we I mean John, Henry, 
 and Pat) we found that early diagnosis was the key to the situation. When we 
 (meaning the general run of people) begin to know about cancer we shall 
 find that early diagnosis is the key to the situation. 
 
 Then the question as to how to tell cancer in the early stages is a most 
 important one. Some of the old ways of telling fail to interest us because they 
 do not help. For instance, the odor of cancer is of no interest because the 
 odor does not develop until the disease is far advanced. A better way of 
 putting the question that interests the general run of people is : What should 
 make one suspicious of cancer? 
 
 Let us try to answer the question for the more important organs. 
 
 The skin : The suspicious growths are those in which the symptoms are 
 between the acute infections and the slow, harmless growths. Infection 
 of the skin causes boils and bumps. These quickly become sore and give 
 pain. In ten days or two weeks the soreness and pain have lessened or 
 disappeared. Ordinary warts and gouty patches do not get sore, cause inflam- 
 mation, or produce pain. The cancer conditions come in between. With 
 them there is no soreness or pain for some weeks. Then the discomfort 
 begins slowly and gradually increases. Generally speaking, small cancer 
 nodules cannot be slid around with the skin as can warts and moles. 
 
 Generally speaking moles are much more suspicious than warts. Most 
 skin growths, and especially warts, need to be trimmed off occasionally. They 
 pile up scales, scabs and horny masses. These are hard, irritate, and cause 
 some tenderness to develop. These need attention just as the nails and hair 
 need to be trimmed. 
 
 The moles stay about the same size. If any mole gets sore or grows the 
 matter should be investigated. The growth there is deeper in the tissues. A 
 certain amount of attention to warts and such growths, what may be termed 
 toilet of them, is proper. Moles should be left unmolested. 
 
 If an ulcer of the skin develops slowly and persists it is a cause for sus- 
 picion. It may be due to infection (tubercular, syphilitic or some other), 
 but it is better to have someone pass on it. 
 
 The location has much to do with the case. If the knot or ulcer develops 
 on the lip or at some other point where there is frequent irritation it is more 
 suspicious than if it develops in other areas. 
 
972 CANCER 
 
 CANCER OF THE UTERUS 
 
 I am sure there are many right-thinking people who will be sorry to 
 see this subject touched upon. While they think it all right for themselves 
 they think there are other readers of this volume for whom this article will 
 prove too plain spoken. If we can persuade each reader to settle the question 
 for herself alone we shall make some headway. 
 
 On the other hand, a national organization composed of some of the 
 ablest, most conscientious people in the country is quite convinced that, 
 as a result of false modesty and a lack of plain speaking seyeral thousand 
 women annually lose their lives unnecessarily. It has, therefore, appointed a 
 committee charged with the duty of public education on this necessary 
 subject. 
 
 Cancer of the body of the uterus is one of the milder forms of cancer. 
 When removed it is not expected to return. It is frequently found rather 
 advanced at the time diagnosis is made. Nevertheless, operation is suc- 
 cessful. 
 
 Cancer of the os, as it is termed, is one of the wildest and most malig- 
 nant forms of cancer. It develops rapidly and after removal comes right 
 back. In 60 per cent of cases it is back in six months. This unfavorable 
 outlook is because the disease is not recognized until a late stage when it 
 might just as well not be recognized at all. 
 
 A committee appointed by the Chicago Medical Society has issued a 
 circular on cancer with a short statement on: (1) "How to Eecognize Cancer," 
 (2) "When Cancer Can Be Cured," (3) "How Cancer Can Be Cured," (4) 
 "The Nature of Cancer." 
 
 "The chief symptoms of cancer," it says, "located anywhere, are a 
 growth, pain, bleeding (when near the surface), weakness and loss of flesh. 
 
 "The earliest sign of cancer of the uterus, and the most important one, 
 is marked by some irregularity in the monthly period. 
 
 "Cancer, in its early stages, is a local disease. It is at this time that 
 it can be cured by a simple cutting operation. Cancer, if neglected and 
 allowed to develop, will become an extensive disease, and then it cannot be 
 cured by any method. Advanced cancer cannot be cured by surgery (the 
 only real cure), hence the necessity of seeking surgical aid promptly." 
 
 SARCOMAS 
 
 Sarcoma is a kind of cancer. Scientists have been trying for a long 
 time to divide sarcomas off from the cancers but they have never succeeded 
 in making a distinction that was of practical importance. Every now and 
 then a tumor run through a series of lower animals will change from one 
 class to another. The main reason for trying to keep the class sarcoma to 
 itself is because the sarcomas act so much more like infections than the 
 carcinomas. 
 
 Half a century ago the changes in the lungs brought about by consump- 
 tion were held to be due to cancer and men wrote about them as if they 
 
TO WARD OFF CANCER 973 
 
 Were cancers. Then came the discovery of the tubercle bacillus whereupon 
 tuberculosis was permanently taken out of the cancers. 
 
 Along about the same time the gumma was called a cancer. However, 
 after we learned about venereal disease and mercury the gumma was taken 
 out of the group of cancers. This happened a long time before the spirochete 
 was discovered. 
 
 Scientists keep looking for a germ for sarcoma and some day they will 
 find one whereupon it will come out of the cancer list where it now is. 
 
 The large, massive cancers which do not ulcerate are usually sarcomas. 
 Again, it is the sarcoma of young people as contrasted with ordinary cancer, 
 the cancer of older people. It is the cancer which follows a single injury as 
 compared with ordinary cancer which comes from long nagging injuries such 
 as the cutting of the tongue by a ragged tooth, of the lip by a pipestem, of 
 the breast by a corset steel. For instance, I have just seen a boy who was 
 struck on the bone of the arm and shortly thereafter a swelling commenced 
 and in time it was found that the swelling was a sarcoma of the bone. 
 
 All cancers grow rapidly (at least at times), tend to destroy the tissues 
 around them, tend to come back after they are removed and tend to form 
 metastases; that is, in them there is a tendency for some of the cells of 
 the tumor to break away and be carried to other parts of the body and there to 
 grow. In ordinary cancers these cells are carried to near-by lymph glands 
 and cause these to swell. Until late in the disease the cancer sticks rather 
 close by. In sarcoma the cells get into the blood and are carried everywhere. 
 They are liable to locate anywhere in the body and there to stay and start 
 new tumors. 
 
 How is one to know that a given tumor is a sarcoma? 
 
 If the growth is coming up like an inflammatory swelling but not fast 
 enough for that, if it is not painful enough or hot enough or red enough for 
 inflammation but still is coming one should be on his guard. If it is a pretty 
 well denned tumor he had better let his physician pass on it. If the physician 
 cannot form a judgment right away he is justified in watching it for a 
 few weeks only. By that time, the mass growing meanwhile, he had better 
 take out a piece the size of a good-sized pea and examine it microscopically. 
 
 TO WARD OFF CANCER 
 
 Let us say that a young man takes stock of his family strain. He 
 finds that several relatives who have descended from his great-grandparents 
 have had cancer. The percentage of those who died between 40 and 60 
 years of age who had cancer was large — let us say twenty-five. He is of a 
 cancer family. Perhaps neither of his parents had cancer. That makes no 
 difference. 
 
 The eugenists say that cancer is a recessive. Diseases of the recessive 
 group such as cancer, albinism and bleeding often skip a generation. What 
 shall he do? Choose a wife who does not belong to a cancer family. But 
 you will say that he may protect his children and his grandchildren but not 
 protect himself. What can he do to protect himself ? 
 
 Miss Slye says: "Cancer is not transmitted as such, but rather as a 
 
974 CANCER 
 
 tendency to occur from a given provocation, probably in the form of overirri- 
 tation. The elimination, as far as possible, of all forms of overirritation to 
 the tissues of an individual of high cancer ancestry should go far to get rid 
 of the provocation of cancer, and the eugenic control of matings, so that 
 cancer shall at least not be potential in both sides, ought to eventuate in a 
 considerable decrease in the frequency of human cancer." 
 
 Suppose a man has discovered that he belongs to a cancer family, is an 
 "individual of high cancer ancestry." Specifically what should he do to be 
 saved from his family tendency? He should give up smoking. It has been 
 proved that smokers, and especially pipe smokers, are unusually subject to 
 cancer of the lips and tongue. The harm results from irritation by the pipe- 
 stem. 
 
 If he is an inhabitant of the Philippines he should give up the chewing 
 of betel nuts. About the only Filipinos who have cancer are the betel nut 
 chewers. They have cancer of the cheek. 
 
 He should have all ragged teeth removed or smoothed off. He should 
 not wear a dental plate if it irritates. If he has any chronic sores anywhere 
 on his body he should have them healed up. If his work irritates any part 
 of his body he should change his occupation. For instance, in olden times 
 there were a group of men who made their living by cleaning chimneys. In 
 doing their work they sat straddling the top of the chimney, working their 
 long-handled brooms. The position which they constantly occupied caused 
 sores to come on the inside of the thighs. Most chimney sweeps died of chim- 
 ney sweeps' cancer, cancer of the inside of the thighs. 
 
 A man with a cancer ancestry should not neglect any chronic stomach 
 trouble which he may develop. Cancer of the stomach often grows out of un- 
 heeded dyspepsias and neglected ulcers of the stomach. 
 
 If a woman has the bad family history she must be extra careful with her 
 breast glands. Corset steels must not be allowed to irritate nor must the 
 clothing be irritating in any way whatsoever. The breasts at nursing and 
 pregnancy periods must not be neglected. It is almost as important that 
 there shall not be neglect of the generative organs. In the first place, venereal 
 diseases must be avoided or having been contracted must be completely 
 cured. Pelvic suppurations and discharges must not be allowed to continue 
 indefinitely. 
 
 Eisks that a person of another family strain can safely take the person of 
 a cancer strain cannot. The latter must avoid all forms of chronic irritation. 
 
 CAN ANYTHING BE DONE TO CURE CANCER? 
 
 Not very much. If the disease is discovered early and operation is done 
 promptly the chance of cure is fairly good. If the disease is advanced, opera- 
 tion, radium, and X-rays are of limited value. The only cancers cured by 
 pastes are not cancers at all. Somebody has been mistaken, honestly or other- 
 wise. 
 
 Can anything be done to prevent cancer? Yes. Cancer is to be classed 
 as a preventable disease. As soon as the information can soak into the general 
 public's mind, that fact is most important. 
 
CAN ANYTHING BE DONE TO CURE CANCER? 975 
 
 There are three phases to the cancer prevention question. In a certain 
 sense cancer is an inheritable disease. Inheritance can be prevented. 
 
 Cancer results from long continued irritation of the tissues of a locality. 
 This irritation can be prevented. Cancer develops most readily and grows most 
 readily in overnourished people. Over nourishment can be controlled. There- 
 fore, the statement that cancer can be prevented. 
 
 Now for the details of the first of these proposals. The statistical proof 
 that cancer runs in families has been known for a long time. Of the people 
 who die at the cancer age about one in ten dies of cancer. If, in a given 
 family, the death rate from cancer among those dying at the cancer age is 
 one in five or higher, we say that they belong to a cancer family. There are 
 families in which the cancer rate among the people concerned is much more 
 than one in five. 
 
 For several years Miss Slye of the University of Chicago has been pa- 
 tiently working out the proof that cancer runs in families. She has made 
 thousands of observations. Mice have cancer. As mice multiply abundantly, 
 breed when very young, and, in their breeding, can be completely controlled, 
 she chose to study the family histories of mice rather than that of men. 
 
 She had one family of cancer mice under observation for twenty-five 
 generations. As the result of these thousands of completely controlled ex- 
 periments she is able to state certain conclusions with great positiveness. 
 She says : 
 
 "Cancer follows the laws of heredity with an inevitableness which makes 
 it a character which can be manipulated." 
 
 The inheritance law of cancer is exactly the same as that of albinism. 
 There need be no albinos. The condition can be absolutely prevented. 
 
 Continuing, she says : "Cancer can be bred into or out of a strain at will. 
 It can be put into a strain where it has never existed before. It can be 
 bred out of a line one side of which originally carried 100 per cent of 
 cancer." 
 
 She knows these statements to be true, because she took a strain of mice 
 in which cancer had been inbred for twenty-five generations and in which 
 all the members suffered from it, and she bred it out until the line was free 
 from it. She took another strain in which there was no cancer, and by mating 
 them with cancer strains bred cancer into the stock. 
 
 RADIUM, X-RAYS, AND ULTRA-VIOLET RAYS 
 
 There is reason to believe that X-rays, radium, and radio-active sub- 
 stances and ultra-violet rays can cure certain cases and certain kinds of 
 cancer. There is reason to believe that they cannot cure or even benefit other 
 cases or other kinds of cancer. The difficulty is for a man to decide which 
 group his cancer is in. If he decides rightly, he will have a good chance to live. 
 If he decides wrongly he will throw away his chances of living. 
 
 Cancer cells are young, actively growing cells. The chemists tell us they 
 are rich in glycogen. Glycogen is the form in which sugar is put when it is to 
 be used by the cells. As young, growing, dividing cells need a great deal 
 of glycogen and older, resting cells need but little, analyses of cancers show 
 a great abundance of glycogen. 
 
976 CANCER 
 
 When tissue is exposed to X-rays, radium, or the other agents, the cells 
 rich in glycogen are destroyed much more rapidly than the other cells, pro- 
 vided the curative agent can get at the tumor cells. This proviso is the 
 key to the limitation of these agents. 
 
 The skin is for the purpose of keeping things out. That is what it was 
 built for. It will keep out sun rays, X-rays, ultra-violet rays, and radio- 
 active substances. 
 
 If the cancer is on the surface and not covered by skin these agents 
 are of service. If their rays must penetrate to reach the cancer, or any con- 
 siderable part of it, or any secondary growth of it, they do no good. 
 
 They can cure cancer of the skin. Possibly they can cure cancer of 
 the neck of the womb. And that is about all. 
 
 They cannot cure cancers of these tissues if the cancer has jumped 
 (formed metastases, the doctors say) in the lymph glands. 
 
 Some of the cancers in these localities can be better cured, cured with 
 less pain and more certainly cured by operation than by any one of the different 
 forms of radiation. Just which cases are best suited for radiation and which 
 for operation call for good judgment founded on knowledge and experience. 
 
 Internal cancers are not cured by these agents. There is no reason for 
 thinking they can cure or even help cancer of the stomach, liver, or intestines. 
 There is no reason for thinking they can cure cancer of the breast. Cancer 
 in this locality does not break through the skin until the disease is far 
 advanced. At such time it is certain to be in the muscles and also in the 
 glands. Even if the cells under the ulcerated area were killed those tucked 
 away in the muscles and glands would continue the growth. 
 
 They are of no service in cancer of the kidneys, peritoneum, bladder, or 
 female generative organs above the neck of the womb. They are of no 
 service in bone or muscle cancers. 
 
 They are of service in cancer of the lip. This mild form of cancer is cured 
 by almost any "cancer cure." 
 
 They may be able to cure cancer of the tongue, and yet it is doubtful if 
 they should be tried on cancer in this location. Cancer of the tongue spreads 
 to the glands so promptly that one is not justified in trying time-consuming 
 experiments on himself. 
 
 Probably Not Cancer. — M. A. W. writes: "I have a cancerous growth 
 on my face as large as a 25-cent piece. 1. What can I put on it to prevent 
 it from increasing in size? 2. Is tea made from red clover blossoms injurious 
 if taken frequently and in large quantities? I find it some help in retard- 
 ing the growth on my face, not so much as is claimed for it, but there is 
 more discharge and more rapid growth if I do not drink it" 
 
 Reply. — 1. Nothing. The chance is good that the growth is not a 
 cancer. Most so-called face cancers are not cancers. If it is a cancer, 
 either keep it clean and do nothing or have it completely removed. 
 
 2. No. 
 
 Needless Cutting Deplored. — A. V. V. writes: "Noting your answer to 
 ' Adelaide/ regarding a lump in her breast, your advice being that she 'had 
 better have a doctor see it and decide whether it is cancer,' I beg to know 
 whether you hold that a superficial examination, even by the most ex- 
 
CANCER 977 
 
 perienced physician, could absolutely determine whether a lump in a 
 woman's breast was cancer? It has long been my understanding that 
 not until such lump has been removed by the surgeons knife and a 
 microscopical examination thereof made can its nature be determined; 
 therefore, it would seem best that any lump in a woman's breast should 
 immediately be removed, and no chances taken that it may not prove 
 to be of cancerous growth." 
 
 Reply. — To remove every nodule in the breast as soon as it is noted, 
 making the diagnosis after removal, would lessen the number of deaths 
 from cancer if the women would come for examination. It also would 
 sacrifice many breasts needlessly. If surgeons were to adopt that policy 
 they would save themselves some mistakes but on the other hand, the 
 women, knowing this to be the policy of surgeons, would be liable to 
 keep away until they were pretty certain that the nodules were cancers. 
 This would substitute the woman's opinion in place of the surgeon's. 
 The character of the growth, the feel of it, the rate of growth, the loca- 
 tion, the presence of pain, the age of the patient — judging by these a 
 fairly reliable opinion can be formed. On the other hand, part removal 
 stirs cancers to active growth. Cancers should either be removed wholly 
 and with a good deal of surrounding tissue or they should not be cut 
 at all. 
 
 Cancer of Stomach. — Mrs. 0. M. R. writes: "What are the symptoms 
 of cancer of the stomach? Is there any cure?" 
 
 Reply. — What you want to know is what symptoms would make you 
 suspect cancer of the stomach and cause you to investigate further. Of 
 first importance is your age. The age of maximum liability is 45 to 60. 
 In Welch's series of 2,038 cases 24.5 per cent were between 40 and 50, 
 and 30.4 per cent between 50 and 60. 
 
 Next is family history. Do you belong to a cancer family? 
 
 Next is a history of ulcer of the stomach. In Rodman's series of cases, 
 14 per cent had had ulcer; in Klausa's series, 26 per cent. 
 
 Next is a history of dyspepsia. A prominent sign is a progressive 
 decline of appetite. There may be a sense of oppression in the pit of the 
 stomach after eating. There may be a little pain and occasionally there 
 is vomiting. If there is vomiting there may be a little blood in the vomit. 
 The skin begins to show pallor early. The weight begins to drop early. 
 The strength and endurance fail inexplicably. 
 
 Anyone inquiring into his condition and history who can reasonably 
 decide that these details apply in his case should have an examination. 
 When tumor or vomiting or great wasting appears it is too late. The 
 examiner will make an analysis of the stomach contents for acid, will 
 examine the feces for blood, will make an Abderhalden test and will take 
 an X-ray in addition to making a physical examination. 
 
 See Your Physician. — B. S. writes: "I am a widow 28 years old. My 
 left breast has little pains in it, and they seem to be moving all around it. 
 I can't say they are sharp pains, but I feel somewhat uneasy about it, 
 as I think there is something wrong, or these pains would not bother me 
 at all. Do you think it could be a cancer coming? Sometimes when I 
 raise my breast up it pains me to do so. About two years ago I went 
 walnut hunting. Two walnuts, both on the same stem, fell on this left 
 breast. It turned black in a few minutes and pained me badly at the time. 
 
978 CANCER 
 
 There does not seem to he any swelling at all, no sores of any kind, and 
 it looks all right. I had a nervous shock from my husband's death, and 
 have been nervous since. My hands and head shake, and my nerves are 
 sensitive. I have doctored for this trouble, but medicine relieved me only 
 for a while. I can hardly sleep, my body jumps so, and the least thing 
 scares me. This has been going on for nearly three years. During one 
 bad spell I had my heart beat so rapidly in turning over in bed that I had 
 to take heart medicine every fifteen minutes. Is there any cure for my 
 trouble?" 
 
 Reply. — 1. Probably you are free from cancer. Have a physician 
 examine your breast. If there is no nodule pay no attention to the little 
 pains. 
 
 2. You should not take heart medicine every fifteen minutes unless 
 you are being watched by your physician. Have your physician examine 
 you. If you have no thyroid enlargement and no other organic trouble 
 then proceed to get your nerves under control. This is not a medicine- 
 taking proposition. Perhaps you will succeed best by going to a rest cure. 
 Perhaps you can succeed by study of some book such as Courtney's 
 "Control of Nerves." 
 
 Senseless Worry. — Mrs. A. W. writes: "I am 56 years old and am 
 extremely nervous. I recently saw an article which you wrote about cancer. 
 I had a sore breast when my first child was born, twenty-eight years ago. 
 I fear blood poisoning started to set in. I always feel a queer sensation 
 in that breast. My doctor assures me it is the nerves. There are no 
 lumps, but I am always worried, fearing I might get a cancer, as you say 
 cancer can come from ulcers" 
 
 Reply. — As you say you have no lump in your breast you have no more 
 cause for worry than any other woman. Because occasionally a woman is 
 run over by a street car is that any reason why every woman should be 
 afraid to cross the street or to worry about the dangers of street cars? 
 Be level-headed, do your work, take proper care of yourself and let the 
 future alone. 
 
 Cancer Cause Not Known. — H. J. asks the following: 
 
 "1. What is the cause of cancer? 
 
 "2. Can you in any case attribute the origin of a cancer to a previous 
 injury ? 
 
 "$. If you assign various causes of cancer for the different parts of the 
 body, then please state what is the cause of a lady having cancer of the 
 breast" 
 
 Reply. — 1. Causes are divided into main and contributing. The main 
 cause of cancer is not known. There are two principal theories : (a) It 
 is due to some organism — a bacillus, spirillum, yeast mold or some other 
 low form of life, (b) It is due to perverted cell tendencies — the ordinary 
 cells of the body get away from where they belong and lose all tendency to 
 mature but instead multiply wildly. The food theories have not many 
 followers. There are not many facts to support either of these theories. 
 
 2. Yes, injury is a contributing cause. 
 
 3. Among the contributing causes of cancer of the breast are injuries 
 from blows, from corset irritation and from abscess. 
 
CANCEB 979 
 
 Cancer. — Mrs. B. R. writes : "In what length of time would an internal 
 cancer develop?" 
 
 Reply. — The question in this form cannot be answered. If you mean 
 how soon after an ulcer shows itself will a cancer develop the question 
 is nearly as difficult. The theory is that cancer develops from epithelial 
 cells that have got out of their proper place. Sometimes cancer develops in 
 a few weeks after such displacement. On the other hand, there is some 
 proof that cells destined to develop into cancer can lie dormant for a long 
 time. 
 
 Stomach Cancer Symptoms. — M. L. S. writes: "Will you kindly advise 
 me what the symptoms of cancer in the stomach are?" 
 
 Reply. — Cancer of the stomach causes pain, vomiting and rapid loss of 
 flesh. Examination of the stomach secretions shows blood present and acid 
 absent. Sometimes the tumor can be felt. The blood may be black or red. 
 There are chemical, bacteriological and X-ray bismuth tests that help. 
 
 Unfortunately there is no way of diagnosing cancer of the stomach 
 that helps much. When the diagnosis can be made it is too late to operate. 
 
 Anyone of cancer age who has a persisting stomach pain and vomiting 
 had better go promptly to a physician and have the diagnosis of cancer 
 ruled out or confirmed. 
 
 Cancer Not Inherited. — G. B. S. writes: "1. Is cancer ever inherited? 
 2. Is there any danger of contracting the disease by kissing a person suffer- 
 ing from an open cancer of the breast? 3. Is cancer communicable through 
 the discharge from an open cancer sore?" 
 
 Reply. — 1. No. However, there are families in which the middle- 
 aged members are more subject to cancer than the average. 
 
 2. No. 
 
 3. It is barely possible. The danger is slight. 
 
 No Good for Cancer. — S. writes: "Dr. Trebes Ross of London advo- 
 cates salts of potash as a help, and perhaps cure, for cancer. What is your 
 opinion? Can any harm come from taking it?" 
 
 Reply. — 1. Will do no good. 
 
 2. Not much. Potash salts are slightly poisonous but not highly so. 
 
 X-Ray and Cancer. — D. A. B. writes :"1. What success has the medical 
 profession had in treating cancer with the X-ray? 2. Is it not a fact that 
 the X-ray causes cancer and is positively dangerous for such uses? 3. 
 Would the X-ray have any curative effect on stomach troubles, such as in- 
 flammation, gastritis, ulceration, or on a kinked bowel due to muscle dis- 
 placement or pressure? If. How are physicians who make such claims and 
 secure patients by reason of such, looked upon in the medical profession?" 
 
 Reply. — 1. Very good success with skin cancer; poor success with can- 
 cers situated deep in the body. 
 
 2. Yes, X-ray causes cancer. If by the last half of the sentence you 
 mean dangerous when used to cure cancer, the answer is no. The worst 
 that can be said is that in cancers unsuited for its use some people have 
 used it instead of having the growth removed. 
 
 3. No. 
 
986 CANCER 
 
 4. No reputable physician would claim to cure gastritis, ulceration of 
 . the stomach, or kink of the bowel with X-ray. 
 
 Fish and Cancer. — Mrs. M. P. writes: "1. Do you consider a fish diet to 
 be a cause, or contributing cause, of cancer? 2. Are fish known to be sub- 
 ject to any vicious growths that make them, when so affected, unfit for 
 food? 3. If so, can their condition be detected in fresh caught fish?" 
 
 Reply. — 1. No. In speculations as to the cause of cancer fish, toma- 
 toes, meat and various other foods have been accused. There is no reason 
 to think food a factor of consequence in cancer. 
 
 2. Fish have cancer. Periodically, all kinds of animals have cancer. 
 
 3. Buy none but healthy looking: fish. Buy no fish with a tumor. 
 Cancer in a fish shows plainly. Nobody cares to eat a fish with cancer 
 even though the chance of so contracting the disease is negligible. 
 
 Need of Cancer Knowledge. — No Name writes: "For pity sake, do let 
 up talking about cancers. You are making people morbid on the subject 
 and we all are getting sick and tired hearing about cancer." 
 
 Reply. — For years the advertising cancer fakers such as Chamlee and 
 Byers have devoted a few hundred words every day in hundreds of news- 
 papers to misinforming and misleading the public. Do you not think it 
 fair to devote some space to telling the truth? Or let us look at it from 
 another standpoint. Out of every 100,000 people in the United States 
 seventy-five die each year from cancer. Cancer causes one-twentieth of 
 all the deaths. The people who have the disease now in an incurable 
 stage once had it in a curable stage. They let it pass beyond that stage 
 because they did not know. About 100,000 such die in the United States 
 each year. Do you not think you are selfish to wish information with- 
 held from these merely because it disturbs your peace of mind? Do you 
 not think that you and your group ought to be more patient, consid- 
 erate ; and especially more Christian ? The very great majority of you are 
 sane enough not to be harmed. A small minority are so ill balanced as to 
 be harmed. Should we not try to do the greatest good to the greatest 
 number? Be fairer with your unfortunate fellows. 
 
 Cancer of the Bladder. — J. L. writes: "Why is it my urine has such a 
 fetid odor? Could it be cancer of the bladder?" 
 
 Reply. — Cancer sometimes affects the bladder. There is no cancer 
 odor. Cancers become infected with the germs of putrefaction. The odor 
 of a cancer depends upon which one of these happens to get into it. 
 Therefore some cancers are odorless and others have odors of different 
 kinds. Fetid odor in the urine probably is dependent upon the bacteria 
 present. Tour physician may be able to remedy the condition with anti- 
 septics which are eliminated by the kidneys. Odors sometimes result from 
 certain aromatics in the food — for example, asparagus. 
 
 Should Not Cause Cancer. — J. 8. T. writes: "I have remarked that 
 without any other noticeable cause cancer occasionally follows closely 
 after a severe case of poisoning by poison ivy. Poison ivy grows in such 
 great abundance that it would seem as if it must have some use other than 
 just to inflict punishment on hapless children, who so often fall victims 
 to its evil effects. Has any experiment ever been made to test whether 
 poison ivy would cure cancer?" 
 
LAXCEE 981 
 
 Eeply. — I have been unable to find that poison ivy has been used to 
 cure cancer. I do not think it would hare any effect. Cancer frequently 
 follows long continued inflammation and irritation. These influences are 
 factors in causing it. An acute inflammation such as that caused by iTy 
 should not be a factor. 
 
 Wait Three Weeks. — German writes: "I am a married woman, 25 
 years old. For the last week I have noticed a tender spot on my left breast. 
 There is no mark or bruise there, and I don't remember ever having hurt 
 it. But it feels sore when touched, and there seems to be no swelling. 
 1. Do you think this may be a cancer? 2. Should I go to a doctor at once, 
 or wait a while to see if it goes away? 3. Will you please describe symp- 
 toms of cancer of the breast? I have a good appetite and I am in good 
 health otherwise. If. Will the taking of a preventive medicine finally 
 weaken the female organs or cause a tumor later on?" 
 
 Reply. — 1. Yes, cancers cause pain when small — small enough to be 
 overlooked. The chances are that you have not cancer. 
 
 2. I judge the pain is but slight. You are justified in waiting three 
 weeks more. 
 
 3. Any tumor of the breast should be examined and then reexamined 
 at intervals if it is not operated on at once. Generally cancers grow more 
 rapidly than other tumors. Pain, especially a sharp, shooting pain, is sug- 
 gestive. Kernels come under the arms, the nipple retracts and sores form 
 but these are late symptoms. The breast should never be left long enough 
 for these three symptoms to develop. 
 
 4. Xo. 
 
 See a Surgeon at Once. — Mrs. M. 0. writes: "About a year ago I 
 noticed a small lump in my left breast. Since then it has grown till it is 
 now the size of a small lemon. It gives me a burning sensation and itches 
 at times. I am 39 years old, but never had any breast trouble, and none 
 of my people is afflicted with breast trouble. Do you think it is cancer 
 and what do you advise?" 
 
 Eeply. — See a surgeon at once. There is no cure for breast cancer or 
 a tumor of the breast the size of a lemon (not a cancer) except operation. 
 As this growth is so large and has pained so little it may not be cancer. 
 If not, the lump should come out. If it is cancer the operation required 
 is even more radical. 
 
 Might Be Cancer. — T. J. writes: "What would a small lump in one 
 breast mean, about the size of a common walnut? Xo pain or soreness in 
 a woman of Jfif" 
 
 Eeply. — It might mean fibroma or cancer or retention cyst. Of these 
 fibroma is the most frequent and cancer the most important. The ab- 
 sence of pain does not rule out cancer. Have an examination. 
 
 Pork Doesn't Cause Cancer. — Mrs. J. B. writes: "Will you please an- 
 swer in your column if there is any truth in the statement that cancer 
 comes from eating pork?" 
 
 Eeply. — Xo. 
 
CHAPTER LII 
 
 Tumors 
 
 What is a tumor? This has always been a difficult question. Every- 
 body knows the ordinary superficial appearance of a tumor — knows one when 
 he sees it — but when he is asked what is a tumor he would probably have to 
 answer, Why, a tumor is — a tumor. 
 
 What is the essential difference between the growths called tumors and 
 growths and swellings that go by other names? In answering this question 
 two principles stick out: the one that the mass of growing tissue feeds on 
 the body but does no part of the body work; the other that the growing mass 
 seems to have no limit placed on its growth. 
 
 Let us think about the first of these principles. The body is a com- 
 monwealth. Every tissue in that community has its work to do and the 
 amount of food distributed to it is automatically determined by the amount 
 of its work. The blood vessels come to have a size and arrangement that make 
 it possible to carry the amount of food required; but as the amount of work 
 varies, and therefore the amount of food must vary, the blood vessels are 
 provided with muscles and nerves whose work it is momentarily to regulate, 
 increase, or decrease the amount of blood going to the organ. 
 
 These things are worked out with scientific exactness and on the most 
 approved basis of community life. It will be centuries before social common- 
 wealths come to have the scientific adjustment that has always prevailed in the 
 commonwealth called the human body. 
 
 In society we develop groups of parasites called paupers or criminals. 
 In the human body we develop similar groups of parasites feeding on the 
 body and doing no part of the body work and we call them tumors. 
 
 Some of these parasites are harmless fellows in a certain sense. They 
 are drones in the hive. They eat but they do no work. At most they get 
 in the way. In these passive ways they may indirectly do great harm and 
 they may even terminate life. For instance, a fibroid tumor — and there are 
 none more harmless — may grow in the windpipe and cause suffocation; or it' 
 may grow in the uterus and cause a woman to bleed to death. 
 
 Pursuing the parallel, a harmless parasitic tramp may innocently, if you 
 please, become infected with smallpox and spread it over a good part of a 
 state. Such an unusual occurrence has no bearing on the main point. 
 
 In the body politic tramps, hoboes and paupers, such by inheritance or 
 whose status is fixed and unchangeable, are not expected to do much harm. 
 They are parasites but until community life has been developed much beyond 
 its present point society must make provision for the care of such 
 burdens. 
 
 Along this line it is possible to distinguish between benign and malignant 
 tumors. The pauper is content to be carried by society but toward it he 
 
 982 
 
TUMORS 983 
 
 b-ars no ill will. He draws upon the thrift of others in so far as his needs 
 demand but he has no quarrel with the thrift of any man. 
 
 The criminal takes a different view of the rights of property, life, and 
 v.berty. He is supported by the thriftier members of society — yes. He 
 contributes nothing to society. He is free to do what he wants. This freedom 
 grows out of the fact that the average man, in fact the great majority of men 
 respect the rights of others. This feeling results in all law and custom 
 being based on the idea that men want to be fair with their fellows. Liberty, 
 therefore, becomes wise and proper. 
 
 The criminal in the exercise of his liberty is a parasite upon the general 
 liberty guaranteed by the law. So far he is at one with the fixed pauper. 
 Where he becomes different is in that he is an active enemy of society whereas 
 the pauper is a passive enemy. He is not only a parasite on thrift but he is 
 an enemy of thrift. 
 
 A fibroid tumor is content to draw its sustenance from the body and con- 
 tribute nothing — and there the matter ends. A cancerous tumor is a parasite, 
 contributing nothing to the work of the body and in addition pouring into 
 the tissues substances which are harmful. Like the criminal and unlike 
 the tramp it is anti-social and would destroy that on which it has been 
 sponging. 
 
 The second principle is that tumors seem to have no limit placed On their 
 growth. The tendency to automatic limitation of growth by the ordinary 
 tissues is one of the wonders that are as non-understandable as electricity. 
 We know what electricity will do, what laws it conforms to; but no man 
 knows what electricity is. 
 
 We know that a certain cell in the human embryo will start out to make 
 an arm, that it will multiply and its successors will develop until a certain 
 size and contour is attained and there growth will stop. We say there is an 
 inherited growth impulse which carries the arm about so far and its length 
 having been reached the impulse automatically ceases. While this states the 
 scientific fact it explains nothing. It leaves us no nearer an explanation than 
 when we began. 
 
 In normal tissues the impulse to grow is in relation to all the other tissues. 
 The two arms grow to the same length and stop, the two sides of the face 
 develop evenly — everything fits in about right. In tumors the tissues destined 
 to form the tumor pitch in and grow and continue growing without any 
 relation to anything except the amount of food they can get. At times even 
 a portion of a tumor will break down because the cells needing food have 
 grown faster than the blood vessels supplying food. Outside of the food 
 feature there is no automatic limitation on the growth of tumor tissue. 
 
 Society has not clone much in the cure of its pauper and crime diseases. 
 When we suspect a man to be an active or passive enemy of society we first 
 diagnose his case and we then cut him out of society by placing him in a 
 poorhouse, an insane asylum, a home, or a prison, depending upon what seems 
 to be the best method for society to protect itself against that particular 
 enemy. That is about as far as the science of community life has been de- 
 veloped. 
 
 When a man develops a tumor we first make a diagnosis, then we arrive 
 at a decision as to whether the growth can be safely left alone or whether 
 
984 TUMOKS 
 
 it shall be cut out. Assuming it is decided that the growth is a menace the 
 only treatment developed so far is to cut it out. 
 
 The foundation is being laid for a scientific study of criminality in its 
 eugenics and environment relations. The cutting out way costs a lot of 
 money for maintenance as well as a lot of strength by reason of its inefficiency. 
 
 Tumors are being scientifically studied with a view of finding something 
 better than the cutting out method. These studies are taking three general 
 directions. Some of them are trying to find the cause of the malignant tumors 
 with a view to going after the problem along the line of prevention. Some 
 are trying to find methods of detecting malignancy in its early stages; and 
 some are trying to find a specific cure. 
 
 The group engaged in the first type of investigation at the present time 
 is working upon the basis of a modified infectiousness. Many characteristics 
 of cancers indicate that they are infectious though nothing indicates that they 
 are infectious in the same sense that smallpox is. This group has succeeded 
 in inoculating several types of animals with cancers. They have been able 
 to pass these cancers through animals, cure it in some and then use a serum 
 from cured animals with which to cure other animals. 
 
 The group which is trying to find a cure is working to find some form 
 of a biological product, maybe an antitoxin, maybe a serum, maybe some other 
 type of chemical substance, that will be destructive to cancer cells and harm- 
 less to other cells — some substance which will go into the body and pick out 
 the cell for which it has an affinity and destroy it just as quinin will go into 
 the blood and pick out the malarial organism and destroy it leaving all 
 other cells pretty much as it found them. 
 
 The other group is trying to find some chemical or biological test of the 
 blood or of the secretion from a cancer area that will serve to diagnose cancer 
 earlier and more certainly than the microscope now does. 
 
 The old way of judging a cancer by its odor was of no service at all, for 
 the sign was no good until the case was hopeless. The old way of judging 
 by the history and the appearance was somewhat better, but very little. The 
 microscopic method is a great improvement. Nevertheless it is to be hoped 
 the research workers may be able to discover some serum test which will be 
 even earlier and more certain. 
 
 The great New York Congress of Surgeons went on record in favor 
 of operation for cancer on the basis of microscopic examination, provided the 
 diagnosis is made early. So far as late cases are concerned every surgeon 
 in the land would be happy if he were never called upon to operate on 
 them. They advise against operation in such cases, hold out no hope for ul- 
 timate favorable results and are generally persuaded to perform such opera- 
 tions against their judgment. 
 
 If somehow the public could he educated to have tumors inquired into 
 when they first appear, cancers would come to operation in their curable stages, 
 for cancer is like consumption — curable in its early stages but incurable or 
 nearly so in the later ones. The cancers that appear on the parts of the body 
 that are under observation or are easily made so are often cured now. 
 
 The significance of a cough that holds on, of a little fever in the after- 
 noon, of a little fatigue and tire has been learned by a million people within 
 the last ten years and in consequence consumption is being diagnosed in its 
 
TUMOES 985 
 
 curable stages. A part of the work of the committee appointed at New York 
 will be to teach the public the meaning of early signs of cancer. Another 
 part of its work will be to keep alive public interest in this subject until a 
 way will be found to escape the present perplexities of the cancer problem. 
 
 Statistics show that the number of deaths from cancer is rising. I have 
 not analyzed the figures closely enough to form an opinion as to whether 
 the increase in cancer mortality is wholly due to the increasing age at death 
 or not. It may be that like Bright's disease the rate of increase is dispro- 
 portionately greater than the increase in the number who live to reach the 
 cancer age. 
 
 Davenport in his chapter on the "Inheritance of Family Traits" — sub- 
 division "Cancer and Tumor" — says: 
 
 "The question is are there human strains that are easily and others with 
 difficulty inoculable ? The whole question is complicated, as cancer is a disease 
 of middle or later life. Thus, in the census of 1900, we find that the heavy 
 incidence of cancer occurs between 40 and 80 years (84.4 per cent). The 
 very high death rates are from 50 to 70 years. 
 
 "The answer to the question of heredity of cancer is to be found in a 
 careful analysis and comparison of individual families. One then sees in 
 many families no deaths from cancer among ten to twenty persons dying 
 at cancer age, while in other families there will be even four deaths from 
 cancer amongst those dying at cancer age. Such questions as these are 
 suggestive of the many and varied points of the cancer problem." 
 
 See Your Physician. — C. A. B. writes: "Is pain in a breast tumor 
 always to be regarded with suspicion? I am Sk and for the last three 
 years have had a lump in my breast. The lump appeared first shortly after 
 I had weaned my baby, and at that time I was often conscious of a sharp, 
 stinging pain, frequent but not severe. My physician examined the breast 
 and said if the lump increased in size he would remove it. For a year or 
 more it remained apparently the same, hurting only at intervals. Then 
 it practically disappeared, although I could always feel a slight enlarge- 
 ment, as of a swollen gland. It gave me no further trouble until about 
 a month ago, when it suddenly swelled to the size of a walnut and be- 
 came quite hard. The pain returned and for several nights hurt enough 
 to disturb my rest. I tried both hot and cold applications, and both re- 
 lieved the pain. Then the swelling gradually receded until now it is almost 
 imperceptible and I feel no pain whatever." 
 
 Reply. — A cancer would scarcely change so in size. Nevertheless do 
 not take any correspondence opinion on a point of so much importance. 
 See your physician. 
 
 Lump in the Breast. — Mrs. C. T. B. writes: "I have had a small lump 
 in one breast for ten years. I noticed recently that this breast is larger 
 than the other. There is no soreness. A physician told me when I first 
 discovered it not to bother it unless it developed into something later. 
 What would you advise? I am in good health and 31 years old" 
 
 Reply. — A lump in the breast for ten years is probably not a cancer. 
 Even fibrous tumors in the breast are not safe, and you should seriously 
 consider having the growth removed. If you decide not, then have it 
 watched by a physician, to whom you should go four times a year. 
 
986 TUMOKS 
 
 Tumor. — C. E. B. writes: "Can a small tumor in the cul-de-sac he 
 removed by absorption, or is an operation necessary? How does it affect 
 the system?" 
 
 Keply. — Everything depends on what the nature of the tumor is. If 
 it resulted from an infection and the infection has now subsided, most of 
 the tenderness is gone. The mass may, and probably will, be absorbed. If 
 it is a growth or is an enlarged, tender, displaced ovary the "tumor" will 
 not disappear by absorption. If the trouble caused or the nature of the 
 growth is such as to call for removal an operation will be necessary. 
 
 Each Case Different. — J. E. writes: "1. How long would you advise the 
 postponement of the removal of a fibroid, lemon-sized tumor, exterior but 
 attached to the uterus? 2. What disagreeable symptoms should one expect? 
 3. How much inconvenience and disturbance should one endure before sub- 
 mitting to the expense, inconvenience, and possibilities of an operation? 
 ^. If not removed at the age of J/O, what later possibilities does it offer?" 
 
 Reply. — 1. This question cannot be answered in a general way. It must 
 be answered for each case. The answer depends on the rate of growth, the 
 pain, and invalidism caused by it. A fibroid in that location in one 40 
 years of age is not necessarily a serious matter. It does not necessarily 
 call for an operation. 
 
 2. Most of its symptoms will result from crowding the bladder and other 
 pelvic structures. A fibroid in that locality seldom causes hemorrhage or 
 gets infected. However, when there is one fibroid there is generally more 
 than one. 
 
 3. Until it threatens to cause invalidism or semi-invalidism, unless it 
 is growing rapidly, when operation should be done earlier. 
 
 4. Of greatest moment is the progressive increase in size after the 
 change of life. 
 
 Let Doctor Decide. — Adelaide writes: "I have had a lump in one breast 
 for eight or ten years. I think it grows a little. What caused it and what 
 would you advise me to do? Is there any application that will help remove 
 it?" 
 
 Reply. — In all probability it is a harmless tumor. If so, let it alone. 
 Put nothing on it. Do not rub anything on it. However, you had better 
 have a doctor see it and decide whether it is cancer. If cancer it should be 
 thoroughly removed. If it is not cancer let it alone. 
 
 Medicine No Cure. — Mrs. F. R. writes: "1. What is a cystic tumor and 
 where is it usually located? 2. What are the symptoms? 3. Can medicine 
 remove it?" 
 
 Reply. — 1. A cystic tumor may be located anywhere in the body. With 
 one exception cysts consist of a bladderlike wall and a cavity filled with 
 fluid. 
 
 2. The symptoms depend on the location. 
 
 3, No. 
 
CHAPTER LIII 
 
 Crile's Method of Anesthesia 
 
 The nerves are the sentinels of the system by which the body is warned 
 of enemies without. At the outside is the nerve ending which senses the foe 
 and telegraphs the news. In the brain are the cells which receive the tele- 
 gram, decide what to do about it and then telegraph the orders to the 
 proper place. 
 
 There are certain parts of the body that have always been in danger 
 zones. The nerve cells and fibers that have to do with those zones have learned 
 by experience to be on the lookout; they are apprehensive and "keened" by 
 fear. 
 
 There are other localities that are so well protected that they have never 
 trained their nerves to be on the lookout. 
 
 The organs of the first group cannot be operated upon without danger 
 of shock ; those of the second are not easily shocked, according to Crile. 
 
 The brain, the lungs, the stomach and intestines, the deep structures of 
 the back belong in the second group. Practically all the balance belongs in the 
 first. 
 
 When a patient is anesthetized in the ordinary way, every cut of the 
 knife sends an impulse to the brain cells. The patient is unconscious and 
 in consequence does not suffer mental shock — the horror of being opened up. 
 His sensations are paralyzed and in consequence he neither feels pain nor is 
 he able to fight back. 
 
 The nerve cells at the center are being shocked, although the patient is 
 asleep, feels no pain and is non-resistant. 
 
 Crile says : "We must therefore conclude that, although ether anesthesia 
 produces unconsciousness, it is in reality only a veneer, as it protects none 
 of the brain cells against exhaustion from the trauma of surgical operations." 
 
 The new method is the natural next step. It uses inhalation anesthesia, 
 and it adds to it some procedures to cut off the sources of shock not cut off 
 by inhalation anesthesia. 
 
 First, the patient is given morphin before the operation. A person 
 under morphin is neither chesty, as after whisky, nor depressed; he simply 
 does not care one way or the other. Then comes the ether, chloroform or 
 laughing gas, whichever the surgeon prefers. 
 
 The operation is not begun until the field of operation is anesthetized 
 with a local anesthetic. The idea is to cut the telegraph wires in the field 
 of operation so that the messages cannot travel to the center. 
 
 The pain in and near the wound is fearful for two or three days after the 
 operation. To prevent the shock from this pain Crile injects some quinin 
 into the tissues near the wound. This anesthetic does not wear off for 
 half a week. 
 
 987 
 
988 CHILE'S METHOD OF ANESTHESIA 
 
 The Crile method then consists in: (a) A dose of morphin an honr 
 or more before the operation to prevent the mental shock of fear and dread ; 
 (b) ether, chloroform or laughing gas to prevent the mental shock and pain 
 of the operation and to make the surgeon feel that he may take the time to 
 do things as they should be done; (c) local anesthesia along the wound to 
 protect the central nerves from operation shock; (d) quinin along the wound 
 to save the nerves from the aftershock. 
 
CHAPTEE LIV 
 
 Eugenics 
 
 FOR RACE BETTERMENT 
 
 Many years before Galton 7 s time eugenics had been trying to be born. 
 Facts were being accumulated: theories were being tried out: the harm of 
 bad inheritance and the advantage of good stocks were being referred to: 
 society was- sensing both the need and the method. 
 
 Galton. with good judgment and poise, gathered together a lot of this 
 material, related the different parts to one another and made a community of 
 what was just before a lot of separate individuals. 
 
 Ey® Elf© 
 
 <&\h<b ®S © G!Df<$> is ®(5 & ® 5 (& 
 
 dTiicD® 
 
 Fig. 402. — Pedigree of a family in which the father's parents (upper left) are both nervous (N) 
 and have four nervous children. The mother is nervous; so were her father and four of her 
 brothers and sisters, while one is insane. Of the three grandchildren one is insane (I), one 
 epileptic (E), and one extremely nervous (N). (Cannon and Rosanoff.) 
 
 Factories have what are called assembling rooms to which are brought 
 wheels and springs and bodies from all parts of the factory and in which 
 these parts are put together to make the product. Galton assembled these 
 wheels, springs and bodies with discretion. 
 
 In this sense he deserves the title of the "Father of Eugenics." 
 
 As the average run of people know but little about the assembling of 
 facts and as they do know a good deal about the assembling of machines it 
 seemed advisable to shift our metaphor from facts to machines. Xow it is 
 advantageous to shift it back again. 
 
 The custom is to name beings that are made. Galton got the science 
 ahead by naming it eugenics — meaning the science of beginning well. 
 
 Most of the investigation as well as most of the legislation up to the 
 present time has been devoted to those who have not begun well. Many 
 of them (it is certain in the light of what we know) had no chance of begin- 
 ning well. Therefore there are those who say that the science is not well 
 named. This does not follow. The health department works nearly all of its 
 time on ill-health; it spends its energies in studying disease; yet nobody 
 proposes to call it an ill-health department. 
 
990 
 
 EUGENICS 
 
 1§ 
 
 
 ®rGD n 
 
 [£]<n)[b] Ob (S) |b| (n) *v|b] § |b] 
 
 Fig. 403. — Pedigree of Family with Color- 
 blindness (B). ("Heredity and Eugenics.") 
 
 Some day it will be possible to develop the work of increasing efficiency 
 
 and well-being in a positive way until it is of equal importance with the 
 
 work done now against unhealthy conditions. Health properly comprehends 
 
 r— i both points of view, both lines of 
 
 ©j[b] (n] activity. Health departments are 
 
 not improperly named. 
 
 I now speak of positive 
 eugenics, meaning thereby every- 
 thing which can be done in any 
 proper way to encourage proper 
 mating and the birth of children 
 who begin well. By negative eu- 
 genics we mean everything which 
 can be done in any proper way to 
 prevent improper mating and the birth of children . 
 
 who do not begin well. GDtO 
 
 We are hearing more just now about negative cn/p/e 
 
 eugenics. That side lends itself most readily to 
 scientific and statistical study. By reason of the 
 preponderance of literature and legislation on the 
 side of negative eugenics it has been proposed to 
 rename the science and call it dysgenics. 
 
 It was Galton's science and his right to name it 
 should not be disputed. Besides, by the time you 
 would get the new name accepted positive eugenics 
 would be well developed and the onesidedness of the Fig 
 name now complained of would again prevail, the 
 shoe being on the other foot. The science is well 
 named. Let it alone. 
 
 Dr. Goddard has recently issued a most interesting eugenics study of 
 rr— i , a family whose identity 
 
 Oj© [d] he hides under the name 
 
 of the Kallikak family. 
 In his institution 
 for the feeble-minded 
 he had a girl whose de- 
 generacy bore the ear- 
 marks of inheritance. 
 He found that her 
 
 A \ I unAnonrn 
 
 © 
 
 ff$3> 
 
 ane/rcepk 
 . 404. — Pedigree of 
 Family Showing De- 
 generation. ("Hered- 
 ity and Eugenics.") 
 
 O 
 
 rr~T 
 
 N N 
 
 </>,tetrrn or $■ 
 
 a 
 
 ^tatoHM^ » 
 
 N ? 
 
 N: 
 
 N 
 
 * £|'0T(S)'0T(S) J n * 0T© <&<&<&& feat-grandfather had 
 
 had improper relations 
 with a feeble-minded, 
 loose female character, 
 the girl's great-grand- 
 mother, and that to 
 them was born the 
 girl's grandfather. 
 The great-grandfather had married a woman of good stock and they 
 
 had had children. 
 
 Fig. 405. — Pedigree of a Family with Deaf Mutes (D) in a 
 Large Proportion of the Later Generations. ("Her- 
 edity and Eugenics.") 
 
CW rO ft) 
 
 o 
 « 
 S 
 
 ft 02 
 
 5 % 
 
 02 
 
 
 
 3 < 
 
 o 
 O 3 
 
 991 
 
992 
 
 EUGENICS 
 
 These two parallel streams were started from one male head, one stream 
 flowing into jails, insane asylums, and poorhouses, the other into the walks 
 of highly respectable society. 
 
 The men and women of the first group are largely criminals, paupers, 
 and insane; of the second, sturdy, high grade, good citizens. A study of the 
 first comes within the realm of negative eugenics; of the second within that 
 of positive eugenics. 
 
 The first is more easily studied and the facts disclosed are most dra- 
 matic. We shall hear much, as we should, of the millions of dollars that these 
 degenerates have cost the state. 
 
 Martin Kallikak, the first, deserted his illegitimate offspring, but the 
 community has been holding the bag. The taxpayers, including the legiti- 
 
 L-TW T_JTW[-L_]T^' 
 
 d) 5 m ®5® ®J5 Eho 6-d i T o i T o 
 
 01® u d) 6 5 Ori D r 6-D 6 
 
 timSTTSoS 
 
 fJO attempt A?<? fff 
 tub *o fAoot 
 
 cra6&d 
 
 •□ 
 
 bb-n6 
 
 6Gb 
 
 Fig. 407. — Pedigree of a Feeble-Minded Family in Which Criminalistic (C) and Licen- 
 tious (Sx) Traits Also Appear. ("Heredity and Eugenics.") 
 
 mate descendants of Martin Kallikak, have been carrying the load that Martin 
 thought he had dumped off the face of his earth. Martin was near-sighted. 
 
 As compared with the tragedy of the illegitimate line the story of the 
 legitimate line is free from thrills. In consequence the study has been put 
 on the illegitimate line, and the lessons drawn are widely circulated. There 
 are some lessons to be learned from the legitimate line and a way should 
 be found to spread the information gained from such study. 
 
 Someone has said that society takes care of positive eugenics in an 
 intuitive way and that there is no need for teaching, to say nothing of 
 research and study. The' saying is that the admiration for, and the selection 
 of, the strong, muscular, courageous male by the female and the fondness 
 of the male for beauty in the female acting by natural selection constitute 
 all the positive eugenics we need. 
 
 To this Havelock Ellis replies that under our prec^nt social demands 
 the female seeks as her source of information Bradstreet or Dun and not 
 the war record or the gymnasium showing of her prospective lord. When a 
 female becomes infatuated with a prize fighter pity is the mildest emotion 
 that her fellows bestow upon her. When on the other hand a female bestows 
 her hand on some whiskey-soaked, disease-filled, lame and halt rake who has 
 ample means her fellows are apt to approve. 
 
FOR RACE BETTERMENT 993 
 
 It is also stated that the male has discovered the difference between 
 apparent and real beauty in the female ; that the apparently beautiful woman 
 of the present day is largely dependent upon harness for her beauty and 
 that this harness is destructive of native beauty and is also eugenicallv 
 bad. 
 
 According to the view of these gentlemen whatever power making for 
 positive eugenics lay in the customs of primitive society has been lost in the 
 complications of modern society and at the present time we are worshiping 
 at the shrine of a god that is mud and which has been since the days of the 
 cave dwellers. 
 
 As right thinking men should, however, they do not propose to be 
 destructive and there stop. They have a positive offering. 
 
 We are growing fond of the study of genealogy. Great numbers of 
 books are written on the subject. With such writings great sections of 
 libraries are filled. Family trees are worked out as the result of great study 
 and these are conspicuously displayed. 
 
 The proposal of these gentlemen is that use be made of this demand 
 and that some machinery be created to supply the demand. 
 
 First, that each individual keep his personal history embodying therein 
 each fact that would or could have any eugenical bearing. Such a record 
 should contain height, weight and some tests of muscular ability, a properly 
 abbreviated medical history and an educational history. 
 
 For the purpose of this record mothers are to carry forward the inter- 
 esting baby records now so frequently kept and to make them show similar 
 facts as to childhood. 
 
 The baby record now referred to is that which commonly contains such 
 items as date of birth, weight and length at birth, date of first tooth, date 
 of sitting alone, walking alone, first word, date of different child diseases 
 and disorders. 
 
 The proposal is that the record further show date of entering school, 
 dates of making the different grades, weight and height at different ages and 
 some estimate of physical and mental gains and losses. So much for the 
 mother's record. 
 
 Out of these records, some accurate and some less so (as is the case 
 with the data on which the genealogist now bases his findings) there will 
 be built up family trees with eugenical value. 
 
 A necessity is that such trees should record the bad as well as the good. 
 It must especially show the outcroppings of feeble-mindedness, insanity, 
 epilepsy, drug addiction and certain types of criminality. 
 
 Galton has shown that there is a tendency to return to mediocrity. The 
 children of a genius, of a man of great money-getting ability, of a statesman, 
 exhibit tendencies to return to average capacities and average accomplish- 
 ments. 
 
 The daring, the unconquerable courage that makes generals of finance 
 and generals of war practically always gives way to safe and sane mediocrity 
 in the succeeding generation. 
 
 Why then deify courage in a family tree since everybody knows that it 
 peters out in the span of one life? Nobody is fooled. 
 
 On the other hand Goddard has shown that feeble-mindedness sticks. 
 
994 
 
995 
 
996 EUGEMCS 
 
 No change of environment will make any material difference. When it 
 gets into the blood it stays and the proportion of actives and latents in a 
 given generation can be determined pretty accurately according to Men- 
 delian law. 
 
 These are two illustrations toward each end of the line. In between are 
 a lot of items that are not so well worked out. 
 
 Scientists have not worked out the degree of disadvantage in having 
 insanity in the blood, for instance. 
 
 Man is a mongrel. Follow up any man's family stream far enough 
 
 h/BOCWOOO 0/3/? WM C ALTON 
 
 *t9 9 T*T 9 ^T 9 
 
 l — — ' itjJ~17~"« nri* 
 
 cr 9-pi* © ir r 
 
 I 
 
 E — L — I L ~L — i 
 cf •* «r «r •* © 
 
 ~1 rH — I 
 
 ef © © cf © 
 
 ^ show* t «ttn of scientific ability ; £ shows a man of scientific ability, woo is also a 
 Fellow of the Royal Society ; (s) shows five other children, and so oa. 
 
 Fig. 410. — History (Condensed and Incomplete) of Three Markedly Able Families 
 
 (After Whentham) (Kellicott). 
 
 and you will be certain to find some muddy ditches flowing in. How could 
 it be otherwise? 
 
 The solution of the problems of eugenics, though, is dependent upon 
 facts and we have the consolation that every stream tends automatically to 
 purify itself, some faster, some slower. 
 
 The practical problem of eugenics is to keep the purification ahead of 
 the pollution, and that can be done by working along two lines — by increasing 
 the things that make for purification and by decreasing those that make for 
 pollution. 
 
 It seems to me that Ellis' plan of a family tree is better than the old 
 one. It does not frame so well or look so well on the library wall but it 
 would be more serviceable. 
 
 In time a standard will be worked out and a normal line will be estab- 
 lished; then those whose inheritance is above the average will have charts 
 
COLLECTING EUGENIC DATA 997 
 
 made, framed, and hung in their libraries. Those below will keep their 
 trees locked up; but they will strive hard to purify their blood stream. 
 
 COLLECTING EUGENIC DATA 
 
 "How momentous for the nations are the betrothals that are taking 
 place this year !" Davenport exclaimed. Momentous for this nation are the 
 weddings that are taking place this June and October. About 2,500,000 
 babies are born each year. About 2,000,000 survive the hazards of infancy. 
 The additions to the population from immigration are large but the babies 
 born far outnumber them. 
 
 The marrying couples are worth thinking about and enough is now 
 known about the questions of inheritance to make that subject worth while 
 for marrying couples to think about. Nor should thinking about the subject 
 be limited to marrying couples. The marrying fever is liable to break out 
 in the most unexpected places. 
 
 Davenport tells us in "Eugenics: Twelve University Lectures/' that in 
 the middle of the eighteenth century John Lowell, as he was being graduated 
 from Harvard, vowed he would never marry. . No doubt John Lowell meant 
 what he said but in spite of that John Lowell married three times and from 
 him descended the present president of Harvard; James Eussell Lowell, 
 the poet; Gen. Charles Eussell Lowell, the soldier; the founder of Lowell, 
 Massachusetts, and its cotton mills; a director of an astronomical observa- 
 tory ; the founder of the Massachusetts General Hospital ; and many other dis- 
 tinguished public servants. 
 
 Fortunately for society, the young graduate, John Lowell, had within 
 him a cosmic urge that the plans for his life had overlooked. Marrying con- 
 cerned him though he vowed to the contrary. 
 
 Let us assume that marrying in our society is a matter of universal 
 concern. 
 
 The Eugenics Record Office at Cold Spring Harbor, New York, has pre- 
 pared a schedule for recording family traits. These are sent out upon request. 
 They are to be filled out and returned to the office. 
 
 There are in that office about 10,000 family records. Not all or even 
 a large part of these have been filled out by people asking advice about 
 matrimony. Only about 2 per cent, or one in fifty, of the people who write 
 in for these family trait blanks fill them out. 
 
 In only two cases in which marrying was not advised have the parties 
 agreed to accept the advice. This seems a discouragingly small proportion. 
 For the small result several causes are responsible. 
 
 1. Few people know of the Eugenics Eecord Office. It has never done 
 anything dramatic enough to catch the attention of the general run of men. 
 
 2. There has not been time enough since eugenics was launched as a 
 constructive program to convince people of its importance. Only a small 
 fraction of the people understand that the program is or can be made personal. 
 It is not generally known that this constructive program contemplates the 
 preservation of the family unit and the promotion of the most attractive 
 features of romantic love. 
 
998 EUGENICS 
 
 3. Even though the eugenic family tree as planned by this office only 
 runs to the grandparents and their descendants the average person has not 
 the information necessary to fill it out and will not take the trouble to get 
 it. Many of the points inquired about do not stand out in the family mind 
 as did such items as money, prominence and the like. 
 
 4. Some of the information asked for one hesitates to put on record 
 anywhere. The Eugenics Eecord Office has always been careful not to 
 expose anyone. The published reports designate families by such names as 
 the Nam family, the Hill folk, and the like, to prevent unpleasant notoriety. 
 Nevertheless, many people are conservative and therefore are unwilling to 
 disclose information until such time as the continued trustworthiness of the 
 record office shall have reassured them. 
 
 The record of 2 per cent of returns to the central office is by no means 
 a measure of the results from sending out the family trait books. The person 
 receiving blanks and instructions as to the information of importance at a 
 time when his mind is concretely on the subject of matrimony will never 
 forget what he reads in that book. He may not write to Cold Spring 
 Harbor but that does not mean that he will not heed what he has read 
 in the book. 
 
 5. Some trouble is required. A great many people who think themselves 
 interested have only a psychological interest. If effort, change in habits or 
 plans or customs is required they drop the matter. To them the prospective 
 gain does not offset the trouble. 
 
 6. The rules for guidance which the eugenist can now lay down are too 
 few to make a broad appeal. The subject is a new one. On some points 
 it is possible to speak positively. In a few instances it is possible to say 
 "Thou shalt do" or "Thou shalt not do." But on most of the points that 
 people are interested in it is not possible to say anything one way or the 
 other. This the eugenist knows better than anybody else. 
 
 It is to correct these defects that the office has been created, that ten 
 thousand family records have been gathered and are being studied, that a 
 corps of field workers are investigating, that the proposition to advise as to 
 matrimony has been made. 
 
 Davenport is much more definite in his teachings than any of his 
 associates. As to many qualities he speaks with the positiveness of a" teacher, 
 More than anyone he follows the plan of a great teacher of obstetrics of 
 twenty years ago, Dr. W. W. Jaggard. Dr. Jaggard was accustomed to say : 
 
 "Gentlemen, I tell you this dogmatically to be accepted, not tentatively 
 to be argued." 
 
 Davenport, though, after enumerating some fifty or more qualities con- 
 cerning which eugenics speaks dogmatically finally said: 
 
 "The great work of the future in eugenics is to determine as accurately 
 as possible the law of heredity of each human trait." 
 
 It is to this end that these thousands of family trees are being gath- 
 ered. When eugenics has developed its doctrine it will find the people ready 
 to accept it. In fact the people will be ready before the doctrine is ready. 
 
 I believe it was Sir Francis Galton who suggested the eugenics family 
 tree and the development of a regenerated romantic love around the central 
 idea of family trees. Immediately following his suggestion individuals began 
 
COLLECTING EUGENIC DATA 999 
 
 keeping life albums in which there would be entered the intimate personal 
 history of individuals, and families began constructing family trees along the 
 Lines laid down by Sir Francis. 
 
 The Family History Book, issued by the Eugenics Eecord Office as 
 Bulletin No. 7, gives detailed instruction as to how to construct such a family 
 tree. In the record there is a place for an analysis of the capacities, likes, 
 dislikes, peculiarities, and other qualities of the individual. 
 
 Some day the plan will be modified so as to enter certain desirable 
 qualities with the ease of entry now provided for certain bad qualities. A 
 glance at the plan as now outlined shows that the work has been done by men 
 whose chief interest has been in the abnormal. 
 
 We find a key in which fifteen inheritable undesirable attributes are 
 to be noted by a single letter: A, alcoholic, decidedly intemperate; B, blind; 
 C, criminalistic; D, deaf; E, epileptic; F. feeble-minded; G, gonorrheal; 
 I, insane; M, migrainous; N, neurotic; P, paralytic; S, syphilitic; Sx, 
 sexual, immoral; T, tuberculous; V, vagrant, tramp, confirmed runaway. 
 
 In this list there is one symbol for the desirable — X, normal — and one 
 to designate an infection that is not inheritable — G, gonorrheal. 
 
 Further analysis is necessary in many of these entries and therefore 
 such suggestions are made as that the capital I for insanity should be 
 modified to make, for instance, Is, senile dementia ; Ig, general paresis ; 
 Ip, paranoia. All these differ in their importance from the inheritance 
 standpoint. 
 
 Davenport tells us that in this country there are aristocratic families, 
 such as the Harrisons, statesmen; the Morgans, financiers; the Edwards and 
 Dwights, scholars; the Wilkinsons, inventors; the Lees, soldiers; the Hulls 
 and Footes, sailors; the Jeffersons, actors. 
 
 There are cacogenic families such as the Jukes, Ishmaelites, Nams, Hill 
 folk and Kallikaks, a large portion of whose descendants manifest crimi- 
 nality or some other evidence of subnormality. 
 
 If one marries into the one group the majority of the offspring will 
 be a source of happiness to the family. If one marries into the other group 
 a majority of the offspring will be a source of misery to the family. 
 
 Some of the inheritance relations of the above have been well worked 
 out. Some have not. 
 
 The blood will clear itself of any inheritance in four generations. This 
 statement requires some modification. There are a few qualities that can- 
 not be bred out. Those are pretty well understood. They conform to de- 
 veloped principles of Mendel's law. 
 
 Occasionally a quality will appear that has not appeared elsewhere in 
 the family tree which goes back three generations — to the great grandparent. 
 In such case the Family History Book tells us that the searcher delving 
 farther back will find some forerunner. 
 
 These are the exceptions; the rule is that four generations is enough. 
 In some instances it is more than enough. For instance, gonococcal infec- 
 tions are usually included. This infection produces sterility, causes blind- 
 ness in the newly born child and in other ways is related, but in no proper 
 sense has it inheritance features. Two generations clears the stock of both 
 the infection and the effects of the infection, 
 
1000 EUGENICS 
 
 Syphilis, on the other hand, extends "even unto the third generation" — 
 bnt not beyond that. Alcoholism, epilepsy, insanity, migraine, wanderlust, 
 tuberculosis, neurasthenia, are qualities from which the stock clears itself by 
 the fourth generation if given any chance. 
 
 The tendency to normal mind, normal stamina, normal resistance, to 
 epileptic convulsions, to a certain color of skin and eyes is marked. It is 
 
 M 
 
 F F 
 
 I I 
 
 F F 
 
 I I 
 
 M 
 
 M M 
 
 I I I I 
 
 F F F F F F 
 
 I I 1 _L 1 l_ 
 
 II I I I I I I I I I I I I I I 
 
 M M M FMMFFMMMFFMFF 
 
 1 
 
 Fig. 411. — Pedigree Showing Hereditary Persistence of Color-Blindness. M, male; 
 F, female; Bold-faced type- color-blind subjects. ("Heredity and Eugenics.") 
 
 called a dominant. Even though an abnormality in any one of these qualities 
 should be introduced in the next generation it would be half gone and in the 
 third generation it would have disappeared for all practical purposes. 
 
 In hereditary ataxia, astigmatism, otosclerosis (a form of deafness), 
 Thomsen's disease and non-resistance to consumption the normal is the 
 dominant, and the abnormal does not last beyond the Biblical teaching that 
 
 
 
 1 
 M 
 
 1 
 
 
 
 
 
 1 
 F 
 
 1 
 
 
 1 
 
 M 
 1 
 
 1 
 M 
 
 1 
 
 1 1 
 F F 
 
 1 
 F 
 
 1 
 
 
 
 1 1 
 F M 
 
 1 
 
 1 1 
 F F 
 
 1 
 
 1 ! 
 
 M M 
 
 1 
 1 1 
 
 1 
 M 
 
 1 1 
 M M 
 
 1 
 
 1 1 
 M F 
 
 1 1 1 
 M F F 
 
 1 
 
 1 
 F 
 
 1 1 1 
 M F F 
 
 I 
 M 
 
 Mil 
 
 M M M F 
 
 M M 
 
 Fig. 412. — Pedigree of a Family Containing Color-Blind Members. 
 ("Heredity and Eugenics.") 
 
 "the sins of the fathers shall be visited upon the children even unto the third 
 and fourth generations." 
 
 Certain abnormal conditions are dominants. For them three or four 
 generations will not clean the blood. Among these are Huntington's chorea, 
 cataract, ptosis of the eyelid, night blindness and extra toes and fingers. 
 
 Sex-limited traits tend to disappear spontaneously if certain rules of 
 mating are observed. They tend to be indefinitely perpetuated if the rules 
 
THE OPTIMISM OF EUGENICS 1001 
 
 are not observed. Among the self -limited traits are color blindness, atrophy 
 of the optic nerve, hemophilia, muscular atrophy, multiple sclerosis, nystag- 
 mus and myopia. 
 
 This is only a beginning. The Eugenics Eecord Office will not succeed 
 until it offers a program with a broader appeal. In order that it may do 
 so it is piling up studies. 
 
 THE OPTIMISM OF EUGENICS 
 
 Some of the opponents of eugenics have ridiculed and maligned it 
 because, they said, every man's family tree goes back to the beginning and 
 it is therefore a reasonable certainty that among any man's ancestors were 
 some who had inheritable defects, physical, mental or moral. 
 
 Had these critics taken the trouble to inquire they would have learned 
 that the blood has a tendency to clean itself and that the great teaching of 
 eugenics is in the laws of cleaning. 
 
 Irving Fisher in Good Health says: "Thus it is possible to apply the 
 laws of heredity as laid down by Mendel in a thoroughly practical way and 
 to get results in one short generation. It seems, and it is, a colossal task 
 to change average human nature one iota. Yet in the light of modern 
 eugenics, we could make a new human race in 100 years if only people 
 in positions of power and influence would wake up to the paramount impor- 
 tance of what eugenics means." 
 
 Professor Fisher quotes David Starr Jordan's report on the lessening 
 of cretinism in Aosta, the result of a ten-year effort. 
 
 Most of the bad qualities are recessive. That means that the blood 
 clears itself of them if it has any chance to do so. This power of the blood 
 to clean itself is so strong that the human race holds its own well in spite 
 of the haphazard lines along which it has been run. 
 
 The eugenists propose that in the case of those bad conditions that are 
 dominant (the blood not having much power to clean itself of them) 
 propagation shall be prevented but — and this is the part that they especially 
 insist upon — that study shall be made of the natural laws by which the blood 
 clears itself of the recessive defects and that the people shall be educated 
 to make use of the information gained. 
 
 When Galton launched the eugenics movement he called it a eugenics 
 education movement. There has never been any killing of babies or infan- 
 ticide or breed-'em-like-hogs proposals even from the followers of the move- 
 ment and certainly none from the leaders of the movement. 
 
 The influence of heredity does not go back indefinitely. To consider 
 the parents is the main necessity. 
 
 However, that is not quite enough. A little thought should be given 
 to the four grandparents and all who have descended from them. Some 
 thought must be given to the eight great-grandparents and their descendants. 
 That is about all. 
 
 A man need be interested only in about one-half the defects found among 
 his first cousins and one-quarter of those among his second cousins. 
 
 The most important part of eugenics is its teaching as to what are 
 
1002 EUGENICS 
 
 good limbs and what are bad limbs on a family tree. Of importance is 
 the teaching that a family tree need not go back into more than three 
 generations. 
 
 Of great importance is it that the young person live cleanly not only 
 because it is the proper preparation for parenthood but because he is the 
 temporary custodian of the seed of the race. 
 
 PROBLEM OF THE FEEBLE-MINDED 
 
 Kecently, when I was in Momence, Illinois, two most intelligent gentle- 
 men told me of the large number of feeble-minded along the Kankakee valley. 
 There is much intermarriage amongst the families in which the strain runs, 
 and in consequence the condition is on the increase. 
 
 The people of the district referred to do not change location often. They 
 show a disposition to stay in the neighborhood wherein they were born, to 
 marry neighborhood girls, to rear their families among old friends and 
 (their lives coming to the end) to be buried in the neighborhood burying 
 ground — the wisest and best of plans if there is combined with it efficient 
 supervision of the stock to keep feeble-mindedness out; the worst of plans 
 once a transmissible condition like feeble-mindedness gets into the stock. 
 
 In his address before the state charities commission Dr. Henry Goddard, 
 who knows more about this subject than anyone else, estimated that there 
 are 20,000 feeble-minded in Illinois. 
 
 What the feeble-minded cost the state there is no way of telling but 
 the sum must be enormous. No accurate compilation has been made of 
 the crime which may justly be laid to the mental inferiority of its perpetrator. 
 The mental defective is a positively aggressive enemy of society whether it 
 be through a large progeny or criminal activities, or both. 
 
 Based upon views of this character Dr. Goddard advises that legisla- 
 tion be passed. Just what this legislation is to be is a difficult question to 
 decide. 
 
 The best authorities are of the opinion that some of the states have gone 
 forward too rapidly in their negative eugenic laws. Such opinion is strongly 
 put in the last bulletin from the eugenics laboratory, that on the marriage 
 laws of the United States. 
 
 The English have been worried about the problem of the feeble-minded. 
 Their people stay even more closely in their neighborhoods than the people 
 of the Kankakee valley. When feeble-mindedness gets into a family inter- 
 marriage and marriage among neighbors tends to increase it. 
 
 The British parliament appointed a committee to investigate the sub- 
 ject. Dr. Goddard tells us that no subject before that body has had more 
 earnest consideration than the mental deficiency bill and that when it finally 
 becomes law it will probably be a fit example for other countries to follow. 
 
 David Lloyd-George has succeeded in turning the thought of English 
 statesmen to problems of this character. Perhaps he could not have suc- 
 ceeded had not the Boer War made the English introspective. 
 
 If, as a result, solution is found for some of the ills of society the world 
 will be the beneficiary of that unfortunate contest. 
 
EUGENICS CONCLUSIONS 1003 
 
 EUGENICS CONCLUSIONS 
 
 Salaman, studying the facial expression of English Jews, found in 136 
 families where the father was a Jew and the mother was a Gentile that there 
 were 336 children with Gentile faces and 21 with Jewish. In five families 
 where one parent was a Gentile and the other half-Jew and half-Gentile 
 there were 11 Gentile faces and none Jewish. 
 
 Jews are supposed to have about as fixed a facial type as is to be found. 
 That was the reason for the study. Therefore Jews marrying out of their 
 race will have children with Gentile faces in nearly all instances. Those 
 children, marrying an out strain, will have no children, with Jewish facial 
 characteristics. 
 
 Ewart, studying the 105,000 inhabitants of XLiddlesborough, England, 
 came to these among other conclusions: 
 
 "1. The children of the better working classes are above the average 
 standard of those of the professional classes. 
 
 "2. A mother produces her best girl before her twenty-fifth year, and 
 her best boy in the twenty-six to thirty year period. Add five years to each 
 group and the figures apply to fathers. 
 
 "3. Children born in the first half of the year are larger than those born 
 in the second. 
 
 "4. Xo pregnant woman can nurse her child at the breast without hav- 
 ing the unborn or the born child suffer. When children come far enough 
 apart (three years), so that the woman is not nourishing a born and an 
 unborn babe at the same time, the majority of mothers improve as child 
 bearers as their families increase. The third averages better than the first 
 or even the second. When children come at a shorter interval than two years, 
 the later children are not so strong mentally and physically as the first." 
 
 The quotations from recent writings on eugenics have been given with 
 a view to stimulating interest in a greatly neglected subject. 
 
 In Davenport's book nearly every physical, mental and moral trait is 
 given some consideration. However, it is all so new that neither Pearson, 
 presiding over the Galton Laboratory in England, nor Davenport, presiding 
 over the Eugenics Laboratory in this country, has facts enough for final con- 
 clusions. But the subject is so important that it must not be neglected longer. 
 
 Statistics show that men and women of bad stock have twenty-five per 
 cent more children than normal. The flowers must have a chance to outgrow 
 the weeds. Xock says England's mournful lesson is that you cannot have 
 national greatness bottomed on unsound men and women. Unsound men and 
 women result from bad environment and bad heredity. The first is the more 
 important; but the second deserves more thought than it has had. 
 
 Mental Defects. — "Two mentally defective parents will produce only 
 mentally defective offspring." — Goddard. 
 
 If a person belonging to a strain in which a mental defect is present 
 marry a cousin the chance of some defective children is very great. When 
 two persons of strong minds but with mental defects in their blood strain 
 marry, one-fourth of the offspring may be expected to be mentally defective. 
 
 Mongolians. — (Feeble-minded children, looking somewhat like the 
 
1004 EUGENICS 
 
 Chinese type.) "A Mongolian is usually the youngest or oldest child, the 
 last or the first born. Such a child is born to a mother (or occasionally a 
 father) who is too young or too old, or who, for other reasons, is in a bad 
 condition of nutrition/' — Davenport. 
 
 There is a eugenic relation between genius and feeble-mindedness. Says 
 Havelock Ellis: "It is no paradox to say that the real affinity of genius is 
 with congenital imbecility rather than insanity/' He notes that eminent men 
 are more apt to be eldest or youngest sons. 
 
 Memory. — "When both parents, having poor memories, are from fam- 
 ilies so characterized, few of the children have excellent memories. When 
 one parent has a fair memory and the other has a poor memory, all children 
 have poor memories." — Davenport. 
 
 Criminality. — Davenport, from whose book these illustrations have been 
 
 M F 
 
 I I I I I I 
 
 M F M F M M 
 
 _L I I I 
 
 I I I .1 I I I I I I I I I ! I I I I I I I I F 
 
 MF FMMMFMMF F MMMFM FMMFMM 
 
 I I III III I 
 
 MF 
 
 II I I I I I I Mill III II 
 
 MF MFMFMF FMFMF FMF MF 
 
 Fig. 413. — Pedigree Showing Hereditary Transmission of Hemophilia. Bold-faced type 
 indicatesbleeders. ("Heredity and Eugenics.") 
 
 drawn, says : "It is just as sensible to imprison persons for feeble-mindedness 
 or insanity as to imprison criminals who are of a criminal strain. The ques- 
 tion whether a given person is a case for the penitentiary or the hospital 
 is not primarily a legal question, but one for a physician with the aid of a 
 student of heredity and family histories." 
 
 Hemophilia. — A disease characterized by frequent, almost uncontrollable 
 nose bleed; the afflicted are known as "bleeders." 
 
 Eugenic teaching — Sisters of bleeders should not have children. Males, 
 whether bleeders or not, may marry and reproduce with impunity. Their 
 descendants will not be bleeders. 
 
 Cancer. — "This disease is much more frequent in some families than in 
 others. Children born to old parents are more liable to have it than children 
 born to young parents or parents in the middle of the reproduction age." — 
 Ewart. 
 
 TENDENCY OF BLOODS 
 
 In a certain "Village consisting of 1,000 Souls" (Gesell tells us), there 
 are 220 families. He studied the life history of these people from 1880 on 
 and classified them according to eight conditions : Feeble-mindedness, insanity, 
 suicidal impulse (successful accomplishment), alcoholism, epilepsy, criminal- 
 ity, eccentricity and tuberculosis. 
 
 In thirty-three years no member of 111 of these families has shown any 
 
THE SURVIVAL OF THE FITTEST 1005 
 
 manifestation of any one of these conditions. In 109 families the stock was 
 found tainted by one or more. 
 
 Numerically the two worst family records were one in which there were 
 three cases of tuberculosis, one of insanity and one of alcoholism, and another 
 in which there were two insane, one suicide and two eccentrics. 
 
 Xine of the families had four subnormals each. In one of these families 
 there were four feeble-minded; in another there were two insane, one feeble- 
 minded and one alcoholic. Out of the thirty-six members nine were insane, 
 five were feeble-minded and seven were tuberculous. 
 
 Ten of the families had three subnormals each. In two there were two 
 feeble-minded in each and in one there was one. Two had two insane each 
 and two had one each. 
 
 Twenty of the families had two subnormals. Two of the families had 
 two feeble-minded each and ten had one. Two families had two insane each. 
 Forty-one of the families had two or more abnormal members. In the 220 
 families there were 187 subnormal individuals. Two per cent, one out of 
 fifty, of the pupils in the public school were feeble-minded. 
 
 Gesell found it difficult to classify two eccentric druggists, a hard-hearted 
 stepmother, the local banker who lost the savings of most of the people, one 
 bigamist who used the money secured from the second wife to provide com- 
 forts for the first wife and her children, and three young men who became 
 vagrants. 
 
 A point indicating decadence that I have never seen noted before is 
 the tendency of men and women in this village to come to a standstill at about 
 thirty-five. A good stock grows in intellect and power to a later life period. 
 So much for one side. 
 
 As for the other side nine of the families produced fourteen quite supe- 
 rior individuals. Several ball players in the Xational League came out of 
 this town. 
 
 Of greater significance is the mediocre stock of this village — just the 
 ordinary, everyday people, the common run of people, the people who go 
 through life raising their families, carrying on the everyday work of the 
 town, neighborly, helpful, practicing the homely virtues. 
 
 In this village this group makes a good showing. There is that tend- 
 ency to stop growing in capacity at an early day but almost every other 
 observation indicates that the mediocrity of the village is getting on quite 
 well. 
 
 As Gesell says, "Feeble-mindedness tends to be transmissible, but so does 
 normality." The proof is conclusive that bloods tend to cleanse themselves. 
 With a little study and planning the stock can be protected against the 
 subnormals. But help is needed. It is needed in the quiet, peaceful, happy 
 villages as well as in the city slums. 
 
 THE SURVIVAL OF THE FITTEST 
 
 When the movement for the conservation of health began to attract the 
 attention of the indifferent there were those who lent it no aid, and even 
 at times opposed it because they believed in Herbert Spencer s doctrine of 
 "the survival of the fittest/' 
 
1006 EUGENICS 
 
 Before the Chicago City Club Mr. Bridges of London called attention 
 to the difference between the ordinary idea of what this doctrine meant and 
 Herbert Spencer's idea. The survival of the fittest means the survival of 
 those fittest to survive and that is all. The best of a race are not necessarily 
 the fittest to survive. The advancements are always made by those who are 
 a little out of joint with the times. "When the average has been adapted 
 to advanced standards the force for advancement becomes the fittest to 
 survive but when it does it is no longer a force for advancement. 
 
 A judge who in his decisions sticks close to precedents will have few 
 reversals — an offshoot of the idea of the survival of the fittest. But on the 
 other hand he will petrify the law. Justice is carried forward by men with 
 a sense of social justice directed by judgment. Such men are often reversed. 
 As Mr. Bridges put it, if a polar bear and a Lincoln were set down on an 
 arctic island the bear would survive because he was fittest. 
 
 Galton uses the term "worthy 7 ' as meaning those who should survive 
 and who can do so when society is so organized as to make for race betterment. 
 
 Another influential group has opposed the entire health conservation 
 movement both in its hygiene and in its environment features because, they 
 have argued, the policy served to keep alive many who (for the benefit of 
 the race) should not live; that in the long run the race would be better off if 
 the weaklings were allowed to die. 
 
 When in a state of savagery man has acted upon this conception with 
 brutal directness. The lame, the halt, the weaklings, the excess of females — 
 any who in the judgment of the masters were thought to be, or liable to 
 become a burden were killed and custom and law held the murderers justi- 
 fied. As civilization came on a bit outright murder stopped but murder by 
 neglect was countenanced. 
 
 The next step in the evolution was neglect, but neglect short of murder. 
 The successive steps following were poorhouse care, asylum care, humane 
 care, curative care which brings us to where we now are, preventive care; 
 at least, we are at the dawn of this era. 
 
 If the idea of those opposed to the policy of human conservation because 
 of their belief in the survival of the fittest was correct why is it that society 
 has been evolving away from the old habits? 
 
 Mans tendency is always upward. The constant trend from savagery 
 (even when it be justice to humanity) must be right because it is the trend. 
 
 Again, the death rates are getting low, invalidism less, the average of 
 efficiency higher — the newer ideas must be right, the older ideas must be 
 wrong. 
 
 Scientists find ample demonstration of the truth of this logic. Care of 
 environment and thought for inheritance mean lowered death rates ; they also 
 mean heightened health rates. 
 
 Havelock Ellis says: "In a policy of the survival of the fittest the fit 
 survive, but though the relatively strongest have survived, their relative 
 strength has been impaired by the very influences which have proved alto- 
 gether fatal to their weaker relatives." 
 
 "Furthermore," he elsewhere adds, "not only must an undue struggle 
 with unfavorable conditions enfeeble the strong as well as the weak; it also 
 imposes an intolerable burden upon these enfeebled survivors. It involves 
 
"UNTO THE THIED AXD FOURTH GEXERATIOX" 1007 
 
 the multiplication of the diseased, the maimed, the feeble-minded, of paupers, 
 lunatics, and criminals." To which might be added neurasthenics. 
 
 A convincing demonstration of the truth of this conclusion is given by 
 a comparative study of the death rates of the countries where the infant 
 mortality is high and those where the infant mortality is low. Without 
 exception those countries where the infant mortality is high have an adult 
 mortality rate which shows that sickness in childhood undermines resistance 
 for the rest of life. 
 
 For instance, Eussia where the infant mortality a few years ago was 
 more than 300 and still is over 250 has much more sickness and a much 
 higher adult death rate than Norway which has a low baby death rate. 
 
 As Carpenter puts it, "A high infantile mortality means a far higher 
 infantile deterioration rate," or as someone quoted by Ellis puts it, "A 
 dead baby is next of kin to a diseased baby." 
 
 From no standpoint is a nation justified in neglecting its people. Or 
 to quote Goldscheid: "The protection of the weak is the protection of the 
 strong against degeneration." 
 
 ''UNTO THE THIRD AND FOURTH GENERATION" 
 
 The above was selected as the title for a paper to be read before the 
 Canadian Medical Association by Professor Adami of McGill University, 
 Toronto. 
 
 Many years ago "Weismann of Freiburg University, Germany, wrote that 
 environment was of no importance and inheritance was all important in shap- 
 ing the destinies of men. His teaching was that the cells of the body fell into 
 two groups — the somatic cells (including all cells except those of generation) 
 and the generation cells which in the developing child were the progenitors 
 of all the cells but that thereafter originated only cells of generation. 
 
 Somatic cells sprung from generation cells but the chain having started, 
 they were thereafter produced only by somatic cells. Generation cells origi- 
 nated from generation cells always and could never originate otherwise. 
 Somatic cells inevitably died bu t>e germ plasm acting through generation 
 cells was perpetual. 
 
 The practical effecv of the teaching of "Weismann is that the germ cells 
 are wholly protected from the influence of environment — for instance, that 
 whatever may be the experiences of a woman her children will not be affected. 
 Parents are born with all their germ cells complete and finished. 
 
 There is, of course, much truth in the dogma of Weismann. though 
 even the last modification of his views is not thought to be the whole truth. 
 Studies have shown that the gTandchildren of people who have consumption 
 are highly susceptible to the disease. Susceptibility may even skip the first 
 generation and appear in the second — the sins of the fathers visited upon 
 the children even unto the second generation. 
 
 In Adami's opinion, the results of one's living a^e manifest even unto 
 the third and fourth generation and he sets forth in this paper his reasons 
 for that belief. 
 
 Of course his is not a one-sided belief. Those who live right impart the 
 
1008 EUGENICS 
 
 good gained to their descendants just as those who live wrong impart the 
 harm done to theirs. 
 
 The term "sin" is used entirely with a scientific and not with a moral 
 meaning. 
 
 He quotes experiences that show that lead, mercury, and alcohol effects are 
 carried over into succeeding generations. He also makes use of observations 
 on poisoning with the toxins of tuberculosis and certain other diseases where 
 proof is somewhat easy to make. 
 
 Adami says that when Weismann cut off the tails of mice and from these 
 bobtails bred long-tailed mice he proved that a race of bobtailed mice could 
 not be bred in that way but that was all that he proved. 
 
 The action of the important organs of the body and the resistance to deli- 
 cate chemicals is much too subtle to conform to the same laws as regulate the 
 tail of a mouse. 
 
 There is proof that subtle changes do result from change in environment. 
 Besides, it is common sense. Individual man is influenced by his surround- 
 ings and in time the race comes to feel the influence though the cells 
 charged with carrying on the race are better protected against outside influ- 
 ences than are the cells that do the day's work. 
 
 THE BABY SCIENCE 
 
 We have been so busy with environment that we have forgotten team 
 work. Eace betterment is loaded in a two-horse wagon, to which are hitched 
 improved environment and eugenics. The horses wear blinders. Improved 
 environment (including the workers for its improvement) has been so busy 
 pulling on its end of the doubletree that it has forgotten the fellow on the 
 other side of the pole. 
 
 Sir Francis Galton calls eugenics "the science which deals with all in- 
 fluences that improve the inborn qualities of the race"; which Davenport 
 further clears by saying: 
 
 "The eugenical standpoint is that of the agriculturist who, while recog- 
 nizing the value of culture, believes that permanent advance is to be made 
 only by securing the best blood. Man is an organism — an animal — and the 
 laws of improvement of corn and of racehorses hold true of him also. The suc- 
 cess of a marriage from the standpoint of eugenics is measured by the 
 number of disease resistant, cultivable offspring that come from it." 
 
 Davenport in his "Heredity in Relation to Eugenics" has set forth many 
 eugenical principles. That the science of Mendelism has proceeded far enough 
 in the human subject to permit of eugenical formulae covering so many fields 
 will come as a surprise to many. 
 
 Mendel, the Austrian monk, wrote the story of the breeding of the sweet 
 pea a quarter of a century after the railroad was invented. He made his 
 experiments, recorded his results, wrote his book — and died — his life a failure 
 so far as he could see. When William McKinley was president, Devries 
 happened to read this little book and seeing the seed of a science in it found 
 for it a hearing. 
 
 Most of Galton's writings were during the presidency of Cleveland, Mc- 
 
THE BABY SCIENCE 1009 
 
 Kinley, and Eoosevelt. It was in 1911 that he died leaving his estate as an 
 endowment for this work. The bulk of the literature on the subject has been 
 written since Taft became president. 
 
 Not much senility about a science which runs back only to the last 
 Roosevelt administration! A baby science immature in years will certainly 
 be immature in its conclusions and error will creep in. Some of its pres- 
 ent principles will be abandoned in the light of broader information and 
 others will be modified. But the methods and the general outlines will 
 stand. 
 
 Davenport says: "As we may now predict with precision the characters 
 of the offspring of a particular pair of pedigreed poultry, so may it some 
 time be with man." 
 
 We will all agree with Nock that man made laws will never supplant the 
 laws of nature. Even the laws of custom and society will yield slowly where 
 they yield at all. The students of eugenics as a general rule think the re- 
 generation of the race will come about more through intelligence and informa- 
 tion than through legal enactments. 
 
 Medical examination and certification as a basis for a marriage license is 
 not advocated by Havelock Ellis, Newsholme, Saleeby, Davenport and Hut- 
 chinson. They think that some of our state laws have gone too far or rather 
 too fast having been enacted without enough preliminary study. Asexualiza- 
 tion of the very lowest strata of society is about as much as they are ready to 
 advocate. They propose to state the known facts and the principles de- 
 ducible from them and then to leave the results to the wisdom of men. 
 
 While the majority of men will drift along as heedless as ever a fair 
 number will give some thought to the subject, knowing that unwisdom will 
 be "visited upon their children and their children's children even unto the 
 third and fourth generation." 
 
 Now let me set down a few selections, principally from Davenport's work, 
 illustrating what eugenics is teaching: 
 
 Deaf-Mutes. — The first eugenic recommendation is that two deaf-mutes 
 should not have children especially if they come from the same long settled 
 community or are known to be blood relatives. Bell, in a special census 
 report to the United States government in 1906, showed that intermarriage 
 was a very important cause of deafmutism. Where a deaf person has inherited 
 his deafness about 25 per cent of his children will inherit deafness. Where 
 a deaf person has acquired deafness through neglected tonsils, and such causes, 
 2 per cent of his children will be deaf. 
 
 In a marriage where one partner is congenitally deaf and the other 
 has no deafness in the family 7 per cent of the children will be deaf. If 
 the partner with good hearing has deafness amongst his relatives 35 per 
 cent of the children will be deaf. If one or both partners are deaf as the 
 result of neglected tonsils, ears, or other defects, and have no deaf relatives 
 only one-quarter of 1 per cent of the children will be deaf. 
 
 Becoming Hard of Hearing with Age. — Two persons with this as a 
 family tendency should not marry as probably all their children will be 
 "hard of hearing" as they grow older. But a person with such a family 
 tendency could marry into a family with no such tendency and the children 
 would have no such tendency. 
 
1010 EUGENICS 
 
 Blue Eyes. — When both parents have pure blue eyes all the children will 
 have pure blue eyes. 
 
 When one parent has brown eyes, while the other has blue, either the 
 fraternity of children will show no blue eyes or half of them will be blue eyed 
 — more accurately, 48 per cent and 52 per cent. 
 
 When both parents are brown eyed, 75 to 100 per cent of the children 
 will be brown eyed and no per cent to 25 per cent blue eyed. 
 
 Color Blindness. — The eugenical conclusion is that while color blind 
 males will have no color blind sons and (typically) no color blind offspring 
 of either sex yet their daughters married to men of normal stock will have 
 color blind sons. 
 
 Cataract. — The eugenical rule is that if either parent has cataract at 
 least half the offspring will have it also. 
 
 Cretins. — Absence of the thyroid gland, the opposite condition to goiter, 
 appears especially in families which have intermarried for several generations. 
 There is a large cretin colony in Switzerland. For some time these have not 
 been allowed to intermarry and Jordan, in the Eugenics Review for 1910, 
 says that cretinism has about disappeared from the village. 
 
 Exophthalmic Goiter. — This is clearly inherited, as certainly as epilepsy. 
 The laws of inheritance have not been worked out. 
 
 Neurotics. — In a certain case where a nervous person married a neuro- 
 path of eleven known offspring six are normal and five neuropathic. Where 
 two neurotics married two out of six children are normal and one insane. 
 Where an insane and a normal married of thirteen children four are normal 
 and two insane. Where a neurotic and a normal married of twenty-eight 
 children sixteen are normal, nine nervous, one feeble-minded and two insane. 
 
 Multiple Sclerosis of the Nervous System.- — This disease is transmitted 
 through unaffected females. The eugenical conclusion is that unaffected 
 females who have affected brothers should not have children. Neurotic 
 parents will have about 50 per cent of neurotic children. 
 
 St. Vitus' Dance. — Occurs in families of a neuropathic make-up. 
 
 Insanity, Alcoholism, Drug Addiction. — Says Davenport : "Probably an 
 hereditary predisposition lies at the basis of most cases of insanity, and this 
 predisposition behaves in heredity like a defect." Alcoholism and drug 
 addiction as modified insanities belong in this group. 
 
 Cancer.— a There is a family liability to cancer, but along what lines this 
 liability is transmitted and what plan shall be pursued to prevent its trans- 
 mission has not been worked out." — Davenport. 
 
 Consumption. — Coolidge says that old New England families show a rela- 
 tively high resistance to consumption as compared with recent immigrants. 
 The opinion is quite generally held that the mortality from this disease 
 among negroes and Indians is due in part to bad hygiene but in greatest part 
 to the fact that the disease is to them a new one. They have an inherited 
 susceptibility to it. 
 
 Davenport's study of the family histories in his eugenics files shows 
 some with no consumption, others with little and some with a consumption 
 death rate of 75 to 80 per cent. He concludes that children of families with 
 a tubercular history should not intermarry. 
 
 The above illustrations have been drawn in miscellaneous fashion from 
 
THE HILL FOLK 1011 
 
 "Heredity in Eelation to Eugenics." The principles are based on data 
 which in most cases are abundant enough to prevent errors due to individual 
 variations. In some instances there are enough data to meet the requirements 
 laid down by Pearson for the law of probabilities; in most instances, far 
 from it. 
 
 THE HILL FOLK 
 
 The man who lives in the country reads of the unworthy citizen and 
 the slums of the city in a detached way thinking of them and all such 
 much as he thinks of aborigines in Australia or pygmies in Africa. As a 
 matter of fact the only studies of bad family inheritance ever made in this 
 country have been of rural families. 
 
 The Eugenics Eecord Office has recently published another of these family 
 studies under the title "The Hill Folk/' It is the story of the descendants 
 of two men who came into a small Massachusetts town in 1800. The town, 
 now with 2,000 inhabitants, lies in a fertile valley surrounded by less fertile 
 hills. The population in the main consists of industrious, intelligent farmers. 
 
 Through this placid mass of good citizens the progeny of these two bad 
 citizens has sifted making desolate, alcoholic homes and furnishing wards to 
 the state for over fifty years. 
 
 The taxpaying, law abiding citizens have lived beside these troublesome 
 paupers so long that they are too disgusted with them and also too accustomed 
 to them to do anything. 
 
 About every so often one of the Hill folk goes to jail or to some other 
 institution and the people temporarily threaten to do something about the 
 whole worthless stock. But it stops at that. 
 
 The cost to the taxpayers for caring for these Hill folk has been a little 
 short of $500,000. 
 
 The first generation or two cost little or nothing thus limiting the years 
 on which the cost has fallen to about the last fifty. The average cost has thus 
 been about $9,000 a year, a pretty good price for a community of law abiding, 
 frugal farmers to pay for the luxury of paupers, drunkards and criminals by 
 inheritance. 
 
 In the last ten years the cost has increased fourfold so the promise is that 
 Mr. Farmer Xeighbor will have to dig down into his jeans a good deal deeper 
 within the next ten years. 
 
 About every so often the good people have been so aroused at boys getting 
 drunk and girls going wrong that some officer has gone among the Hill folk 
 and taken the children to some public or philanthropic institution. Where- 
 upon the drunken parents, relieved of the need of finding bread for their brood, 
 have proceeded to raise another brood. 
 
 The neighbors having never studied the problem the Eugenics Eecord 
 Office has become intent upon digging right down to the roots. What has been 
 found out about this family may not be of service to this Massachusetts village 
 that has suffered the nuisance for a century but it may be of service to 
 communities that are just beginning to get a "katzenjammer." 
 
 For instance, they find that half the school children of this family 
 show evidence of mental deficiency. As their mental weakness shows a 
 
1012 EUGENICS 
 
 tendency to make habitual drunkards of them one might say that communities 
 which pass prohibition laws are striking at the root of the difficulty, are not 
 idly drifting in the face of a menace. But are they striking at the tap root or 
 only at a surface root? 
 
 I was struck with this: "Old Neill," the father of one of the lines, lived 
 to be 110 years old. He was a chronic drunkard and shiftless but was 
 described by old men as a "harmless fellow and rather decent." 
 
 Had he burned a few houses or killed a few men and been hanged therefor 
 he would have been less harmful and more decent than his progeny has 
 proved him. 
 
 THE NAM FAMILY 
 
 The second memoir issued by the Eugenics Record Office gives the results 
 of a family of ne'er-do-wells that originated, so far as the study showed, in 
 Massachusetts about 1750. Soon after 1800 this family began to inhabit 
 the jails, asylums and poorhouses in a certain rural district in New York. 
 The farmers of this neighborhood have had to bear the expense of caring 
 for the defectives in this large family since about 1830. 
 
 A certain portion of them migrated to Minnesota and the investigators 
 followed up those branches with a view to discovering whether the new en- 
 vironment would bring the stock up to standard. 
 
 The report quotes an old history as saying of the Nam who started the 
 strain : 
 
 "He is one of a set of vagabonds by the name of Nam who lived in the 
 mountains." One of the sons is described as "ignorant, alcoholic, irascible, 
 and indolent." 
 
 "One son emigrated to New York, bought 160 acres of land, and there, 
 in 1810, built a log cabin which was occupied until 1880 and is still standing. 
 This log cabin may justly be called 'the Cradle of Nam Hollow/ for every- 
 one born in this cabin has been socially inadequate and has helped to swell 
 the number of degenerates who give this place its character." 
 
 The conclusions quoted below are based upon a study of 1,795 individuals 
 of whom 852 were descended from the original Nam. The cost of this family 
 is estimated at $1,411,000. 
 
 The non-social traits in this family are indolence, alcoholism and licen- 
 tiousness. 
 
 The eugenic principles of laziness are as follows : 
 
 "When both parents are industrious, 90 per cent of the children are 
 industrious; when both parents are indolent, 76.5 per cent of the children 
 are indolent. 
 
 "Two lazy parents may become the founders of industrious strains, but 
 indolent strains arise chiefly, if not exclusively, by marriage with indolent 
 persons." 
 
 Alcoholism is extraordinarily high — 88 per cent, of the females and 90 
 per cent of the males. "Where both parents were alcoholics every child became 
 alcoholic. Where one parent was alcoholic and the other possessed self-control 
 the offspring who were alcoholics ranged from 50 to 75 per cent." 
 
 A study of the cousin marriages in this strain (where the bad predomi- 
 
EUGENICS AND ASYLUMS 1013 
 
 nated) showed consequences of infant mortality, imbecility, feeble-mindedness 
 and other defects fearful to contemplate. 
 
 On the possibilty of improving the strain by improving the environ- 
 ment the authors say: 
 
 "Placing out in better families and asylum life give a veneer of culture 
 and tend to strengthen the sex impulses, but that effect is uncertain and fre- 
 quently discouragingly slight." 
 
 As to the effects of the migration to Minnesota one report says : 
 
 "The Nams were of the inefficient, worthless sort, not lazy and not 
 criminal. None of them was ever arrested except for drunkenness." 
 
 Another report says of the second Minnesota generation: 
 
 "They are inefficient and alcoholic." 
 
 The general conclusion as to the emigrants is that they have the same 
 mental traits as those that remained in New York State. 
 
 Another general conclusion is that it is three times as expensive to main- 
 tain the offspring of a degenerate couple as it is to segregate the original pair 
 and maintain them in idleness. 
 
 EUGENICS AND ASYLUMS 
 
 The insane committed to institutions make up about three-tenths to five- 
 tenths of 1 per cent of the population. Every town having a thousand inhab- 
 itants has about four insane who are being cared for by the government. The 
 percentage is increasing continuously. 
 
 It is doubtful, however, that there is any increase in insanity. As some- 
 one puts it, our standards of sanity are increasing, which means that many 
 people are now regarded as insane who a generation ago would have been 
 regarded as merely peculiar. 
 
 Another reason is that the standards of custodial care have advanced 
 until now persons are willingly released to asylums where a generation 
 ago they were kept at home by reason of the inhumanity of many of the 
 provisions for custody. 
 
 Asylums were of the first eugenics agencies. By segregating the insane 
 they have always protected the stock, not perfectly but fairly well, as the 
 results show. 
 
 The insane m a rough way fall into three groups: The paretic, the 
 dementia precox, and the maniac depressive. As a eugenic measure asylums 
 are quite effective in relation to the first two groups but not as to the third. 
 
 Mott in his paper showed that of the children born to insane parents, 
 8 per cent were born after the first attack of insanity. This maniac depressive 
 group includes the emotional insane — the people who get worse and better, 
 those who come and go in asylums, sometimes being held sane about half 
 the time and insane the other half. 
 
 It is from another standpoint that asylums as eugenic agents fail. 
 The border line between sanity and insanity is hazy. Insanity is not in- 
 herited. A certain mental instability is inherited and environment pushes 
 those of that group into sanity or insanity. Mott quotes Morel as follows : 
 
 "Nervous, irritable weakness, the neurotic temperament, neurasthenic 
 
1014 EUGENICS 
 
 predisposition may be the first evidence of degeneration of a stock. The 
 signs of degeneracy which may be exhibited are self -centered, narrow minded- 
 ness in religious beliefs, fanaticism, mysticism, spiritism, an unwholesome 
 contempt for traditional custom, social usages, and morality, a vain spirit of 
 spurious art and culture, a false self-loving vanity in the pursuit of a sen- 
 timental altruism, or by eccentricities of all kinds. 
 
 "Such signs of degeneracy are often combined with talent and even 
 genius, but the brilliant intellectual qualities of a degenerate are invariably as- 
 sociated with either a lack of moral sense or of sound judgment and the 
 highest control." 
 
 As showing the relation of inheritance to insanity as demonstrated by a 
 study of the provable insane Mott studied the family relationships of the 
 insane in London asylums. 
 
 He found 750 closely related persons, about 3.5 per cent of the whole. 
 He is certain that not 3.5 per cent of all the people in London are so closely 
 kin. 
 
 He argues that the strains with a large infusion of mental twists produce 
 an undue proportion of the insane. 
 
 THE IMMIGRANT'S CHILD 
 
 In 1910 the National Immigration Commission issued a study entitled 
 "Changes in the Bodily Form of Descendants of Immigrants." It was issued 
 as Senate Document No. 208. 
 
 Are we amalgamating the people who come to us? Is this the "melting 
 pot" ? We think we are taking people from all parts of the world and making 
 them Americans. Are we doing this socially, politically, mentally, physically? 
 
 The question as to the physical amalgamation was that which this com- 
 mission set out to solve. It compared children born abroad with children 
 born in this country to immigrant parents. It compared children from 
 mothers who had recently come over and from those who had been over one 
 year, five years, ten years. These different groups were compared with one 
 another and with children born before the mothers emigrated. 
 
 Jews principally from Poland and Eussia and Italians principally from 
 Sicily and Calabria were studied. Some of the commission's conclusions 
 follow : 
 
 The Sicilian type of head is long and narrow. Sicilian babies born in 
 New York within five years after the mother landed have a shorter, broader 
 head and those born later have a still shorter, broader brain box. 
 
 The East-European Jew has a round head. Babies born to Jewish mothers 
 in this country have longer, narrower heads than those born abroad. 
 
 Comparing the different groups of children — mothers here ten years, five 
 years and two years — it was found that the change of type from children born 
 abroad to the two-year type was rapid ; from the two- to five- to ten-year type 
 that the change was slower. 
 
 It is the first few years in this country which contrast most with what 
 the mother has been accustomed to and her children show it in their make-up. 
 
 The other parts of the body are changing even more strikingly. The 
 
SMALL FAMILIES 1015 
 
 head changes are noted here because the head shape is supposed to be fixed 
 and hard to change. 
 
 Thus we see that while inheritance counts environment gradually makes 
 us even — regardless of race, religion or region of origin. 
 
 Another interesting conclusion was that while the Jewish child born 
 in this country shows an improved physique as compared with the Jewish 
 child born abroad the physique of American-born Sicilians and Calabrians 
 shows a downward tendency. American city life is helping the children of 
 Jews from eastern Europe. It is harming those of Sicilians and Calabrians. 
 
 SMALL FAMILIES 
 
 The baby death rate in large families is high. The prospective mother is 
 nearly always run down and frequently is ill nourished. The duty of caring 
 for her child already born, the nourishment which she furnishes it from her 
 own body, the broken rest — when these are added to the strain of childbearing 
 at short intervals — lower the nourishing power of the mother so that the form- 
 ing baby does not get nourishment enough. 
 
 The baby starts out poorly. If to this is added bad environment a high 
 death rate can be expected. The rule is that in families where there are many 
 children the nursing is done by young children, the bedrooms are crowded, 
 cheap milk and inexpensive food other than milk is used, the family income 
 is small — and in many instances the parents know neither the language nor 
 the customs of the country. 
 
 The argument of the thinkers and investigators is practically unanimous 
 for small families as against large. This plea is the very backbone of the 
 booklets on race regeneration written by Ellis, Xewsholme and Saleeby. Sup- 
 porting this view are some conclusions of Boas in the report of the Immigra- 
 tion Commission. They say that first born children exceed later born children 
 in stature and weight. Investigations made of the school children of Toronto, 
 Canada, and Oakland, California, showed a decided decrease in development 
 of the individual according to the increasing size of the family. 
 
 Havelock Ellis in writing about the decreasing size of families says tha 
 decrease starts in the more advanced nations and works down — as it starts 
 in the most intelligent families and gradually invades all levels. It began in 
 highly enlightened, thrifty France, extended to Germany, thence to England, 
 and within a generation or two will reach the nations of eastern Europe. 
 
 The immigration commission finds support for this view. For example, 
 those from rural Poland where community life is simple have large families 
 in the first generation; in the second generation their families are nearer the 
 American average and in the third the American level is practically reached. 
 
 On the other hand small families are not an unmixed blessing. The 
 Galton laboratory files show a higher tuberculosis, insanity and criminality 
 rate among first bonis than among later children. However, these an 
 conditions which develop in adult life and are due to social and economi 
 causes rather than to inheritance. 
 
 When a baby's chance of living is small a part of it is due to bad heredity. 
 a part to bad environment, and a part of it is due to the bad condition during 
 
1016 EUGENICS 
 
 these borderline nine months between the beginning of the child and its 
 birth. 
 
 THE ONLY CHILD 
 
 In presenting the arguments for small families I would not have you over- 
 look the disadvantages of the only child. 
 
 Pearson found that first children, the normal consumption rate being 
 66, had a rate of 112. The normal criminality rate being 56 they had a rate 
 of 120. They had a lunacy rate which is above the normal. Where the first 
 child is the only child these rates are the family rates. 
 
 The only child is usually well shielded against summer complaint, 
 measles, scarlet fever, diphtheria and smallpox. It has more of the mother's 
 care than the child who is one of several and there is some advantage in 
 this but there is more than enough disadvantage to offset. 
 
 The limitation of the family to one child, as a rule, is voluntary. This 
 means also, as a rule, that the parents are self-indulgent and weak-spirited 
 — a bad inheritance. The child is indulged, coddled and pampered. He is 
 overhoused, overdressed and of low resistance. He is spindle-legged, thin- 
 chested, anemic and flabby. He is a poor player, is self -centered, nervous, out 
 of sympathy, anti-social. He is neurotic, neurasthenic, "whiny." 
 
 There are "only children" to whom none of these criticisms applies. But 
 averaging 1,000 such children these qualities will be found more frequently 
 than among 1,000 children of three-children families. 
 
 The hardest problem of life is to find one's self — to get a line on one's self 
 as compared with one's fellows. This the only child finds very difficult. He 
 has been talking with adults instead of having cooperative and competitive 
 play with other children and he has not had a fair chance to find himself. 
 
 Grinker, in his paper on "Race Breeding/' emphasizes the difficulties of 
 rewards and punishments, of control of emotions and nervous impulses. 
 These are doubly difficult where the child is an only child. To be an only 
 child is awfully hard on the child. If the records show that the child of a 
 large family stands a poor chance I am sure that the only child also stands 
 a poor chance. 
 
 Small families are wise — but they should not be too small. A French 
 authority says that the good of the state demands that a family should con- 
 sist of at least three children. The best family, from the standpoint of the 
 state contains four healthy sound children. 
 
 Prenatal Marking. — Anxious writes: "1. At what time during preg- 
 nancy is a fright or scare to the mother liable to affect the child? 2. Is it 
 natural for the breasts to be very sore? S. Do they remain so the entire 
 period?" 
 
 Reply. — 1. At no time. A fright or scare cannot mark an unborn 
 child. When development starts the child is from under the influence 
 of the mother except as to its nutrition. If she is being starved or poisoned 
 the baby will follow suit. If she is well nourished the babe will be. The 
 developing child is liable to be hurt and thus deformity may be brought 
 about. This, however, is due to other developmental principles. Gen- 
 
EUGENICS 1017 
 
 erally speaking, everything relating to inheritance from mother or father 
 has laid out its work when the child begins to form. 
 
 2. Yes, with some women. 
 
 3. Somewhat so, but proper care of them reduces the soreness greatly. 
 
 No Cause for Worry. — Mrs. A. writes: "I expect to give birth to a 
 little one in January and have become frightened several times. A great 
 many people tell me I probably have marked my child. I have been 
 brought up to believe that there is nothing in this, that it is an old-fash- 
 ioned idea, and that it is impossible to mark a baby, as the unborn child 
 is so well protected. I find it impossible to argue with these women, as 
 I am not certain myself. Your kind advice on this subject will be greatly 
 appreciated. Also will you tell me whether an 8-month baby lives?" 
 
 Eeply. — Birthmarks, harelips and other deformities do not result 
 from frights, scares or other violent mental shocks to the mother. This 
 fantastic idea has never had any foundation in fact. Whenever instances 
 have been investigated it has been found that there was no reason for 
 believing that the deformity was due to anything which the mother had 
 seen or heard. 
 
 The mental state of mothers, some of the diseases which affect them 
 and their nutrition may affect the growth and nutrition of the child but 
 they cannot cause organs to develop wrongly. 
 
 At some time I shall go further into the subject of the influence of the 
 parent on the unborn child. 
 
 An eight-month baby has a good chance to live; nearly as good as a 
 nine-month baby. 
 
 Cretinism. — 0. B. D. writes: "What is the cause of cretinism? How 
 
 does it differ from idiocy?" 
 
 Reply. — Cretins have poorly developed thyroid glands. They are gen- 
 erally feeble-minded; occasionally they are idiotic. Idiots may be such 
 because of insufficient thyroid or by reason of other deficiencies. Not all 
 idiots have poorly developed thyroid glands. In fact, some idiots have a 
 good muscular, bony, and thyroid development. Idiocy is a condition of 
 mind. Cretinism is a condition of the thyroid gland. 
 
 Exceptions Not Convincing. — C. L. R. writes: "The argument as to 
 small families versus large families has another side to it which does not 
 mean precisely what the argument would, at first sight, seem to indicate. 
 I shall first give the argument, or, rather, a few facts, and then point to 
 the real meaning, as distinguished from the apparent meaning. In a sur- 
 prising number of cases the eminent man has been the youngest, or almost 
 the youngest, child of a large family. Franklin was the fifteenth child; 
 Josiah Wedgwood was the eleventh child; Thomas Young, the tenth child; 
 John Hunter and many others were the ends of large families. If these 
 families had been curtailed to make small families, these eminent men 
 would not have been born; and the list, when extended, includes many 
 hundreds of men who have been of the most use to the world and have 
 contributed most to its progress. Apparently this means that the large 
 family is desirable, but when investigated further it is found that there 
 is something else than mere largeness of family which is desirable. The 
 really eminent persons are nearly all born when their parents are of more 
 than mature age; in fact, when their fathers are comparatively old. But 
 
1018 EUGENICS 
 
 on investigating still further it is found that age of itself is not the teal 
 thing, any more than mere largeness of family is the real thing. Both are 
 incidental to the production of the real thing, and that real thing is 
 energy accumulated by work performed before reproduction takes place. 
 Age in parents is time, which is always a factor of energy, and the large 
 family is simply the commonest means by which children are produced late 
 in the lives of their parents. An analysis of the few exceptional cases in 
 which eminent men have come from comparatively young parents shows 
 that the process of accumulating energy is one which extends back through 
 generations. As a collateral on this investigation it is found that as long 
 as parents retain their health and strength, the older they are when their 
 children are born, the longer is the normal life of those children. This 
 has a direct bearing on what you are teaching/' 
 
 Reply. — Some studies made in Chicago show that the children of 
 immature parents are not healthy and strong. Studies of children born to 
 old parents show them not to be strong. The strongest children are those 
 born to parents in the years of strength. The citation of seeming excep- 
 tions is not convincing, because we must stand by averages and also be- 
 cause, as Havelock Ellis has shown, great genius is closely related to 
 mental defects. 
 
 Have Effect on Child. — L. D. P. writes: "A woman at the age of 26 
 becomes a mother. She has taken laudanum as a preventive against child- 
 birth and is also quite a heavy drinker of whisky. Do these have any effect 
 on the child?" 
 
 Reply. — Yes. 
 
 Marriage of Cousins. — L. writes: "What do you think about cousins 
 marrying? I am about to take such a step, as I believe there is no harm 
 in it. The family is opposed to it, asserting that such a marriage is hurt- 
 ful to the next generation. I have among my friends some married 
 cousins and one couple still closer related. All have children, and every- 
 thing seems all right. Why do royal families intermarry, and such families 
 as the Rothschilds? My father objects most because he and his brother 
 are so much alike in temperament and that I am so much like him, also 
 that I am so nearsighted." 
 
 Reply. — The marriage of cousins is advisable or not according to the 
 family history. The mental and physical strength of the European aris- 
 tocracies including royalties can scarcely be held to be a proof of the 
 advantage of intermarrying. All improvements in breeds of domestic 
 animals has been brought about in part by judicious inbreeding. That it 
 has done more good than harm with animals where mating is under the 
 control of dominating minds working with no regard for any consideration 
 except a given end does not argue that it would do more good with the 
 human race whose mating is not thus dominated. Experience shows 
 that with men inbreeding has done more harm than good. If in the blood 
 strains there are dominant good traits those traits will be strengthened in 
 the progeny by the marriage of cousins. If there are bad traits such as 
 insanity, epilepsy, feeble-mindedness, nearsightedness, and the like, those 
 will be made worse. Finally there is a slight deterioration in cousin- 
 mating which is like the gambler's 15 per cent — though it may be over- 
 come temporarily, if persisted in, it finally comes to the front. 
 
EUGENICS 1019 
 
 Law Forbids Marriage. — P. L. writes: "If you will kindly write a 
 paragraph or more on the inadvisability of the marriage of first cousins, 
 it will be greatly appreciated. A young friend — male — is corresponding 
 with a first cousin, and I wish some authoritative statements to put before 
 them." 
 
 Eeply. — The marriage of first cousins is prohibited by the laws of 
 Illinois and some other states. Except in selected cases, the marriage of 
 first cousins is bad for the offspring. Any defect in the stock is especially 
 apt to crop out in the children of such marriages. 
 
 If a careful search shows the stock exceptionally free from inheritable 
 defects marriage of first cousins is not bad for the stock. 
 
 The rule, then, should be that first cousins should not marry. But 
 those passed by some such authority as the staff of Eugenics Laboratory 
 should be allowed to marry. 
 
 Size of Family. — S. A. B. writes: "I had hoped that your article on 
 'Small Families' would state what all writers on this subject seem to have 
 overlooked or ignored: That there is a distinction between death rate and 
 death percentage. It is no scientific discovery that the death rate in big 
 families is greater than the death rate in small families. It could not be 
 otherwise. Where a larger number of children are born and consequently 
 exposed to sickness and death, there are bound to be more deaths. But it 
 does not necessarily follow that the percentage of deaths in the big family 
 is greater than in the small family. If the large family is given decent 
 social and industrial conditions under which to live and grow — a natural 
 right that society is now denying them — it is my opinion that there will 
 be among the children of large families a greater percentage of survivals 
 than among the children of small families, a conclusion justified by statis- 
 tics, which seem to indicate that the physical condition of 50 per cent of 
 the male portion of the population of marriageable age is not comme il 
 faut; and this approximately 50 per cent includes, I believe, only a small 
 portion of the so-called poorer class, saved from inclusion not on account 
 of any superior sense of morality but rather by virtue of proneness to 
 early marriage and their conspicuous fecundity. Is it not a fact that, 
 for the big death rate among the children of the poor, society,, and not the 
 existence of a large family, is to blame? The large family cannot be con- 
 sidered an evil per se. Society, however, is at fault, when it makes the 
 raising of a large family a hardship to worthy parents, and almost an 
 impossibility to the poor. The remedy, if remedy is needed, lies not in the 
 reduction of the size of a family but in the increase in the earnings of the 
 members of the family." 
 
 Reply. — Conclusions as to the advantage and disadvantage of families 
 of different sizes are based on : 
 
 A. Mortality among the children. 
 
 B. The prevalence of different diseases among children of small and 
 large families. 
 
 C. Measurements of children at a given age. 
 
 D. The percentage of abnormally dull children in the different groups. 
 Conclusions drawn from infant mortality alone, as you show, would be 
 
 misleading. The conclusions generally favor three or four children, or 
 more, if the intervals between them are long. If you will look into the 
 matter you will find that infant mortality is generally figured on the basis 
 of total infant population. 
 
1020 EUGENICS 
 
 Eugenics. — J. W. B. writes: "I have heard mentioned several times 
 lately a new science coming into vogue called eugenics. What is it and 
 where can I read up on it?" 
 
 Keply. — Eugenics is the science having to do with the improvement 
 of the race through heredity. By negative eugenics is meant measures for 
 the prevention of reproduction by those whose children would certainly be 
 burdens on the community. By positive eugenics is meant all of those 
 measures that make for improvement in inheritance. Go to any library 
 or to any book store and ask to see the catalog of books and magazines 
 on eugenics. 
 
 Birthmarks. — L. H. P. writes: "If you do not believe a mother can 
 mark her child, how do you account for these cases, which I know to be 
 true? A neighbor s boy in leading a cow with a rope had one of his fingers 
 cut off between the rope and a tree. His mother saw the accident, and 
 when her baby was born it was minus the same finger on the same hand. 
 
 "My wife's aunt in going by some currant bushes reached through the 
 fence and picked some. A woman came out and shouted at her to stop. 
 In trying to get her hand out it caught between the pickets and she was 
 obliged to drop the currants. When her baby was born it had a perfect 
 bunch of currants on its arm in the same place where the mother s arm was 
 caught in the fence. This birthmark turns a bright red when currants 
 are ripe. At other times it is faint. 
 
 "My mother had a servant with red hair that made her a lot of trouble. 
 When my mother s baby was born he had red hair, and during his life was 
 a constant worry to my mother. No other red hair in the family that I 
 ever heard of. My mothers hair was black and my father s a dark brown. 
 I know of similar cases." 
 
 Reply. — You have not set forth all of the facts although you probably 
 stated all known to you. For example : How much red was there in your 
 father's dark brown hair? How about your grandparents? Your great- 
 grandparents? No one of the phenomena related could possibly be the 
 result of maternal impression. 
 
 Question of Physical Condition. — J. P. writes: "In a recent discussion 
 on the feasibility of first cousins marrying I found that it was considered 
 impracticable by most people present. Would the offspring be affected if 
 the physical condition of the parents was perfect? Under what conditions 
 could cousins marry without ill effect upon their children? Perhaps you 
 would rather refer me to some eugenics society or literature published on 
 the subject. I should like full information." 
 
 Reply. — 1. In order to decide whether first cousins should marry it is 
 necessary to find out, first, if the individuals are free from inheritable 
 conditions and, second, if the stock as far back as the great-grandparents 
 is free. If so, there is no reason why they should not marry if they live in a 
 state where the marriage of first cousins is allowed. 
 
 2. Write the Eugenics Laboratory, Cold Spring Harbor, L. I., New 
 York, for their blanks. Fill them out and return them with a request for 
 counsel. 
 
 No Bar to Marriage. — G. G. A. writes to ask about a marriage to be. 
 The young man is of average height, slender, healthy color, lives a clean, 
 temperate life, is full of energy and ambition and has a great love for 
 
EUGENICS 1021 
 
 work. He is 30 years of age. The woman is about 5 feet 7, well de- 
 veloped, has never been seriously ill in her life but is not the husky type. 
 She is eighteen months older than the man in question. Of late she has 
 heard a great deal about the kind of people one should marry to insure 
 healthy children. She is imbued with the idea because of something she 
 has read that she has no right to marry a man so entirely her opposite 
 physically and eighteen months younger than she. Also the fact that she 
 is of German parentage and he of a mixture of Welsh and Irish troubles 
 her. 
 
 Reply. — There is no reason why they should not marry. The difference 
 in age, the difference in nationality and what yon write of the difference in 
 their physiques are in no sense a bar. 
 
 Marriage of Cousins. — D. L. D. writes that she is engaged to marry her 
 cousin. He seems fond of her and she of him but she is doubtful and 
 wants to know what she shall do about it. 
 
 Reply. — I cannot answer your question without knowing more of the 
 facts. There are certain blood strains that are made stronger by inter- 
 marriage of members of the strain. There are certain conditions and 
 diseases which appear with more frequency and in worse forms in the 
 strain as a result of intermarriage. In addition to these last there are 
 a few conditions which tend to develop in the children of intermarriages, 
 even though there is no taint in the stock. I should suggest that you 
 write to Professor Davenport, Eugenics Laboratory, Cold Spring Harbor, 
 New York, giving your family history and that of your affianced, what 
 diseases they have had, what they have died of, the family traits — and 
 ask his advice. 
 
 Second Cousins May Marry. — J. G. writes: "Is there any danger in 
 the marriage of second cousins? Would their children be all right?" 
 
 Reply. — No. There are some families where the stock is so bad that 
 not even second cousins belonging to them should marry but such families 
 are few. 
 
 Intermarriage. — W. B. writes: "Is it a fact that intermarriage is 
 detrimental to the offspring?" 
 
 Reply. — Intermarriage may or may not be detrimental to the off- 
 spring. Every improved breed of stock has been inbred. Individuals with 
 points desirable in the offspring are inbred until those qualities are fixed. 
 A time comes, however, when outbreeding is necessary to save the stock. 
 On the other hand it has been proved that intermarriage brings about 
 imbecility, nervous instability, and a long train of undesirable conditions. 
 Mendelism teaches under what circumstances intermarriage is helpful and 
 under what detrimental to the offspring. Even when it is gainful it be- 
 comes harmful if persisted in for more than two or three generations. If 
 a stock has strength in it, intermarriage fixes it in the strain. If it has 
 insane or epileptics or cretins or a number of other undesirables in it 
 intermarriage fixes those qualities in the strain. 
 
 Blindness Not Inheritable. — Mrs. 0. B. writes: "A few days ago a lady 
 wrote the Tribune opposing the bill now before the legislature for a 
 colony for the blind. In this letter the lady said children bom to the 
 blind will be blind. Is this correct?" 
 
1022 EUGENICS 
 
 Reply. — No. The children of the blind are not especially liable to be 
 blind. The most frequent cause of blindness is infection of the eyes. An- 
 other group of causes is the general or systemic infections which affect the 
 eyes secondarily. The next most important cause is accidents and injuries. 
 Into these three groups fall nearly all cases of blindness. Such are not 
 inherited and not inheritable. 
 
 Weismann tried out this question thoroughly. He cut off the tails of 
 mice and bred the tailless individuals. He kept this up for thirty genera- 
 tions and found that no mouse was born tailless. 
 
 Blindness, the result of infection or accident, is on a par, from the 
 inheritance standpoint, with the Weismann bobtailed mice. The idea that 
 blindness is inherited is due to the number of blind babies. The infection 
 of the eyes which results in blindness is very apt to take place during birth 
 or shortly thereafter. 
 
 Such Marriage Forbidden. — J. H. W. writes: "1. Is it lawful for a 
 to marry her uncle? 2. What do you think of a marriage of this kind?" 
 
 Eeply. — 1. No. 
 
 2. Such a marriage should not be allowed. If there is insanity, feeble- 
 mindedness or viciousness in the stock it is apt to crop out in the progeny 
 of such a union. As in times past no particular effort has been made to 
 keep stocks pure or even to know what stocks are pure there is no way of 
 telling when such unions would be safe. In fact, such unions are practically 
 never safe. 
 
 Marriage of Double Relations. — H. writes: "Would you kindly tell me 
 whether there is any danger of weakness in the children horn of a couple 
 who are cousins? The girl I wish to marry is doubly related to me. She 
 is a cousin to me on my father s side and a second cousin on my mother s 
 side. Both her health and mine have been nothing but the best since our 
 birth. We have never been subject to any sickness, except the measles. I 
 am strong. Our morals are of the highest standard. Our ancestors, as far 
 as we can trace them, over 200 years, have been people of strong and healthy 
 mind and body and have been long lived. As far as- we know, none of our 
 ancestors ever died of any disease, but succumbed to old age, most of them 
 having attained 65 to 90 years. Do you think that there is danger that 
 the children who may be born to us will be weak mentally or physically 
 in any way?" 
 
 Reply. — There are states in which you could marry. In the family his- 
 tory submitted there is nothing noted that should prevent your marrying. 
 You are so closely kin that you had better search your family history for 
 inheritable bad traits and conditions. It is not enough that you and your 
 intended are free. Go back three generations. Write to the Eugenics 
 Laboratory, Cold Spring Harbor, New York, for blanks. Eill these out 
 and return to the laboratory. 
 
 Should Cousins Wed? — G. A. writes that he is anxious to marry his 
 first cousin. So far as can be learned her ancestors have never inter- 
 married. Good health is the rule. In fact, both cousins are of sturdy 
 stock. 
 
 Reply. — Irving Fisher says that by prohibiting improper marriages an- 
 cient Sparta raised its vitality to a high point of physical excellence. In 
 twenty states marriage of first cousins is illegal. Arner's "Consanguineous 
 
EUGENICS 1023 
 
 Marriage in the United States" discusses the subject excellently, according 
 to Fisher. 
 
 In a family tree there can be a few intermarriages without deteriorating 
 the stock. In fact, experimenters in Mendelism and expert breeders of 
 stock and plants habitually cause inbreeding as a means of fixing a type. 
 Where a prospective parent has an especially good point it can be em- 
 phasized by inbreeding in the offspring. But scientific breeders recognize 
 that while they are strengthening one quality they are weakening the sub- 
 stratum, and inbreeding, persisted in, undermines the whole structure. 
 
 The conclusion, which we believe justified, is that while inbreeding in 
 beasts controlled as it is by practical scientists is justified, inbreeding in 
 the human species where mating is the result of sentiment and impulse is 
 subjecting posterity to risks which are not justified. 
 
 Mendel Theory of Eugenics. — A. W. S. writes: "1. Please explain the 
 Mendel theory of eugenics. 2. What countries or states, if any, have passed 
 or are seriously agitating a eugenics law?" 
 
 Reply. — 1. The Mendel theory of inheritance relates both to good breed- 
 ing or eugenics, and to bad breeding. The Mendel theory is too long to be 
 given as an answer. To understand it get Castle's book or Drinkwater's 
 booklet. 
 
 2. In one way or another the subject is covered. 
 
 Eugenics Literature. — C. 0. J. writes: "Please give me a list of the 
 hooks and pamphlets mentioned in your first lectures on eugenics at the 
 Y. M. C. A. Any other important literature on hygiene and eugenics you 
 would like to recommend will be appreciated" 
 
 Eeply. — "Heredity in Relation to Eugenics," Davenport; "Studies 
 from the Eugenics Laboratory, Cold Spring Harbor, N. Y." ; "Problems in 
 Eugenics," from the Eugenics Laboratory, Cold Spring Harbor, N. Y. ; 
 "Heredity and Eugenics," Castle and others; "Race Regexieration" series; 
 "Heredity," Castle; "Eugenics Review," Eugenics Education Society; "The 
 Super Race," Nearing ; "The Task of Social Hygiene," Ellis. 
 
 Risk Four Cents. — A. B. writes: "In a recent answer to questioners you 
 said: 'Write to the Eugenics Laboratory, Cold Spring Harbor, N. Y ., for 
 blanks. Fill these out and return to the laboratory.' Am I to understand 
 from this that anyone can thus secure aid in looking up ancestors? Is it 
 done free of charge for anyone?" 
 
 Reply. — In looking up ancestors, no. In safeguarding descendants, 
 yes within reasonable limits. Risk 4 cents in postage in finding out just 
 what they will do for you. 
 
 Advice on Eugenics. — K. K. writes: "At what institution can one find 
 out as to whether he or she is fitted mentally to marry?" 
 
 Reply. — Eugenics Laboratory, Cold Spring Harbor, Long Island, N. Y. 
 
 Book on Eugenics. — Inquirer writes: "What book would you recommend 
 on eugenics (from a physical standpoint)? Where can it be procured? 
 Can Slemons' 'Prospective Mother be bought in any large book store?" 
 
 Reply. — Davenport's "Heredity in Relation to Eugenics." Your book- 
 seller probably will not have Slemons in stock. He can call up his jobber 
 by telephone and get Slemons and Davenport. 
 
1024 EUGENICS 
 
 Mentality of Twins. — R. A. B. writes: "I read an article some time since 
 on the effect the heaVth or the mind of one twin has on the other twin. 
 For example, if one were happy, the other, though miles away, would be 
 likewise, or vice versa. If this is true, what effect would the mind of a 
 twin who has been made feeble-minded by an overdose of a drug have 
 upon the other twin? Or is the article I read all nonsense?" 
 
 Reply. — It is nonsense. Twins are liable to be of the same general type 
 of mind, and, therefore, are disposed to be alike in taking things seriously 
 or lightly or in some other general quality. However, there are many ex- 
 ceptions. Two ova from the same mother stimulated by two cells from the 
 same father, the two cells resulting in two children developing simultane- 
 ously, are liable to result in children much alike mentally. According to 
 Mendel's teaching the children may be very dissimilar mentally. Why 
 not get a copy of the report on the "Heredity of Feeble-mindedness" from 
 the Eugenics Laboratory, Cold Spring Harbor, Long Island, N. Y. ? It 
 sells for 4 cents. 
 
 Reason for Birthmarks. — 8. K. writes: "1. If birthmarks are not 
 caused by impressions of the mother, what is the cause? 2. Why is ergot 
 given in postpartum cases to prevent hemorrhage? I cannot understand 
 how the same drug is used in almost opposite ways. 3. Are there any par- 
 ticular reasons why a person who has nightmare should not marry? Could 
 such a thing be hereditary?" 
 
 Reply. — 1. Birthmarks are of so many different kinds that it would take 
 a good many columns to refer to each. Each has its reason for being. I 
 can discuss but one in the limits of this reply — strawberry marks. The 
 area just below the skin is rich in blood vessels. When, in a given patch, 
 the blood vessels are larger than in the surrounding skin, the area shows as 
 a strawberry mark. As the child develops the size of the vessels in the skin 
 is large as compared with their size after the skin upbuilding has come to 
 a rest. The need for blood in the skin, the size of the blood vessels, lessens 
 relatively. In a strawberry area this diminution does not take place. Na- 
 ture leaves a bit of scaffold behind. The reason may be a local injury or 
 hurt or infection. The mind of the mother is not hooked up in any way 
 with the capillaries in the skin of the baby. 
 
 2. Ergot contracts smooth or involuntary muscle fibers. The blood 
 vessels contain such fibers — therefore ergot contracts them, makes them 
 smaller, stops hemorrhage. The uterus is composed of smooth or invol- 
 untary muscle. Ergot stimulates this muscle to contract. The contracting 
 muscle squeezes the blood vessels and collapses them. This action is of 
 importance in stopping uterine hemorrhage. It is pretty well agreed that 
 ergot is just about powerless to bring about abortion. 
 
 3. No, but if the supposed nightmare is really epilepsy the person 
 should not marry. 
 
 Fright and Birthmarks. — L. writes : "I must take issue with you on the 
 question of birthmarks. I know of a young wife who was called on by a 
 one-armed fish peddler. Without thought he thrust the stump of his arm 
 almost into her face. It gave her a shock.' A few months later she gave 
 birth to a fine girl baby with no hand on one of the arms. It was as if the 
 hand had been amputated. I have imagined that your positive stand re- 
 garding birthmarks might be taken in order to free expectant mothers 
 
EUGENICS 1025 
 
 from apprehension. I did not think it could represent your actual opinion 
 in the matter." 
 
 Eeply. — After the first third of pregnancy is passed the arm of the de- 
 veloping child is just as definitely developed as it is in an adult. It would 
 be just as easy for a woman to think her own hand off as to think off the 
 hand of her baby. The cord got caught around the hand and strangled it off 
 or the child was injured in the arm region while carried by the mother. 
 Why go snooping around looking for mystery in connection with a case 
 like this since when the facts are known the explanation of them is as 
 simple as the ringing of a bell when the button is pushed? 
 
 Deafmutism Inheritable. — B. L. D. writes: "Kindly enlighten me as 
 to why, as a rule, as far as my observations have been, the children of 
 married first cousins are bom deaf and dumb? Is it due to some physical 
 cause through the mating of first cousins?" 
 
 Reply. — Deafmutism is inheritable. Intermarriage where there is 
 mutism in the stock is liable to result in a certain proportion of the chil- 
 dren being deaf-mutes. By "in the stock" is meant all the descendants of 
 one's great-grandparents. Back of that is not of much consequence. 
 Deafness coming on after middle life is in a smaller degree an inheritable 
 quality. 
 
 The Yolta Bureau, Thirty-fifth and Volta Place, Washington, D. C., 
 would be glad to have an accurate statement of the inheritance phenomena 
 of deafmutism noted by you. Davenport's book gives the laws of in- 
 heritance of deafmutism. 
 
 Eugenics No Fad. — I. writes: "Is this talk of eugenics merely a fad, 
 or is it something which is really sane, serious, and necessary? Where 
 does one secure the certificates for a eugenic marriage?" 
 
 Reply. — No, eugenics is not a fad. It is sane, serious and necessary. 
 The marriage laws differ in different states. The Wisconsin law, commonly 
 referred to as a eugenics law, has just been upheld by the Supreme Court 
 of that state. 
 
 It will be some time before it will be certain just what should be the 
 requirements of a eugenic marriage. Let me suggest that you get a copy 
 of the blank required in Wisconsin and have any reputable physician ex- 
 amine you as required by that blank. 
 
 Books on Eugenics. — N. A. W. writes: "Where can I secure a copy of 
 Davenports 'Eugenics, Twelve University Lectures/ or other writings 
 relating to marriage? Can a person obtain any information by addressing 
 the Eugenics Record, Cold Spring Harbor, N. Y .? What is meant by 
 gonococcal infection?" 
 
 Reply. — 1. Your bookseller will get them for you. "Twelve University 
 Lectures" is published by Dodd, Mead & Co.; "Heredity in Relation to 
 Eugenics," by Davenport, is published by Henry Holt & Co. 
 
 2. Yes. If you want to know about marriage it will send you blanks 
 to fill in. 
 
 3. Infection with gonococcus, the germ which ordinarily causes gonor- 
 rhea. 
 
CHAPTEE LV 
 
 Massage 
 
 MASSAGE A CURATIVE AID 
 
 Hospitals and dispensaries usually stop when they do as much as 
 medical care and nursing can accomplish. The rule is to carry the patient 
 to the point where convalescence is established and then to dump him out 
 of his bed to make room for another case. Incidentally he must work his 
 way back to a condition to earn his living the best he can. 
 
 Usually he succeeds admirably and 
 then everybody is happy. Sometimes there 
 is nowhere any reserve to carry him back 
 to strength and then he drifts back to the 
 hospital or to something worse. 
 
 A few years ago a New Englander, a 
 crusader born and bred, Cabot by name, 
 began to preach the gospel of a broader care 
 of the sick. According to his doctrine to 
 care for a man sick of disease was not 
 enough. The man must be taken into ac- 
 count before the disease and then the man 
 left by the disease must be cared for and 
 trained back into efficiency. The cure was 
 not completed until the man's muscles 
 were hard, his wind good and his physical 
 machine pulling together. This required 
 the services of physicians, nurses, social 
 workers, masseurs and physical trainers. 
 He succeeded in getting the Massachusetts 
 General Hospital to put most of the plan 
 in operation. Since then most of the better 
 regulated hospitals have felt the influence 
 of Cabot. 
 About three years ago a Jewish hospital in New York City fitted its dis- 
 pensary to give massage, mechanotherapy and muscle exercise to patients 
 referred to it from other departments of the hospital. One of the fields 
 which it has worked on especially is to cure up fracture cases so that they 
 could work efficiently. 
 
 In the old days it was the custom to amputate badly broken, badly 
 torn or badly infected limbs. One-limbed people were plentiful. 
 
 The practice was bad but treatment was so poor that it was better to 
 lose one's limb than to lose one's life. 
 
 1026 
 
 Fig. 414. — Exercise Bars to be At- 
 tached to Window. 
 
MASSAGE A CUEATIVE AID 
 
 1027 
 
 Now treatment is so much better that in spite of the greatly increased 
 hazards of our heavy machinery one-limbed people among the younger men 
 are rarely seen. Every year will see the number grow less. 
 
 A few years ago our methods 
 
 of handling fractures were so crude 
 that if we could get the bones to 
 knit together everybody was satis- 
 fied. If the limb was somewhat 
 crooked or if the adjacent joints 
 were a little stiff it was thought to 
 be inevitable. Ofttimes we had to 
 be satisfied with a false joint — the 
 bones would not knit. 
 
 Now a failure to knit is inex- 
 cusable except where the fracture 
 is of the hip within the capsule. 
 
 The next step will be for the 
 surgeons to operate promptly on 
 those hip fractures (intra-capsu- 
 lar), nailing the fragments to- 
 gether. When such' fractures are 
 treated by operation the day of old 
 ununited intracapsular fractures 
 will be over. 
 
 So far as the other fractures 
 are concerned they are now expected to heal in such a way as to leave the 
 limb strong and the joints just as pliable as before. 
 
 To bring about this last result several procedures have contributed. The 
 first is the use of the X-ray. When a bone is thought to be broken the X-rays 
 
 Fig. 415. — Door Exercising Bar. 
 
 Fig. 416. — Exercise for all Muscles, Especially for Leg and Shoulder Muscles. 
 
 show the location and the nature of the break. When the fracture is reduced 
 so that everything is in the right place and no tendons or nerves are caught 
 between the fractured ends are not guessed at but are demonstrated with 
 X-rays. Then, when, during the course of the recovery, it is thought neces- 
 sary the X-rays show just how things are. 
 
 The next procedure that is contributing to the better result is the use 
 of massage and exercise of the limb. Mr. Eumely tells us of two men with 
 broken legs whom he saw treated in a German hospital. One, a professional 
 
1028 MASSAGE 
 
 man, was told that he could have his leg put up in an ambulatory splint and 
 that he could come and go as he pleased. He could get the advantage of 
 sun, air and exercise. 
 
 The other was insured under the government insurance. He would have 
 none of the ambulatory splint. He was entitled to his month of rest in 
 bed and he would have it. He never had heard of a man with a broken 
 leg walking around the street. The man who had more care and what he 
 regarded as better treatment got the worse result. 
 
 Thirty years ago a Frenchman, Champonniere, said he thought broken 
 bones should be massaged from the beginning but the idea was too radical 
 for that day and, besides, it was quite risky before the days of X-rays. 
 
 One department of the Mount Sinai Hospital gives massage just as soon 
 as it seems good judgment. The nearer the fracture is to a joint the quicker it 
 must be begun, because a stiff joint following a fracture is no longer held 
 allowable. Those stiff jointed people are always at a disadvantage and must 
 not be tolerated among this race so near to the super-race. 
 
 A frequent fracture is Colics' fracture, a fracture of both bones of the 
 forearm just above the wrist, the fracture one gets in cranking an automobile 
 or falling on the ice. 
 
 When these fractures were put up in splints and massage started in the 
 first week it was found that the arm was cured in twelve to twenty days. 
 When massage was begun in the second week cure took three or four weeks. 
 
 When massage was begun in the third and fourth week cure took six 
 weeks. When the massage was postponed longer than four weeks the cure took 
 six to twelve weeks and longer. 
 
 In fractures through the elbow the same general results held true. If 
 the massage was begun before the week was out the cure was effected in 
 three to four weeks. 
 
 In the case of fracture of a long bone as, for instance, the thigh bone, 
 inches away from a joint, it is safe to hold the bone steady for two weeks 
 before beginning massage. 
 
 The massage indicated is a gentle rubbing pressure. The part to be 
 massaged is to be well greased with vaselin, steadied with one hand and the 
 pressure gently applied with the other. 
 
 Wolf in his report advises us to be guided by pain. Do not cause pain; 
 for if you cause no pain you can be certain that no harm is being done. 
 
 Not only should the effort be to prevent the joint from becoming stiff 
 but the muscles must not be allowed to shrink. 
 
 Therefore, toward the end of the treatment, say after the third week, the 
 massage may be of the kind ordinarily called massage. Instead of a gentle 
 rubbing of the skin it may be the usual pinching and digging effort to 
 stimulate nutrition in the muscles. 
 
 However fractures cause but a small part of the crippling one sees. 
 There are joints stiffened and gnarled by rheumatism, gout, rheumatoid 
 arthritis, and by gonococcal infections. 
 
 There are also flabby and weakened muscles. They may result from 
 infantile paralysis, locomotor ataxia and other forms of paralysis and disuse. 
 These conditions distort the human machinery, getting it out of balance. 
 
 "I am all crippled up with rheumatism/' is an expression as familiar as 
 
MASSAGE A CURATIVE AID 
 
 1029 
 
 a household word. Why are you so? The reason is to be found usually in 
 the fact that you have not completed the treatment. 
 
 A man comes down with rheumatism: he sends for a physician; the 
 physician prescribes for him and he gets better. His pain subsides and he 
 goes back to work. 
 
 That is not enough. The use of the salicylates will relieve the pain all 
 right; they make work more bearable: they may limit the damage which the 
 infection otherwise would have done but they do not effect a cure. 
 
 
 V 
 
 Fig. 417. — Exercise for All Muscles, Especially for Muscles of Abdominal Wall. 
 
 In acute rheumatism the joint is infected. The germ which causes the 
 rheumatism gets into the blood stream through some part of the body such 
 as the tonsils. 
 
 In the treatment of the disease, then, regard should be had not only 
 for the relief of pain but for rinding the port of entry of the germ which 
 causes it and putting and keeping it in order. 
 
 Rheumatism, though, does more than cause pain. Being an infection 
 it may be of sufficient degree to cause the bones of the joint to grow together 
 resulting in stiffness. If it does not reach this degree of damage it causes 
 injury to delicate and important structures of the joint. 
 
 As the result of the injury there may be a creaking, popping sound 
 besides more or less pain when using the joint in after years. 
 
 Treatment of rheumatism then should have in view not only relief of 
 pai?i and the control of the gateway of infection but the correction of damage 
 done to structures that have suffered from the rheumatic attack. 
 
 This can be done in two ways : by treatment directed to the care of the 
 joints proper and by treatment having regard for the care and protection of 
 the soft parts involved such as muscles and the various organs of the body — 
 heart, kidneys, and the like. 
 
 For the relief of the pain of rheumatism the salicylates and vaccine 
 
1030 
 
 MASSAGE 
 
 are our chief remedies. Vaccines have approached perfection so closely that 
 they are being used quite generally at the present time* 
 
 A much more important phase of the treatment of rheumatism consists 
 of efforts looking to the prevention of stiffness of the joints, or, if stiffness 
 has occurred, looking to the correction of it. This can be largely done by 
 massage and exercise. 
 
 People who have stiff joints resulting from rheumatism and arthritis 
 should be encouraged to practice passive use until they can be brought into 
 
 Fig. 418. — Mild Exercise for Trunk and Leg Muscles. 
 
 active service. Massage greatly helps to restore functions and hasten absorp- 
 tion and elimination of diseased products which have been left in the wake 
 of rheumatism. It not only does this but it gives tone to the muscles, thereby 
 creating a more normal balance between the joints and muscles and insuring 
 a more harmonious working of the human machine. 
 
 Where it is desired to employ exercise for the restoration of the function 
 of an arm, a hand or a limb a well defined plan of exercise procedure should 
 be followed. The exercise treatment of one extremity or joint does not mate- 
 rially differ from that to be employed in treating another. 
 
 For this reason when a plan or system of exercises has been worked 
 out and carefully followed for a short time it becomes less irksome to execute 
 each succeeding time. 
 
 When doing exercise one should do his test to accomplish something. 
 Each succeeding attempt should have in view the accomplishment of just a 
 little more good. 
 
 Where a hand or wrist, for instance, is crippled as the result of arthritis 
 effort should be made each day to make it a little more useful. Try to move 
 each finger just a trifle more each day. Use gripping exercises and note 
 the increased strength and mobility. 
 
 In the beginning these* efforts will present many discouragements but 
 by persistent application and effort better use of the part affected will be your 
 ultimate reward. 
 
 Since the germ theory of the cause of rheumatism and arthritis has been 
 
MASSAGE A CUKATIVE AID 1031 
 
 advanced many people have got the notion that mineral springs have lost their 
 usefulness in the treatment of this disease. 
 
 This is not so. Mineral springs are most valuable auxiliaries in the treat- 
 ment, especially in the chronic stage. Nothing more greatly assists in ridding 
 the body of poisons and increasing its resistance. 
 
 In locomotor ataxia, where the muscles have become flabby and weakened 
 from lack of nourishment and disuse, much good has resulted from the sys- 
 tematic employment of massage and scientifically planned exercise in efforts 
 to restore muscular function. 
 
 By this means muscles that have been wasting away have been made strong 
 and brought under such control of the mind that it is difficult to identify 
 those afflicted with this disease. 
 
 In other words where formerly the sufferer acted automatically he now 
 acts mechanically but on account of his persistent training he has been able 
 to establish a walking gait and such control over his arm movements that it 
 is difficult to distinguish him from the normal. 
 
 What has been done for a man suffering from locomotor ataxia can also 
 be done for those suffering from rheumatism and a tendency to arthritis if 
 the treatment is begun early enough. Even where the deformities are pro- 
 nounced and no efforts at correction have been made for a period of years, 
 one is not justified in a lack of effort at correction along the lines outlined. 
 
CHAPTER LVI 
 
 Exercise 
 
 Professor Schock of Munich tells us that we must exercise on all fours. 
 We are descended from four-footed animals. Our veins, our stomachs, and 
 various other organs have not fully adjusted themselves to the upright posture. 
 Therefore, back to the four-footed at least for an hour or two each day. Be it 
 curvature of the spine or stomach trouble or biliousness — back to the four- 
 footed. 
 
 breast bone 
 
 cervical vertebrae 
 clavicle or collar bone 
 
 elbow 
 
 innominate or hip bone 
 
 ulna 
 
 radius 
 
 pelvis 
 
 femur 
 
 knee cap 
 
 tibia 
 fibula 
 
 bones of metatarsus^! 
 phalanges of toes J 00 
 
 Fig. 419. — The Skeleton. 
 1032 
 
EXERCISE 
 
 1033 
 
 Fig. 420. — Upper Surface of Left Clavicle or Collar Bone. 
 
 The advice may be good under rare circumstances. Some lazy, lolling 
 folks will be improved by anything that takes them out of easy chairs. Gen- 
 erally speaking, the plan will do more harm than good. Why? 
 
 Much the most bendable part of the spinal column, except the neck, is 
 that in the small of the back — the lumbar region. The little cartilages 
 between the vertebrae permit of a good deal of sway. Whenever the lumbar 
 part of the column 
 sways forward the dor- 
 sal or chest part of the 
 column arches back. In- 
 crease the forward curve 
 of the abdomen and 
 there always follows 
 some increase in the 
 
 backward curve of the chest. When this is bad it is called humpback. 
 But the trouble does not stop with the back. As the chest column arches 
 back the ribs shape the chest narrow and deep. Whereupon the shoulders slide 
 forward — the condition is stoop shoulders. The shoulder blades flare out — 
 winged scapula. The forward gliding shoulders make the chest cave in in 
 front — hollow chest. These conditions make for consumption, anemia, and 
 low vitality. 
 
 Dr. Wiener of Chicago pursues a plan just the oppo- 
 site of that of Schock. He makes his subjects lie on their 
 abdomens on a hard surface. He then makes violent trac- 
 tion on the head backward and on the shoulders back- 
 ward, at the same time pressing hard on the back of the 
 spinal column in the chest region. Thus he lessens the 
 chest curve and at the same time indirectly he straightens 
 the lumbar curve. The ribs flatten out. 
 
 Woods Hutchinson and M. G. McHugh found out a 
 long time ago that consumptives had narrow chests. These 
 Wiener movements broaden the chest, throw the shoulder 
 blades back, move the shoulders around back of the vertical 
 line and banish the hollows above and below the collar 
 bone. In time the chest takes on a shape midway between 
 the hollow chest and the bantam type. 
 
 Other exercises consist in lying on the back and 
 bending the head back over the edge of the table and 
 carrying the arms over the edge of the narrow table. 
 The idea is to throw the chest up by dragging the arms 
 down. 
 
 Another exercise consists in having the patient lie 
 with the face down on the table but with all the upper 
 part of the body projecting over the end of the table. 
 The operator supports the patient by the arms. The arms are drawn up as 
 far as possible and the head is bent as far as possible toward the floor. 
 
 The purpose of these various exercises is to straighten the spinal curves, 
 to slide the shoulders bach and to eliminate the hollows about the collar 
 bone. 
 
 Fig. 421.— Fibula, 
 Lower Leg, Tied 
 in a Knot, After 
 Maceration in a 
 Dilute Acid. 
 From a specimen 
 preserved in spirit. 
 (Dalton.) 
 
1034 EXERCISE 
 
 The man who spends his days at sedentary work accumulates fat in some 
 inconvenient localities, converts his muscles into structures of low efficiency 
 and loses his wind. While he is better oif for the day's work with poor 
 muscles than with good ones he should keep them as high as a certain base 
 line. 
 
 There is no reason in having a big-muscled man do brain work or in a 
 
 Fig. 422. — Left Scapula, or Shoulder Blade. 
 
 brain working man having monster muscles. Such a combination is a waste, 
 and eventually harms the person in whom the combination exists. 
 
 On the other hand a man who keeps himself physically fit gains in effi- 
 ciency and in his ability to fight disease. 
 
 A walk for a mile or more in the morning and again in the evening, 
 kept up for a few weeks, will put the average person in pretty good shape. 
 Begin the exercise with a small dose and gradually increase it. The 
 exercise should be active enough to fill the skin vessels with blood and to 
 bring about a profuse perspiration. The perspiration of itself does no 
 good. 
 
 Sweat carries off practically none of the body waste. It is composed of 
 
LEAEX HOW TO WALK 
 
 1035 
 
 water and salt and little besides. The common idea about sweating out poisons 
 has very little of truth in it. But to fill the vessels of the skin with blood 
 does wash the waste out of the tissues back to those internal organs capable of 
 burning them up. That's where the good 
 comes in. 
 
 The amount of exercise taken should be so 
 gradually increased that no stiffness and soreness 
 is produced. Bear this in mind : stiffness and 
 soreness are signs that mean the thing has been 
 overdosed. In time an ordinary dose of overdoing 
 will be recovered from, at least so far as the pain 
 and soreness is concerned, but a record of it is 
 made on the arteries. 
 
 If overdoing is persisted in. it may finally end 
 up in arteriosclerosis, high blood pressure or some 
 other disease of the worn out group. Some people 
 will find it better to train for the vacation by 
 swimming once or- twice each day, others by climb- 
 ing stairs. 
 
 If one's office is on the fourteenth floor let 
 him get off at the tenth floor and walk up. In 
 the afternoon let him walk down to the tenth 
 floor and take the elevator there. Two days later 
 let him make the eighth floor the end of his ride 
 and so on until he climbs the fourteen flights with- 
 out panting or soreness coming after. Whatever 
 method is the most convenient let him follow it 
 until he has some wind. When he lands at the 
 resort chosen the impulse will be to try every 
 stunt the first day. 
 
 The gypsy in him is calling. The memories 
 of his youth in the woods and fields, the recollec- 
 tions of the old swimming hole, of fishing in the 
 creek, of hunting with the old muzzle loader; all 
 these are calling. Besentment at days spent cooped 
 up, jailed — this is driving. The man feels an 
 almost irresistible impulse to do it all at once. 
 He overdoes. In consequence he is again cooped 
 
 up with stiff -joints, sore muscles, aching feet, or 
 
 r , x i t i ix Fig. 423.— Right Femur, 
 
 sunburnt back — days are lost. Thigh Bone 
 
 LEARN HOW TO WALK 
 
 Physiological laboratories and even the well organized boards of educa- 
 tion equip themselves with an instrument called an ergograph. This little 
 instrument accurately records the power and rhythm of muscle movements. 
 Making use of it, we have learned many things about muscles that the ath- 
 
1036 EXEECISE 
 
 letes had suggested in a crude, dogmatic way as the result of their ex- 
 periences. 
 
 We know much about fatigue, its causes, its effects, the differences in the 
 rate of its development according as muscles work within easy limits or under 
 some stress. I have never seen any ergograph testing of the leg and foot muscles 
 to discover the extra strain of "walking wrong" as compared with "walking 
 right." But there is a lot of curbstone opinion that the man who "walks 
 wrong" may "get there just the same" but he is more tired than the other 
 fellow when he does. I am sure the ergograph would confirm this curbstone 
 opinion. 
 
 The ankle joint can only move backwards and forwards. The little lateral 
 play in the foot is between the bones of the foot itself. The muscles of the leg, 
 upper and lower, are so placed as to move the foot forward or back — toward 
 the toes or toward the heels. When in walking the foot is carried forward, 
 slewed out, the muscles waste some of their power pulling against their tendon 
 sheaths. From the mechanical standpoint, the toes should point straight 
 forward or a little in — a very little pigeon toe is a good arrangement. 
 
 When the body is still plastic it is good judgment to. spend some effort 
 in learning how to walk rightly. Why should the mother stop her teaching 
 when the baby learns to walk? Most children under the school age point 
 their feet about right. The turning to one side or the other is noticeable 
 in the mid-school years. 
 
 Possibly the knee breeches age shows up a degree of deformity which 
 may pass unnoticed when the clothes are worn longer. If this is true the 
 trouble may be progressive from shoe time on. At any rate, in those years 
 the body is changing so much that with proper care a tendency to toe out or 
 toe in can be corrected. 
 
 Under efforts made to correct the bones will shape themselves just a wee 
 bit differently, the tendon sheaths will move a fraction of an inch forward 
 or back, the muscles will change their location a bit, the body will readjust its 
 automatic balancing apparatus a little differently; whereupon the leg muscles 
 will be able to work at higher efficiency and with less tire. 
 
 The first step in the training to cure toeing out will be to teach the child 
 to stand with the heels apart. When standing in this way the toes are natur- 
 ally disposed to turn conversely. When the child is pigeon-toed, to stand 
 with the heels together will throw the toes out. 
 
 ATHLETIC GAMES 
 
 From the physical standpoint, handball is the kingpin. In it the eye must 
 see, the brain must judge, and the muscles must move with lightning rapidity. 
 In fact, as Congressman MacKenzie of Kentucky once said: "In comparison, 
 the lightning is a puling paralytic." 
 
 Handball is the exercise of the fit. When a man is fit enough to play 
 handball he is in such good physical condition that he does not need to play it. 
 
 Tennis is an expurgated handball. It is also a game for the fit but 
 the same degree of fitness is not required. By beginning with a slow com- 
 petitor, a man or woman with a soft heart muscle, in fact one who is generally 
 
ATHLETIC GAMES 
 
 1037 
 
 soft, can stand the pace. In tennis, the eye, the brain, the muscles are not 
 compelled to act with the lightning rapidity of handball; nevertheless they 
 must move much faster than in golf. It is the best of all exercises for men 
 
 Articulated with radius 
 forming wrist joint. 
 
 Carpus 
 
 Metacarpus 
 
 Fig. 424. — Bones of the Left Hand Palmar Surface. 
 
 and women with low blood pressures, no thickening of the arteries, good heart 
 muscles and no special superfluity of fat. 
 
 Why baseball should have such a grip on boys does not appear at first 
 glance. It comes pretty near being a game for men of an age in between that 
 of tennis and golf. What spoils it for older men is that 90-foot top speed 
 run — a run occasionally stretching to 360 feet. That run takes wind and, 
 therefore, baseball is a game for boys. 
 
1038 EXERCISE 
 
 Of all games it has the center of the American stage. It takes hundreds 
 of thousands of people out of doors and gives them an afternoon of fresh 
 air and sunlight; but more than that, it makes millions of boys exercise in 
 the open air during all the months of the late spring and early summer. 
 It is a great health department. 
 
 What has made it so is the fact that it is our great spectacle. The 
 spectator who goes wild over the game, the hero worshiper who pedestals the 
 players, the sporting extras, and the pink sheets — these are factors which fill 
 every vacant lot with "kids" playing baseball. 
 
 And, in that it makes every boy want to play, want to own a mask 
 and "mitt," the game is worth all that it costs. In fact, it is cheap at the price. 
 
 PLAYING GOLF 
 
 Golf brings out of doors exercise within the reach of men whose hearts 
 are enveloped in a good deal of fat and whose artery walls are pretty thick. On 
 the one hand, this group of people could not play tennis, handball, or lacrosse. 
 The exercise is too intense. On the other, they will not botanize because 
 it has no competitive features — is not intense enough. They need fresh, clean 
 air and the smell of grass. They need long walks. 
 
 They need just that momentary allover muscle tension of driving, the 
 unrestrained muscle action of putting, and the community muscle action of 
 holing. They need to tighten the play strings that they may loosen the 
 business strings — for all the strings cannot be slack at the same time. They 
 are not built that way — the keyboard would fall to pieces. 
 
 When a man has reached forty years of age without having educated 
 certain groups of muscles to work together for a drive or putt he can never 
 teach them the tricks so well as a young man can train his. But let us not 
 miss the spirit of it. Golf is a means to an end and competition is incidental. 
 As a means of keeping men and women able to yoork at a high degree of effi- 
 ciency during the forties, fifties, sixties and sometimes the seventies it has 
 no equal. 
 
 PLAYING BILLIARDS 
 
 A cable is made up of wire through which the electric current passes, 
 insulation to prevent the current from leaking out and wrapping to give 
 strength and protection to the parts within. 
 
 When a baby starts to kick its foot it kicks with the whole works from 
 "stem to gudgeon." When a baby starts to wiggle its toe it makes it 
 unanimous — it wiggles all over. 
 
 The reason — a baby's nerves have no insulation. When its brain cell 
 sends out word to move a toe the impulse spreads over everything, like 
 water over a levee. The impulse not only moves the toe but it moves a score 
 of muscles uselessly. 
 
 As time goes on its nerves are wrapped in insulation and as they be- 
 come so wasted motion is decreased. After a while the brain can send out 
 an impulse to move a single joint, the impulse travels straight to its appointed 
 place and no energy is lost. 
 
PLAYING BILLIARDS 
 
 1039 
 
 All this is education — education for efficiency. 
 
 The billiard player has developed to its highest degree this capacity to 
 move just the right muscles and no others. His eye sizes up a situation, its 
 mathematics, its physics. His judgment weighs one stroke against another. 
 A line of procedure is determined upon. 
 
 :^"Tfr> ; 
 
 Trochlea 
 Fig. 425. — Left Humerus. 
 
 Artie, with semilunar and 
 Radial head scaphoid of carpus. 
 
 Fig. 426. — Left Radius and Ulna, or Bones of the Forearm. 
 
 The telegrams are sent out from his brain to the different muscles. Each 
 is given just its work to do — no more, no less; each is told just when to do 
 its work — no sooner, no later. The action is loosed. 
 
 Upon the judgment the muscle sense, the touch sense, the cooperation, 
 the coordination, the insulation, the work together, the control depend 
 whether the shot wins or loses. 
 
1040 
 
 EXERCISE 
 
 Some have said the measure of civilization is control— that society 
 succeeds if government controls and if men have self-control. Assuming this 
 to be true, governmental control, self-control, brain control, muscle control, 
 are a part of the same scheme. 
 
 It is a very poor view of health work that does not include work for a good 
 physical development, a well controlled mind and body. In this broader view 
 billiard playing has its health relations. 
 
 Billiard halls are usually badly ventilated. Many prominent billiard 
 players have died of consumption. There could be no better monument to 
 Schaefer and Ives than a solution of the problem of ventilation of billiard 
 halls. 
 
 ARCHERY 
 
 Women write to me: "How shall I get rid of pimples?" The answer 
 is to "get fit." A prize fighter who is pimply never wins. Women write to 
 
 3 2 
 
 Fig. 427. — Thorax, Anterior 
 (Sappey.) 
 
 View. 
 
 Fig. 428. — Thorax, Posterior View. 
 (Sappey.) 
 
 me : "How shall I prevent wrinkles f The answer is to develop the muscles. 
 The muscles of the skin are a part of the same muscle system as those of 
 the arms. 
 
 Women can play any games except football. They should swim and row, 
 play tennis and golf — but none of these gives them any better field than 
 archery. 
 
 The training gained in archery is similar to billiards, with the added 
 advantage of being an out-of-doors diversion. In archery the eye must be 
 trained to find a point of aim, which is often a small leaf on a tree sixty 
 yards away. The muscles must be under such control that the arrow is not 
 loosed too soon or too late and, if the arrow is to go right, muscle sense, 
 muscle control and muscle cooperation are all made use of. 
 
 Says Miss Leigh in Badminton: "Nevertheless, archery has advantages 
 
SWIMMING 1041 
 
 over many amusements which renders it specially suitable for ladies. No 
 hurried movements or violent exertion, no ungraceful attitudes or contortions 
 are necessary; it need never be anything but quiet, graceful, and ladylike. 
 And also, there is no restriction as to age — young, middle-aged, and old can all 
 shoot in some form or other if they have bows suited to their strength. For 
 delicate or growing girls it is a most healthy exercise, taking them out into 
 the fresh air; they must hold themselves upright, and their chests are ex- 
 panded in drawing up. It is a gentle and elegant amusement for young 
 ladies, and most suitable for the matron who feels it undignified to take 
 part in some outdoor games and yet is quite young enough to enjoy them." 
 
 Archery develops and strengthens the muscles of the arms and wrists as 
 well as those of the abdomen. Walking to and from the target and bending 
 to pick up the arrows that fall on the ground all bring into play other muscles, 
 especially those of the legs. 
 
 SWIMMING 
 
 The human animal is somewhat up against it for exercise in hot weather. 
 He knows every muscular contraction means more heat and already getting 
 rid of heat is a question. Furthermore, the more muscle work the more 
 tissue used up and, therefore, the more food required. But the more food 
 eaten, the more heat made. What can be done about it ? 
 
 Theoretically, he knows he should exercise in the cold but how is that 
 to be done? Why, swimming of course. The answer is plain and there is no 
 other this side of the line of perpetual snow. 
 
 ^Yhen swimming the muscles are working hard, squeezing out waste, 
 pumping in new nourishment — processes good for the muscles, for every other 
 life process within the body — therefore highly desirable. 
 
 But these muscle movements make a great excess of heat. If they are 
 made in hot air it is difficult to get rid of this heat. On the other hand, 
 when made by swimming the excess heat is easily got rid of. The temperature 
 of water is 50° to 70°. Water is a better conductor than air; bathing suits 
 are lightweight ; swimming fills the bill. 
 
 Swimming teaches proficiency in an art which may be a life-saver. It 
 gives an opportunity for plenty of muscle exercise without danger of over- 
 heating. It gives opportunity for the stimulus of cold applied to the skin — 
 good in summer as well as winter. Therefore, every community should 
 see that its people have ample swimming facilities, for such facilities are just 
 as necessary to high grade health and first class physical efficiency as garbage 
 disposal, and much more necessary than an excess of paving. 
 
 And yet what town pays any attention to its swimming hole ? If a village 
 boy wants to go in the creek he must undress and dress on a muddy bank, 
 swim in sewage pollution and then go home to take his chance of a licking. 
 
 One of the men rescued from the Titanic who was in the water for several 
 hours gave it as his opinion that any man who could have kept a level head 
 should have been able to keep afloat until the rescuers arrived. This man's 
 opinion was right in part, although he apparently overlooked the fact that the 
 average man cannot make heat enough to keep alive when submerged up to his 
 chin for several hours in freezing water. 
 
1042 EXEKCISE 
 
 EXERCISES FOR CONVALESCENTS 
 
 Around any hospital one can see men and women feebly walking along 
 the street. Many of them are convalescents leaving the hospitals for their 
 homes and boarding-houses. In a certain sense they are well. Their dis- 
 ease is cured, their operation wounds have healed and they have been 
 asked to surrender their places to others who need to have their diseases 
 cured, who need operations. 
 
 Though cured of their former afflictions they are not ready to take up 
 their former tasks. Some are fortunate enough to have good homes to 
 convalesce in. Others can go to the convalescents' hospital at Algonquin or 
 elsewhere. Many must fight for strength under circumstances that do not 
 make for strength. 
 
 In the Journal of the American Medical Association, April 19, 1913, a 
 New York surgeon, Dr. Pool, tells how he teaches his patients to harden their 
 muscles while they are still in bed. Following this plan, the convalescent can 
 go forth from the hospital with muscles strong and enduring enough to get 
 him home with ease and after a little while he will be equal to a day's work 
 at carpenter's bench or anvil. 
 
 The exercises are twelve in number : 
 
 1. Bending the feet up and down. 
 
 2. While lying flat in bed roll the right foot out and then in. Eepeat 
 with the left foot. 
 
 3. Lying flat on the back raise the right leg to the vertical position; 
 carry it back. Repeat with the left leg. 
 
 4. Draw the knees up one at a time; straighten them. 
 
 (After appendicitis operations, hernia operations, and abdominal op- 
 erations these exercises should be done with caution.) 
 
 5. Fist closed and opened. 
 
 6. Hands bent forward and back. 
 
 7. Hands turned palm down and then palm up. 
 
 8. Elbows bent and straightened. 
 
 9. Arms carried forward and back. 
 
 10. Head raised and lowered. 
 
 11. Head moved from side to side. 
 
 12. Breathing — very deep. 
 
 To get the most good from exercises 1 to 9 Dr. Pool says, "All move- 
 ments should be performed with voluntary muscular resistance." By this 
 is meant, all of the muscles of a part are held tense while the movement 
 advised is carried out. 
 
 To begin with, each movement is done five times each period and there 
 should be three periods a day. The number may be gradually carried up from 
 five to thirty. 
 
 The result of this plan is that the patients feel better and get well faster. 
 They leave the hospital with muscles that have some strength in them. Instead 
 of having to learn to walk over again they are able to make their muscles 
 do team work from the start. 
 
 One would think that the danger of sudden death would be increased 
 
EXERCISES FOR CHILDREN 1043 
 
 by these exercises but Dr. Pool says no. Rather, he asserts, will the better 
 circulation and better muscle tone of these patients prevent them from the 
 thrombi and emboli which sometimes cause sudden death in convalescents. 
 
 EXERCISES FOR CHILDREN 
 
 Professor Sudor in charge of physical training in the Chicago schools 
 recently sent out a book of instructions to principals from which the following 
 is extracted: 
 
 "Practically no attention has been paid to posture, and this .is only 
 brought about by thorough drill in calisthenics and apparatus work. These 
 movements will tend to develop the chest and trunk muscles, and guard 
 against possible spinal deformities." 
 
 The instructions for open-air centers are as follows : 
 
 1. Inhale and exhale several times. 
 
 Raise arms sideward and inhale; lower arms and exhale. 
 
 Rise on toes and inhale; lower heels and exhale. 
 
 Bend head backward and inhale; raise head and exhale. 
 
 Raise arms sideward, rise on toes, and inhale; lower arms and heels 
 and exhale. 
 
 Raise arms sideward and twist, bending head backward, and inhale; 
 lower arms, raise head, and exhale. 
 
 2. 1 — Hands behind neck, and sit erect — place ! Hands on lap — place ! 
 2 — Hands behind neck, and lean back — place ! Sit erect, and hands on 
 
 lap — place ! 
 
 3 — Head backward — lower ! Raise head, and sit — erect ! 
 
 4 — Head backward, and lean back — lower ! Raise head, and sit — erect ! 
 
 5 — Lower head backward, raise chest and inhale deeply — lower ! Raise 
 "head and exhale — raise! 
 
 6 — Raise left arm sideward and turn head left — raise ! Lower arm, 
 and head to the front — turn ! 
 
 7 — Like exercise 6, but right. 
 
 8 — Place right hand behind neck and turn head left — place ! Lower arm, 
 and head to the front — turn ! 
 
 9 — Like exercise 8, but vice versa. 
 
 10 — Lower head backward, raise chest, inhale deeply, and lean back. 
 Raise head, exhale, and sit — erect ! 
 
 The above exercises to be conducted by command. Practice each exercise 
 several times. 
 
 Recreation exercises. 
 
 Exercises in sitting position. 
 
 From the erect position, forearms toward chest, finger tips touching, 
 elbows sideward. 
 
 1 — Move arms slowly sideward as far as possible, and twist the arms, 
 knuckles down. Return to starting position. Practice several times. 
 
 2 — Like 1, but inhale at first movement, and exhale at second. 
 
 3 — Like 1, but lower head backward at first movement and raise head 
 at second. 
 
1044 EXEECISE 
 
 4 — Like 3, but with inhaling and exhaling. 
 
 5 — Like 1, but with leaning backward, arms over desk in rear. 
 
 6 — Same, with inhaling and exhaling. 
 
 7 — Like 6, but with lowering head backward and raising. 
 
 8 — Like 7, but with inhaling and exhaling. 
 
 Exercise in standing position: 
 
 From the erect position, forearms toward chest, finger tips touching 
 elbows sideward : 
 
 1 — Move arms slowly sideward as far as possible; twist arms, knuckles 
 downward, and rise on toes. Return to starting position and lower heels. 
 Practice several times. 
 
 2 — Like exercise 1, but at first movement inhale; exhale at 
 second. 
 
 3 — Step position forward left (right) like exercise 1, but with first 
 movement bend left (right) knee, and with second movement straighten the 
 knee. 
 
 4 — Like exercise 3, but with first movement inhale ; at second, exhale. 
 
 5 — Like exercise 3, but with bending of knee bend head backward, 
 and raise head with straightening of knee. 
 
 6 — Like exercise 5, but with inhaling and exhaling. 
 
 7 — Like exercise 3, but with bending of rear leg. 
 
 8 — Like exercise 7, but with bending head backward, raising head, and 
 with these movements, inhaling and exhaling. 
 
 Note: All exercises in sitting as well as standing, especially with 
 breathing, must be practiced slowly. 
 
 THE PLAY CURE 
 
 It may sound strange, but the play months are the healthy months and 
 the play people are the healthy people. 
 
 In May the general death rate drops, pneumonia lessens and contagion 
 declines. Nothing is bad evcept spring fever and spring fever is nothing 
 more than energy trying to find itself. It is a yearning of the spirit to stop 
 the doing of winter things or to stop doing anything in a winter way. The 
 desire to do is strong but it is a different "do" that is wanted. 
 
 Play is educational. It makes for mental and physical training. It 
 makes for judgment. It trains, it breeds bravery, decision and courage; 
 and finally it makes for health, both of itself and through the environment 
 in which it places one. The brain is composed of cells and fibers which 
 bind them together. No cell is separate and isolated. When the brain cells 
 send impulses back and forth cooperating to do a certain thing they train 
 themselves for other kinds of brain work. 
 
 Quoting Maria Montessori: "These exercises are truly intellectual gym- 
 nastics; such gymnastics reasonably directed aid in the formation of the 
 intellect just as physical exercises fortify the general health and quicken the 
 growth of the body. . . . True rest for muscles intended by nature for action 
 is in orderly action just as true rest for the lungs in the normal rhythm 
 of respiration taken in pure air. ... To act in obedience to the hidden 
 
THE PLAY CUEE 1045 
 
 precepts of nature, that is rest. . . . The child wishes to coordinate his volun- 
 tary actions — to exercise his muscles by lifting, to train his eyes to estimate 
 distances, to exercise his intelligence in the reasoning connected with his play, 
 to stimulate his will power by deciding his own actions." 
 
 The keynote to her entire method: Self-development is almost the only 
 pleasure of children. 
 
 It is a good thing to have good muscles.' They make up 65 per cent 
 of the body weight after leaving out the weight of the passive bones. They 
 do their work. They have no diseases, or rather they have so few that muscle 
 diseases can be forgotten. They protect us against enemies, they take us 
 where the air is good and they establish our breathing requirements; for, as 
 Woods Hutchinson says, "We breathe with our legs." 
 
 As the working muscles burn tissue into waste, they use and pollute air — 
 and to renew the supply is the purpose of breathing. The gases flow in the 
 air tubes as far as they go and then they get into the blood cells and are 
 carried the balance of their journey. 
 
 Commonly, we say the heart circulates the blood (and it does furnish 
 a part of the drive) but contracting, moving muscles squeezing out tissue 
 juices furnish an important part of it. 
 
 The muscles are the servants of the commonwealth. They stand and 
 serve. They have a right to use the motto of the English royal family, "Ich 
 dien." 
 
 But development of muscle, while important, is not the most important 
 aim of exercise. More important is the use of muscles in groups, each 
 muscle doing exactly its work, no more, no less, and each doing its work at 
 just the right time, not too early, not too late. That is the work of nerve cell 
 control. 
 
 Moving the muscles in groups cooperating each with the other is good 
 mental training. Xo mind is educated or trained until it has taught its cells 
 cooperation and control. Did you ever see an overeducated, bespectacled, 
 learned man who could do nothing with his hands ? You haven't quit laugh- 
 ing at him yet, have you? Or had you pity? 
 
 A brain gains in abstract power when it gains the power to control 
 muscles, particularly the muscles of the hands — what Hetherington terms the 
 fine muscles — the muscles which are exercised in the arts, crafts and most 
 of the manipulations of skilled labor. 
 
 The first point is — it makes for health to build up the muscles and 
 keep them in good condition. The next is — it makes for general well-being 
 to train the muscles to control and cooperation. But cooperation is the 
 basis of society. Cooperation is society. Where there is cooperation things 
 are social. When there is no cooperation things are anti-social. 
 
 It is only an easy step to pass from a group of muscles playing together 
 to accomplish an end and a group of boys working together on a base- 
 ball nine. And proper play combines all these good things in one. It 
 gives growth of muscles, good muscle tone, proper burning up of waste, 
 good open air brain exercise, mental training, control, spirit, courage, coopera- 
 tion, community spirit, the social point of view — the whole flavored with zest. 
 
 That there is a difference between muscular development and health 
 is attested by Eustace Mills : "I do not consider a mere athlete to be a really 
 
1046 EXERCISE 
 
 healthy man. He has no more right to be called a really healthy man than 
 the foundation or scaffolding of a house have a right to be called a house." 
 At that, an athlete in that he has mental control over his muscles, is a 
 grade better than the muscular monstrosity whose muscles stand up like 
 Pikes Peak and, like Pikes Peak, are mighty, massive, immovable, useless — 
 a mere knot on the landscape. 
 
 Athletics in that they furnish a spectacle have served a most useful 
 purpose. It is easy to see how the spectacle stimulates a desire for better 
 physical development which in turn fills every vacant lot with small boys play- 
 ing baseball and football and occasionally makes the spectator do a few ele- 
 phantine stunts. There is no doubt but going to baseball games stimulates 
 many a man to play golf or to swim. 
 
 The objection urged against athletics is that it serves to overdevelop the 
 fit and to neglect those who need physical development most — the soft- 
 muscled, the short-winded, those lacking coordination, those who cannot do 
 things with their hands. But that need not worry us. Competition between 
 social units will find a way to become more social. It is only a step from a 
 jumping contest between the best jumpers in your high school or college and 
 those in a neighboring institution to a contest between the average jumper of 
 the senior class of the one against the senior class of the other. When this 
 time comes the jumpers who know how will put in some of their time helping 
 those who do not know how. 
 
 The nearest approach to community in athletics is the methods of the 
 Turngemeinden. 
 
 From development of a muscle to muscle control was a step, from muscle 
 control to athletics another, from athletics to play is even more a gain, for 
 play combines the social, the muscular and the mental to an exceptional 
 degree. 
 
 For a child "the play's the thing," or still further paraphrasing Shake- 
 speare, "All the world's a play and all the men and women merely players." 
 That was not what Shakespeare meant but it is true enough to belong with 
 the myriad of true things said by Shakespeare. 
 
 Developing muscles may pall, exercising may become irksome, athletics 
 may lose its relish but the appetite for play abides. In the language of Mon- 
 tague Glass, "Business is business, Mawruss, and sometimes pleasure." 
 
 Children need play to get them into the open air, to get them into the 
 sunlight, to make them breathe deep, to grow red faced and excited, to tingle. 
 As Luther Burbank puts it, "Every child should have mud pies, grasshoppers 
 and tadpoles, wild strawberries, acorns and pine cones, trees to climb and brooks 
 to wade in, sand and snakes, huckleberries and hornets, and any child who 
 has been deprived of these has been deprived of the best part of his educa- 
 tion." 
 
 There is no place where a child learns things so readily as in play. Wirt 
 with his Gary school system is wise beyond his generation in making the 
 playground the place to teach geography, arithmetic, and other didactic 
 branches. But better than geography, play teaches self-control, social sense, 
 honor, enthusiasm, determination, the never-say-die. As Gulick says, "Play 
 is the spontaneous enlistment of the entire personality. We do not have to 
 pursue the goal; we wish to — it is our main desire. The people who accom- 
 
"OUTSIDE OF A HORSE IS GOOD FOE INSIDE OF A MAN" 1047 
 
 plish things are the people who play the game. They let themselves go; 
 they are not afraid. Play up, play up, play the game." 
 
 Says Allen in "Civics and Health": "Hygiene and play teachers would 
 have an incalculable effect on the reduction of tuberculosis not only in making 
 healthier physiques but by inculcating habits of outdoor life and love of fresh 
 air. The danger of those contagious diseases which ravish childhood would 
 be greatly reduced. An ambition for physical integrity would make unnatural 
 living unpopular. Competition in games with children of the same physical 
 class develops accuracy, concentration, dispatch, resourcefulness, as much as 
 does instruction in arithmetic. Smoking can easily be discredited among boys 
 trying to hit the bull's eye. A boy would sooner give up a glass of beer 
 than the championship in rifle shooting or a home run." 
 
 Encourage your boy to play marbles, your girl to skate; show your pride 
 in his jumping or in her game of tennis. Plan organized play for your 
 children and do not forget the value of what Colonel Roosevelt terms "un- 
 bossed play" — play for the sake of play — spontaneous play — just play. 
 
 "THE OUTSIDE OF A HORSE IS GOOD FOR THE INSIDE OF A 
 
 MAN" 
 
 The truth of the above proverb men have always known. The man of 
 the stone age made a close companion of his servant, the horse. Whenever the 
 archeologist uncovering relics of the neolithic age finds the remains of man, 
 he always finds those of a horse near. In the fifth book of the Yonkug we 
 are told that 2,637 years before Christ the Chinese cavalry were placed on 
 the wings of the army. 
 
 When the Lord speaking out of the wilderness rebuked Job as recorded 
 in the thirty-ninth chapter of the Book of Job the following reference to 
 the horse appears: 
 
 "She scorneth the horse and his rider. Hast thou given the horse 
 strength? Hast thou clothed his neck with thunder? Canst thou make him 
 afraid as a grasshopper? The glory of his nostrils is terrible. He paweth 
 in the valley and rejoiceth in his strength; he goeth on to meet the armed 
 men." 
 
 Plutarch tells us that the Greeks at first did not make use of horses. 
 When they saw cavalry in the armies of the barbarians they thought them 
 superhuman and called them centaurs. In their mythology centaurs were 
 descended from the son of Ixion and the cloud and some Magnesian mares. 
 In mythological literature they are taken to signify the rays of the sun, the 
 children of Apollo. 
 
 There is precedent for horseback riding. Its bitterest enemy would not 
 charge that there was anything of the fly-by-night about it. Any opinions 
 about its advantages have had time for a tryout. The motto, "The outside 
 of a horse is good for the inside of a man" has stood long enough to have 
 had fair trial. The fact that it still stands is proof that it is true. 
 
 Why is horseback riding good for the internal organs? It is exercise in 
 the open air. It fills the lungs full of the freshest and cleanest of air and 
 it gives the sun a fair chance to get in its beneficent work. It massages the 
 
Wff -wE in 
 
 m m I 
 
 jft, nn 
 
 Bn i 1 
 
 
 No. 2 
 
 No. 3 
 
 No. 1 
 
 1 — Correct chest position: Head up, chin in, chest expanded front, shoulders 
 "back and down, neck pressing collar at back. Assume this position, slowly draw 
 in long breath through nostrils and slowly exhale. Repeat until tired. 
 
 2 — Deep breathing: Assume position shown, fill the lungs, exhale breath 
 slowly through nostrils, pushing the arms forward, bending the body at the same 
 time. Return slowly to upright position, drawing the air slowly into the lungs. 
 
 3— Slowly raise the arms from side forward and upward in line with the body, 
 drawing in a deep breath through the nostrils, hold the breath while the arms 
 are swung around (backward) to the side, completing a circle. 
 
 "No. 4 No. 5 
 
 4 — Exercise to prevent stoop in shoulders: Slowly inhale a deep breath 
 through the nostrils while assuming the position shown, exhale breath in return- 
 ing to upright position. 
 
 5— -Extend arms to position shown and walk into a corner of a room, then 
 inhale' ami exhale through the nostrils from four to ten deep breaths. 
 
 Fig. 429. — Exercises to Develop the Chest. (Johnson & Johnson, New Brunswick, 
 
 Contagious Disease Bulletin, 1910.) 
 
 1048 
 
"OUTSIDE OF A HOESE IS GOOD FOR INSIDE OF A MAN" 1049 
 
 abdominal organs, especially the liver. As the body comes down with a jolt 
 into the saddle the liver is caught between the diaphragm and the structures 
 below it and out of it are squeezed all stagnating liquids. The abdominal 
 organs are likewise shaken up. 
 
 The great good of riding is in the shaking up. It strengthens the ab- 
 dominal muscles. The impact of the jolt drives toward the abdominal muscles 
 and these grow strong by resisting. 
 
 It develops the leg muscles. It trains the muscles to work together. 
 It stimulates the spirit of mastery. It invigorates and it stimulates. As 
 a measure of personal hygiene it appeals to reason and it is backed by ages of 
 precedent. 
 
 Expanding the Chest. — H. V. K. writes: "Can a man SO years old, who 
 is 'chicken or 'pigeon breasted, as it is called, broaden his chest by breath- 
 ing exercises, or is the bony structure hardened too much at that age? 
 What is the proper method of exercising for permanent expansion of the 
 chest walls?" 
 
 Reply. — He may accomplish a little, but not much. Climbing exercises 
 are better than breathing" exercises. Ladder work, chinning, ring work — 
 these are types of climbing exercises. 
 
 Exercise Rests Tire. — J. S. D. writes: "Is a two-mile walk beneficial 
 after working in an office eight hours, said eight hours being spent mostly 
 on the feet? Am generally pretty tired by the time I reach home. Will 
 the good gained from the oxygen eventually offset the tired feeling?" 
 
 Reply. — Yes, one kind of exercise rests the tire produced by another. 
 
 Play in Open Air. — M. W. writes: "I am £4 years old, and 5 feet 6 
 inches in height, but I weigh only 117 pounds. I am troubled with a pain 
 in my back below the waist and sharp pains around my heart, and I feel 
 tired nearly all the time. I sleep and eat well. Do you think I ought to 
 see a physician, as I am losing weight steadily." 
 
 Reply. — You are underweight and are losing weight, but that seems to 
 be about the only trouble with you. Suppose you have a careful physical 
 examination. If nothing is found out of the way do enough work in the 
 open air to get up an appetite and to get your nutritive apparatus going 
 right. People who feel tired all the time do not work enough. If you can 
 do it, play in the open air — that would be better still. 
 
 Not Injurious to Health. — N. M. W. writes: "Do you consider motor- 
 cycle riding liable to injure in any way the health of the average person? 
 I hear motorcycles called kidney destroyers, producers of floating kidney. 
 What is your opinion?" 
 
 Reply. — 1. No. 
 
 2. Nothing to it. 
 
 Exercise for Muscle. — Subscriber writes : "Will you kindly inform as to 
 what foods I should eat to gain weight? I am 19 years old, and I weigh 
 only about 115 to 120 pounds." 
 
 Reply. — A 19-year-old boy weighing 120 pounds should not eat to gain 
 weight, regardless of his height. "Subscriber" does not state his height. 
 Let him exercise for muscle and let eating take care of itself. 
 
1050 EXERCISE 
 
 Too Much Exercise. — L. M. H. writes: "Do you approve of gymnasium 
 exercise in the evening for a woman who works during the day as a cleric? 
 I have been going to a gymnasium class twice a week for about an hour 
 each evening, being of the impression that the exercise would benefit my 
 health generally. I find that the next day I am fatigued generally, that is, 
 my muscles are sore, my back aches, my head aches, and all together I feel 
 miserable. This lasts for two or three days. I am a clerk in a department 
 store and, of course, am on my feet and get quite a bit of exercise during 
 the day. I am thirty years of age. I am told that this condition will last 
 only for the first few weeks, but I have been going to gymnasium for 
 six weeks, and my condition does not improve; that is, I don't seem to be 
 getting used to the exercises at all. Do you think it wise for me to keep 
 onf 
 
 Reply. — Clearly the exercises you are taking are too strenuous for you. 
 An excellent method of resting is to exercise the groups of muscles not ex- 
 ercised by the day's work. To plan such exercises requires thought. 
 
 Whenever one is sore after exercising it is proof that too much exercise 
 has been taken. 
 
 Needs Outdoor Exercise. — B. S. B. writes: "Do cold morning baths 
 make one nervous? I have been told they are good for a person, but a 
 few days ago someone said they made people nervous. I know I am terribly 
 nervous, and don't know the cause. I eat and sleep well, but my head and 
 eyes ache all the time. I went to an oculist and got glasses, but they do 
 not seem to help much. I am a stenographer, so my work is naturally 
 hard on the nerves. The cords in the back of my neck get stiff often. I 
 seem to be on a strain all the time and catch myself holding portions of 
 the body stiff, and cannot seem to relax. Any little thing upsets me. I 
 am in an office where there are a good many and it is noisy. I think 
 sometimes I cannot stand it. I do not think going to a doctor and taking 
 medicine would do me any good." 
 
 Reply. — One cold bath may increase nervousness temporarily. Syste- 
 matic cold baths are a tonic. You need exercise in the open air. You 
 also need to learn to control your nerves. See if studying "Physiology of 
 Faith and Fear," by Sadler, or "Conquest of Nerves," by Courteney, is not 
 what you want. 
 
 Physical Exercise. — Blank writes: "I am 19 and studying pretty hard 
 at school. Do you think it advisable for me to go through certain physical 
 exercises in my room just before going to bed? Also is it a good plan to 
 take a run around the block before breakfast in the morning?" 
 
 Reply. — Yes, as to each question. 
 
 Horseback Riding. — H. L. W. writes: "What do you think of horseback 
 riding as an exercise? I am tied down to my office a good deal, not active 
 enough for baseball, and too young for golf (they tell me it's an old man's 
 game); tennis bores me." 
 
 Reply. — Go to it. If you want to know how many muscles it exercises, 
 ride six hours and then try to find a muscle that is not sore. Golf is an 
 old man's game in the sense that an old man can play it. It is a young 
 man's game as well. 
 
EXEECISE 1051 
 
 Riding Astride. — Constant Reader writes: "1. Is riding horseback 
 astride injurious to girls? 2. Can this be carried to excess without injury 
 to the girl's general health? 3. Will horseback riding moderately, astride, 
 be likely to affect the girl's health later in life? In other words, is it a 
 menace to the race?" 
 
 Eeply. — 1. No. 
 
 2. No. 
 
 3. No. 
 
 Perhaps the answer to question 2 requires modification. Anything can 
 be done to excess but I interpret your question to mean : Is there anything 
 in the anatomy or physiology of girls that makes horseback riding more 
 dangerous or more harmful (when it is dangerous or harmful) for them 
 than for men? 
 
 Skating Fine Exercise. — B. H. writes: "Is skating more unhealthy than 
 visiting saloons and moving picture theaters? If not, why do the South 
 Park commissioners refuse us our usual skating in Jackson Park tliis 
 winter?" 
 
 Reply. — Skating is about the healthiest exercise that has been devised. 
 It keeps you out of doors at a time when house air is hot and infectious. 
 We cannot understand why they do not allow skating on the South Park 
 ponds in winter and swimming in them in the summer. We hope you are 
 incorrectly informed as to skating not being on the program for the 
 winter. 
 
 Advice on Tennis. — C. F. H. writes: "How about tennis for recreation 
 for a fairly robust man of 36, engaged at desk work? Is a good hard 
 'man's game' of one or two hours too strenuous? Would a heart examina- 
 tion be advisable before commencing, presuming that the subject had not 
 played for four or five years?" 
 
 Reply. — 1. It is all right. 
 
 2. To begin with, yes ; after the muscles have hardened up, no. 
 
 3. Not unless you have reason to think your heart is off. 
 
 Gymnastic Dancing. — B. P. writes: "Would it be injurious for a woman 
 of 46 to take gymnastic dancing if her general health is good?" 
 
 Reply. — No. 
 
 Enter a Gymnasium. — L. J. S. writes: "What would you advise me to 
 do to develop my arms? When I was Ik years old I worked in a factory 
 where I had to swing a heavy hammer. I had to reach far up over my 
 head and pound hard. I remember having lumps as large as pigeon eggs 
 under the arms. Do you think this incident had anything to do with my 
 arms not being developed? They measure only seven and one-half inches. 
 I am 32 years old, weigh 165 pounds, and am 5 feet 11 inches tall. My 
 chest measure is 31 inches. I am not strong." 
 
 Reply. — The part of your arm referred to is the first four inches meas- 
 uring downward from the tip of your shoulder. That part of your arm is 
 largely made up of muscles which run from your body to the upper part 
 of the arm. In doing the work described you would use just those muscles. 
 Probably you overused them and thereby injured them. The lumps under 
 your arms were enlarged lymph glands. These enlarged glands meant 
 
1052 EXERCISE 
 
 that you were suffering from some infection about that time. The two 
 acted together to harm you. Carefully regulated exercise should build you 
 up and increase the size of your arm muscles. If you can, join the Y. M. 
 C. A. and have the physical director lay out an exercising plan for you. 
 
 Needs More Exercise. — J. M. writes: "What is the cause of that eter- 
 nally tired feeling in the case of a woman of JfO? She sleeps fairly well and 
 has a good appetite. Often she rises in the morning as tired as when she 
 went to ted the night before. After dinner she is ready for bed and scarcely 
 has enough strength to undress. She weighs about 120 pounds and is under 
 average height." 
 
 Reply. — She is neurasthenic. She does not exercise enough. Pusey 
 says, in "Care of the Skin and Hair" : "The average person who is tired 
 all the time, who, after a day of ease, finds himself worn out at night, is, as 
 a rule, not a victim of overwork or nervous fatigue but of too much food 
 and too little exercise." 
 
 Should Take Exercise. — S. T. B. writes : "I am a young man, 21 years 
 of age and 5 feet 2 inches tall, and weigh only ninety-five pounds. Please 
 advise me what to do. I do not use liquor or tobacco." 
 
 Reply. — You are nearly twenty pounds underweight and are undersized 
 as well. If you will trace back your ancestry you will find some inherited 
 reason, either in your parents or a little further back. You ought to exer- 
 cise as systematically as you eat. That is, you should give a part of each 
 day to exercise, preferably in the open air. You can increase your weight 
 and stature fairly well in this way, although in the latter you will never 
 get up to the average. 
 
 Exercise After Operation. — N. writes: "Having had an abdominal op- 
 eration, later a rupture and it also operated upon, is it safe to take swim- 
 ming exercises, or to roll or lift the hands over the head and down to touch 
 the floor? I fear another strain, maybe another rupture. I wish to exercise 
 to keep from getting stouter." 
 
 Reply. — Begin swimming and the bending exercise mildly and grad- 
 ually increase them. Violent strain is liable to cause the weak places to 
 give. On the other hand, if flabby muscles do not do their part of the 
 holding up the weak places are threatened. The policy of gradually and 
 slowly building up tone in the abdominal muscles incidentally strengthens 
 the weak place. 
 
 Exercise for Women. — A. X. writes: "I wish you would write upon the 
 advisability of women returning to the bicycle. My patients are so fat 
 and unwieldy it would be simply a new lease of life for them; but, alas, 
 the bicycle is not fashionable. If clubs were formed it might be brought 
 back, and your advice would help. The average well-to-do woman of today 
 is a horror when undressed. I mean women between 30 and 50. They 
 usually suffer from some disease; real or otherwise. No woman who rode 
 five miles a day would ever get to be out of shape. I am a masseuse and 
 trainer, and know all about fat and what it does. I wish you would help. 
 If some power could make women exercise, eat less, cut out all alcohol 
 etc., there would be fewer divorces." 
 
 Reply. — I wish you success in your efforts to convince women that 
 the figure is developed through exercise. One of the methods of positive 
 
EXERCISE 1053 
 
 eugenics is to teach men the difference between a good female physique 
 and one that appears so by reason of clothes and accouterments. 
 
 Special Exercise Necessary. — M. L. M. writes: "Am a matron of 31, in 
 
 apparently good health, hut since fall set in have been constantly troubled 
 with cold feet, especially at night. After I go to bed I have a near chill, 
 sometimes lasting all night. What is the trouble and what the remedy? 
 I take plenty of outdoor exercise and eat simple, wholesome food." 
 
 Reply. — You are a poor heat maker. Since you make so little heat 
 your heat regulating apparatus economizes by sending as little as possible 
 to your skin, ; especially to the skin of your hands and feet. First, you 
 should know whether you are anemic or not. You may have to leave this 
 to a blood test. If anemia is not the cause, you must decide whether you 
 will make more heat by muscular work, heavier eating, cold baths, air and 
 water, followed by a brisk rubbing or whether you will increase your 
 comfort by heavier clothing, particularly stockings.- Old people must fol- 
 low the latter plan. Young ones should follow the first. The young ones, 
 if healthy, can train themselves to be good heat makers. Blood vessels 
 in the feet and hands of old people cannot carry enough blood to keep the 
 skin warm all the time. They must help out by using woolen clothes to 
 retain the heat in the skin. 
 
 S. C.'s Exercises. — Morning exercises which have kept S. C. and his 
 son in prime condition: 
 
 Lying Prone on Bed or Couch. — For the trunk: 
 
 1. Hands clasped behind head, sit up. 
 
 2. Raise legs perpendicularly, knee stiff. 
 
 3. Arms folded, sit up. 
 
 4. Draw up legs, knees bent. 
 
 5. Hands extended above head, sit up, bend over, and touch toes. 
 With a Chair. — For the arms: 
 
 6. Right arm extended at side; lift chair, then rest. 
 
 7. Left arm extended at side; lift chair, then rest. 
 
 8. Both arms extended in front; lift chair, then rest. 
 Standing in Doorway. — Additional for arms: 
 
 9. Heels against back jamb, body thrown forward; push it with both 
 arms to erect position and let it fall forward again. 
 
 10. Toes against front jamb; grasp casing on either side of jamb with 
 fingers ; let body go backward to extent of arms and pull forward as far as 
 possible. 
 
 For fingers: 
 
 11. Grasp casing above door and raise body on fingers to tiptoe position. 
 For toes : 
 
 12. Rise on tiptoes and with hands against top of doorway push body 
 down. 
 
 Standing Free. — For neck and shoulders: 
 
 13. Hands on hips, fingers pointing backwards; throw the head for- 
 ward and then back as far as possible. 
 
 For legs : 
 
 14. Left foot forward, hands extended above head; bend over and 
 touch toes. 
 
 15. Right foot forward; same. 
 
 16. Heels together, knees stiff, hands extended above head; bend, for- 
 
1054 EXERCISE 
 
 ward and come as near touching toes as possible so as to stretch the back 
 leg muscles. 
 
 Take a full breath before each movement and let it out as the move- 
 ment proceeds so as to get a rhythmic relaxation of entire body. 
 
 Twelve to fifteen repetitions of each movement. Follow with a cold 
 bath or rub with dry towel if possible. 
 
 Benefit from Massage. — C. L. writes: "Would you kindly answer the 
 following queries: 
 
 "1. Is there any benefit derived from vibratory massage for weak 
 muscles? 
 
 "2. Is Faradic electricity good for the same, in conjunction with mas- 
 sage? 
 
 "3. Is the galvanic current also a benefit? 
 
 '% Which is the best? 
 
 "5. Should the massage be applied before or after electric treatments?" 
 
 Reply. — 1. Yes. 
 
 2. Yes. 
 
 3. Yes. 
 
 4. Faradic. 
 
 5. Makes no difference. If exercise in the open air is possible, it is 
 much better than either or all. 
 
 Exercise to Prevent Cramps. — L. W. L. writes: "Please state the cause 
 and prevention of cramps in the feet of elderly persons who lead more or 
 less sedentary lives." 
 
 Reply. — Cramps come from lack of use of the muscles. Muscular 
 exercise systematically carried out is the way to prevent it. Cold air, 
 cold baths and persistent exercising is the way to ward off attacks of 
 cramps while swimming. 
 
 Swimming Better Exercise. — H. C. L. writes: "Do you recommend 
 running as a summer exercise? What is the longest distance a boy of 18 
 may run each day with no bad effects? Is it advisable to run before 
 breakfast? Is it better to swim?" 
 
 Reply. — 1. Yes. 
 
 2. Depends on the boy and the condition he is in. Run enough 
 to keep your muscles in condition. If you are stiff or sore afterward 
 you have overdone the exercise. 
 
 3. Yes. 
 
 4. Yes, swimming is better than any other exercise in hot weather. 
 
 Effect of Swimming. — Mrs. S. C. H. writes: "I have been in bathing 
 and swimming four times this season, and each time on leaving the water 
 I notice my lips are blue and my finger tips numb. Will you please 
 tell me if I should discontinue? I do not think I have heart trouble." 
 
 Reply. — Probably you remain too long in the water. If a short plunge 
 causes the same effects refrain entirely. 
 
 Exercise Before Breakfast. — C. J. M. writes: "When I arise I have no 
 appetite, but regain it later for dinner and supper. What is the cause of 
 this? Will one-half a glass of warm water before breakfast help any?" 
 
EXEECISE 1055 
 
 Reply. — It is all right to drink a glass of warm or cold water as one 
 of your bathing stunts on arising. Ventilate your room better and get a 
 little exercise before breakfast. 
 
 Exercise Out of Doors. — Exliausteds write: "1. It is our understanding 
 that you do not approve of blood purifiers, such as old-fashioned sulphur 
 and molasses, etc. Do you advise some substitute 1 ? 2. Is there any way for 
 business girls, confined in offices, to offset that tired feeling which is in- 
 evitable in spring? We sleep with our windows wide open and eat as 
 sensibly as we know how. We abstain from tea, coffee, and pastry/' 
 
 Reply.— 1. No. 
 
 2. Out-of-door exercise — walking, tennis or golf — will turn the trick. 
 
 Do Gymnasium Work. — C. R. wishes to know what will help a woman 
 who has a well-developed figure but is chicken-breasted and has a promi- 
 nent right shoulder blade. 
 
 Reply. — Take up gymnasium work persistently until you have de- 
 veloped the muscles in your back. You will find that your right shoulder 
 blade is prominent by reason of a lateral curvature of your spine. Gym- 
 nasium work will lessen this though it may not wholly remove it. Gym- 
 nasium work will do as much for chicken breast as anything you can do. 
 Not much can be done for chicken breast in people over 15 years of age. 
 
 Rowing Good Exercise. — Elmer writes : "I am desirous of knowing the 
 best way to develop my arms, especially from the elbows down to the 
 wrist. Am 35. Not ever having done any manual labor, they are under- 
 sized/' 
 
 Reply. — The muscles below the elbow bend the wrist joint and close 
 and open the fist. Any stunts which call for gripping develop these mus- 
 cles. The wrist work of rowing is helpful. Bob Fitzsimmons developed his 
 forearm by blacksmithing. 
 
 Stop the Exercise. — D. 8. L. writes: "Have a slight and intermittent 
 pain in the heart, due to overexertion in a gymnasium. What is the danger 
 and what would the trouble be known as?" 
 
 Reply. — A pain in the heart due to overexertion in the gymnasium 
 is cause enough for stopping the work. Have your heart examined when 
 you are suffering from this pain and just after exertion. If you are right 
 in concluding that the cause is exercise stop the exercise. 
 
 Bathing Bracing Practice. — D. H. writes: "At what temperature of 
 the water do you consider it dangerous to swim in Lake Michigan? I 
 have been going into the lake since the middle of the summer, when the 
 temperature of the water was about 70 degrees. It is now about 5Jf degrees 
 and going down about 2 degrees each week. By continuing to go into the 
 lake am I doing something dangerous, or is it a good thing for me? 
 I have normal health and do not feel chilled after coming from the 
 water/' 
 
 Reply. — Daily bathing in the lake after rising by the young and 
 robust is one of the most bracing practices and is of great assistance in 
 warding off colds and catarrhs. 
 
 The minimum temperature at which lake bathing is permissible de- 
 
1056 EXERCISE 
 
 pends greatly on the constitution of the bather and the amount of 
 "hardening" he has undergone. The exact minimum temperature will 
 vary in different persons. One must rather depend on the physiological 
 reaction. 
 
 If the reaction — that is, the rush of blood back to the capillaries of the 
 skin after emerging from the water — and a pleasant, glowing sensation 
 accompanying it are present the bathing is not harmful. If the sensation 
 of chilliness and blueness of the lips and finger nails are noticed, with the 
 reaction delayed or absent, then the water is manifestly too cold. 
 
 Massage and Exercise. — Mrs. L. H. G. writes: "Over eight weeks 
 ago I fell on the stairs, hurting my left leg at the top of the shoe. A 
 lump appeared immediately. The shin was broken. The leg from the knee 
 to the foot swelled badly. Later both sides of the foot turned black and 
 the discoloration extended to the top of the foot and over the ankle, but 
 it was not so dark as on the sides of the foot. I have worn an elastic 
 bandage with good results, but when it is removed and I walk much the 
 swelling is extreme. My age is forty-seven. Is that significant? Am 
 suffering with a little touch of rheumatism in my fingers, but the foot 
 trouble appeared first, I think." 
 
 Reply. — Your injury has stopped one of the channels by which fluid 
 returns from your foot to your body. The condition will pass away in 
 time if you do not neglect it. Other channels will enlarge to do the extra 
 work. Massage and exercise that foot and leg systematically every day 
 unless the soreness forces you to exercise at longer intervals. 
 
 Walking Good for People. — M. O'N. writes: "What about walking for 
 women? I am a stenographer employed in the city and vmlk to my home, 
 or from my home to the office, a distance of seven miles, at least once a 
 week and often twice a week. Two weeks ago Sunday I walked from 
 Wilson Avenue to Fort Sheridan, a distance of twenty-three miles. Is 
 this too much for a woman 25 years old in perfect health?" 
 
 Reply. — No. I wish you could influence a few thousand people to 
 walk more. 
 
 Continue Swimming. — B. R. D. writes: "Will you please help me out 
 of a difficulty? The last two times I have been out bathing my skin all 
 over the body turned a dark purple, almost black. My health is good and 
 I enjoy the water. What is the cause? Is there anything to do to avoid 
 such occurrences, or would it be better to forego the pleasure entirely? 
 If it is caused by the temperature of the water, why does it affect me that 
 way and not others?" 
 
 Reply. — Your skin circulation is more susceptible than that of your 
 companions. Continue your swimming but exercise more actively. The 
 purple color will pass away when you swim or splash hard enough to get 
 in a glow. 
 
 Roller Skating Example. — W. G. G. writes: "I like your article on 
 swimming, etc., for the young of our city. The authorities could follow 
 with profit one thing done in Kalamazoo, that of roping off two or three 
 blocks in different sections of the city from traffic in the early evening 
 hours for roller skating. It would do you good to see the crowds of 
 youngsters enjoying themselves here each evening." 
 
 Reply. — Cities everywhere should follow the lead of Kalamazoo. 
 
EXERCISE 1057 
 
 Exercise in the Open. — C. A. H. writes: "I have been troubled for some 
 time with a feeling of depression not due to a melancholy nature. I have 
 a desire to yawn constantly and find it difficult to get a good, deep breath 
 without a sigh or yawn. Thinking it might be due to indigestion, I have 
 eliminated all pastry from my diet, and endeavor to eat nothing but 
 healthy food. I have not drunk coffee for some time. I am taking an 
 iron tonic. Do you think this could be heart disease? What more can I 
 do to overcome it?" 
 
 Reply. — I do not think it means heart disease. Get some vigorous 
 exercise in the open air — swim, play tennis, golf, or something equally- 
 violent. You need to have your heart beat fast, your face turn red, your 
 lungs draw deep and your skin sweat. 
 
 To Strengthen the Ankle. — Reader writes: "Can you tell me how to 
 strengthen my foot? Some time ago I worked a foot press for about two 
 years and have in the last year been troubled with my ankle. I cannot 
 bend it outwards. It seems to have no give to it. Sometimes it bothers 
 me much, then again I have no trouble with it." 
 
 Reply. — The ankle proper should not bend out. There is a little in 
 and out bending leeway in the foot below the ankle. The best way to 
 strengthen the ankles and feet is to exercise regularly and habitually the 
 muscles of the legs below the knees. If this is kept up the ankles get 
 strong. There is no other remedy. But do not try to stretch the lateral 
 ligaments of the ankles, for a foot which turns in and out is not worth 
 much to walk on. 
 
 Take More Exercise. — 8. F. M. writes: "Please tell me the cause of and 
 cure for frequent and deep yawning in a man of 55 years of age. I am 
 in good health, my work is light, working hours short, I sleep well, am not 
 a heavy eater, not especially strong, although exceptionally active and 
 energetic. I yawn heavily and long, perhaps twenty-five times a day, 
 during my waking hours. Does this indicate anything constitutionally 
 wrong with me, or a condition needing a physician s attention?" 
 
 Reply. — You are not getting enough air to your tissues. It may be that 
 the room is not ventilated, that you do not take enough air into your blood 
 through your lungs, that your blood does not carry enough to your tissues, 
 or several of these combined. There are two things to do — ventilate better 
 and get more exercise. If you eat a heavy meal you especially need to 
 exercise during the succeeding four hours. 
 
 In Need of Exercise. — M. writes: "You have stated that the arteries 
 age from wear and tear, which are causes of arteriosclerosis. Should a 
 person, then, of middle age do as little physical work as practicable? 
 Would not moderate gymnasium or other exercise be beneficial, even to 
 one in the fifties, by giving tone to the muscles of the arteries, heart, and 
 elsewhere?" 
 
 Reply. — Enough exercise, either golf, gymnasium work or other work, 
 to keep a man's muscles firm is advisable. The man of fifty needs it a 
 little more than does the younger fellow. 
 
 More Exercise Needed. — Miss L. J. writes: "Kindly inform me what 
 causes blind spells and dizziness, also a fever every morning until about 
 noon. I am about 5 feet 8 inches tall, weight 137 1-2 pounds. My appetite 
 
1058 EXERCISE 
 
 is good and I sleep well, with the exception of a dry cough occasionally 
 at night, but never during the day. I have also had pains coming from 
 the heart. Would this indicate heart trouble?" 
 
 Eeply. — Blind spells and dizziness in a young woman generally mean 
 that she is eating too much and exercising too little. Fever every day and 
 cough frequently mean consumption. If you are certain as to the fever 
 by all means have your chest examined carefully, especially for con- 
 sumption. 
 
CHAPTEE LVII 
 
 Posture — H eight 
 
 POSTURE 
 
 MAN AND HIS POSTURE 
 
 Fig. 430. — Bad Posture, Due to 
 Desk Which Is Too High. 
 
 Early in the game the animal man was having a hard time competing 
 
 with the other inhabitants of the jungle. He was shrewder than they and 
 
 he pitted his brains against their strength and 
 
 endurance. To his mind the suggestion came 
 
 to rise up on his hind legs and to release his 
 
 forelegs from the duty of carrying him; it 
 
 should be possible to change his center of 
 
 gravity and two legs were enough to carry 
 
 any animal around. 
 
 Mowgli was right. The monkey tribe con- 
 stituted the only people shrewd enough to see it 
 
 in that early day and at that they tried to com- 
 promise. Said they: 
 
 "This walking on the hind legs is a good 
 
 thing in some cases, but there is about half the 
 
 time when the old way is the better way. 
 
 We, the banderlog, have more wisdom than 
 
 Mowgli. We will walk on two legs when that is best and on four when that 
 
 way is best." 
 
 The banderlog missed the essen- 
 tial point. The reason for walking on 
 the hind legs was to free the forelegs 
 for other work. Work was more im- 
 portant than walking. 
 
 The upright posture is far from 
 being a perfect posture for man. In 
 the thousands of years that he has been 
 walking that way he has not wholly 
 rearranged himself on that basis. 
 Many of his anatomical points are on 
 the old basis. From an incomplete 
 adjustment the appendix results and in 
 its wake comes appendicitis. From it 
 comes constipation and the list of ills 
 
 that follow it. In many things in life we gain by following our animal instinct. 
 
 When in doubt in many situations the way to trump is to follovj instinct. 
 
 1059 
 
 Fig. 431. — Bad Posture, Due to Desk 
 Which Is Too Low. 
 
1060 
 
 POSTURE— HEIGHT 
 
 However, this is not true of posture. Man holds himself upright as the 
 result of the call to higher things. His instinct would make him slouch 
 and slump. 
 
 The spirit in him calls on him to toe, to stand straight and square, to 
 hold his head up and his chin in and to look straight to the front. 
 
 The animal in him, the great instinct that has come down in his germ 
 plasm through the ages, bids him slouch. 
 
 When the best in him is dominating he 
 stands four square. When he is worn by sick- 
 ness or by age he stoops. 
 
 One of the helpful chapters in Bancroft's 
 "Posture of School Children" is entitled "Erect 
 Carriage as an Expression of Intelligence and 
 Character." He says : 
 
 "That a person standing 
 erect looks to be more intelli- 
 gent and energetic than one 
 in poor posture needs no ar- 
 gument; it is self-evident. 
 Under this appearance, giv- 
 ing it reality, lies the bio- 
 logic fact that the erect posi- 
 tion has been coincident with 
 the development of the brain 
 as it exists in man." 
 
 The way a man stands 
 tells many stories of his life 
 to those who have learned to 
 read. Eugene Sue told us of 
 men who worked in one po- 
 sition until their bodies got 
 set in that position. So some- 
 times we can learn of a man's 
 trade by the way he stands; 
 we can learn of some of the 
 ill health experiences through 
 which the man has come; we can learn of the experiences of childhood. 
 The character of the man, his occupation, his disease history and the 
 experiences of his childhood — even though each of these stories is incompletely 
 told it represents a good deal of talk to the person whose observation has 
 been cultivated. 
 
 During the years of childhood and youth there was no chance to learn how 
 to stand, how to walk, and how to live and in consequence in early manhood 
 pains and aches and inefficiencies have developed. 
 
 There was no way of learning about the arches of the feet, the work of the 
 toe and that of the heel. The sentiment about small feet and pretty feet was 
 working at its trade. Before chance to know was at hand tight shoes had 
 dwarfed the toes, twisted the bones of the feet around until nerves had got 
 out of their grooves and blood vessels were pinched at every step. 
 
 Fig. 432. — Faulty 
 Posture Favor- 
 ing Enteroptosis. 
 
 Fig 433. — Faulty Posture. 
 
 Enteroptosis. 
 
POSTURE 
 
 1061 
 
 The same is true, though in lesser measure, of the shoulder girdle. The 
 nerves, bones, arteries and muscles do not fit so snugly as they do in the feet, 
 but sagging shoulders do press at times on structures which resent the pressure 
 by pains, aches, and tires. Much of the pains and aches called neuritis, rheu- 
 matism, gout, and other names that signify disease are the result of such 
 maladjustment. 
 
 This factor is important enough to be the basis of at least two schools 
 of healing. As a general proposition, however, those schools place emphasis 
 
 Fig. 434. — Normal Broad Chest. Wide 
 angle between rib margins, giving 
 wide upper abdomen. 
 
 Fig. 435. — Enteroptotic Build. Long, 
 narrow chest and abdomen. Long, 
 narrow angle between rib margins. 
 
 upon the nerves which emerge from the spinal column in a position to be 
 pinched. The degree of distortion of the spinal column is never so great as 
 is frequently found in the feet, and the more general opinion is that exag- 
 gerated curves or lack of curves in the spinal column do harm by disturbing 
 the cubic capacity of cavities that contain vital organs rather than by pinching 
 nerves. 
 
 Dependent upon the curves of the spinal column are the chest, occupied 
 by the heart and lungs, and the abdomen, occupied by the digestive apparatus. 
 
 When man walked on all fours his heart had less work to do. Walking 
 upright adds to the work of the heart and therefore when the heart is 
 diseased the shoulders droop forward — an effort is unconsciously made to fall 
 back into the position of ease. 
 
 On the other hand, the lungs are better off in the present human chest 
 than in the old-style arrangement. 
 
 The hands are seldom used together. Almost everything done by the 
 
1062 
 
 POSTURE— HEIGHT 
 
 hands is done better by one hand. This makes it possible to do two things 
 at a time, one with one hand and one with the other. 
 
 Again, all down the line this release from the need of using the two hands 
 together has made it possible for the chest to broaden out. 
 
 Man is bom with a deep, narrow chest — a tendency to return to the old 
 animal type. If the gain is to be held it must be fought for. The broad- 
 shouldered type must be cultivated; it is not natural. 
 
 The most important curve of the spine is that in the abdominal region. 
 It is known as the lumbar curve. In young children there is no sway in 
 the back. In grown people a sway is natural. 
 
 If it is too great the abdomen will pouch out 
 in front and the pouching may seriously interfere 
 with the digestion and assimilation. About as 
 many people of middle life are made inefficient 
 by reason of large girth measure as from any 
 other cause. 
 
 As a further consideration, unless the lum- 
 bar curve is as it ought to be the pelvis tilts and 
 too much or too little pressure is exerted on the 
 pelvic structure. 
 
 Some of the people who limp around with 
 sciatica and other leg pains get no relief from 
 liniment and neuralgia medicine because the real 
 basis of the trouble is in the way they stand. 
 The spinal column has some twenty-five joints 
 in it. If the column were straight every step 
 would jar all the delicate machinery of the body. 
 There must be curves in the column for the same 
 reason that automobiles have pneumatic tires. 
 
 A back curve is needed in the chest for the 
 lungs and the heart. You cannot curve the 
 column back in the chest region without curving 
 it forward in other directions to make up for it. 
 There must be compensation. 
 
 There is a forward curve in the neck and 
 
 one in the abdomen to make up for the backward 
 
 curve in the chest. If any one of these bows 
 
 curves too far in one direction there must be a 
 
 compensating increase in the bows in the other 
 
 directions. If the abdomen pouches out too far 
 
 then the shoulders must rear back too far, which 
 
 adds to the inefficiency. 
 
 The human body is a machine. This machine does not move forward 
 
 with the minimum expenditure of energy when it starts from a backward 
 
 slant. It is easier to maintain a column in the straight line than it is to 
 
 maintain a series of curves. 
 
 All of these weights hung some on one side, some on the other, but 
 so placed as to maintain the vertical in balance represent an artificial 
 condition. 
 
 Fig. 436. — Enteroptosis, Show- 
 ing Head Forward, Shoul- 
 der Blades and Lower 
 Part of Belly Prominent. 
 
POSTUEE 
 
 1063 
 
 The broad-shouldered base of the pyramid high in the air five feet or 
 more from the ground, tapering to the apex of the pyramid at the ankles — all 
 this is artificial. 
 
 The pitching forward of the body held rigid and the catch on the 
 heel, the physics of walking which Goethe first showed — this, too, is artificial. 
 
 When strength, virility, elasticity are gone the gait is a shambling 
 amble. The enfeebled person drags, slops along. 
 
 The upright posture has made it possible for the human race to develop 
 a thumb and a prehensile hand ; to develop arms that work better when work- 
 ing singly ; to develop a flat chest ; to develop a resistance to wind and storm ; 
 to bacteria ; to artificial conditions of living unapproached by any other 
 animal; to develop a brain that puts man in a class by himself. 
 
 A proper posture gives one individual a great advantage in health and 
 efficiency, in mental vigor and spirit, over another. But it is not a natural 
 posture with man. 
 
 Many of his anatomical structures are not adjusted to it. 
 
 Its best can only be secured and held by training begun in youth and 
 continued through life. 
 
 STOOPING SHOULDERS 
 
 I know of nothing more quarreled about than stooping shoulders and I 
 know of nothing else about which quarreling accomplishes so little. There 
 must be a reason. There is a reason. 
 
 A person carries his shoulders stooped 
 because that is the easiest way for him 
 to carry them. To carry them in any 
 other way means ache and fatigue. So 
 long, therefore, as the boy is near his 
 mother or the commandant he will carry 
 his shoulders square. As soon as he for- 
 gets it down they go, for down is the easy, 
 comfortable position. It is the position 
 in which he works most easily, because 
 in that position the bones fit and in no 
 other position do they. 
 
 All athletics, all work, is done with 
 the tones in their natural position. The 
 ramrod, square shoulder is fit for dress 
 parade and nothing else. 
 
 Nevertheless, some girls and boys 
 have bad shoulder positions. Caught 
 early, the bones can be made to sit in a 
 position which will improve with age. 
 Stoops left to themselves will lead to bone 
 positions in which the tendency of the 
 slide in the years to come will lead to 
 worse positions. 
 
 Why is it that instructors meet with such poor success? Because they, 
 parrotlike, ding-dong : "Throw your shoulders back !" 
 
 Fig. 437. — Belt foe Enteroptosis. 
 Straps between thighs hold it down. 
 
1064 
 
 POSTUEE— HEIGHT 
 
 The shoulders are not to blame. The shoulders are great, broad, flat 
 bony plates working on the rounded ribs. If the chest is too barrel-shaped 
 the shoulders naturally stoop. The instructor, to get results, must go back 
 at least as far as the ribs. 
 
 The chest gets progressively more flat from birth to adult life. During 
 the first fifteen years the flattening is 21 per cent; during the remainder 
 of life it is only 8 per cent. 
 
 Therefore play, exercise and athletics are to be taught in childhood. Climb- 
 ing trees for both boys and girls stands at the head of the list. But the in- 
 structor must go even back of that. 
 
 Hard teething, summer complaint, rickets, in fact any severe illness 
 in the first two years of life, mark up the body more or less permanently. 
 One of the methods of marking is some form of barrel chest over which 
 the shoulders slide to cause stooping shoulders. 
 
 Again, the error, as Mosher has shown, may not be in the shoulders or 
 
 ribs. She finds a group, par- 
 ticularly in girls, where the 
 trouble is with the curves in 
 the backbone. 
 
 In order to take the 
 stoop out of these girls she 
 tells them to stand so that 
 their dresses hang low in 
 front. This pitches the lower 
 spine curve forward and back 
 goes the shoulder curve to 
 hold the equilibrium. 
 
 An idea prevails that 
 stooping shoulders box in the 
 lungs and thus predispose 
 to consumption — which is 
 wrong. Consumption causes 
 stooping shoulders by using 
 up the fat and weakening 
 the muscles so that the 
 shoulders slide forward — the 
 winged scapulae. 
 The most important point is that the narrow-chested folk who are espe- 
 cially susceptible to consumption are built right for the shoulders to slide. 
 
 If a man is long chested and well muscled let him leave his shoulders 
 where they are. In that way he will get the greatest efficiency and work 
 with the least fatigue. 
 
 The army has abolished the ramrod attitude except on dress parade. 
 Eamrod attitude and dress parade are both playthings. 
 
 Fig. 438. — Faulty Posture Favoring Enteroptosis. 
 
 NARROW CHESTS 
 
 The chest of a baby who has never breathed is broader from side to 
 side than it is from breastbone to back. Soon after it begins to breathe the 
 
POSTUKE 
 
 1065 
 
 chest is about as broad as it is deep — in other words, it is round. As time 
 goes on it continues to get flatter until at puberty the depth from breast- 
 bone to back, as compared with the width, is as 100 to 80. When adult life 
 has been reached the proportions are 100 to 70 as compared with the youth 
 and the infant. The adult chest is flatter. 
 
 Now, averaging a large number of people, it has been found that con- 
 sumptives have round chests and hatchet chests rather than flat chests. The 
 disease develops more frequently in people with the puberty type of chest 
 form than in the adult type. The teaching of these observations is that 
 disease and deficiency are prone to develop in those whose chest development 
 has stopped at the puberty type — has not gone on to the adult shape. 
 
 Fig. 439. — Normal Chest 
 and Abdomen. (Herb.) 
 
 Fig. 440. — Flat Chest and 
 Sagging Abdomen. (Herb.) 
 
 Fig. 441. — Showing Differ- 
 ence Between Fig. 439 
 (heavy line) ; and Fig. 440 
 (dotted line). (Herb.) 
 
 The shoulders and the shoulder blades are hung on the bony frame 
 of the body proper something as a coat is. To take out stoops and straighten 
 shoulders the work must begin back of the injunctions to "throw the shoul- 
 ders back/' to "stand square shouldered." To begin with, there should be 
 systematic breathing exercises — not for any effect on the oxygen of the blood 
 but to develop the muscles of the diaphragm, abdomen and chest wall and 
 to change the shape of the chest box from narrow and deep to broad and 
 shallow. To breathe in and breathe out violently using every helpful muscle 
 everywhere, if begun early and persisted in, will cure stoop shoulders by 
 giving the shoulder blades a flat surface to lie on. 
 
 At the same time undue accentuated curves on the spinal column can 
 be straightened out by developing the two sets of muscles which run up and 
 down it. One set is just behind this column and bends it backward; an- 
 other is just in front of it, or its processes, and bends it forward. Bending 
 
1066 
 
 POSTUKE— HEIGHT 
 
 forward, backward, and to the sides while all of the muscles are held rigid 
 will straighten out some of the curve. 
 
 VERTICAL LINE TEST 
 
 Above the line of the hips the spinal column points in three directions. 
 In the region of the abdomen the direction is forward; in the region of the 
 chest it is backward; in the region of the neck it is again forward. This 
 zigzag line crosses and recrosses the vertical line. 
 
 When a person stands properly a line dropped vertically from just in» 
 front of the ear will fall just behind the ball of the foot. 
 It is the vertical line. This line passes in front of the 
 shoulders, a little in front of the hip joint, just behind 
 the kneecap, in front of the knee joint 
 proper and in front of the ankles. 
 
 Let one stand a curtain pole ver- 
 tically on the floor and then take his 
 position by the side of it. The outside 
 of the shoe two inches back of the tip 
 of the toe should be placed against 
 the pole. When one is standing prop- 
 erly the pole will run just in front of 
 the ear. 
 
 This is an easy way to establish 
 the vertical line. The method is called 
 by Bancroft the vertical line test. This 
 is the gravity line. 
 
 In a person who stands properly 
 the abdomen will not pouch much in 
 front of this line and the back will not 
 push much behind it for if the spine 
 curves much in one direction the bal- 
 ance is maintained by overcurvatures 
 in other regions and in other directions. 
 The muscles holding the body in the 
 upright position are on the back — on 
 the back of the calf, on the back of the thigh, on the back of the trunk and 
 on the back of the neck. These muscles are strong. They could hold the 
 body up even though it were out of plumb, even though it projected forward. 
 The head might be thrown forward and the chin might droop but the 
 muscles of the back of the neck would be under constant strain and neck 
 pains, aches and tires would develop early. 
 
 The shoulders might droop forward unduly and the individual not fall 
 but it would be because the muscles of the back were always pulling hard 
 enough to offset and that means aches, pains, and tire. 
 
 If, on the other hand, the poise is right mechanically the work of these 
 back muscles is reduced to the minimum. 
 
 Incorrect position spells inefficiency. It spells vague aches and pains. 
 It spells exaggerated spinal curves with cramping of vital organs. 
 
 Fig. 442. — Normal 
 Chest with Ribs 
 Running Normal- 
 ly. (Herb.) 
 
 Fig. 443.— Ribs Run- 
 ning More Near- 
 ly Perpendicu- 
 lar in a Poorly 
 Developed Chest 
 and Sagging Ab- 
 domen. (Herb.) 
 
POSTUKE 
 
 1067 
 
 Stoop-Shouldered Girl. — J. H. N. writes: "Our daughter, 16 years 
 of age, is developing a had case of stooped shoulder and hollow chest. 
 We have endeavored to correct this by calling her attention to the results 
 that may be expected if she does not get over the stooping habit. Can 
 you suggest some remedy for thisf 
 
 Reply. — To chide her will do no good. To put braces on her will be 
 just as useless. She is narrow chested and her shoulders slide forward 
 on her strongly arched ribs. She probably sways the lower part of her 
 back too far forward which makes her upper back arch backward too 
 much. 
 
 Some months ago I wrote of an orthopedic surgeon who, by a series of 
 manipulations and exercises, developed the muscles necessary to pull the 
 
 Fig. 444. — Normal Angle of 
 Ribs in Front of Chest. 
 Normal Well Developed 
 Chest. (Herb.) 
 
 Fig. 445. — Narrow Angle of 
 Ribs in Front of Chest. 
 Poorly Developed Chest. 
 A Very Poor Sign. (Herb.) 
 
 excess out of the spine curves and develop the back muscles needed to 
 hold the shoulders in place. Or it can be done by exercise. 
 
 If she takes up this work in a gymnasium she must keep it up until 
 her back is straight and the back muscles are big and strong. 
 
 Round Shoulders. — A. W. E. writes: "Can you recommend a shoulder 
 brace for straightening round shoulders and advise me as to its costf" 
 
 Reply. — Exercise is a better shoulder straightener than braces. Mosher 
 says that the way to throw the shoulders back is to drop the front of 
 the pelvis — in the case of a woman for her to stand so that the front 
 of her dress hangs low. Mosher's observation has been that this neces- 
 sarily takes the curve out of the back. Some cases of stoop shoulders 
 are due to narrowness of the chest. In such a chest the flat shoulder 
 blades pitch forward and their back edges stick out like wings. The 
 point to all of this is that the shoulders naturally fall into the easiest 
 position. Therefore to correct stoop shoulders it is necessary to correct 
 the body curves or the narrow chest or the position at work, one of which 
 is responsible for the stoop. Ordinary braces built on the suspenders 
 principle cost but little more than suspenders and help some. The wise 
 thing to do is to go to a gymnasium and find the underlying cause and 
 work to remedy that. 
 
1068 POSTURE— HEIGHT 
 
 Stoop Shoulders. — W. wants to know: 
 
 1. What is the danger in allowing young people to become stoop- 
 shouldered? 
 
 2. How may the evil be corrected? 
 
 3. Are the ordinary shoulder braces practical? 
 
 Jf. Is a cold shower or a cold plunge, followed by a vigorous rub, good on 
 a winter morning? 
 
 Reply. — 1. There is not much danger. The type of chest most liable to 
 develop consumption is the narrow chest which results from arrested 
 development. Stoop shoulders are undesirable, decrease efficiency and 
 do harm in some other ways. 
 
 2. Gymnastics and exercise persisted in for a long time; avoidance 
 of incorrect posture and occupations which cause it. 
 
 3. They are of little service. The proper plan is to straighten the 
 spinal column by properly developed muscles and by habitually keeping 
 the position right. 
 
 4. Yes. For those strong enough to react well. 
 
 HEIGHT 
 
 One's height is largely determined by inheritance. In regard to in- 
 heritance one must remember that influence on the germ plasm extends "even 
 unto the third and fourth generations." Possibly also children can be made 
 to grow larger by the use of internal glandular secretions but that fact is not 
 fully determined in the first place and in the second the substances are too 
 powerful to use except under close medical control. 
 
 Any number of experiments with school children have proved that good 
 feeding in childhood will add somewhat to the height. In fact, the great 
 school feeding movements in Germany and England were based on this 
 principle. 
 
 Examinations for the armies of those countries disclosed an awful per- 
 centage of runts and misfits. Those nations flew into a panic, appointed 
 investigating commissions and as one of the results began school feeding. 
 
 We are pretty generally agreed with Bryant that "chronic underfeeding 
 or incorrect feeding is shown in the child by constant failure to come up to 
 the average of weight and height, lung capacity, grip, etc/' 
 
 Something can be added to the stature by standing straight. Bancroft 
 has measured pupils who showed a difference in total height of one to three 
 inches brought about by change from bad to good posture. Goldthwaite, 
 by regulating the sway in the back, increased the height from one-half to 
 three-quarters of an inch. 
 
 About the only curve in a baby's back is in the chest region. When the 
 head is held up the neck curve starts. When the baby begins to sit up the back 
 curve begins to show in a few positions. 
 
 During kindergarten years the back is straight. Up to nine years of age 
 the back of a standing child is straight. When the child has reached twelve 
 to fifteen the hollow in the back is much more pronounced. 
 
 It is about this period that more or less steady variations from the 
 normal curves begin to show themselves. 
 
HEIGHT 1069 
 
 During the grammar grades the heart more than doubles in weight, the 
 lungs treble and the liver doubles. Bancroft says these heavy organs are 
 growing most rapidly when the child is from twelve to fifteen years old, while 
 Donaldson says the muscular system is not growing at its best for several years 
 thereafter. Therefore, the heavy organs are liable to overcurve the spine 
 in these years of muscular weakness. 
 
 The suggestion is that children be encouraged to play and to exercise 
 judiciously. The regulated exercises are advised from the eighth year on. 
 Such exercises as develop proper curves and prevent the development of over- 
 curves add to the height. 
 
 INCREASING THE HEIGHT 
 
 I receive a good many letters from people who want to grow taller. 
 While a part of this interest has been stimulated by advertisements in the 
 main these advertisements have merely served to convert a vague desire into 
 a moving impulse. 
 
 A man "by taking thought can add a cubit to his stature." At least he 
 can add a fraction of an inch. 
 
 Many years ago it was noted that when the thyroid gland was removed 
 from a young animal its bony growth was stunted and that feeding thyroid 
 to young animals stimulated their bony growth. From this it was con- 
 cluded that when young animals (including the human) were fed thyroid 
 they would grow taller than their inheritance would lead one to expect. But 
 this drug is too powerful for general use and it is doubtful if it helps much 
 anyhow. 
 
 The real secret of gaining a fraction of an inch in height is to take the 
 curves out of the backbone. Some of the backbone curves are caused by 
 tuberculosis of the bone. These cannot be straightened much. But ewe 
 neck, stoop shoulders, and occupation stoops can be straightened out — the kind 
 you read about in Eugene Sue's "Mysteries of Paris" — the kind you see 
 about you on every hand. By proper, persistent muscle training these can 
 be straightened out and the subject will grow taller inconsequence. 
 
 1. As Ritchie says — "Stand tall, thrusting up the top of the head as high 
 as possible and drawing the abdomen and chin in is the best rule for position 
 in standing and walking." 
 
 2. Spend some time each day pulling hard on all those muscles which pull 
 the backbone straight. (Never mind the names of them.) Experiment until 
 you find just what pull straightens you. You can feel the muscles contract. 
 Having found yourself, each day make a few good, hard, tense pulls with the 
 "pullers" which you have discovered. In this the setting-up exercises of the 
 soldier are excellent aids. A good one is to bend forward until the fingers 
 touch the toes or knees and then to straighten up. This should be done with 
 the opposing muscles resisting hard. 
 
 Are we getting taller or shorter, larger or smaller? I have heard men 
 bewail the rareness of the tall, broad, brawny men of the old rail-splitter type 
 and the abundance of little runty fellows. As a matter of fact, these opinions 
 are without basis. The element of immigration makes conclusion from 
 observation almost impossible in this country. Where the increase in popu- 
 
1070 POSTURE— HEIGHT 
 
 lation is mostly due to immigration, where over 9,000,000 immigrants (mostly 
 adult males) come into a population of 90,000,000 in ten years their influence 
 is felt. If a large part of them were Patagonian giants the onlooker might 
 think the race was growing larger. On the other hand, a certain proportion 
 from the African pigmy tribes might make one pessimistic. 
 
 Hansen of Copenhagen gave the Eugenics Congress the results of com- 
 parative measurements of certain peoples in Europe. Their populations being 
 more stable than ours conclusions from measurements are much more de- 
 pendable. 
 
 By way of a general conclusion, he says : 
 
 "In many European populations, the most obvious racial quality of all, 
 the stature, has in the last fifty years or more, undergone a very sensible 
 improvement, having increased by as much as two inches or more." 
 
 A comparison of the boys fourteen to fifteen years old, at Marlborough 
 college in England 1874-78, with those there at 1899-1902, showed an average 
 increase of .56 inch. In the last fifty years the height of the average grown 
 Dane increased 1.4 inches. Hansen says the Swedes and Norwegians have 
 increased about as rapidly as the Danes. Certain measurements of the Dutch 
 made in 1866, 1883 and 1899 showed a total gain of a little over an inch. 
 Bolk says in fifty years the Netherlander increased their average height four 
 inches. He thinks this gain is too great to have been wholly the result of 
 improved conditions but that fifty years ago the Netherlander were passing 
 through hard times and that they are now returning to their normal condition. 
 
 Pearson gives the average weight in England of boy babies at birth as 
 7.3 pounds, girls about a quarter-pound less. In twenty years the average 
 weight of British boys at birth increased 1,262 grams, nearly three ounces; 
 girls, 908 grams, nearly two ounces. In Denmark the increase in thirty- 
 five years was 600 grams. Observations made on school children show that 
 there is a gradual gain in weight, height and chest measure. 
 
 Hansen says: "It is permissible to believe that the increase of stature 
 during the school age is a great deal due to the progress of school hygiene. 
 The development of all kinds of bodily exercise that has taken place in the 
 last decade must have* had a considerable influence on the growth of the 
 children/' 
 
 LONG-BODIED PEOPLE 
 
 The "folks" on the farm hold that it is bad policy to buy a horse that 
 "shows too much daylight under the belly." It may be too long-legged, 
 or if it stands spraddled out it will not be strong and active in proportion 
 to its weight and muscle. 
 
 If it is too long bodied it will be too hard to keep. It will require too 
 much feed for the work it does. 
 
 Men lose in efficiency and in effective use of food by being too long- 
 legged and too long-bodied. 
 
 Another horse sign is too much space from the last rib to the hip bone. 
 This means that the animal will require much feed. 
 
 The height of man is due to the length of leg plus the length of body plus 
 the length of neck plus the depth of the head from crown to neck. From the 
 standpoint of vitality what counts is the length of the trunk — the height of 
 
HEIGHT 1071 
 
 the person when sitting. To be still more accurate, that which counts is the 
 height of the collar line when the person is sitting. 
 
 Length of legs is especially serviceable in the doing of a few things. 
 Length of trunk is especially serviceable in the great majority of life 
 functions. Tyler tells us that "during the first three years the legs grow 
 one-third more than the trunk; from the third to the sixth year of age 
 they grow almost half again as fast as the trunk; from the sixth to the ninth 
 year the legs grow proportionately three-fourths more than the trunk; and 
 from the twelfth to the fifteenth more than half as much. After the fifteenth 
 year the trunk grows faster than the legs." 
 
 A baby is long-bodied and short-legged. A grown person is long-legged 
 and short-bodied. His legs are about as long as his body, neck and head 
 combined. His center of gravity, as Eeynolds and Lovett show, is about 
 his hips. His legs and feet weigh about as much as all the balance of his 
 body combined. 
 
 There is a disadvantage in a short trunk which, in the horse, is held 
 to be an advantage. Short-bodied people are prone to lay on fat. As a 
 horse is on an economic basis a tendency to lay on fat is an advantage. A 
 short-bodied horse which will do a hard day's muscular work and keep in- 
 prime condition on a small allowance of oats is a desirable animal to have 
 in the barn. 
 
 Man is not an economic basis. He does not do muscular work. His train 
 has lifted him out of that class and each year finds for him still other means 
 of escape. He wants to eat overmuch and not get overfat. 
 
 If he is short-trunked he cannot do it. If he measures far from his last 
 rib to his hips he is reasonably certain to fatten up as he passes from youth 
 into middle life. 
 
 The men with endurance and vitality are those with long trunks, those 
 that "sit high." They are the men who can work hard and long and keep it 
 up for successive days, months, and years — that is, assuming that there is 
 breadth of shoulder along with length of trunk. 
 
 They have chest room for well developed hearts and lungs. They have 
 abdomen room for completing the processes of digestion and preparation of 
 food for proper use by the tissues. Storing food as fat is not proper use by 
 the tissues. 
 
 "Wants to Increase Height. — M. E. W. writes: "Can you suggest any 
 exercise that will tend to develop the height f 
 
 Reply. — Height is much more a question of inheritance than exer- 
 cise. The bones attain their growth early in life. Therefore, exercise 
 and feeding, to influence stature, must be made use of in youth. 
 
 Abundant feeding and good hygiene in childhood and in youth can lend 
 a helping hand to heredity. A part of an inch can be gained by the use 
 of such exercises as tend to straighten out sway backs, stoop shoulders, ewe 
 necks, and similar faults in posture. A few years ago dried thyroid, per- 
 sisted in for years in youth, was thought to have some value. 
 
 Exercises to correct posture and thus increase stature are not of much 
 service except under the guidance of a physical culture expert. 
 
 Will Not Grow. — L. writes: "I am a woman of 21, and should like to 
 add two inches to my height. Will thyroid tablets do this?" 
 
1072 POSTUEE— HEIGHT 
 
 Reply. — If you are twenty-one you will not gain in height from using 
 thyroid. Competently directed youths in their teens might be justified in 
 trying it. 
 
 Rules for Height. — J. 8. writes: "Is it possible for me to increase 
 my height about two inches by means of stretching exercises, after I have 
 reached the age of 23, without impairing my health? If so, what exer- 
 cise would you recommend?" 
 
 Reply. — Follow the exercises issued by Sudor for use in the Chicago 
 public schools. By standing straight you can increase your height, but 
 not so much as two inches. 
 
 How to Grow Taller. — J. H. J. writes: "Could you tell me something 
 to make me grow taller?" 
 
 Reply. — There is nothing to do but to eat plenty of meat, bread, 
 vegetables and fruit. Exercise a lot and stand straight. Some day physi- 
 cians may be able to increase stature by using the ductless glands but the 
 plan has not yet been worked out. 
 
 To Increase Height. — F. S. M. 8. writes: "Can the stature of a per- 
 son 19 years of age be increased by stretching the cartilage between the 
 bones? If so, how much of an increase can be had? Are there any harm- 
 ful effects caused by using this method?" 
 
 Reply. — By standing straight and thus lessening the curves you can in- 
 crease your height somewhere near an inch. It is not stretching the cartil- 
 ages that brings about the result. The treatment is harmless ; in fact, it is 
 beneficial. Do not waste money on expensively advertised systems. Work 
 in a properly directed gymnasium will do as much for you. 
 
CHAPTEK LVIII 
 
 The Muscles 
 
 The tissues of the human body are divided into hard workers such as 
 brain, kidney and muscle, and those which merely sland and serve such as 
 bone and fat. 
 
 Of the workers, the muscles comprise the largest part. Their weight is 
 65 per cent of the body weight, after the bone weight has been subtracted. 
 They do more than 65 per cent of the work. The brain sleeps but the heart 
 and breathing muscles work on through the resting hours. 
 
 The most important reason for eating is that the muscles may have food; 
 for breathing, that they may have air. If the muscles are burning up food 
 properly the stomach will take care of itself. 
 
 The real reason of dyspepsia and indigestion is in the muscles. The place 
 where food is burned into waste is not in the kidneys or the liver but in the 
 muscles. The kidneys and 
 the liver merely eliminate 
 the ashes as the lungs elim- 
 inate the smoke. 
 
 Muscle movement 
 squeezes juices rich in waste 
 products out of the tissue 
 spaces and into the blood 
 vessels where circulation is 
 more active. 
 
 Flabby, soft muscles 
 mean several things. In 
 
 the first place, they mean that 65 per cent of the man is not much man — 
 is in a poor state of vigor. Besides that they mean poor breathing, poor 
 burning up of waste, clogged elimination all over his body, a certain amount 
 of lowered resistance and premature senility. 
 
 Every man needs muscular exercise. No mans work gives all his muscles 
 the needed exercise. About nine-tenths of the men are engaged in work requir- 
 ing physical labor yet these too require some form of play to exercise muscles 
 unused in their work, to empty the dead ends of their sewers — for such are 
 inactive muscles. 
 
 Properly planned play after the day's work is done is restful to the 
 mind and the body. As to housewives, brain workers, clerks and office work- 
 ers, there is no need of arguing that their muscles are flabby, their circulation 
 poor, their digestion troublesome, their biliousness frequent, and that these 
 call for better muscular development. 
 
 Every flabby person is willing to admit that he ought to take more 
 exercise but systems take time and apparatus. Some of them would build up 
 
 1073 
 
 Fig. 446. — Biceps Muscle as It Appears When Arm 
 Is Extended. 
 
1074 
 
 THE MUSCLES 
 
 Fig. 
 
 447. — The Bones of the Upper Extrem- 
 ity with Biceps Muscle. 
 
 their muscles if it could be done without apparatus or without going to a 
 
 gymnasium. 
 
 Let them get busy for to build up muscles it is not necessary to have 
 
 apparatus or to go to any gymnasium or to take lessons from any physical 
 
 culture professor or to use up any 
 particular time. One can be a 
 home-made Sandow. 
 
 The plan which has been pro- 
 posed any number of times is that 
 instead of lifting a weight or chin- 
 ning a bar the lifting be done 
 against opposing muscles. No- 
 where in the body is there a group 
 of muscles that works unopposed. 
 Universally whenever there is a 
 group of muscles that pull in one 
 direction there is another group 
 which pull opposite. The simplest 
 
 and best plan to develop the muscles is to use the pull of one group against 
 
 the other. 
 
 The man who is exercising according to this plan should go over his body 
 
 systematically at least once every day. 
 
 Step one is to pick out in the mind a group of muscles to be exercised. 
 
 Step two is to move the part selected by pulling on one group of muscles 
 
 and pulling against that group with the 
 
 opposing group. Eepeat this three times. 
 For this it is not necessary to know 
 
 the names of the muscles. The motion 
 
 having been decided on experience teaches 
 
 just what muscles are to be used to accom- 
 plish it. 
 
 Having gone over the face muscles 
 
 next go over those of the neck. For in- 
 stance, draw the head back pulling it vio- 
 lently with the muscles of the back of the 
 
 neck and pulling violently against these 
 
 with the muscles of the front. Exercise 
 
 all the muscles of the neck by pulling hard 
 
 and slowly with each group opposed by a 
 
 hard pull from each opposite. 
 
 The hands, wrists, forearms and arms, legs, chest, back, and abdominal 
 
 muscles are gone over in the same systematic way. 
 
 Five minutes in the bathroom in the morning while one dresses, and 
 
 five minutes as one undresses at night will be all that is needed for the home 
 
 part of the plan. 
 
 Following it, within a week one can pick out any muscle and exercise 
 
 it and one can squeeze out as much waste from his biceps by bending his 
 
 elbow with the triceps pulling opposite as he can by lifting a bag of 
 
 shot. 
 
 Fig. 448. — Biceps Muscle as It Ap- 
 pears When Arm Is Bent. 
 
THE MUSCLES 
 
 1075 
 
 The best part of the plan, however, is that as soon as one gets going he 
 does not have to bend his limbs to get the exercise or to do anything else that 
 attracts attention. As one rides in the street car or automobile, sits at his 
 desk or does anything else which does not occupy all his mental energy he 
 can throw his muscles 
 into tension without 
 moving or giving any 
 outward sign. 
 
 Let the man who 
 goes home from work 
 in the afternoon loggy 
 and heavy — - perhaps 
 suffering from a head- 
 ache — systematically 
 pick out and contract 
 all the muscles of his 
 abdomen and back. 
 He will not only gain 
 for himself a muscle 
 control that will keep 
 his belly flat but he 
 will flush out the 
 waste of peripheral 
 tissues, cause himself 
 to breathe deeper, to 
 think more clearly and 
 to resist infection bet- 
 ter. 
 
 Following this 
 very simple plan for 
 ten minutes in the 
 bathroom at home and 
 from time to time 
 during the day a man 
 can build up muscle 
 lumps that will com- 
 pare favorably with 
 the pictures in the 
 street cars. 
 
 If the advice were 
 stopped at this point this article would do more harm than good. Muscle 
 building is not enough. Muscle training is of importance. A muscle building 
 system must be supplemented by a muscle training system and this last calls 
 for play of some sort. 
 
 The big-muscled fellows are not in very good condition. Many of them 
 die from consumption and pneumonia. They do not live long; they never 
 are good prize fighters or wrestlers; they never win any running races; they 
 are never golf champions; they are never good billiard players or bowlers; 
 nor do they win any games at tennis. 
 
 Fig. 449. — Great Muscles of the Back, Neck and Arm. 
 
1076 
 
 THE MUSCLES 
 
 Everyone needs some play out of doors. There is genuine physical 
 need of the freshness of the open air in sunshine and in storm. One needs 
 differences in temperature — to breathe deeply of fresh air — to have the wind 
 and rain beat in the face — to have the heart beat fast — to have the skin red 
 from blood in the capillaries — to siueat. 
 
 Fig. 450. — Various Types of Striped or Voluntary Muscles. 
 
 Add to the above program for "auto-muscular" development some exer- 
 cise in the open air such as walking to and from the office or even climbing 
 stairs instead of using the elevators. 
 
 Striking a golf ball is a wonderful act. For it at least fifty muscles are 
 required. Each must do just exactly its work, no more, no less. It must 
 do its work at just exactly the right time — neither too soon nor too late. 
 Each must do its work in proportion to the work done by each other member 
 of the force. If any one lags or fails to do its share some other must com- 
 pensate in one way or another. 
 
THE MUSCLES 1077 
 
 A bowler sends a ball down the alley with just the right speed and aimed 
 to strike the front pin at just the right place. In order to do this he makes 
 use of almost every muscle in his body. Each does exactly the right amount 
 of work in the right way and at the right time. 
 
 If a railroad system were as complicated as ■ the act of bowling train 
 dispatchers would score "strikes" and "spares" less frequently than do 
 bowlers. Muscle coordination is wonderful and well worthy of development. 
 
 Play builds up long, lithe, quick acting, trained muscles. In addition 
 to that it burns up the fuel of the body completely instead of halfway. It 
 therefore is an aid to digestion. It uses up gases; it therefore is an aid in 
 breathing. It squeezes the waste out of the by-places. It therefore helps 
 the organs of excretion. It teaches cooperation, coordination and community 
 life. 
 
 As muscles work they make fatigue toxins. These toxins stimulate the 
 formation of fatigue antitoxins — a way in which play rests those tired from 
 hard work. 
 
 Ten minutes a day is not enough time to give the muscles; but not all 
 days are fit for play. Then let one devote a few minutes each day to a system 
 of muscle development and add to it training of coordination through play 
 as often as it can be made to fit into the program of work. 
 
 We may not agree with Friedman that we are breeding a race of people 
 with big minds and little bodies. We may not agree with the statement 
 attributed to Wellington that Waterloo was won on the cricket field. But 
 we can all agree that average men, those with good (not big) muscles well 
 trained, are healthy animals, and that good playing in that it teaches working 
 together by healthy men makes good citizens. 
 
 s 
 
 LEG AND ARM MUSCLES 
 
 The fingers, hand and wrist are moved by the muscles below the elbow 
 in the arm and those in the hand. The movements of the hand muscles are 
 of two kinds: closing the fist and opening it; of the forearm muscles, bend- 
 ing the hand forward and backward, bending it to the thumb side and in 
 the opposite direction. In addition the hand can be rolled so that the palm 
 faces up and turned so that it faces down. 
 
 Here are six movements, three groups of two each. Here are six groups 
 of muscles, three groups of two each. 
 
 To build up these muscles there are six exercises. 
 
 1. Close the fist by pulling hard with the palm muscles, pulling against 
 these with the muscles of the back of the hand and arm. 
 
 2. Open the fist, antagonizing the same groups. 
 
 3. Move the hand toward the thumb side, pulling hard on the opposing 
 muscles. 
 
 4. Move the hand toward the little finger side, pulling hard on the 
 opposite group. 
 
 5. Eoll the palm up while pulling hard on the muscles which roll it 
 down. 
 
 6. Eoll the palm down while pulling hard on the opposing muscles. 
 
 To exercise the muscles which move the elbow is simpler still. There 
 
1078 
 
 THE MUSCLES 
 
 are but two groups : Those on the front which crook the elbow and those on 
 the back which straighten it. The exercises are but two. 
 
 1. Crook the elbow by pulling hard with the muscles on the front of 
 the arm, pulling against them with the muscles on the back. 
 
 Muscles op the 
 Leg. 
 
 Muscles of 
 the Arm. 
 
 Muscles of the Body. 
 
 Fig. 451. — Muscles. 
 
 2. Straighten the elbow by using the muscles on the back of the arm 
 to outpull those on the front. 
 
 The shoulder is lifted upward by the neck muscles and pulled down- 
 ward, forward, and backward by the chest muscles. It should be successively 
 pulled in each direction by having the muscles in each group outpull its 
 opposing group; 
 
THE MUSCLES 1079 
 
 The leg muscles, including those of the feet and toes, are to be exer- 
 cised in the same way. Ten minutes a day given to leg and arm exercises 
 will keep these muscles in fine tone, will increase their size and will give the 
 brain increased control of them. 
 
 It will not teach rapid or properly controlled use of them. That is 
 another story. 
 
 MUSCLE SAGGING 
 
 The organs work best when they are where nature put them. Because 
 this is so there are arrangements of bones, ligaments, and muscles to hold 
 them in their proper places. No organ is wedged in immovably tight. 
 Every organ is so arranged as to permit of a little play. Such an arrange- 
 ment permitting of a little play is necessary to save wear and tear. An 
 immovable timber in the midst of movable water wears out and breaks up 
 much more quickly than one that gives a little with every wave. Therefore, 
 whenever there are pleuritic adhesions which fix the lungs from pleurisy, 
 pleurisy pains are frequently felt. 
 
 Whenever any organ is firmly fixed in one position "hurts and aches" 
 in that organ will be frequent. But the amount of movement in so-called 
 "fixed" organs must be but slight. An exaggerated movability is worse than 
 too much rigidity. Above all does harm come from a markedly persistent 
 •sagging. 
 
 Any of the structures whose duty it is to hold organs in place may 
 get out of place or fail to do their work for other reasons, but the muscles 
 are usually the worst offenders. 
 
 The organs of the abdomen are held in a box. At the top is the chest; 
 there cannot be give in that direction. At the bottom is the bony pelvis; 
 there is not much chance to give in that direction. Behind are the spinal 
 column and the heavy back muscles; there can be no pouching backward. 
 
 The front is the weak area. Those muscles are not overstrong in mus- 
 cular people while they are exceedingly weak in flabby folk. To make mat- 
 ters worse, the backward bend of the lower back pitches the strain against 
 the front. The weak muscles give; they pouch out; they pot and into the 
 pot the stomach, intestines and liver sag. Sagging of the organs is called 
 ptosis by the doctors. 
 
 Ptosis is important because it produces intestinal stasis and intestinal 
 stasis in turn leads to a great variety of diseases and disabling conditions 
 not called diseases. 
 
 In intestinal stasis the intestines do not pass the food along so rapidly 
 as it should be passed. Where such a condition is present nutrition is mate- 
 rially interfered with, resistance lowered, and the system exposed to attack 
 by disease producing germs. 
 
 To Metchnikoff and Lane much credit is due for working out the harm 
 done by intestinal stasis. Where intestinal stasis exists the organs of elimi- 
 nation — kidneys and bowels — are unable to throw off the waste products. The 
 system becomes clogged up. 
 
 It takes the food about six hours to pass through the stomach and small 
 intestine. It takes it about forty hours to get through the eight feet of large 
 intestine. At best the large intestine has its trouble preventing its contents 
 
1080 THE MUSCLES 
 
 from stagnating- and when it sags or kinks the movement of the contents 
 is more difficult; stagnation is more frequent and stagnation effects are more 
 harmful. 
 
 Metchnikoff says: "Particularly injurious are the microbes of the large 
 intestine. Thence they penetrate into the blood and impair it alike by their 
 presence and the products they yield — ptomaines, alkaloids, and the like. The 
 auto-intoxication of the organism and poisoning through microbes are an 
 established fact." 
 
 MetchnikofFs theory is that the arterial changes which cause many of the 
 diseases of old age are due to bacteria in the intestines. He* says that the 
 poisons generated by these intestinal bacteria are the cause of the common 
 diseases of degeneration of the organs of the human body and the chief 
 cause of premature old age; that if we could preserve the intestinal tract 
 in a state of freedom from intestinal bacteria we could prevent most of the 
 diseases that can be traced to the action of these germs, including chronic 
 heart disease, arteriosclerosis and most kinds of headaches. Not only that 
 but we could greatly prolong life because the greatest cause of old age, 
 the absorption of bacterial poisons in the intestines, would be nonexistent. 
 
 The process of tearing down and building up is going on in the body 
 all the time. Waste which results from this process should be promptly 
 removed if the individual is to enjoy good health. To carry away the waste 
 product nature has provided us with lungs, kidneys and bowels — the latter 
 being by far the most important as they have so much more work to do. 
 
 The retention of waste products affects the system by undergoing changes 
 which produce gas and various forms of disease-producing germs. These 
 products of fermentation and decomposition are harmful in two ways. 
 
 1. The gaseous condition causes distress particularly when present in 
 the colon. On account of the size of the colon, when it becomes distended with 
 gas it crowds the neighboring organs. It may even irritate them and if 
 greatly overdistended interfere not only with its own function but with those 
 of its neighbors. Many times when the irritation is of sufficient degree, if pro- 
 longed it may excite inflammation in the neighboring organs. 
 
 2. They are harmful in that the poisons which result therefrom so fre- 
 quently get out into the blood current and produce a train of symptoms 
 which are not always easily classified. 
 
 Where the colon is overdistended and full of gas it may materially 
 interfere with stomach digestion. It may interfere with the free and easy 
 movement of the food in the stomach and even cause undue retention. It 
 is this interference with the normal disposition of the food once it has 
 arrived in the stomach, that produces such distressing symptoms of stomach 
 indigestion. 
 
 The chief source of danger resulting from the accumulation of products 
 of decomposition and fermentation in the bowels and stomach is absorption. 
 When large quantities of poisonous materials result therefrom much of 
 it is likely to get through the walls of the intestines into the blood current 
 and materially interfere with nutrition to the part. 
 
 The colon particularly has great absorbing powers. For this reason 
 when decomposition of organic substances (comprising food) occurs in the 
 colon the products are rapidly absorbed and borne away by the blood to 
 
THE MUSCLES 1081 
 
 all parts of the body, to be brought in contact with the tissues to their serious 
 injury. Thus the kidneys, lungs, nerves, arteries, in fact all the organs in 
 the body, undergo a change which diminishes their vitality and resisting 
 power. 
 
 While it is accepted that most diseases are of germ origin it should not 
 he forgotten that lowered physical resistance and loss of vitality have much 
 to do with preparing a field in which the particular germ may lodge and set 
 up its particular type of disease. 
 
 A certain germ may lodge in the crypts of the tonsils, may remain there 
 indefinitely and do no harm. If, however, its environment should be changed 
 so as to reinvigorate it and give it new life it may immediately get into 
 the blood current, be carried to some remote joint, lodge there, and cause a 
 train of symptoms of a rheumatic type. It may pass out into the muscular 
 structures and lodge producing a muscular rheumatism. It may produce 
 other diseases. 
 
 If, however, the system had not become so changed that the germ was 
 given a renewed vitality it might have remained in its original lodging place 
 and have done no harm. 
 
 Dr. Franklin H. Martin considers ptosis responsible for the kinks in the 
 lower end of the small intestine, the lower end of the stomach, cystic duct of 
 the gall bladder, transverse colon and in other portions of the large bowel. 
 
 When sharp kinks in the various abdominal viscera are subjected to pro- 
 longed mechanical irritation and inflammation it happens sometimes that 
 strong fibrous adhesive bands fix the organs in unnatural positions or fix 
 the unnatural kinks. 
 
 Such adhesions may produce a long line of symptoms often vague. 
 These have been worked out and described in simple language by various 
 writers. None, however, has expressed them more systematically than Mr. 
 Chappie. He made a study of a number of cases and found the symptoms 
 complained of by most of them about as follows: 
 
 1. Headaches, severe and frequent. 
 
 2. Attacks of nausea often followed by retching or actual vomiting. 
 In some cases the vomiting was frequent indeed and of a severe nature. 
 It was interesting to note that in several of the cases blood was frequently 
 present in the vomit and had led able men to the diagnosis of gastric ulcer 
 although none such was found in the operation. 
 
 3. Loss of appetite was almost constantly present. 
 
 4. Loss of weight was present in all cases. 
 
 5. Markedly cold hands and feet, which gave an indication of defective 
 circulation. 
 
 6. Mental apathy. This was definite in most cases. Many felt that death 
 would be a welcome relief from their physical and mental misery and two 
 had actually attempted to bring about that end. 
 
 7. Constipation, which in all was persistent and its previous treatment 
 a failure. One case had gone on several occasions for twenty-eight days 
 without an action of her bowels, in spite of treatment. 
 
 8. Attacks of abdominal distension due to gas. 
 
 9. General muscular pain and a loss of freedom in the action of the 
 joints. 
 
1082 THE MUSCLES 
 
 People whose abdominal organs had sagged, particularly those in whom 
 sagging had caused kinks which had later become fixed, generally had a 
 sallow skin. In many were the so-called liver spots. In some there were 
 brownish patches under the arms and in the groin. 
 
 The farther from the stomach the intestinal kink was located the deeper 
 the color of the patch and the larger it was. 
 
 The people who have been going to beauty specialists for liver spots 
 should have been hitching up their abdominal organs. 
 
 In some cases not much can be done in the cure of ptosis and stasis 
 by building up the muscles, until the adhesions have been broken up by 
 operation. Breaking up of adhesions by operation may require more than 
 one operation. 
 
 Following the breaking up of adhesions and the reduction of misplaced 
 organs to their normal positions active muscular exercises and massage may 
 be employed to build up the muscles of the walls of the abdomen, chest 
 and back. These are the muscles that need especial care and training in the 
 treatment of ptosis. 
 
 Dr. Martin has proposed a plan of exercises to develop these muscles. 
 These exercises consist in placing one end of an ordinary ironing board 
 or board of about similar dimensions on a chair, allowing the other end to 
 rest on the floor. The patient is then required to lie down on the board 
 with the head downwards. This position of the body permits the gravita- 
 tion of the viscera upward under the border of the ribs. 
 
 While in this position the patient is required to practice active exercises 
 by flexing the lower leg on the thigh and the thigh on the abdomen. 
 
 Dr. Martin also recommends deep breathing exercises. These are to be 
 practised while the body is in the same position as when taking the muscular 
 exercises. 
 
 1. Place both hands on the lower abdomen towards the diaphragm. 
 
 2. Elevate the shoulders with arms extended slowly at right angles to 
 the side. 
 
 3. Elevate the arms above the head perpendicular to the body. 
 
 By practicing these exercises one brings into play the diaphragm, the 
 abdominal muscles, the back muscles, the muscles which raise and lower the 
 ribs, the shoulder muscles, the strong muscles over the front of the chest, 
 those of the back covering the shoulder blades and even the muscles about 
 the neck. 
 
 Walking Will Help. — M. H. wants to know if the muscles can be 
 exercised without moving the joints. He has no time to play golf or 
 any other game. He has lived in the country and got plenty of exercise 
 there but does not have any chance in the city. He has tried exercising 
 his muscles as he sits at his work but does not know that he does it right. 
 
 Reply. — Yes, the muscles can be exercised without moving the joints. 
 Take, for example, your hand. You can tighten each group of muscles 
 without bending a finger. You know that you have exercised them be- 
 cause you can see and feel them contract. With a little practice you 
 can do the same with the muscles everywhere. Facility in picking out 
 muscles and in exercising them can be acquired without having set 
 
THE MUSCLES 1083 
 
 exercises and a set time to do them in. At the same time this does not 
 take the place of play or exercise in the open air. I wonder if you walk 
 to and from your work or two miles of the distance riding the remainder, 
 or if you walk up and down stairs. 
 
 Deep Breathing Benefits. — 0. B. Q. writes: "1. What, please, is the 
 benefit of taking deep inspirations? 2. Does the practice of holding the 
 breath for a minute or longer do one's lungs any material good?" 
 
 Reply. — 1. The breathing automatically regulates itself. We breathe 
 as often and as deeply as we need to to get rid of the gaseous wastes of 
 the body and to provide the blood with oxygen. 
 
 Deep breathing for a short while drives the blood out of the lungs 
 and into the circulation. It is a great quickener of capillary circulation. 
 It is an excellent means of overcoming drowsiness and cold feet. It is a 
 means of exercising the trunk muscles, especially the accessory respiration 
 muscles. It has some effects in ridding the body of carbonic acid and 
 increasing the oxygen in the blood. 
 
 2. No. 
 
 Arm Muscles Exercise. — M. B. says that she does not know how to go 
 about making one set of muscles pull against another. For example, how 
 could she exercise her lower arm muscles? 
 
 Reply. — Take a brick in your hand. Lay your arm on a table, hold- 
 ing the brick in your hand. Keeping the elbow on the table, raise the 
 brick slowly until it is one foot above the table. Slowly lower it. Now 
 go through the same movement without the brick using about the same 
 amount of muscle pull as when you held it. 
 
 Cramps While Swimming. — F. K. L. writes: "Every time I go in 
 swimming I get a cramp 'in the arch of my left foot. What causes it, and 
 what will prevent it?" 
 
 Reply. — It is caused by a combination of unusual exercises, cold, and 
 apprehension. 
 
 To prevent it: (a) Exercise every morning in your bathroom; per- 
 form exercises that make use of your leg muscles, (b) Exercise when 
 nude in a cold bathroom, (c) Quiet your apprehension; to fear cramps 
 is to invite them. 
 
CHAPTEE LIX 
 
 Housing 
 
 Charles Dickens said: "I have systematically tried to turn fiction to the 
 good account of showing the preventable wretchedness and misery in which 
 the masses of the people dwell and of expressing again and again the con- 
 viction, founded upon observation, that the reform of their habitations 
 must precede all other reforms, and that without it all other reforms must 
 fail." 
 
 WHERE SHALL ONE LIVE? 
 
 Many people move on October 1. The October crop of movers is next in 
 size to the May crop. 
 
 What do they look for? They consider transportation, accessibility, the 
 neighborhood, the general appearance of the house, the front entrance, the 
 parlor, the bathroom, the kitchen conveniences and the price. This is about 
 as much as the average house hunter goes into it. No one of these considera- 
 tions should be lost sight of. They are immensely important. 
 
 Important though they are, they should not be the "only things thought 
 of. Whether the house is a healthy place to live in is very much more 
 important. 
 
 Houses are built of brick and stone. Health is not built in. The man 
 who builds is not thinking of that. He was not thinking of it when he 
 bought his lot. So when the house hunter goes around with health as one 
 of his yardsticks he does not find much that measures up. 
 
 The employed members of the family are going to be in the house about 
 twelve hours out of the twenty-four; the school children somewhat more than 
 that; the younger children and the housewife will be there for twenty hours 
 out of the day's total. 
 
 A healthy home is highly important. It is important in shielding against 
 definite disease. It is more important in making for efficiency. What we 
 mean is this : It is more important that a man should go to his work or that 
 the child should go to his study bright, clear and vigorous, well rested and 
 overflowing with life, than it is that they should be protected from particu- 
 lar diseases. 
 
 I am going to write about some things in a house which are more 
 important than the front entrance. 
 
 HOUSES AND HOUSING 
 
 Houses are one thing; housing is another. Houses may be all right; 
 the housing may be poor. The housing is what counts; the house is of 
 
 1084 
 
% HOUSES AND HOUSING 
 
 1085 
 
 secondary importance. Improving the houses may make the housing worse. 
 In fact, it usually does. With us it certainly will. Why? Because we 
 have our minds set on houses. It is the common experience that even when 
 a housing situation is tinkered with just enough to improve the houses the 
 housing is made worse. 
 
 It is a basic law that rent cannot take more than 25 per cent of the family 
 income. Generally it takes less. If the family is one of low standards it 
 will not allow the proportion to get to 20 per cent, or anywhere near it. 
 
 If the rent goes up the family moves to a cheaper place or it takes 
 lodgers or the women and children go to work — which means that when 
 the rent goes up the housing goes down. To improve the houses puts the rent 
 up; therefore it puts the housing down. There are too many experiences 
 demonstrating the working of this rule to leave it in doubt. 
 
 When we require larger rooms, more windows, more of the lot un- 
 
 % 
 
 ■JKircH nor cn/iyv.y to jr/iif. 
 
 FVRNITVR.E STOR£ ROOM 
 
 eriTEAncc 
 
 Ml ^- -SINK. ■ »«•■■•• ".>.■. w t ~.v^« 
 
 1 CLOSETS CLOSET 2> CLOSET 3 <^ 
 
 j \ j r £- 4 a 
 
 ' Oi/ntt/* uati ^7 rt rANA A F' 
 
 CLOSET 4 CLOSET J 
 
 PUBLIC HALL 37 MT LONG . 4- Ft. WIDE 
 
 ¥ 
 
 £=--£ 
 
 Russell Sage Foundation. rmr <* Bu "- Omo 
 
 Fig. 452. — Diagram of a Bad Tenement in Springfield, III. 
 
 occupied, better construction, better plumbing, we increase the rent. When 
 we do many of the people who formerly occupied houses in that neighbor- 
 hood must move into basements or into alley houses. Others will pay 
 the greater rent but they will crowd in lodgers to make the extra money. 
 
 There must be better housing. Health demands it. Business demands 
 it. Labor demands it. The life of the .nation demands it. To have better 
 housing we must have better houses. 
 
 Is there any way to get them without raising the rents? When you 
 tackle that question you quit thinking. 
 
 Several remedies have been proposed. One is for the government to buy 
 up the bad housing districts, tear out the old houses, build new ones and 
 rent those to the people. This plan is based on the idea that if all the land 
 were used to the best advantage and all middlemen were eliminated the 
 government could furnish a workingman a good house for the rent he now 
 pays for a poor one. 
 
 Another is excess condemnation. By this is meant that the government 
 would buy up all the bad housing, tear it out, rebuild, improve, — and sell 
 back enough of the beautified, adorned and homogeneously developed land 
 to pay for the improvements. 
 
 Another is the tax on unearned increment and use of the funds for re- 
 building poor districts. The plan is for the government to get a certain 
 part of the increase in value of privately owned land and to use the funds 
 
1086 
 
 HOUSING 
 
 so collected as a land fund. This land fund is to be collected in order to 
 purchase poor houses, rebuild them, and rent or sell them to workingmen on 
 easy terms. 
 
 Another is the single tax or a modification of it. Under this plan taxes 
 are to be taken from personal property and from improvements on land. 
 This will greatly increase the taxes on land. On unimproved property the 
 taxes will be greatly increased. On improved real estate the tax increase 
 
 LOCATION 
 
 FROMTAQE 
 
 REPAIA PROPORTfONOF VOT COVERED SUPPLY 
 
 LOCATION 
 
 FREEVOBSTRUCTFO SCWND'vPATCHED COVERED VXPOSED DAMPNESS 
 
 RLPA1R 
 
 VENTlbATION 
 
 IKJHT FlOOfll^YlHH 
 
 HOUSINQ CONDITIONS IN 1003 HOUSES 
 
 PHinDtiPHia — \ys. 
 
 VyW 
 
 :FA1R. 
 
 Henry Phipps Institute, 
 11th Annual Report. 
 
 Fig. 453. — Diagram Giving an Analysis of Conditions in 1003 Houses in Philadelphia. 
 
 will not equal the reduction because of the release of the improvements from 
 taxation. With the housing property paying less taxes the rent will be 
 lowered, or a good house will rent for what a poor one now rents for. 
 
 There are several cures. Tinkering is not one of them. But even 
 tinkering is better than doing nothing. Vis inertia is the hardest of forces 
 to overcome in a democracy. 
 
 HOUSING PROBLEMS IN AMERICA 
 
 When the second National Conference on Housing was opened Jacob 
 Eiis was noticed in the hall and called on for a speech. He declined. On 
 the closing day of the conference he took the platform and told his old-time 
 friends the reason he had refused to speak on the opening day was that he 
 wanted to size them up first. 
 
 "Let me tell you," he said, "of what I saw of you. I saw the same clear- 
 
HOUSING PROBLEMS IN AMERICA 1087 
 
 eyed enthusiasm that I was familiar with in the old days and with that I 
 saw the calm confidence which knows how to go and how far it can go. 
 That was a new thing, friends, to me. I saw a balance had come into you, a 
 balance that was good to see. It was clear that yon are no longer only de- 
 termined to go ahead bnt that you know also how far to go and how to 
 go, and that is a great thing/' 
 
 With this speech the conference closed. 
 
 Some part of Mr. Riis' opinion is justified and some of it is not. When 
 men first began to complain about "the horrid slums" the attitude was one of 
 wild-eyed enthusiasm. They were for ripping out the tenements and doing 
 many other acts born of zeal. Nobody talks that way now except the Pauls 
 whose Saul wings were shed overnight. 
 
 It is easily apparent that men working on housing have had a "balance 
 come into them, a balance that was good to see." In my judgment, that 
 balance is more the result of a recognition of "how far you can go" which 
 carries with it always the corollary "how far you cannot go," than it is 
 knowledge of "how to go." 
 
 According to my way of estimating it, the housing workers have settled 
 down to the work of the day. They are tackling the little problems of every 
 day, trying to solve them as sensibly as they can; but they have no greater 
 vision of the remedy, the great how-to-go, than they had in the rosier 
 morning. 
 
 They seem to have accepted it as inevitable that the children of Israel 
 must wander forty years. They have quit climbing mountains to look out for 
 the Promised Land and are giving their thought to daily manna, camp 
 sanitation and to the other things necessary if any of the Israelites are to 
 be on earth when the pilgrimage is past and the Promised Land is at hand. - 
 
 In this three days' discussion there were hundreds of talks on the prob- 
 lems that relate to housing. Seventy-six cities and twenty-three states were 
 represented and each delegate told of things as they were where he came from. 
 
 Suggestions were occasionally made as to methods of bettering things. 
 But at least nine-tenths of the discussion might be termed inventorying — 
 telling of conditions, perhaps of machinery for control, perhaps of plans 
 for the future — and yet the question, What is the remedy? remained with- 
 out answer. How to go was answered by "We are trying this" or "We have 
 tried this," but never a clear-cut answer "Thus and so." 
 
 The thread began with the admirable speech of the British ambassador, 
 James Bryce, who struck the keynote when he said: 
 
 "I am not prepared to say what are the remedies that can be applied" 
 [the how-to-go]. 
 
 It ran to the end, for the association adopted no resolutions embodying 
 its opinions or making any attempt to standardize procedure. Mind you. the 
 conference was discussing the bad features of bad housing, not the funda- 
 mental underlying principles, and not even on the how-to-go of these was 
 opinion crystallized. 
 
 Mr. Bryce gave seven reasons why a great city was a great evil. His 
 first was as follows : 
 
 "From the point of view of health. In the city — and most of the great 
 cities are crowded — there must be less oxygen and more microbes. I believe 
 
1088 HOUSING 
 
 it is a fact that no city has maintained itself and its standards of physical 
 excellence without an indraught from the country. If you were to leave 
 the city alone, stop the indraught of the people who have grown up and 
 formed their constitutions in the air of the country, the population would 
 decline physically and, perhaps, begin to die out." 
 
 I shall digress from the main point enough to impress the truth of Mr. 
 Bryce's statement on the readers of this article. For instance, every year 
 Chicago gains 15,000 population by natural increase but it gains an additional 
 30,000 by drawing on the country for them. 
 
 If it were not for this Constant skimming of the country the city death 
 rates would not keep down in spite of its good health department. On the 
 other hand, were it stopped the country death rates would drop even though 
 the state health departments remained as inactive and inefficient as many 
 of them now are. 
 
 Ambassador Bryce said: "Instead of letting a few huge cities grow to 
 more than a million in population it would be far better to have more and 
 smaller cities not exceeding 150,000 population or perhaps even 100,000. 
 This would furnish all the things that are needed for comfort and social 
 enjoyment." 
 
 Many authorities place 250,000 as the limits of a city's population, 
 beyond which there is loss for the city and the country at large. Thus 
 we see that so long as Ambassador Bryce stuck to the problem everybody 
 was agreed. When he ventured into the fringe of the remedy opinions 
 varied. 
 
 We must not get the idea that bad housing only exists in the huge cities 
 of a million or more. Mr. Ball of the Chicago health department has ex- 
 amined the housing in Washington, New York, Louisville. St. Louis, and 
 Duluth and he tells me that their problems differ from Chicago's only in 
 details. 
 
 Professor Tufts has made a housing survey of small cities, towns and 
 villages in Illinois, and his testimony is that the variance is only in details. 
 
 Professors Condra and Bailey and other men who have written on rural 
 homes and Professor Blair, who has reported on rural schools, all say that 
 no pot can call the kettle black. 
 
 In opening the conference President De Forest said of it : 
 
 "It is a propagandist body. It does not attempt to go anywhere and 
 tell people with authority what they should do. Its function, if I may put 
 it so, is maternal rather than paternal. It seeks to help, but it never seeks 
 to command. . . . 
 
 "Have this thought in your minds as you leave this conference : Do 
 not let us try to do everything. We cannot do everything. Do not let us try 
 to remedy all these bad conditions. We cannot do it in a lifetime. 
 
 "There are certain practical things every one of us can do in every 
 city in which we live. Pick out the particular things that can be done; 
 center yourselves on those; do them, and, when they are done, turn to the 
 next thing." 
 
 Every organization has the right to be measured by the yardstick of 
 its choice. These words of President De Forest constitute the yardstick by 
 which this conference has the right to be measured. Measured by this yard- 
 
HOUSING PROBLEMS IN AMERICA 1089 
 
 stick, the failure to adopt standard methods does not in any way argue that 
 the meeting did not accomplish its aim. 
 
 About five years ago the Chicago department of health startled the 
 community with a description of the relay bed system. Under this system 
 the beds are occupied for about eight hours by one shift of sleepers 
 who yield them to another set that hold possession for an equal length of 
 time. Sometimes the beds are worked in two relays and occasionally in 
 three. 
 
 I am sure that many people thought it mistaken when it said thrift was 
 more largely responsible than was need. A considerable part of the lodger 
 evil is the result of need but a larger part is due to greed. 
 
 In the conference discussion of room overcrowding there was related the 
 
 PROPORTION OF LOT COVERED BY BUILDING. 
 Total 
 
 Jewish 
 
 Italian 
 
 Negro 
 
 □ 
 
 .80% and Less of _Over 80% of 
 
 Lot Covered Lot Covered 
 
 Henry Phipps Institute, 11th Annual Report. 
 Fig. 454. — A Certain District in Philadelphia. 
 
 old chestnut about a room in which four families lived, one in each corner, 
 and one family took lodgers. 
 
 As to the degree of overcrowding, one speaker told of finding thirteen in 
 one small room in rural Indiana. A story from Boston was of a man who took 
 seventeen lodgers, and these so crowded the rooms that the proprietor's four 
 daughters, 16 to 22 years of age, had to sleep in a closet. 
 
 In another place a man occupied three small rooms. In one small room 
 he had six boarders while another housed his four grown daughters. In- 
 vestigation showed that the five working members of the family had a com- 
 bined income of $39 a week. It was thrift that was beneath this bit of over- 
 crowding. 
 
 In the experience of the speakers on this topic thrift often results in so 
 low a standard of living as seriously to imperil the health and well-being of 
 the overcrowded families. As a general proposition, however, the speakers 
 found that greed underlay overcrowding. 
 
 When a municipality tries to prevent room overcrowding violent opposi- 
 tion always arises. There is much talk about liberty, "invasion of the home/' 
 "a man's home is his castle," "the oppression of the poor," "paternalism" ; 
 gentlemen of experience record their judgment that when you scratch deep 
 
1090 HOUSING 
 
 enough you usually find that these battle cries come from men who raise them 
 as a means of protection while they earn usurious interest rates by exploiting 
 the poor. 
 
 Mr. Veillier came forward with a solution of the lodging evil, based upon 
 the idea that greed is the most frequent underlying cause. He would hold 
 the landlord responsible. In a dozen ways, under existing laws, he is held 
 responsible for various conditions. He has abundant means of knowing 
 the use to which his property is put, and he generally does know. A recent 
 Chicago experience shows that it is the best way to tackle vice. 
 
 Mr. Veillier proposes the following ordinance: 
 
 "No tenement house, nor any part thereof, shall be used for the letting 
 of lodgings without the consent in writing of the board of health, nor 
 shall any person not a member of the family be taken to live within an 
 apartment occupied by any family without such consent. 
 
 "It shall be the duty of the owner of such tenement house to see that 
 the provisions of this section are at all times complied with, and a failure 
 to so comply on the part of any tenant, after due and proper notice from 
 him, shall be deemed sufficient cause for the summary eviction of such 
 tenant and the cancellation of his lease." 
 
 Here was a definite how-to-go which was indorsed by some of the 
 speakers but not concurred in by others. 
 
 The advantage of locating factories in the suburbs was advocated by 
 John Nolen, landscape architect, of Cambridge, Massachusetts. By suburbs 
 he means the peripheral part of a city and not suburban towns trying 
 to maintain a separate government without proper revenues to meet the 
 demands put on a village government in close proximity to a city. 
 
 In the discussion Mr. Fulton of the Keokuk (Iowa) Industrial Association 
 said his society had employed Mr. Nolen to carry out his ideas on 400 acres 
 of ground purchased at $250 to $400 an acre to be developed as an industrial 
 city in connection with its newly developed electric power. 
 
 In the discussion Mr. Martin of Stapleton, N. Y., referred to "the 
 city that is alive to the social value of the nickel fare." One of the walls 
 around a city and perhaps the most impenetrable one is "the limit of the 
 nickel fare and the one-hour ride." 
 
 In New York City the Public Service Commission has entered into a 
 contract with the subway corporations under which the city puts up half 
 the money and is then in the position of a stockholder guaranteeing the bonds 
 of the bondholders — the subway owners. 
 
 This is a most improvident arrangement, holds Mr. Martin, except for 
 the right given the city to command the building of the subway to any 
 part of the municipal territory. This right, Mr. Martin thinks, will bring 
 vast unoccupied areas into the 5-cent-fare, hour-ride zone. 
 
 Mr. Wright of New York City at once picked a flaw in Mr. Martin's 
 point about the subway contract. Of course, the subway will build any- 
 where the city wants it to build if the city will pay the bill. This brings 
 the question of where lines are to be built back where it began, namely, 
 in a proper answer to the question, What will the traffic bear? 
 
 An interesting paper was that of Dr. Frankel on financing the small 
 home. As a basis for a policy Dr. Frankel has studied the plans in use 
 
HOUSING PROBLEMS IN AMERICA 
 
 1091 
 
 in Europe, particularly Belgium and Germany, and he discussed these. 
 
 The discussion of this paper illustrated how far we are from knowing 
 
 what is the best plan for financing the small house. The Albany House 
 
 Building Compan}', the General Electric Company, the Roland Park Com- 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 Minneapolis Civic and Commerce Assn. Report. 
 Fig. 455. — Chart Showing Comparative Standing of Localities as "Cities of Homes. 
 
 pany, Mr. Pischel of the Cook County Real Estate Board and Dr. Bryce of 
 the Dominion government each reported on methods that had been given 
 a trial. 
 
 Other subjects ably discussed regarding "Housing Problems of America" 
 were "Health Departments and Housing," "Regulation by Law/' instructive 
 Sanitary Inspection," "Wage Earners' Houses," "Garden Cities," "Rural and 
 Suburban Housing," "City Planning," "What Are Tenements?" "To What 
 Extent Are Tenants Responsible for Bad Housing" and "The Alley Problem." 
 
1092 HOUSING 
 
 HOUSE PLANNING 
 
 Housing is the most neglected problem of the present civilization. Towns 
 allow houses built without proper regard for health. Then when those houses 
 cause disease and the disease causes poverty the county agent or some 
 charity takes up the burden — but no one thinks of going back to the cause. 
 
 The tendency all down the line is toward too much housing. Cows 
 are housed in elaborate barns and they get tuberculosis. Indians are taken 
 out of shacks and tents and placed in comfortable houses and they do not 
 thrive. Children who are kept indoors get pale and catch everything that 
 comes along. Adults of the races longer civilized adapt themselves more 
 readily than children and the semi-civilized, but they do not thrive under it. 
 
 Much of the consumption, pneumonia and colds is due to bad housing. 
 
 pilillllllllllllllllllllllllllllllllllllllllllllllll 
 
 | AN IDEAL WORTH STRIVING FOR 
 
 §j "I picture in my mind a city in which the child, yet g 
 
 m unborn, will feel in its being tne stimulus of sunshine §§ 
 
 H and fresh air ; in which tne babe will be born into a g 
 
 jj house fit to receive tbe gift of heaven ; in which tne ( 
 
 ( child -will never know the burden of the slum, but g 
 
 jj through normal development will come to manhood § 
 
 jj ready, joyfully, to do his share in the work of the g 
 
 g world and qualified to assume a worthy citizenship." 
 
 — Chas. B. Ball, Chief Sanitary Inspector, Department of Health, Chicago |I 
 
 liiiiiiiiiiiiiin 
 
 Fig. 456. — Ball's Motto. 
 
 Besides this there are the vague ill feelings, the lack of aggressiveness, vigor, 
 and strength, the conditions short of definite illness. These are difficult 
 to weigh. One man gives them undue weight; another thinks they are not 
 important. Nevertheless, they have much to do with the joy of living. 
 
 Bedrooms should be used for no purpose but sleeping. In so far as 
 it is possible work should be done outside the house. In the city garments 
 are carried into the house. The children are driven out on the street. The 
 rooms get crowded, littered, and dirty. In the country some of the farm 
 work is carried into the house. Whereupon the bed and the clothes are pushed 
 over into the corner. When the time for retiring has come around the tempta- 
 tion to go to bed in the unaired and disordered room is irresistible. The bed- 
 rooms will not get the airing and sunning which they need if work is carried 
 into them. 
 
 If it is a question of building in the country the house should not be set 
 facing squarely north or south or east or west. Never mind the road running 
 the section line — set the house so that the sun gets the fairest chance at the 
 
HOUSE PLANNING 
 
 1093 
 
 rooms. Nor should there be much shade. Shade on the streets and shade 
 to a moderate degree in the yard is good, but the sun should have a fair 
 chance to reach the house if the products of human contamination are to 
 be made harmless. And what if the exposed house is hot in the summer 
 
 Minneapolis Civic and Commerce Assn. Report. 
 
 Fig. 457. — Floor Plan of One of a Series of Basement Apartments. The dark room on 
 the right measuring 3x7 feet was used for sleeping purposes. 
 
 time ? The family can move out under the trees, sit there, eat there and sleep 
 there until the house becomes comfortable. 
 
 In building in a city there cannot be the same liberty. Land is too ex- 
 pensive. The house must set straight with the street. There should be 
 enough land to allow sun and air to get at the house. City lots should never 
 be laid out on a multiple of twenty-five feet. A twenty-five-foot lot is too small 
 for a sanitary house of an approved and inviting type. Fifty feet costs more 
 money than the average purchaser can afford. There is no element of city 
 planning which means any more for wholesome lives and low taxes than pro- 
 vision for thirty-foot lots and a proper number of diagonal streets. 
 
 Recently a new building code was adopted in Chicago and the com- 
 
1094 
 
 HOUSING 
 
 mission fought for months over materials to be used, size of beams and 
 matters of that kind. These matters are of consequence and should have 
 had much thought. Important as they are, they are trifling as compared 
 with the light and air and other sanitary provisions of the structures. 
 
 Minneapolis Civic and Commerce Assn. Report. 
 
 Fig. 458. — Six Rooms, One Behind the 
 Other; Outside Windows Only in 
 Front and Rear. Note location of 
 bathroom and toilet. 
 
 Fig. 459. — Three Out of 
 Five Rooms Dark. 
 Not even "through" 
 ventilation possible. 
 
HOUSE PLANNING 1095 
 
 The trouble with the commission was that it was badly balanced. It had 
 brains, skill and technical training galore but the men were "dyed by that in 
 which they worked." Their life work had been stress and beams and mortar 
 and art. The few sanitarians were overbalanced. They brought out a code 
 which was one of the best ever produced in this country from the stand- 
 point of ventilation and light requirements, yet one in which health was 
 written far too small. It went into the city council and certain aldermen 
 fought to have it amended so as to make it less good. 
 
 Eastern cities once allowed bad housing conditions to develop to a degree 
 that we know nothing of. In those old days of license six-story tenements 
 grew up all over lower New York City. They had light courts eighteen to 
 twenty-four inches wide. There were dark rooms by the tens of thousands. 
 When anyone got consumption, pneumonia or a cold in one of these rooms 
 he infected it; and the infection remained potential for a long time. So 
 there came to be "lung" blocks. 
 
 New York organized its tenement house commission and passed a 
 tenement house law. They ripped out old tenements and made wide sunlit 
 courts. They now allow none of the old type to go in. This has cost millions 
 of dollars. The diseases caused by the old-style tenements have cost additional 
 millions. The yearly appropriation for the commission is more than $800,000. 
 
 The question of the housing of poor people is one of great perplexity. 
 The houses should be pleasing to the eye as well as planned right. Houses 
 that look slatternly and unseemly lessen the pride in neighborhood, street 
 and home. 
 
 There is need for architectural ingenuity. The price of the rental 
 cannot pass a certain percentage of the family income. If it does the 
 family takes in roomers or boarders and that usually is worse than a cheaper 
 house. We will say that a man can pay $12 a month for his house. He will 
 not gain anything from occupying quarters for which he pays $16 a month 
 if he rents out enough space to bring in $4 a month. 
 
 On the other hand the money invested must earn at least 7 per cent 
 net after ordinary carrying charges are subtracted. Deterioration is rapid 
 and hazards are high; so that the actual net will not be greater than 4 to 5 
 per cent. To build a house that is hygienic and sanitary and that will fulfill 
 these economic considerations will require skill. 
 
 A housing commission should have builders of originality as a part of its 
 membership. The price of real estate must not be high enough to make 
 carrying charges prohibitive. Therefore, real estate men should be repre- 
 sented. But, finally, the most important point comes — the house must be 
 lived in. Those who live in it must keep healthy and strong. If they do not 
 the earning capacity is lessened, or sickness comes and the earning capacity 
 ceases and the family unit is wiped out. 
 
 The New York Committee for the Investigation of the Condition of 
 the Poor reports that sickness is the largest factor in producing poverty. 
 We are sure that the United Charities in Chicago find that sickness causes 
 more demand for help than any other factor; and bad housing causes sick- 
 ness. And so, finally, a commission on housing should be composed largely 
 of sanitarians and political economists. 
 
1096 
 
 HOUSING 
 
 HOUSING PLANS 
 
 A few years ago a presidential campaign orator said 41,000 of the 100,000 
 laboring families of Glasgow lived in one-room tenements. The inference 
 was that American methods should be continued as, under them, no such 
 conditions prevail. Whereupon Kober commented, "We need not go to 
 Glasgow for such illustrations, for, to our shame, it must be confessed that 
 similar conditions obtain in nearly every American city." 
 
 The New York Tenement House Commission found 370,000 dark 
 
 Minneapolis Civic and Commerce Assn. Report. 
 
 Fig. 460. — Basement Apartments. Rear Rooms Virtually Unlighted Cellar Rooms. 
 
 rooms occupied as living rooms in 1903. No full survey of Chicago has ever 
 been made but two partial surveys indicate, first, that hundreds of thousands 
 of Chicago laborers are physically handicapped, made inefficient and fre- 
 quently made ill by living in dark rooms and, second, that things are getting 
 worse rather than better. 
 
 The fact is that, while our workingmen earn more, our land values 
 are higher, our building costs are higher, we have less town planning and 
 less regulation of building so that, all in all, our housing is no better and 
 in some particulars is worse than that of Europe. 
 
 In Europe and in America the plans for improved housing have taken 
 many directions. In some cities homes and housing companies have built 
 sanitary apartments so constructed that the rents are low and yet the capital 
 invested earns 4 per cent. In other places these societies have built separate 
 one-family houses and in still others houses two stories high and for two 
 families. Plans for such houses so built as to render a proper return on the 
 investment and yet with a rental of only $13 to $14 a month are printed in 
 the Survey and in the Journal of the American Medical Association for 1911. 
 
 What makes the situation so difficult is that cities seldom get interested 
 
INFLUENCE OF HOUSING 1097 
 
 in their housing until conditions are very bad. Then they try to cure rather 
 than to prevent and curing anything, whether a sick body, a sick house, or 
 a sick situation, is always more expensive than preventing it. 
 
 The crux of the situation is the price of land. English authorities say 
 laboring men cannot live on ground worth over $1,500 an acre without being 
 badly housed. Chicago's poor people live on ground worth more than $10,000 
 an acre. 
 
 Had Chicago planned ahead its people could have been properly housed 
 without high rents. Not having done so, square miles of congested, in- 
 sanitary, incapacitating housing must remain for many years. The property 
 will not stand the burden of the taxation necessary for cure. 
 
 INFLUENCE OF HOUSING 
 
 As I sit here trying to stir up interest in housing among people who 
 will be reading this book the question arises in my mind: Why is it that 
 the people who live in poor houses are sickly ? That they are is easy to prove. 
 But why? It is difficult to put your finger on just the causes and prove your 
 point. Time was when we charged it up to sewer gas. 
 
 I have recently reread the public hearings before the Chicago city coun- 
 cil on an ordinance which made yard privies illegal and required that the 
 plumbing of the houses should be properly done. The main provision of 
 this ordinance was one requiring that water closets inside be substituted for 
 privy vaults outside. The objectors painted horrible pictures of diphtheria 
 and other sickness that would result. 
 
 Ten years ago sewer gas was held responsible for most of the diphtheria 
 and scarlet fever. Then came the investigations made by experts employed 
 by the plumbers and they proved that sewer gas did not breed contagion. 
 
 Bad house drainage does harm in a way to be developed presently, but 
 it is not the most prominent reason for the sickness rate in bad housing. 
 
 We place a good deal of stress upon walls with wet feet. By this we 
 mean walls so constructed that the ground water travels up the wall several 
 feet from the ground. 
 
 The English building laws are strict on this point. They require that 
 every wall that sets on or in the ground must have a layer of lead or some 
 other material through which moisture cannot travel, to serve as a barrier 
 to the wet foot. They allow wet foot but not wet ankle walls. 
 
 Cellar rooms or rooms which sunlight cannot get into are unhealthy 
 if the walls are wet. I know of a few cases of blastomycosis where the germ 
 found in the abscesses was also found in the paper of the wet basement 
 walls. There is abundant proof that tuberculosis bacilli live longer and are 
 more dangerous in a wet-walled room. 
 
 What stays on the walls hurts nobody. It is much better that the walls 
 should catch the dirt than that the air should hold it. That is why sanitarians 
 are against dusting. Wet walls give up their moisture and the germs that 
 have grown therein to the air. 
 
 Yet there is no question but that dry room air does more harm than wet 
 room air. If the walls could feed some moisture to the air the average room 
 
1098 
 
 HOUSING 
 
 air would be improved. We can say that wet walls contribute a part but 
 not an exceedingly large part. The cold air leaks through the wall of a 
 poor house and the heat radiates out. The poor man from his slender purse 
 
 Minneapolis Civic and Commerce Assn. Report. 
 
 Fig. 461. — Section of Floor Plan in a New Apartment House (1912). Dining room has 
 "borrowed" light only. Kitchen has opening to a vent shaft several feet under legal size 
 with an odoriferous garbage chute in it. 
 
 must heat not only the air inside his house but a good deal of the outside 
 air. The poorly built walls of his house make this a necessity. 
 
 Poorly built walls make for waste and discomfort. They do not cause 
 
INFLUENCE OF HOUSING 1099 
 
 disease. The consumption causing, cold breeding, adenoid producing house 
 is the comfortable, snug house. Surely thin walls are not the reason for the 
 high sickness rate in poor housing. 
 
 So we might run down the list, trying to put our fingers on just the one 
 thing that does the harm in bad housing, and we should fail. 
 
 I dare say some readers have already called to mind some sturdy, stocky, 
 strong bull of a man who grew up in a hovel. They say : "There's nothing to 
 it; this man proves that bad housing does not cause bad health." 
 
 In order to form any opinion worth while it is necessary to take a broad 
 view. Forget the individual and study a group large enough to have the ex- 
 ceptions balance each other. Study one hundred people, or better still, one 
 thousand, ten thousand, one hundred thousand. Just so to understand the 
 harm of housing one must quit looking for the trees and look for the forest. 
 
 The first thing to do in fairness is to analyze the facts critically. 
 
 The death rate among people who live in poor houses is much higher 
 than among people who live in good houses. The excess in the sickness rate 
 is just as great but it is harder to prove it by figures. 
 
 The greatest excess is in the baby illness. Consumption, typhoid and 
 contagion are also greatly in excess. From time to time health departments 
 publish comparisons between the healthfulness of the different parts of town. 
 In these comparative lists the districts where the well-to-do live show figures 
 to be proud of. The districts where the poor live make us think that our 
 boasted civilization is no better than savagery and our religion is but hollow 
 form and ceremony. 
 
 The man who would be fair and just says that the blackness of that 
 record cannot be charged to bad housing; it is the result of poverty and 
 drinking. 
 
 He is in great measure right; but fortunately we are able to compare 
 the same people in good houses and in bad. For instance, in the Liverpool 
 report the comparison is between the same people with the same income in 
 bad houses and in good houses built on the same ground. As would be 
 expected, even after these poor people got into the good cheap houses they 
 had a higher sickness than prevailed in the good districts. The baby death 
 rate was reduced; but it still remained high. The consumption rate was cut 
 in half; but it was still twice what other districts showed. The typhoid rate 
 was much reduced. A fair way to divide it would be to say that the present 
 rate was the normal poverty rate. The difference between the present rate 
 and the former rate was to be divided between houses and whisk}'. 
 
 John Burns in dedicating one of the last of these new housing areas 
 told of the decrease in the number of saloons. The night before he had 
 walked through the district in which as a young dock laborer he had lived 
 thirty years before and the decrease in drunkenness had been plainly apparent. 
 The police returns of arrests for drunkenness told the same story. 
 
 The reports from other places where housing has been improved tell the 
 same story. 
 
 After a few analyses that are fairly satisfactory we come to a point 
 where the question does not analyze farther with gain. The fact is that 
 influence of bad housing spreads out into many channels, operates in many 
 ways; and all of these must be taken into consideration. 
 
1100 
 
 HOUSING 
 
 Not always but frequently, bad housing goes hand in hand with con- 
 gestion. There are from several hundred to four thousand people living on 
 the acre. Sometimes this great acreage density is due to the height of the 
 buildings occupied. Sometimes it is because of the number who sleep in one 
 room. Six, eight, ten or a dozen people using one small room as a bedroom 
 is not at all infrequent in the congested portions of a large city. 
 
 What disease does overcrowding cause? The answer is: No one disease. 
 ^ Anything that gets in among such a 
 
 group is apt to spread to others of the 
 group. Consumption is the terror, of 
 course. When it gets in there is not 
 much hope for the person who gets it 
 and just about as little hope that it will 
 not get other members of the group. 
 In poor houses it is generally nec- 
 essary for several to sleep in the same 
 bed. The dangers of this are obvious. 
 An overlooked danger is this : It is 
 not possible to provide enough toilet 
 facilities. There are too many groups. 
 One toilet must answer for several. 
 
 If scarlet fever gets into one group 
 it is pretty certain to spread to the other 
 groups. It is not possible to quarantine 
 all the people who use the same toilet 
 as the sick person; and yet it does not 
 do much good to plaster the front door 
 with a sign telling people not to mix up 
 when we know that they must use the 
 same toilet room. Of course in this 
 particular the yard privy and the yard 
 hopper are the worst offenders. 
 
 In an area of bad housing the con- 
 tagion rate is always high. When good 
 housing replaces bad the greatest de- 
 crease is in the typhoid rate. Typhoid 
 is spread by water, milk, flies and in- 
 fected hands. 
 
 Good housing cuts out the com- 
 mon toilet room. It markedly decreases 
 the finger-borne infection. It decreases 
 the fly-borne infection somewhat less, yet 
 materially. Those are the reasons for 
 the fall in the typhoid rate when housing is made better. 
 
 The sharpest contrast between the rates of the rich and those of the 
 poor is in the baby death rate. When the poor are moved from poor houses 
 to better ones the baby death rate declines. The flies are lessened, the general 
 dirtiness lessens, and the baby's milk is bettered. 
 
 When we introduce the subject of general dirtiness we open up a large 
 
 Minneapolis Civic and Commerce Assn. 
 Report. 
 462. — Dark, Unventilated Rooms 
 and Toilets in Buildings. 
 
 Fig 
 
INFLUENCE OF HOUSING 
 
 1101 
 
 field and one that furnishes a large part of the explanation of the high death 
 rate where the housing is poor. 
 
 As I see it, when we answer the question as to what are the standards 
 of a neighborhood we get the answer to the questions as to the cause of the 
 sickness rate. 
 
 The poor are apt to be fatalists. They are forced to say: "It cannot be 
 helped" in regard to so many things that they would like to have changed. 
 
 Minneapolis Civic and Commerce Assn. Report. 
 Fig. 463. — Dark, Unventilated Basement Rooms and Toilets Found in Some Buildings. 
 
 When their children die they grieve but before long they come to think it 
 cannot be helped. Scores of times mothers have said : 
 
 "Mrs. Blank ought to know what to do for a child. She has had ten." 
 
 "How many are dead?" I have asked. 
 
 "Eight, but it could not be helped," was the reply. 
 
 The first standard is that of the babies under a year. Not over one 
 of ten should die. 
 
 The first essential is a proper death rate as a standard. There must be 
 a proper contagious disease standard and a militant discontent when that 
 standard is violated. There must be a proper standard of household cleanli- 
 ness, of yard cleanliness, of alley cleanliness, of street cleanliness, of neigh- 
 
1102 
 
 HOUSING 
 
 borhood cleanliness. There must be a proper, standard of personal cleanliness 
 and of personal conduct. 
 
 When housing is bad all standards go to pot. That statement hits the 
 bull's-eye. If the house is ramshackle and structurally disreputable, if sun- 
 light and air cannot get in there is no use talking about crowding or cleanliness 
 
 Minneapolis Civic and Commerce Assn. Report. 
 
 Fig. 464. — Typical Floor Plan Showing Dark Basement Rooms. Children sleep in many 
 
 of these dark rooms. 
 
 or anything else. There must be some family pride or household pride; 
 otherwise you cannot have standards. Household pride and bad housing 
 are as incompatible as oil and water. 
 
 Where the poor housing is replaced by good housing the flies decrease. 
 The manure box is emptied; the garbage does not litter the ground. The 
 alleys are paved and cleaned; the streets are cleaned. 
 
 * Somehow or other (just how nobody can fully say) the sickness decreases, 
 vitality increases, efficiency increases, headaches and minor ills decrease and 
 the death rates drop. The health and life phases again merely represent 
 the end product. 
 
 This section began by asking: Why is it that the people who live in poor 
 houses are sickly? 
 
EFFECT OF GOOD HOUSING 1103 
 
 The answer is that, while several factors are responsible, the most impor- 
 tant is the influence of housing on the people who live in the houses. The 
 structure of the house, the method of construction, the amount of air space, 
 air and light are of importance, per se, but looming way above these is the 
 fact that poor housing destroys the standards of those who live in the poor 
 houses. 
 
 Poor people have the right to be protected against poor houses. They 
 have enough dragging on them without this added load. 
 
 To keep standards when submerged in poverty is not an easy matter. 
 It cannot be done when bad housing makes against it. 
 
 Most of the people in our cities have come in from the country. This 
 is just as true of the immigrant as it is of the American born. They begin 
 by trying to keep the house clean. 
 
 The poor soon find it impossible under city conditions. When they look 
 out over a yard filled with cans to an alley filled with filth and out into a 
 street where mud and garbage are mixed a foot deep they give up and let 
 things drift. Whenever things drift the death rate goes up. 
 
 EFFECT OF GOOD HOUSING 
 
 When a family income is less than $10 a week the amount paid for rent 
 cannot go above $2.50. If $2.50 a week does not pay for a house in which 
 a man's family can be healthy (and that is all the man can pay) the burden 
 of caring for the sick is put upon the people. 
 
 A rental of $2.50 a week does not mean much on the investment. What 
 is the community going to do about it? It might force employers to pay 
 enough wages so that 25 per cent of their earnings would healthily house 
 their employees. That is slow and difficult. It might carry a part of the 
 cost of housing. 
 
 In Liverpool the money spent for housing earns about 3 per cent. The 
 bonds sold to buy this ground and build these houses and the sinking fund 
 to retire them cost more than 3 per cent. The difference is paid out of taxes. 
 
 How does Liverpool justify this use of taxes? The cost of illness falls 
 on the people. The cost of illness in the families earning less than $10 
 a week falls on the tax funds. The question arises: Does the money spent 
 on housing decrease the cost of illness and immorality materially? If the 
 answer is "yes" there is no doubt of the wisdom of the expenditure. 
 
 Kyffin-Taylor reported for the Housing Commission that in the rehoused 
 areas the general death rate has been halved, the consumption death rate has 
 been reduced to less than half, typhoid has been wholly banished, and infant 
 mortality has been decreased 28 per cent. In the Adlington Street area the 
 arrests for drunkenness decreased from 81 in 1894 to 2 in 1912 ; for assault from 
 40 in 1894 to none in 1912 ; for other offenses from 81 in 1894 to 2 in 1912. 
 
 The report says: "In the rehoused district there is a higher moral tone. 
 Self-respect is more in evidence, and a keener love of home prevails/' 
 
 The report contains a ringing contribution from John Burns, once a 
 dock laborer in Liverpool, subsequently a cabinet member of the British em- 
 pire. He says what he knew in Liverpool thirty years ago had so burned 
 
1104 HOUSING 
 
 itself into his mind, memory and determination that he took a solemn oath 
 as minister to do what he could to wipe out such conditions. 
 
 He declares Liverpool's rehousing was a public health movement and 
 not to be measured by pounds, shillings and pence. Housing was not only a 
 good investment in itself but was the bread of reform cast upon the waters 
 which returned to the people after many days in a manner of which they 
 could hardly conceive. 
 
 "I walked out last night in the old districts where I had known the 
 abysses of human misery/' he states. "What impressed me on Baptist 
 Street was that I did not see a drunken man. As I came out of Baptist Street 
 through Ben Jonson Street and Dryden Street, changed from what it was of 
 yore, I thought of Eobert Burns' great saying: 
 
 "To make a happy fireside chime 
 For weans and wife. 
 That is the pathos and sublime 
 Of human life." 
 
 FINANCIAL PLAN FOR REHOUSING 
 
 After tearing down about 10,000 insanitary houses and in this way 
 unhousing 40,000 people the city of Liverpool asked itself what had become 
 of the unhoused people. It found them crowded into cellars and already 
 crowded rooms. It found that new model houses and tenements were occu- 
 pied by the best tenants of their kind in the city, the cream of the renters, 
 while the skim remained in the privately owned houses. 
 
 In 1902 Liverpool began the policy of rehousing the unhoused in sani- 
 tary, cheap houses. Since that year it has torn out and replaced 5,358 
 houses. There remain 4,585 houses yet to be torn down and replaced. Of 
 these 2,939 are exceedingly bad. The balance, 1,646, are insanitary in many 
 respects but are less objectionable than the 2,939. 
 
 What has been the cost ? The cost of the land and buildings, of remov- 
 ing the old structures and building the new ones has been about $10,000,000. 
 The interest charge and sinking fund are about $240,000. The net rent is 
 about $55,000. The money invested earns a little less than 3 per cent. This 
 rate is averaged over about fifteen years. 
 
 Three per cent will not pay the rate of interest that the city of Liverpool 
 must pay for its money nor will it carry the sinking fund; therefore, some 
 part of the carrying charge is met by taxes. 
 
 The gross rent received in 1912 was about $130,000. The net rent was 
 $53,000. The sum spent on repairs, renewals, general upkeep, taxes, rates 
 and general care indicated that the authorities were taking good care of the 
 property. 
 
 A statement sometimes made is that owners of property in the poor 
 portion of town are entitled to high rents because of the instability of the 
 population. It can be expected that a large part of the property will be 
 vacant. In Liverpool empties decrease the revenues 8.78 per cent below the 
 possible maximum- 
 
FINANCIAL PLAN FOE KEHOUSING 1105 
 
 Another statement is that bad debts are a high figure always. The loss 
 from bad debts in 1912 was 2 per cent. Ninety-nine per cent of the rents 
 were collected. During the year 1912, 630 tenants vacated city owned prem- 
 ises. Of these 205 left under notice from the corporation. 
 
 The corporation has erected two types of houses — one for the exceed- 
 ingly poor, another for those not so poor. The loss from bad debts in the 
 two groups is about the same — five-tenths of 1 per cent and 1.2 per cent. 
 
 The sinking fund retires the debt year by year. The amount outstanding 
 at the time of the report was $4,500,000. 
 
 Thus we see that the Liverpool improvement, leaving out all public 
 benefits, is not quite on a business basis. Taking into consideration public 
 benefits it is on an excellent business basis. 
 
 REHOUSING IN LIVERPOOL 
 
 Liverpool's housing policy is this: Whenever the housing of a district is 
 found to be well below the standard as the result of routine examinations by 
 the sanitary inspectors an intensive study of the district is made. The facts 
 as disclosed are set before the Housing Commission. 
 
 Let us say that in a given instance the commission decides that the 
 district is a proper one for the application of its housing plan. It purchases 
 all of the ground and all of the houses in the district. It then registers the 
 names and addresses and income and rent paid by the people living in the 
 houses. It keeps track of these people until it is ready to rehouse them. 
 
 The board then tears down the houses, rearranges the lots and builds 
 new houses. It leaves open spaces for air ; lays out playgrounds ; builds stores, 
 churches, playhouses and schools; erects houses, and sells off the surplus 
 land, for, since the use of the land is carefully planned, it can give the homes 
 more ground than before and still have land to sell. The commission then 
 hunts up the former occupants of the space and gives them the refusal of 
 the new houses. 
 
 Liverpool is the home of untrained workers. It is a great port, and a 
 large part of the population are dock laborers, firemen on boats, and others 
 who receive but small wages. 
 
 Most of the districts selected for rehousing are near the docks. The 
 houses are built for men of small earning power. Men who earn 16 to 20 
 shillings a week ($4 to $5) are catered to. A dollar in England purchases 
 about as much as two here. Therefore (let us say roughly) houses are built 
 for men earning $8 to $10 a week. 
 
 The premises rent from 1 shilling sixpence a week to 6 shillings a week; 
 say, 74 cents to $3 a week according to money's buying power in America. 
 The average rent paid is around 75 cents a week. For instance, in the Grafton 
 Street dwellings a man can get a three room flat with a separate kitchen and 
 a separate bath and toilet room, all taxes paid, for $1 a week. 
 
 Of the 2,747 dwellings built by the Housing Commission 2,193 are 
 reserved for persons dispossessed when the district was rebuilt. In Burlington 
 Street 99.5 per cent of the people dispossessed moved into the new houses 
 when completed. In Bevington Street, the proportion was 93.93. 
 
 The enterprise is run on business principles. Men who do not pay their 
 
1106 
 
 HOUSING 
 
 rent are thrown out. The bad debt losses are small. It is not a something- 
 for-nothing scheme. 
 
 You ask what has this to do with health? That question will be answered 
 later in this chapter. 
 
 PUNISHMENT FOR BAD HOUSING 
 
 A committee once analyzed the Chicago ordinances relating to buildings. 
 Eighty-five per cent of them related to fire only; 12 per cent to contagion, 
 sewage and garbage and 3 per cent to supply of air and light. If the group 
 
 Fig. 465. — Water May Become Impure in Badly Located Wells from Surface Drainage. 
 
 — contagion, sewage, and garbage — is split evenly between the welfare of 
 the inhabitants and the welfare of the property and the 6 per cent added 
 to the 3 per cent of the third group we get a total of 9 per cent. More 
 than nine times as much legislative attention has been put on fire protection 
 than has been put on health protection. 
 
 Theoretically, government is divided into three branches — administrative, 
 legislative and judicial — and each must keep its hands off the work of the 
 others. It would not be fair to place all the blame on the legislative depart- 
 ment and none on the other members of the triumvirate. Therefore, the 
 exhibit shows why it costs so much to get bad housing corrected even when 
 occasionally there is correction. 
 
 A chart shows a case of bad housing complained of on June 27, 1911. 
 The first inspection was made by the health department on June 30. Bad 
 conditions were found. Fourteen inspections were made. 
 
 The owner paid no attention to orders. After months of disregard of 
 
DISEASE HISTOEY OF HOUSES 
 
 1107 
 
 notices the owner was sued. On October 23, 1912, the case was dismissed 
 with costs. There had been six continnances. 
 
 The cost to the owner was $7.75; the cost to the taxpayers for inspec- 
 tions, health department attention and conrt expenses had been more than 
 $250. The taxpayer paid the bill; the owner went free. 
 
 The usual method of improving the sanitation of housing is by fines— 
 a remedy both inefficient and expensive. In speaking to the English parlia- 
 ment in favor of the national 
 insurance bill David Lloyd- 
 George, then Chancellor of the 
 Exchequer, especially empha- 
 sized those features of the bill 
 that raised the taxes on insan- 
 itary buildings. Since they in- 
 creased the cost of government 
 
 
 J.Q:^.$:c:: 
 
 Mr. Lloyd-George proposed 
 that the taxes be increased on 
 them. He said: 
 
 "That will be a much 
 more effective check [on the 
 causes of excessive sickness] 
 than the old, obsolete form of 
 mandamus." 
 
 In this country (except in 
 Pennsylvania) we employ the 
 fining method — a method 
 much more ineffective and 
 much more expensive than the 
 mandamus. 
 
 If the mandamus is a poor 
 tool how inexcusable is our use 
 of the much poorer tool, the 
 fining system! 
 
 In 1907 the Chicago 
 health department began keep- 
 ing the record for preventable diseases of every residence in the city. One 
 chart contains the records of two small houses. 
 
 One of these in four years had seven cases of consumption charged 
 against it. Another had a record of eight cases of consumption, two of 
 scarlet fever and one of diphtheria. 
 
 In spite of all this, so good an authority as Professor Winslow pronounces 
 the Chicago air and light ordinances of 1910 as basically the best in the 
 country and I think he is right. 
 
 
 ffq^-'-x-vX' — . 
 
 Fig. 466. — Wrong Construction of a Well. Usual 
 method of pollution and even infection of wells. 
 
 DISEASE HISTORY OF HOUSES 
 
 In 1907 the Chicago health department started a card index of com 
 tagion in Chicago according to the houses in which it occurred. This file 
 
1108 
 
 HOUSING 
 
 shows the contagious disease record of every house in the city. Nobody in 
 Chicago needs to move into an unhealthy house. Anyone who wants to know 
 
 the disease history of a house which 
 he is thinking of buying or renting 
 can get the information at the 
 health department. 
 
 This is a very important point 
 in consumption. One of the sec- 
 tions of the model ordinance adopted 
 by the Section on Preventive Medi- 
 cine of the American Medical Asso- 
 ciation requires that all houses 
 wherein people with consumption 
 have lived should be disinfected, 
 cleaned and aired before the next 
 occupant is allowed to move in. 
 
 Every now and then a house 
 gets a bad sanitary reputation. This 
 is not always owing to the fact that 
 lost their lives by certain contagious 
 its bad construction. Its walls may 
 
 Fig. 467. — Proper Construction of a Well. 
 
 Fig. 468. 
 
 -Ground Water. A, high level; 
 C, intermittent spring. 
 
 B, low level; 
 
 it has been occupied by people who have 
 diseases. It may be laid to the fact of 
 be damp or they may be 
 cold. Proper sanitary sur- 
 roundings may have been 
 disregarded in the selec- 
 tion of a site. 
 
 In the construction 
 impervious materials were 
 perhaps left out of the 
 walls, especially of the cellar, so that they are not properly protected against 
 dampness. Due consideration for scientific ventilation may have been over- 
 looked and a poor sys- 
 tem of heating in- 
 stalled. For these rea- 
 sons the house lowers 
 the vitality of the oc- 
 cupants until they are 
 more liable to contract 
 contagious diseases 
 than if they lived in 
 houses in the construc- 
 tion of which due 
 regard for sanitation 
 had been observed. 
 The neighbors gossip 
 about the amount of 
 sickness in this house. 
 Usually the reputation 
 is not deserved. 
 
 Fig. 469. — Wells Curbed with Brick, Stone, Crock or 
 Wood are Improperly Protected and Seldom Safe if 
 there is any source of dangerous contamination in 
 the Vicinity. 
 
CONGESTION" OF POPULATION 1109 
 
 If a careless consumptive has infected a house it may stay infected for 
 a few months but in less than a year all of the consumption germs in dark 
 corners will be killed off. On the other hand, an insanitary house may lower 
 the resistance of the occupants until they are more liable to catch consumption 
 than if they lived in healthier houses. In so far as certain houses deserve 
 a reputation for being a causative factor in producing disease, it may be said 
 
 Fig. 470. — Safe Well. Cement Curbing. 
 
 that it depends upon how much they are responsible for putting people in a 
 condition to catch the disease. 
 
 CONGESTION OF POPULATION 
 
 There are parts of New York City where 4,000 people live on a single 
 acre. A few years ago New York held an exhibit in which one could learn 
 something of the density of population and of the harm which it was doing. 
 
 Congestion of population grew in New York because nobody had planned 
 ahead. Planning to cure is always more expensive than planning to prevent ; 
 but planning to cure is less expensive than allowing present conditions to 
 continue. 
 
 They appointed a Commission on Congestion of Population. This com- 
 mission is composed of ten aldermen, two representatives of the administrative 
 arm of the city government and nine others. 
 
 Their recommendations come under fourteen heads, as follows : 
 
 1. Restriction of the height or volume of buildings other than tenements. 
 
 2. Restrictions upon the lot occupancy of buildings other than tenements. 
 
 3. Restriction upon the height of tenements. 
 
 4. Methods of encouraging three family tenements. 
 
1110 
 
 HOUSING 
 
 5. Measures to prevent room and apartment overcrowding. 
 
 6. Measures to secure better conditions of labor. 
 
 7. Measures to secure a better distribution of factories. 
 
 8. Parks, playgrounds, schools, and recreation centers. 
 
 9. Measures to keep land cheap and to provide good and cheap housing. 
 
 10. Measures to promote health and safety. 
 
 11. Distribution of population through municipal control over charities. 
 
 12. Immigration. 
 
 13. Delinquency. 
 
 14. Public squares and buildings. 
 
 Chicago is headed toward the corner which New York finds itself in. 
 
 Fig. 471.— Diagram Showing How a Well (with waterproof wall) May Extend Through 
 Danger Zones and Risky Zones to Reach Water in Safe Zone. 
 
 The Association of Commerce, the Chicago Plan Commission, the real estate 
 board, the School of Civics and Philanthropy, the Chicago Homes Commis- 
 sion and the health department are each doing a little to stem this tide. But 
 the little is overshadowed by the need. 
 
 Professor Tufts found some bad housing in every town in Illinois which 
 he studied. There is some bad housing in the best of our towns and villages. 
 It is a matter which, uncontrolled, automatically gets worse. No village can 
 be "smuck" on the question of congestion. While one citizen may have a 
 hundred acres somewhere in the village other people are sleeping more than 
 three in a room, and a room with bad sanitation at that. 
 
 Why not read the report of the New York Commission on Congestion of 
 Population? Address City Hall, New York, for a copy. 
 
 PRICE OF LAND 
 
 Upon no other item rests so much responsibility for congestion of occu- 
 pation as the high price of land. In the case of central real estate the build- 
 
TO PREVENT LAND SWEATING 1111 
 
 ings placed on it must go hundreds of feet into the air and two and some- 
 times three stories underground in order to earn the carrying charges. 
 
 But of more importance is the effect of the high price of land on resi- 
 dential congestion. There are forties in Chicago averaging more than 400 
 people to the acre and single acres housing more than 1,000. In New York 
 there are acres which house more than 4,000. Whenever land goes over 
 $10,000 an acre you have to jam people 'together like flies to keep the rent 
 within their means. 
 
 Whenever a building lot for a laboring man's cottage costs more than 
 $200, or $8 a front foot, things are tending in the wrong direction. When- 
 ever it passes $800, or $32 a front foot, the space for sunlight, air 
 and vegetables is going to be cut down, the house is going to be less well 
 built, the tendency to build two or three houses on the lot is going to increase, 
 the number of boarders is going to increase — to sum it all up, the death rate 
 will rise some, the preventable disease rate will rise, more women and children 
 will have to go to work in factories or in service — and the men will work at 
 lower efficiency. Seventy-five to $100 a front foot makes a situation for which 
 there is no cure. 
 
 As Nettleford says: "Poor people live on dear land, rich people live on 
 cheap land, which is absurd." 
 
 The death rates run up* pretty nearly parallel with congestion of occu- 
 pation. In Glasgow, where the people average 1.3 persons to the room, the 
 death rate is 21.7; where the average is 2, it is 28.6. In Budapest, where the 
 average to the room is 2, the death rate is 20; where it is 10, the rate is 79. 
 
 Jewett, in Toiun and City, says: "In Berlin, among the 73,000 people 
 who live one family to one room, the death rate is 163 per 1,000. Among the 
 398,000 people who live one family to four rooms or over, the rate is 5.4." 
 
 Not all this difference was due to differences in congestion, but if even 
 a tenth of it came from crowding it still would be a powerful argument 
 against congestion. 
 
 TO PREVENT LAND SWEATING 
 
 To keep the price of land within bounds, to prevent what the English 
 term "land sweating/' several plans have been proposed. 
 
 Mr. Foulke, while president of the National Municipal League, re- 
 ported to his association on the plan used since 1904 by Frankfort-on-the- 
 Main. That plan provides that every change in land ownership not depending 
 on inheritance (that being otherwise provided for) is subject to a city tax 
 of 2 per cent and if since the last preceding transfer there has been an 
 increase in value of more than 30 per cent of the former price there is an 
 increment tax as follows: Five per cent for an increase up to 35 per cent, 
 6 per cent for an increase up to 40 per cent, 7 per cent for an increase up 
 to 45 per cent and so on — 1 per cent being added for each 5 per cent of 
 increase. 
 
 The limit of the total tax is 25 per cent. This is in addition to the gen- 
 eral increment tax lav/ of the empire, the maximum limit of which is 30 
 per cent. At the end of five years the relation of the general and local 
 increment taxes is to be adjusted. 
 
1112 
 
 HOUSING 
 
 A second feature of their plan is to nave the city go into the real estate 
 business, in part through that power of excess condemnations (generally held 
 
 to be illegal in this country). 
 
 v*- 
 
 D£ ZUYD REVIEH.ofDeLAWAJBE Re,VJR 
 
 Fig. 472. — William Penn's Plan of the City of 
 Philadelphia. The system that might serve the 
 small city is ill adapted for extension to the large, 
 though even on this little plan the waste and in- 
 effectiveness of straight streets and rectangular 
 blocks, with no diagonals, is obvious. ("Charities 
 and the Community.") 
 
 Will our Liverpools try to emulate Liverpool, England, our Berlins the 
 German capital? 
 
 The city owns 2,860 acres be- 
 sides the city forest — about 21 
 per cent of the total acreage. 
 "The purpose of securing this 
 acreage was to prevent undue 
 and unsound speculation by 
 private persons and the hold- 
 ing back of property for ex- 
 cessive prices, intermediate 
 agencies enhancing the price 
 of land." 
 
 According to Foulke this 
 policy was inaugurated in 1898 
 in the German settlement of 
 Iviao Chau in China, "where 
 the government evidently in- 
 tended to receive part of the 
 increased values resulting from 
 the growth of a new com- 
 munity/' 
 
 Two cities in Saxony 
 adopted the plan in 1902. Hel- 
 bersdorf inaugurated it, term- 
 ing the tax an increment tax, 
 in 1902. In 1911, 652 other 
 German communities had 
 adopted it including Co- 
 logne, Essen, Dortmund and 
 Berlin. 
 
 There are many other ad- 
 mirable features of the Frank- 
 fort plan. 
 
 In this country there are 
 ten Frankforts, each probably 
 named for Frankfort-on-the- 
 Main. How many of them are 
 planning as thoughtfully, as 
 learnedly, as wisely as old 
 Frankfort? What say Frank- 
 fort, Ky. ; Frankfort, Mich.; 
 Frankfort, Ind.; Frankfort, 111.; 
 Frankfort, 0. ; Frankfort, Okla. ; 
 Frankfort, S. D. ; Frankfort, 
 
MOKE ABOUT TOWN PLANNING 
 
 1113 
 
 MORE ABOUT TOWN PLANNING 
 
 One of the best laws passed on this subject is the British town planning 
 act of 1909. Part 3 of this act relates to the provisions for and organization 
 of health departments — a recognition of the principle that town planning 
 and housing provisions are essentially health matters. 
 
 AVCWJIS, TO A.ff.STATIOli 
 WITHOUT A WAP. 
 
 Z. G-o rnon 5hoi?££mo 
 
 Of rtONHO£ St TOSHOrtC 
 £-Y0 Of JACKSO" i 
 OUT CI HIS' "^ ■" /"/»*£• 8 
 
 T^/C^L PLAN 
 OF 5*/OflE;d£TrL£rJ£flfr 
 //A f?/fA GAtfSETTBA K 
 
 ABOUT Firrr.cn rJojscHOLOcfis of e#oAOfi£i.D momopoluZ 
 
 THE. iVHOlC 3HOXE. f/?OMT- TH£ P£SrOF TH£ P£OPl.£ MUST 
 BZCOfrrpfTEO MTst OCCASIONAL l/l£tVS f/?0W TH£*D£AO £W0S' 
 ?AL\ Sr/f££T3 • Qfrftf TH£i£ AJfce. QUILT UPO",ALSO. 
 
 « R A O AA/,S ZTT 
 
 e a r 
 
 Fig. 473. — The Usual Way — the Water Front Shut Off. ("Charities and the Community.") 
 
 The Canadian Public Health Association has a housing section and the 
 American Public Health Association has recently organized a sociological 
 section in which housing is to be discussed. 
 
 Fig. 474. — An Admirable Exception — a Promenade along the Shore. 
 ("Charities and the Community.") 
 
 ISTettleford quotes Professor Muirhead as follows: 
 
 "The problem of the last generation was to provide gas and water; the 
 problem of the next is to provide light and air/' 
 
1114 HOUSING 
 
 That health authorities are not well posted in housing and have shown 
 no special interest in the subject is no reason for separating the work from 
 them. I think it fair to infer that health officers will be ready to handle 
 housing by the time the people are ready to have it handled. Town planning 
 and housing are health problems. Let us do all that we can to encourage 
 and nothing to discourage this idea. 
 
 Berlin and Paris were made beautiful by tearing out slums and building 
 boulevards and parks on the vacated grounds. That these improvements did 
 not increase the taxes was because the government condemned large tracts 
 of ground, razed the buildings, improved the property on them and then sold 
 a part of the ground at a price justified by the improvements. The people, 
 rather than land speculators, got the benefit of the increase in price from 
 betterments and public use. 
 
 The legal right to proceed in this way is called the law of excess con- 
 demnation. In this country some communities have tried to proceed in this 
 way but the state supreme courts have found the state laws provided for it 
 to be unconstitutional. 
 
 Crawford, at the 1911 Conference on City Planning, said: "A decision 
 by a state court upholding excess condemnation within reasonable limits would 
 in turn be upheld by the Supreme Court of the United States." 
 
 Without this principle of excess condemnation American cities must 
 either be planned from the very beginning or else city planning on any 
 effective scale must be abandoned, for the cost is prohibitive. How can we 
 make a Supreme Court see this? 
 
 One of the provisions of city plans which is both logical and difficult 
 to bring about is division of the city into zones with a series of regulations 
 adapted to each. 
 
 The following resolution was introduced in the city council at Eochester, 
 N. Y., in 1900 : 
 
 "It is inequitable, as often happens, to sections of our city which have 
 achieved a trade mark of special value by reason of residential unity and 
 beauty, to have some vandal destroy such special value upon the plea that 'he 
 has a right to do as he likes with his own property.' " 
 
 A part of a proper zone plan is variation in the width of streets and 
 in their method of paving. To provide that no street shall be less than 
 100 feet wide and that no house shall be wider than the street on which 
 it is located is wise for central areas. Had it been inaugurated when Chicago 
 was begun downtown property values would never have attained their present 
 dangerously high levels and the city at large would have prospered more. 
 In the outlying districts ordinances requiring wide streets and expensive pav- 
 ing work great hardships. 
 
 Alderman Thompson of the National Housing Reform Council of Eng- 
 land says that under modern conditions of subdivision the cost of roads and 
 sewers reaches from $45 to $225 a cottage and puts up the cost of rents. A 
 forty foot paved road on the outskirts of a town costs $1,000 to $2,500 
 an acre. 
 
 Nettlefold says that where there are fifteen houses to the acre the rent 
 must be advanced one-sixth to pay for the cost of street paving and repair 
 on a forty foot street, 
 
MORE ABOUT TOWN PLANNING 
 
 1115 
 
 Unwin has worked out a plan of adapting the width and improvement 
 of the street to its use so that an owner with twenty acres can put in the 
 improvements and build 340 houses for the same money as 200 houses would 
 cost if rectangular streets of uniform width and paving were paid for. 
 
 • 
 
 ; ///IfPu 
 
 
 
 ~~^Sjto m over. 
 
 ' ■ lIU 1 /Jllll ^^** > sJ-J— 
 
 
 
 
 J 11 ^ULtf^ 
 
 If 
 
 _fS^^J 
 
 | 
 
 llllll rvfiSS* 
 
 SivSi \\ uJU-rnl \\\V^ 
 
 
 Kis^ AJF 59 
 
 ^u\ 
 
 S\ N 
 
 *"■- - ■ — — — — — a ■■■■-■ — -■ ■ «» 
 
 A 
 
 
 15 
 
 ^^>^lJKiw»/: 
 
 h 
 
 
 
 11 IN 11 1 flvJ. 
 
 Ifffilfe 
 
 ILL 44n-PPnuu\\vS . 
 ttt "til 1 \ \\ \\ \ \ WW**' 
 
 1 
 
 L 
 
 L 
 
 •^^^^^S^^ftl 
 
 B 
 
 Fig. 475. 
 
 -Showing Difference Between Haphazard (B) and Scientific (A) Street Plan- 
 ning of Irregular Plot. ("Charities and the Community.") 
 
 In the London Town Planning Convention of 1910 Hogemen of Berlin 
 and Adams of England both said that wide streets caused tenements. "It 
 was necessary that the owner extract from each yard of his frontage enough 
 rent to pay its share of the costly street." 
 
 For outlying districts narrow, winding or diagonal streets make it 
 possible to spend more on the sanitation of the homes. Where traffic of 
 the future promises to be dense and a wide street may at some time be wise 
 in the intervening years a narrow paved area bordered by grass and trees 
 is good economy, good sense and good health. 
 
1116 HOUSING 
 
 As between rectangular streets exclusively and a combination in which 
 some of the streets are diagonal and some rectangular Eobinson says esthetics, 
 sanitation and convenience all favor the latter. 
 
 In Vienna the crowds are handled with less inconvenience than in any 
 other city and there the cars come in on diagonal streets to the Eigstrasse, 
 which they follow around to deliver their passengers as near as possible to 
 their destinations. 
 
 Eobinson says : "The two diagonal streets, Broadway and the Bowery, in 
 New York, saved for the city breathing spots like Madison and Union 
 squares — space out of reach if condemnation had been required." 
 
 Of much more importance than plans for the streets, however, are those 
 for the structures on them. In fact, often expenditure for streets indirectly 
 raises death rates. 
 
 I have in mind several cities near Chicago that have spent all of their 
 money, bonded themselves to the utmost and are now practically bankrupt, 
 having exhausted their resources for expensive paving. Their death rates are 
 high ; yet they can do nothing for their people because of their orgies of street 
 building. They have no health department, no hospitals, no laboratories, 
 no school inspection, no building inspection, no anything which runs straight 
 to the welfare of the people, because of their street improvements. 
 
 FLAT AND COTTAGE 
 
 E. E. Pritchard has lectured for years against flats. His lecture is 
 illustrated by epigram, anecdote and poetry. His auditors go away inter- 
 ested and impressed but the percentage of people living in flats mounts year 
 by year. 
 
 There is much to be said against trying to raise a family in a flat and 
 Mr. Pritchard says it well. Many others have said it. Yet the trend is flat- 
 wards and no amount of preaching stops it. 
 
 In 1912, in Chicago, 42.1 per cent of the building permits were for 
 flats and but 28.8 per cent for residences other than flats. Only 18 per cent 
 of Chicago families, according to the survey displayed at the City Club, 
 live in single family residences. 
 
 An analysis of 12,628 Chicago building permits shows that less than 1 
 per cent of the apartments are to house a household in two rooms. The 
 three-room apartments make up 3 per cent of the whole; the four-room 
 apartments, 33 per cent; five-room, 30 per cent; six rooms and over, 33 
 per cent. 
 
 Not at all a bad showing. A five-room flat with all of its space and labor 
 saving provisions will serve a family as well as did an old-style eight-room 
 house. 
 
 When we study the heights of buildings we find nothing to complain 
 of. Of the permits issued in 1910, 37 per cent were for buildings one story 
 high, 46.2 two stories high, 3.7 three stories high, 1.7 four stories high, 
 and over four stories, 1.1. 
 
 Comparing the type of building with that in vogue in 1870 we find the 
 greatest change is in the reduction of the percentage of one story buildings 
 
FLAT AND COTTAGE 
 
 1117 
 
 from 73 to 37 per cent, and the increase of two-story buildings from 20 to 
 46 per cent. 
 
 No type of building is more unsatisfactory, more uncomfortable and 
 more expensive to maintain than is' the one-story cottage. In fact, much of the 
 trouble in housing at present is the result of one-story house building in 1870. 
 
 ALLEY 
 
 AllCV 
 
 riPSTTIpp'g'RAN 
 
 5e:cond fLporepLAN 
 
 Fig. 476. — A House for Each Family. (Philadelphia.) Two-story brick houses, 4 rooms 
 and bath. Selling price, $1,750. Rent $13 a month. (National Housing Association Publica- 
 tion No. 7.) 
 
1118 
 
 HOUSING 
 
 A study of the location of living apartments with reference to "the street 
 is disquieting at first blush. In a study of about 2,500 insanitary living places 
 over 1,400 were found fronting on alleys, yards and courts rather than on 
 
 Auey 
 
 ALLty 
 
 First Floor 
 
 Second Floor 
 
 Fig. 477. — Mechanics' Homes. (Philadelphia ) Six rooms and bath. Rent $16 a month. 
 Brick houses, built in rows. Sale price, $2,000. (National Housing Association Publication 
 No. 7.) 
 
FLAT AND COTTAGE 
 
 1119 
 
 the street. Yet in old style premises the servants' quarters were reached 
 through the alley. 
 
 Two hundred and seventy-six premises were in the rear of stores and 
 
 Fjg. 478. — Another Type of Mechanics' Homes. (Philadelphia.) Six rooms and bath. Cost 
 about $1,400. (National Housing Association Publication No. 7.) 
 
 yet everybody is agreed that the tendency of modern times is to get industry 
 and trade away from the home. 
 
 Things are getting better; but our standards are climbing faster than 
 the conditions surrounding us. 
 
1120 HOUSING 
 
 Bad Housing Conditions. — Miss. J. I. F. thinks Chicago housing condi- 
 tions should be receiving more attention than they are at present. She says 
 that looking north from West Chicago Avenue, near the terminus of the 
 street-car line fifty newly erected cottages can be seen. They are set along 
 the front line of the lot. They are but two or three stories high but they 
 have not been so erected as to get as much light and air as they should 
 have. One remedy suggested by her is that the houses alternate with re- 
 spect to their positions on the lot, that one house be set in front of the lot 
 and the next on the back. 
 
 Reply. — There is no question that neglected housing constitutes one of 
 the great wastes of the day. We are drifting into congestion and bad 
 housing situations which are going to prove almost impossibly expensive 
 when we come to remedy them. They are costing vast sums now in the 
 way of inefficient labor and consumption and other diseases; but we are 
 drifting along toward worse conditions. Nor is it limited to large cities. 
 Lake Forest has bad housing; Springfield has much of it. The farmer 
 suffers from it. 
 
 The Chicago ordinances passed January, 1911, cannot be enforced be- 
 cause there is no appropriation. The poor people are without protection. 
 
 The checker board plan would give more light and air under certain 
 circumstances and yet a twenty-five foot lawn, plugged on three sides, 
 would not help much. Generally speaking, authorities believe it vital to 
 keep the rear of the lot unoccupied. 
 
 I think the present Chicago ordinances a better solution than yours. 
 The problem is to get money for the health department so that the present 
 ordinances may be enforced. 
 
CHAPTEE LX 
 
 The Home 
 
 SITES FOR BUILDINGS 
 
 Soils have been frequently and justly, too, charged with having much 
 to do with the prevalence of certain diseases not only among men but cattle 
 as well. A knowledge of soils, then, is highly important, since their constitu- 
 tion with reference to moisture and dryness, chemical and physical makeup, 
 
 Fig. 479. — Two Springs. One Protected from Surface Contamination; the Other Not. 
 
 permeability and impermeability and their configuration will have much to do 
 with the selection of building sites. 
 
 Building sites should receive the most careful attention. First of all, 
 the site should be dry and free from the accumulation of organic matter. 
 Granite, limestone, clay, sandstone, slate, chalk, gravel and sand (when 
 the subsoil water is not too high and is free of organic impurities) make 
 excellent sites for building purposes. 
 
 In determining fhe building site high ground is naturally preferable. 
 In the country districts you usually find the house built on the top of a 
 hill, on the hillside or on a knoll. They are usually built when possible in 
 close proximity to a supply of pure water for domestic purposes. 
 
 1121 
 
1122 
 
 THE HOME 
 
 Alluvial soils, marsh lands and gravel and sand with clay subsoil are 
 regarded as unhealthy selections for building sites. Buildings should not be 
 located near marshes, stagnant ponds, swamps, badly kept mill dams and 
 polluted creeks. Sites on the banks of rivers which are subject to periodical 
 flooding or which have a sluggish flow are usually unhealthful. 
 
 In the selection of building sites made lands and sites formerly occupied 
 are to be regarded with suspicion, if not rejected. Such sites are either 
 contaminated with garbage, rubbish and decaying animal and vegetable 
 matter or are honeycombed with cesspools or the accumulated filth from 
 
 Fig. 480. — Popular Idea of How Wells Become Infected from Surface Pollution. 
 
 broken drains, soakage from barnyards, pig sties, stables and outhouses. A 
 well should never be sunk through such ground. 
 
 Finally, in the selection of a building site due regard should be had for 
 the disposition of garbage, household waste, sunlight, air, dampness and 
 ventilation. In valleys and ravines, for instance, the ventilation is not so 
 good; hence the air may become damp and chilly. The same might be said 
 about building a house too close in to a rather steep hillside; in the latter 
 case it ofttimes becomes necessary to construct artificial drains at some di- 
 tance up the hill from the house in order to correct excessive dampness. 
 This is best accomplished by digging a ditch of suitable length into which 
 a number of stones are rolled and then covered over with earth. This ditch 
 should lead into some main drain so that it will offer a proper outlet for 
 the seepage from the hillside above it. 
 
 SELECTING A HOUSE 
 
 From the health standpoint, the bedroom is the most important part of 
 the house. Then, should it not be the best room in the house? — not the 
 
SELECTING A HOUSE 1123 
 
 largest nor the most ornate but the sunniest, the best ventilated and the 
 most quiet, at least during the night hours ? 
 
 The human body throws off much waste during the night hours and 
 sunlight is required to purify. To keep things clean may make amends for 
 lack of sunshine but no sweeper or mop can search out the germs and kill them 
 as well as can sunshine. 
 
 The next most important is the ice box. When the summer time is on 
 it will be no easy matter to keep food free from taint. Some changes in food 
 change the taste and odor; many do not. Ofttimes food is dangerous when 
 it tastes and smells good. Especially is this true of milk. 
 
 We must remember that babies do not have a long list of foods to choose 
 from; it is milk or nothing with them. 
 
 A poorly drained, badly constructed or badly kept ice box means that a 
 few times at least during the summer baby's milk will be unsafe or un- 
 palatable. 
 
 Ice boxes do not keep themselves clean merely because they are cold. 
 They produce odors and slime that grows well in cold water, or on the walls 
 of an unclean but cold ice box. 
 
 Next in importance is the kitchen. However careful one may be the food 
 will touch something here and there. The cap will be removed from the milk 
 bottle, laid wet side down on the kitchen table and then put back in the 
 milk bottle. Such acts will occur in spite of everything. 
 
 One cannot be dodging germs all the time. This means a need for a 
 spotless kitchen, which means a kitchen so built that it can be kept spotless. 
 
 This is no easy matter, as the grease vapors make the dirt stick in the 
 kitchen. 
 
 A part of proper construction is step-saving and back-saving arrange- 
 ments. When the cook gets tired her back aches, and she is certain to quit 
 trying to keep things spotless. 
 
 Next come the pantries and closets; not that they are so frequently 
 visited or are of themselves so important, but because the custom of having 
 them dark and ill ventilated is so nearly universal. 
 
 Two-thirds of the day is spent 'in sitting rooms and one-third in bed- 
 rooms, therefore both of these must be right. Insanitary bathrooms and im- 
 proper kitchens are offensive out of proportion to their use and, therefore, 
 they are of importance. The balance of the house does not count for much 
 from the health standpoint. 
 
 A common fallacy is that large rooms are better than small. Carnally 
 and Haldane found that a man could be comfortable with 100 cubic feet of 
 air space if the air was changed often enough and that 800 was really 
 an excess. Where each occupant had 2,500 to 4,000 cubic feet the air was 
 not so good as where he had a third as much. Large rooms are dirt catchers, 
 coal eaters and a nuisance generally, while they give poorer air than smaller 
 ones. 
 
 Especially is it true that bedrooms should be small. But small rooms 
 must be ventilated. We may trust to leakage to ventilate a large room but 
 not a small one. 
 
 An ordinary wall will leak somewhere about five cubic feet of air per 
 square yard per hour when an ordinary wind is blowing. If the plaster has 
 
1124 THE HOME 
 
 a hard finish, is painted or papered, wall leakage will be about done away 
 with. 
 
 Not so with window leakage. On a very windy day an unstripped win- 
 dow will leak about 400 cubic feet of air per hour. When stripped it will 
 leak only one-twentieth as much. The air which leaks in around unstripped 
 windows is cold air and it falls straight to the floor. The warmer the room 
 the quicker the window leakage falls and the more uncomfortable it becomes. 
 
 The old idea was that a room with a high ceiling was preferable because 
 ventilation would be better. In figuring cubic feet of air space for ventilation 
 calculation engineers have long ago learned to count all over fourteen feet 
 as a liability and not an asset. 
 
 Where the ceilings are not over ten feet high the windows can reach 
 entirely to the ceilings and nearly to the floor. ' The first detail is excellent 
 for lighting; the second makes it easier on very cold days to warm the air 
 which enters. 
 
 The Bohemian school building laws provide that 70 per cent of the 
 students as they sit at their desks must be able to see the sky. The common 
 rule in this country is that the window area must be one-tenth to one-fifth the 
 floor area. 
 
 And then what of the radiation — not only in relation to the size of the 
 room but also to the window and wall leakage? 
 
 Another point worth while inquiring into is whether the walls and floors 
 are deadened and insulated. Where people live in flats noises above and 
 below often spoil the serenity of life. It costs but little to fill the space be- 
 tween ceiling and floor with cinders or sawdust and to do so saves heat as 
 well as nerves. 
 
 Outside walls built hollow and filled in with insulation save coal. They 
 will not sweat when the humidity of the room goes over fifty; and walls that 
 do not sweat keep clean. When walls are hard finished or painted the window 
 leakage is reduced to nothing and accumulated dust is easily removed. 
 
 Houses with basements are to be preferred even in warm climates but 
 the basement must be kept dry. Houses without basements have cold floors, 
 the ground under them is not dry, and wet ground wider a house always breeds 
 molds. 
 
 The English laws provide that basement floors shall be covered with six 
 inches of cement or asphalt and that one surface of this must be treated 
 so as to be impervious to water. The walls are to have a vertical air space 
 running from a point six inches above the ground level to one below the level 
 of the cement floor. Just above the top of the air space and just below its 
 bottom an impervious layer is to be placed — vitrified brick, slate or lead. 
 Ground water cannot travel through the wall into the basement nor up the 
 wall into the house. The basement, if it is to be occupied, must come two 
 and a half feet above the surface of the ground and the window surface must 
 be at least nine square feet. 
 
 The roof of a building is not of much service in tempering the air. The 
 space just beneath the roof is usually hotter than that above it. 
 
SANITARY BATHROOMS 1125 
 
 SUNLIGHT IN THE HOUSE 
 
 A room that does not get some sunshine is not fit to live in. 
 
 If you will notice the ceiling in your kitchen you will see shaggy soot 
 collected here and there. In the main, this soot is grease evaporated on the 
 stove and condensed on the wall. With it is some other organic matter, 
 some harmless dirt and some bacteria. One day's accumulation is too little 
 to be seen but the mass increases day by day until, around cracks, openings, 
 and flues, the mixture hangs like whiskers. The cleanest of kitchens have 
 some whiskers. 
 
 The same process, though less in amount, is taking place on every wall. 
 The condensed matter has not so much grease in it and therefore does not 
 show so plainly. But whether in kitchen or parlor wall dust consists of 
 organic matter capable of decaying and of germs capable of making it decay. 
 
 So come house odors ! Not always harmful but never helpful and always 
 unpleasant. To cure these odors wash the walls and air and sun the rooms. 
 To prevent them either the putrefying matter must be removed or else it must 
 be disinfected. Washing can be done only at long intervals but airing and 
 sunning can be done every day. The organic matter will no more decay 
 without germs than eggs will rot without them. Germs make no headway 
 where there is sunlight and air. 
 
 There are other harmful results of house occupation which call for sun- 
 shine just as much as wall dirt and house odors — the illustrations used above. 
 
 How can sunlight be secured? 
 
 By placing the house, first, so that trees will not keep sunlight out of 
 the rooms; second, so that neighboring houses will not darken the rooms; and 
 third, by facing it in a direction that will expose every room to some sunlight. 
 
 Houses set so as to face squarely east or west or north or south are pretty 
 apt to have some sunless rooms. As a general proposition, houses facing east 
 or west or north are to be preferred. So fronted, an architect can find a way 
 to get sunshine into every room. 
 
 If there must be dark rooms the walls should be washable and they 
 must be aired enough to compensate. See to it that the kitchen and bedrooms 
 are not of them — the kitchen, because its walls gather dirt; the bedrooms, 
 because the bedclothes need sunlight. 
 
 SANITARY BATHROOMS 
 
 The development of house drainage has made the growth of cities pos- 
 sible. It is not possible to house more than ten people on an acre of ground 
 and have them enjoy good health unless the toilet facilities are built inside 
 the houses. 
 
 When people began to understand this and to legislate against outside 
 or yard toilets there was much opposition. It was argued that toilets in 
 houses would increase discomfort and produce illness. In the then state of 
 the plumbing art there was a good deal of force in the argument and many 
 fair-minded people believed and accepted it. But plumbers exercised their 
 
1126 THE HOME 
 
 inventive genius. One device scarcely got on the market until an improve- 
 ment was crowding it out. The present state of the plumbing art represents 
 practical perfection. 
 
 The sanitary standards of house drainage are years ahead of those of 
 any other feature of the house. Even the yard hopper, crude as it is, is 
 in advance of the ventilation, heating, lighting or floor and wall construc- 
 tion of the houses to which they are attached. The high standard of the 
 plumbing has served to elevate other standards and to teach other health 
 lessons. 
 
 Customarily, bathroom iv-alls have a hard -finish, are of washable con- 
 struction, hung with less molding, decorated with less claptrap and freer 
 from dusty foolishness than any of the other ivalls of the house. The kitchens, 
 sitting rooms and bedrooms ought to go to school to the bathroom. 
 
 Another lesson taught, rather incidentally but nevertheless wisely, is 
 the advantage of having wash bowls located in close proximity to toilets. 
 This arrangement prevents some finger-borne typhoids, some venereal diseases 
 and some other consequences. On this point, many factories, stores and 
 offices could advantageously go to school to the bathroom. Inaccessible, 
 inconvenient, uncomfortable facilities might as well not exist. 
 
 And finally, the perfection of house drainage should and will stimulate 
 the inventive genius of ventilating engineers to solution of their problems. 
 While improved house drainage grew in response to a demand that living 
 be made safe for those who are crowded together it has demonstrated its 
 advantages for houses surrounded by an abundance of room. Sanitary toilets 
 and bathrooms in country houses will help to keep the country people from 
 moving to the city. 
 
 KEEPING THE HOUSE 
 
 How hot do you keep your house in winter? 
 
 How dry is the air? 
 
 How often do you blow out your house? 
 
 How much sun do your rooms get? 
 
 How clean do you keep your house ? 
 
 The way you build your house is more important than looks. While 
 this is entirely true it does not diminish the importance of the way you keep 
 your house. 
 
 Guard against a hot house. 
 
 To go into a warm room for a few minutes probably will do you no 
 harm. To stay there throughout the day may do so little harm that it cannot 
 be noticed. To stay there days in succession will first make you languid, 
 then distinctly below physical par and finally definitely sick. 
 
 The sickness may be called one scientific name or another; the basic 
 trouble is bad ventilation. 
 
 Nearly everybody who speaks of flats says abusive things of them. Sev- 
 enty per cent of the basis of this abuse is dry hot air. 
 
 Dry air is the curse of flat life. If some of the energy spent in complain- 
 ing was spent in throwing up the windows occasionally (so that the rooms 
 
COLD WALLS 1127 
 
 might blow out), in ventilating better all the time and in keeping the air more 
 moist, everybody would be happier. 
 
 No amount of air can entirely replace sunshine. The woman of the 
 house can go out to get the light. Is it not better that she should get it in 
 the house also? Besides, it is needed to keep the bed and furnishings pure 
 and sweet. 
 
 KITCHENS, ICE BOXES, PANTRIES AND CLOSETS 
 
 Living rooms are usually too hot and too dry. Kitchens are usually too 
 hot and too moist. 
 
 What is sought in a kitchen is that it be cool and clean. The kitchen 
 is rarely a dark room in the private home. From the standpoint of being 
 supplied with outside windows it ranks next to the company room. 
 
 In order to keep the kitchen cool it is wise to have a hood over the stove. 
 This hood should lead straight to the stack. The room should have a venti- 
 lator into the stack near the ceiling. The hot air from around the stove goes 
 straight up and any system, which tries to take it out from near the floor is 
 sure to fail. Nor can kitchen odors be pulled around in any unnatural way. 
 They must go out over the stove or from the top of the room or else they will 
 go into the house. The same thing is true of the steam. 
 
 Ice boxes must be frequently aired and sunned. There are molds, yeasts 
 and bacteria which grow pretty well at low temperatures. Many of these 
 are odorous. The only way to keep them down is by sunning and airing. 
 In the winter the box can be aired all the time and this is economical and 
 hygienic. The plan is to use the cold outside air in place of ice. The best 
 way to arrange this is to have the ice compartment open to the outside air. 
 When the weather gets cold the door is left open and no ice is bought. Pans 
 of water placed in the ice chamber will freeze solid and will keep the box cold 
 during the days when the temperature rises. 
 
 Just as you never see kitchens crowded into basements wholly under- 
 ground except in some hotels and restaurants, so rarely, except in such places, 
 do you find ice boxes which cannot be ventilated or sunned. 
 
 Pantries need to be well ventilated, dry and clean. If they are not the 
 food goes off rapidly. Molds are more liable to grow in a pantry than in 
 any other room. There is more food for mold in a pantry than in any other 
 room. This means that a moldy pantry is not as clean as it ought to be. 
 It is also moister than it ought to be. 
 
 If any room in the house must be dark let it be the closet. Dark space 
 can be better used in this way than in any other. It is better to have air 
 ducts in the walls and have an opening into such a duct in each closet. The 
 opening can be made so that it can be closed. This and periodic airing will 
 be the only health needs of closets. 
 
 COLD WALLS 
 
 One of Browning's poems, called "House," tells of a home with the front 
 wall cut off and how the wayfarers gazed in at the rooms. While the walls 
 
1128 THE HOME 
 
 of a house may keep you and me out or even from looking in they do not 
 stop the air from leaking in. 
 
 When the temperature of the outside air is thirty-two degrees lower 
 than that of the inside an ordinary brick wall will leak eight cubic feet of 
 air an hour for every square yard of wall. If a hard north wind is blowing 
 against the wall the leakage will be much greater. When the wind is 
 blowing twenty-four miles an hour, a crack of one-sixteenth of an inch around 
 a window sash will leak 402 cubic feet an hour. 
 
 These rough figures teach us that air leakage through walls and around 
 windows are things which we must think about in selecting a house. They 
 tell us that on account of the cold air leaking into the rooms the occupants 
 may mistake the coldness for fresh air and not keep the rooms properly 
 ventilated. 
 
 Improperly ventilated rooms {especially when they are furnace heated or 
 heated with a gas or oil stove) where there is no proper provision for carrying 
 away the product of combustion mean ofttimes that the air in these rooms is 
 charged with poisonous gases, poisonous products of respiration and disease- 
 producing germs. This means that you may expect to find a chronic condition 
 of low vitality followed by such winter diseases as pneumonia, tonsilitis, diph- 
 theria and smallpox. 
 
 Does it face south? If so, the lived in part of the house may be cold 
 in winter. Is it exposed? Can the wind get a good drive at it? How are 
 the walls constructed? Is there any building paper between the inside and 
 outside walls? Is there any other insulation between these layers? How is 
 the inside wall faced? Has it a hard finish that will stop air from coming 
 through and can be washed? Is it papered so that it stops air and can be 
 cleaned? Has the paper been put on over old paper? Does the wall sweat? 
 If there is a basement how are the walls there ? Is there any mildew on them ? 
 Are they stained from old mildew or from old leakage and seepage? Is 
 there an airway around the wall? Is there a "damp course" in the wall 
 so placed as to prevent seepage ? 
 
 DAMP WALLS 
 
 In the north damp walls are a menace in the summer time only. During 
 the winter the heat required to maintain temperature is sufficient to dry 
 the walls even though ground moisture is going into them as oil goes into 
 a wick. 
 
 In the south, on the other hand, damp walls are only troublesome in the 
 winter time. The summer heat dries them out. 
 
 A damp wall does no harm except by keeping alive the germs of the wall 
 dust and making the organic matter of the dust more apt to decompose. When 
 there is plenty of air and sunshine in a room a damp wall is no more harmful 
 than a dry wall, for air and sunshine kill the wall germs. Therefore, damp 
 walls are only of health importance in dark rooms. It is in basements without 
 adequate lighting and in tenements where there is no sunlight that damp walls 
 are productive of disease. 
 
 A solidly built wall is a good conductor of moisture. Walls wet from 
 
CURTAINS AND CARPETS 1129 
 
 rain will get wet through if the outside is not adequately painted and the 
 rain persists. But most of the wet walls are so because of absorption of ground 
 water. A leaking gutter allows water to drop close to the wall or a drain 
 or ditch keeps the foundation wet. 
 
 A few layers of slate, a layer of lead or of vitrified brick a foot above 
 the ground will prevent moisture from climbing. In the case of basement 
 walls an airway outside the wall will keep it dry, but such airway is liable 
 to become insanitary. A better plan is to build the wall hollow. Whatever 
 braces cross the hollow area or cross the wall above the hollow area must be 
 of some material impervious to water. 
 
 Damp walls mean insanitary conditions; insanitary conditions mean 
 lack of efficiency, less likelihood of employment, therefore more poverty, 
 bad food, bad housing and conditions tending to increase the spread of tuber- 
 culosis and other infectious diseases. The problem of damp walls, then, 
 is all important, since its influence, especially on the younger members of 
 the family, will have much to do with the health, comfort and happiness 
 of the community. 
 
 CURTAINS AND CARPETS 
 
 Occasionally a method which is right will develop entirely away from its 
 original lines. The underlying idea may be entirely changed. A good illustra- 
 tion of this is the use of curtains. 
 
 The first people who used curtains wanted to make it possible to keep the 
 windows open. Curtains gave more privacy and also took some of the dirt out 
 of the air. Then the use of curtains to adorn the room became the custom. 
 Now curtains are made of delicate fabrics. They are no longer used to filter 
 air. On the other hand they are so difficult to clean that the windows are kept 
 down in order that the curtains may not be soiled. No doctor would do a 
 surgical operation in any curtained room. Contagion cannot be cared for in 
 curtained rooms. 
 
 Then why not get fine curtains out of the bedrooms and living rooms? 
 Leave them in the show parts of the house — for instance, in the parlors. Let 
 the curtains of the living rooms be plain, simple and cheap. 
 
 As between curtains and air, let us have air. 
 
 Carpets furnish an illustration of a similar point. The old-style wooden 
 floor was cold. It leaked air. It was hard to keep clean. Dirt showed 
 plainly on it. Then came rugs which developed into carpets. The floor was 
 much warmer. It did not show dirt. The carpets increased in cost. The 
 shades were kept down to prevent fading. The windows were kept down to 
 prevent dust from blowing in. 
 
 Now there is a different idea and it deserves every encouragement. 
 Floors are deadened. This makes them warmer. They are being made of 
 hard wood or some impervious composition — not all of them but in increas- 
 ing numbers. The corners with the side walls are being made round. And 
 when they are covered it is with rugs. But rugs are no better than carpets 
 unless they are kept clean. 
 
 Dust from Rugs. — Mrs. W. J. 67. suggests that leases include a pro- 
 hibition of the practice of beating rugs on the porches. 
 
1130 THE HOME 
 
 Reply. — No good neighbor will dust her rugs in any way that sends 
 dust into her neighbor's house. Bad neighbors render life in flats well- 
 nigh unbearable. 
 
 A SENSIBLE CAMP 
 
 Two gentlemen in Mississippi have built an outing home along right 
 lines. They started right by locating right. The spot selected was in the 
 middle of a fifty-acre pasture on soil that is a mixture of sand and gravel. 
 When it rains the water quickly soaks in and there are never any puddles of 
 water standing around. This means no mosquito breeding places as well 
 as no hours of mud-bound idleness and discontent. 
 
 There being no trees, the breezes are not obstructed and the sun gets a fine 
 chance at everything. It is impossible to prevent some ground pollution around 
 a dwelling but this matters little if the sun gets a good chance to sterilize. 
 
 The next exhibition of good sense was in the type of house built. Ninety 
 per cent of the time in summer and 60 per cent of the time in winter the 
 house consists of a roof and a floor. The floor is of cement. In the center is a 
 chimney with two fireplaces. Over the top is a high pitched roof. 
 
 All four sides of the house are so hinged that they swing out until horizon- 
 tal. To facilitate swinging out the side walls are divided into ten foot sections 
 and the counterweights, made of cement, are used to balance the weight. 
 The walls hinge ten feet from the ground. 
 
 The breezes are unobstructed. There are no side walls to absorb heat 
 during the day and radiate it at night. Sunlight and air and an easily washed 
 floor keep the house always free from house odors. Privacy is had by use 
 of light, movable screens. The house is cooler than if it were placed in the 
 woods. 
 
 The next exhibition of good sense was in providing a good water supply. 
 Sixty feet from the house they sunk an artesian well flowing seventy-two gal- 
 lons of water. Artesian water is bacteriologically pure. It is not contaminated 
 and it cannot be. 
 
 The water run-off passes through a milk, butter and meat box, furnishing 
 the next exhibition of good sanitary sense — provision to prevent fresh food 
 from spoiling. 
 
 Over the artesian well is a pagoda with a cement floor. Curtains that 
 can be dropped around this pagoda give a cement-floored bathing pavilion 
 provided with a stream of cold, clean, running water — a shower bath proposi- 
 tion. This is the seventh exhibition of good sense. 
 
 The statement that when these side walls were raised the house con- 
 sisted of a roof and a floor omitted mention of mosquito and fly screens 
 extending from the eaves to the floor on all sides — the eighth item of sanitary 
 sense. 
 
 Compare this simple, inexpensive, sanitary equipment with the usual 
 camp under sun-excluding trees, stuck in a dense mass of foliage, on wet, 
 soggy ground, on polluted soil, with polluted water and insects galore, with 
 no provisions for keeping food cold and with no bathing facilities. 
 
ARRANGEMENT OF HOME 1131 
 
 PORCHES 
 
 Porches can add to or detract from the hygienic qualities of a house. 
 In country homes and sometimes in homes in smaller cities the house is so 
 nearly surrounded by porches that the sun cannot shine into the rooms. 
 Especially is this true of latticed and vine-clad porches. With this reserva- 
 tion porches are to be sought for in finding a home. This is much more 
 necessary in a city than in the country. When houses are standing on lots 
 thirty feet or less in size there is insufficient chance for light and air unless 
 there be porches. 
 
 Sleeping on a porch is much more comfortable than sleeping in a room 
 in most places from May 1 to December 1. With a moderate amount of 
 preparation it is just as comfortable as room sleeping during April and 
 December. With proper preparation and forethought it can be made com- 
 fortable during January, February and March. 
 
 It is much more healthy than sleeping in a room. This is true of the 
 midwinter months as well as the months of spring, summer and autumn. 
 Perhaps there is, here and there, a lingering idea that night air is harmful. 
 It is both cleaner and purer than day air. 
 
 The people of southern California say that 50 per cent of their popula- 
 tion sleep on screened-in porches. With them the percentage should be 90. 
 Sleeping out is so easily made comfortable with them. 
 
 Much the most satisfactory arrangement is to "glass-in" the sleeping 
 porch. This is expensive. Glassed-in sleeping porches may be made so snug 
 and free from drafts that they have no advantages over cold rooms. If 
 the sleeping porch is glassed-in the windows should be movable and free 
 air movement must be had during all sleeping hours. 
 
 The next best arrangement is protection by curtains. The short> 
 coming of curtains is their noisiness in stormy weather. This can be prevented 
 by fastening with strips of wood placed at short intervals. In those parts 
 where roller curtains are used buttons, buckles or hooks should be provided 
 at intervals of two feet on all posts and pillars and supports. 
 
 The simplest arrangement is to have a heavy tarpaulin to cover the bed- 
 stead as well as the bed. This should be rolled out of the way on the head 
 of the bed. When storms come up during the night the covering can be 
 arranged tentlike over the bed. The occupants sleep elsewhere on such windy, 
 rainy nights. 
 
 The other uses of porches will appeal to more people than their use as 
 sleeping places. Has your prospective home a good back porch where you can 
 eat in the open air in the summer time? Does the sun reach it that things 
 may be sunned and aired? Is there a comfortable fr^nt porch where some 
 fresh air can be taken without dressing for the street ? 
 
 ARRANGEMENT OF HOME 
 
 As one goes about seeking a home it is well to ask oneself certain 
 questions about the requirements of a home for comfort and health, to answer 
 the questions in one's own mind and, when a proposed location is being 
 
1132 THE HOME 
 
 looked into, to see how many of the answers apply to the place under in- 
 vestigation. Some of the questions which should be asked and my answers 
 thereto follow: 
 
 Q. — What is the principal source of flies in a neighborhood? 
 
 A. — -Manure boxes and stables; garbage is second in importance. 
 
 Q. — What is the principal source of mosquitoes about a house? 
 
 A. — Small collections of water located inside the house or within 300 
 feet of it. Ninety-five per cent of mosquitoes and flies never get 300 feet 
 away from their hatching place. 
 
 Q. — In which direction should a house face? 
 
 A. — North. The front portion of the house is not often used constantly. 
 On cold, windy days the north rooms generally leak so much cold air that they 
 are uninhabitable. There is advantage in using these rooms as parlors and 
 spare rooms. It is even better to have the house face somewhat west of 
 north. 
 
 Q. — On which side of the house should the bedrooms be located? 
 
 A. — The east side. The beds should have the morning sun and in sum- 
 mer should escape the heating effect of the afternoon sun. Especially is this 
 necessary with the nursery. 
 
 Q. — Is a house in a dense woods advisable? 
 
 A. — No. It is almost impossible to rid a house thus located of mosquitoes 
 and flies. The sun does not get a fair chance to purify the ground around 
 the house nor the inside of the house. 
 
 Q. — Should the house have a cellar or basement? 
 
 A. — Yes. It is a protection against cold floors in winter. It does 
 not make the house warmer in summer. 
 
 Q. — How can a cellar wall be kept dry ? 
 
 A. — A tile drain should be laid around the outside of the cellar wall. 
 The drain should be four inches below the foundation wall, beginning at the 
 corner, and twelve inches below at the opposite corner. 
 
 Q. — Of what material should the cellar wall be built? 
 
 A. — Of concrete or stone, laid in cement mortar. 
 
 Q. — What is the objection to a wall of ordinary brick? 
 
 A. — Brick walls absorb water too readily. 
 
 Q. — How can water be prevented from creeping up the wall? 
 
 A. — By interposing a damp-proof course consisting of one-half an inch of 
 asphalt or slate and by having air spaces in the wall. 
 
 Q. Should the cellar extend above the ground and be provided with 
 windows ? 
 
 A. — Yes. Unless a cellar can be aired and sunned it is liable to be a 
 source of ill health. 
 
 Q. — What are the signs of a damp cellar? 
 
 A— Wingate's "Sanitary Question Box" gives the following: 
 
 1. Eust on exposed metal pipes and flues. 
 
 2. Broken plaster and "bucking" lath. 
 
 3. Dry rot on the floor beams. 
 
 4. Fungous growths on walls. 
 
 5. Spots of mildew and moisture between the cracks of the flooring 
 together with a musty odor and a general sense of closeness. In addition, 
 
ARRANGEMENT OF HOME 1133 
 
 look for wet dirt in the spaces of the flooring and for rotting of the ends of 
 wood in posts that support the floor. 
 
 Q. — How can one tell that the walls of a building absorb moisture 
 from the ground? 
 
 A. — Look for so-called wet feet. Walls that show scaling of the paint 
 and incrustation with a mineral extending a foot or two above the ground. 
 
 Q. — Should a house have high ceilings? 
 
 A. — No. High ceilings add nothing to the ventilation of a house. In 
 fact, they increase the difficulties of ventilation. They likewise increase the 
 difficulties of heating. 
 
 Q. — Should not the houses in warm climates have high ceilings? 
 
 A. — No. The houses in Havana have high ceilings but it is a mistake. 
 It is desirable to have a good deal of space below the roof but that space 
 should be between the roof and the ceiling, not below the ceiling. 
 
 Q. — Should attics have windows? 
 
 A. — They should, especially in warm climates. Attics need sunshine. 
 In warm weather, unless they have windows, much of the roof heat is 
 transmitted to the rooms. In cold weather the windows can be made tight. 
 
 Q. — Can a house have too many windows ? 
 
 A. — Yes. The purpose of windows is to illuminate the room, to secure 
 for it the bactericidal action of sunlight and to permit of ventilation. Too 
 many windows means that the room will be cold, will have cold floors and 
 will be hard to heat. 
 
 Q. — From the standpoint of health what is the most important room 
 in the house? 
 
 A. — The nursery. 
 
 Q. — What is the least important? 
 
 A. — The parlor. 
 
 Q. — Why is it important that the pantry should be right? 
 
 A. — Because food may be dangerously spoiled without being altered in 
 taste, smell or appearance. 
 
 Q. — What is the most important piece of furniture in the pantry? 
 
 A. — The ice box. 
 
 Q. — What are some of the more important points to note about an 
 ice box or refrigerator? 
 
 A. — It should maintain a temperature, when iced, of less than 55°. In 
 comparison with this all other points are of minor importance. It should be 
 lined by some white waterproof easily cleaned substance. The shelves and 
 partitions should be removable. It should be drained by pipes and traps that 
 are easily reached and readily cleaned. It should be in such a position 
 that it can be sunned at times, or else it should be on rollers, so that it can 
 be moved to a place where it can be sunned. It should have walls thick 
 enough and composed of material which will not absorb moisture or pack or 
 lose its air spaces. It must not be an ice eater. It must be open to the out- 
 side so that ice may be put in from the outside in warm weather and so that 
 the outside air may serve for refrigeration in cold weather. Its outward ap- 
 pearance must be one of neatness and cleanliness. 
 
 Q. — Should the pantry shelves be removable? 
 
 A.— Yes. 
 
1134 THE HOME 
 
 Q. — Should the pantry walls have a hard finish ? 
 
 A.— Yes. 
 
 Q. — Should the kitchen have a hard-finished wall? 
 
 A. — Yes. The kitchen should have a washable wall free from molding 
 and dish racks, even if it is the only room in the house with a wall of this 
 type. The vaporized greases soon soil the kitchen wall and nothing suffices 
 except washing. 
 
 Q. — Should the kitchen have an electric fan? 
 
 A. — Yes, an electric fan is needed to distribute the heat properly in 
 both winter and summer. In hot weather the food will not be sanitary if 
 the cook is overhot and perspiring profusely. 
 
 Q. — Should the kitchen have every convenience not only for cooking but 
 for handling the food and for caring for the dishes? 
 
 A. — Yes. Efficiency demands it. 
 
 Q. — Of what material should a kitchen sink be made? 
 
 A. — Enameled sinks are much the best. Porcelain is good. Galvanized 
 iron does very well though it rusts after the zinc has worn off. Slate, soap- 
 stone and iron have much against 'them. 
 
 Q. — How can the kitchen sink be kept free from small scraps of food ? 
 
 A. — Every sink should be equipped with a removable strainer through 
 which all washings should pass. 
 
 Q. — Should the dining room be light? 
 
 A. — While it is very desirable it is not especially necessary. 
 
 Q. — How should the bedroom be arranged ? 
 
 A. — There should be the minimum amount of furniture and the fewer 
 dirt-catching ornaments and trinkets the better. 
 
 Q. — Should the floors be covered with carpet or rugs ? 
 
 A. — Rugs. 
 
 Q. — How should the floors be built? 
 
 A. — Between the floor and the ceiling of the room below there should 
 be enough deadening substance to silence all sounds else the floors will be 
 cold. Where floors are not deadened the flooring shrinks unevenly and in 
 time it draws and creaks. 
 
 Q. — How should the floors be cleaned? 
 
 A. — The house should be equipped with vacuum cleaners whenever it is 
 feasible. 
 
 Q. — What is the objection to beating rugs and carpets on the outside ? 
 
 A. — The noise disturbs the neighborhood; the dust pollutes the air 
 and the bacteria kill the rug beaters. 
 
 Q, — Should the bed be set against the wall? 
 
 A. — No. One's smell tells him that the air on the side of the bed next the 
 wall is not fit to breathe. Crowder has proved it by analysis. 
 
 Q. — Should the bed be put in an alcove? 
 
 A. — No. The bed should be where sunlight and air can get at it. 
 
 Q. — Should a house have sleeping porches? 
 
 A. — It should. When one sleeps in cold circulating air in a room which 
 has had an abundance of sunshine during the day hours he will find that 
 there is a material increase in his working capacity and also that he will 
 be less liable to colds and pneumonia. 
 
SPKING CLEANING 1135 
 
 Q. — Is a glassed-in porch better than one with awnings, curtains or 
 shades ? 
 
 A.— It is. 
 
 Q. — Are glassed-in porches with fixed windows and radiators advised? 
 
 A. — No. Unless the windows can be opened, the air allowed to come 
 in freely, and the temperature to drop the porch loses many of its advan- 
 tages as a sleeping place. 
 
 Q. — Where should the bathroom be placed? 
 
 A. — Convenient to the bedrooms. 
 
 Q. — Should the bathroom have a window opening to the outside air? 
 
 A. — It is desirable but not necessary. 
 
 Q. — Is it proper to put a bathtub, a wash bowl and a water closet in the 
 same room? 
 
 A.— It is. 
 
 Q. — Should a bathroom be heated by a gas heater? 
 
 A. — It is never to be desired. It should be permitted if the heater has 
 a flue or pipe to the outside air. Gas heaters without flues should not be 
 allowed in bathrooms. 
 
 Q. — Should a bathroom have a wall thermometer? 
 
 A.— Yes. 
 
 Q. — What is the reason for special care as to the temperature and the 
 air conditions of the bathroom? 
 
 A. — The disrobed body of the bather requires that the temperature of the 
 bathroom should be several degrees warmer than the temperature of the re- 
 mainder of the house. On the other hand, fainting in the bathtub must be 
 provided against by watching that the temperature of the bathroom does not 
 go too high and that the air is not too much polluted by products of com- 
 bustion. 
 
 Q. — What type of closet should there be? 
 
 A. — Syphon jet, syphon, or washdown. Washout or hopper closets are 
 not satisfactory. 
 
 Q. — Are the present plumbers' methods proper from the health stand- 
 point ? 
 
 A. — They are. 
 
 Q. — How can the air from an open window or from a hot-air register be 
 cleaned ? 
 
 A. — By fastening cheesecloth over the opening. 
 
 SPRING CLEANING 
 
 Spring cleaning is a law of nature. As the glow of spring banishes the 
 winter's chill everything in nature casts off its winter coat, worn and dirty 
 from use, and takes on clean raiment. The Easter bonnet is but a poor 
 response to the great nature call. The trees shed their old dead parts and 
 new clean buds break out. The flowers displace the dirty coverings, the 
 dead grass is washed away and a bright green carpet covers the earth. Nature 
 cleans in the spring. 
 
 Spring cleaning is an instinct. The animals tumble the winter's waste 
 
1136 THE HOME 
 
 out of their lairs. The birds that during the winter have accumulated 
 dirty coats are seen to spend hours in washing and cleaning their feathers. 
 The old drake that has been contented to look like an ashbox will give up 
 hours to drawing its feathers through its beak, cleaning and oiling them. 
 
 Spring cleaning is a custom and always has been. The cave man had 
 the habit of cleaning himself and all about him in the spring time. Back 
 of his custom lay the customs of his ancestors; back of the customs of 
 the ancestors lay the instinct of the animals; back of this lay the laws of 
 nature. 
 
 The groups of women who in the spring of this year will be organizing 
 clean up movements are not illustrations of De Vries' "Mutations" or 
 "Sports." They are in harmony with the eternal fitness of things. They are 
 links in a chain that reaches back to Noah and his ark laws, to Adam, to the 
 cave man, to dumb animals, to nature itself. 
 
 The beginning is with the house. All winter long the waste has accumu- 
 lated there. The housewife has done her best. She has cleaned each day, 
 each week, but the task has been too much. The sun had a short day and 
 could not kill all the offensive matter in all the rooms. The air was cold 
 and could not be allowed to sweep through and do its full share of cleaning. 
 
 Therefore each week the standard of household cleanliness has gone back 
 just a little. If it were 1,000 in October, in November it had fallen by easy 
 stages to 990 and so on until easily and gradually it became imperceptibly 
 lower as the winter went on. 
 
 Now May comes and by one prodigious effort it must be brought to the 
 normal again. 
 
 The shutters are thrown wide open; the rooms are bathed in sunshine; 
 the windows are thrown open; the rooms are bathed in air. 
 
 However, more than that is required to make up for the sins of the 
 winter. So up come the carpets and out they go to a vacant lot where 
 some poor fellow beats them. He stands in a cloud of dust striking away. 
 It is too bad that the principle of vicarious sacrifice should be carried so far. 
 
 Statistics show that janitors and carpet beaters die from consumption 
 like flies in autumn. Though it cannot be shown by statistics they revel 
 in colds during the spring cleaning season. How could one expect anything 
 else? There they stand, day by day, breathing in the germ laden dust, the 
 dust that the housewife knows she must get rid of if her family is to keep 
 well. 
 
 The scoffer says : "Have you not told us that sunlight and air kill germs ; 
 that drying makes harmful things harmless ?" Yes, they do. Given a million 
 germs and admit these agents would kill five hundred thousand of them, there 
 is still danger to the rug beater. 
 
 The danger of carpet dust, though, lies in the fact that not all janitors 
 die from it, and none of them drops dead as he beats. If they did carpet 
 beating would stop at once. 
 
 If the babies all died, or if babies died instantly, from bad milk, bad 
 milk would be a matter of no imoortance to the community. Everybody 
 would stop using it. 
 
 Cannot a better way be found ? 
 
 If there is something to be said against the prevailing practice in carpet 
 
SPRING CLEANING 
 
 1137 
 
 cleaning nothing can be said against washing and scouring the walls and 
 floors, the closets and pantries, the sinks and ice boxes. 
 
 Spring cleaning assumes a rather broad scope. It has for its object not 
 only cleanliness but the laying plans for protection against disease that comes 
 with the approach of summer. 
 
 The doors and windows of the average home have usually been kept closed 
 during the cold, bleak days of the winter. The air in many such homes is 
 more or less foul; dust and dirt have accumulated. The attic and closets 
 have been overworked by the accumulation of useless wearing apparel, old 
 papers, paper boxes and odds and ends. 
 The ceilings, especially of the closets, 
 have become dust and dirt laden. In 
 smoky neighborhoods particularly the 
 paper on the walls is dirty and greasy 
 from coal soot. 
 
 During the last days of the win- 
 ter the good housewife and the good 
 husband have planned for a spring 
 cleaning. They have faced the problem 
 of cost and combined their best judg- 
 ments in arriving at conclusions as to 
 what shall and what shall not be done. 
 
 Unfortunately, all of us cannot 
 step to the phone, call the vacuum 
 cleaners to take an order to clean 
 apartment at No. — or home at such 
 a location. While it is the ideal method 
 of cleaning it is too expensive for most 
 people, and necessitates their resorting 
 to soap and water and hard labor. 
 
 When the wife and husband 
 planned their spring cleaning they 
 were not wholly influenced by selfish 
 
 Board or \ 
 pfafe J/&SS 
 io SO" h/g/? 
 fie/o/jbyc/eafc 
 
 Michigan Public Health. 
 Fig. 481. — Ventilating by Means of Win- 
 dow Lowered at Top, Raised at Bot- 
 tom, With Deflector. 
 
 s . 
 
 motives. They might leave some 
 things undone. They might get along 
 without such extensive cleaning. But 
 their neighbors have rights. They do 
 not want to maintain a menace to the 
 health, comfort and happiness of their 
 neighbors. Hence they have endeavored to be more liberal in their calcu- 
 lations. 
 
 There is no better way, no more economical way, no more effective way 
 to spend money than in maintaining a clean, hygienic home. 
 
 The best way to clean a house is to begin with the closets. See that they 
 are thoroughly cleaned and put in order before anything else is undertaken. 
 Next, empty and clean bureau drawers, take down curtains and portieres, clean 
 and put them aside until the cleaning and decorating has been completed. 
 Bric-a-brac and pictures should be cleaned and placed where they will be pro- 
 tected until the carpets and rugs are laid. 
 
1138 THE HOME 
 
 House cleaning, as usually referred to, has regard only for the dusting of 
 pictures, bric-a-brac and books, wiping the dust from the walls, beating the 
 carpets and upholstered furniture and rugs, hanging the mattresses and 
 bedding in the sun all for a few days each year. 
 
 However, house cleaning should have for its object a little mere than this. 
 It should mean getting the house and its immediate surroundings into a hy- 
 gienic and sanitary condition. 
 
 Insects are carriers of infection. They are responsible fcr many epi- 
 demics. They may carry the germs of typhoid and typhus fever. 
 
 The mosquito carries the germ of malaria, the bedbug carries the germs 
 of relapsing fever, fleas may carry the germ of many diseases. The damage 
 that the common house fly does by carrying disease laden tilth on its feet 
 is pretty generally understood. 
 
 The necessity for thorough spring cleaning seems to be only too apparent. 
 Every corner, every niche should be thoroughly cleaned and freed of vermin. 
 
 Cockroaches and all fields which oiler good breeding places for them 
 should be destroyed. Containers to foods should be provided to bar their 
 entrance. 
 
 These pests may have paid a recent visit to some outhouses where they 
 crawled over disease laden feces, only to return hastily to your kitchen and 
 crawl over your bread, cake and other articles of food. They are kind and 
 considerate enough to leave the germs of typhoid or typhus fever. 
 
 Eoaches have an especial liking for dark, dirty, damp corners in the 
 kitchen and about the pantry. For this reason extra care should be used when 
 cleaning and repairing in the kitchen and pantry to provide against the pos- 
 sible invasion of the cockroach. 
 
 In rural districts the houses may not contain so much dirt as the homes 
 in the great cities but there are outhouses such as barns, chicken houses, pig 
 pens, cow pens, stables, smokehouses and wagon sheds which need thorough 
 cleaning. 
 
 In the spring cleaning season they should all be carefully gone over. 
 All the debris and waste which favors the breeding of vermin must be 
 destroyed. 
 
 It should not be forgotten that rats, mice, flies and fleas are especially 
 partial to fields of filth that are located in and about such areas. They 
 are all carriers and spreaders of disease; and if the home is to be free from 
 disease breeding vermin their habitations must be destroyed. 
 
 It has been known for some time that the mosquito is the carrier of the 
 malarial poison. No disease so insidiously and secretly undermines the 
 constitution and decreases physical efficiency as malaria. 
 
 To do away with the mosquito it is important that cesspools and mosquito 
 breeding habitations be destroyed. Mosquitoes breed in water tanks, tin 
 cans lying about the yard, barnyard, in the street or road, in barrels used 
 to catch rain water or that for some other reason contain water, and in cisterns 
 and flush tanks in toilet rooms. 
 
 The water tanks, cisterns and flush tanks should be covered to keep the 
 mosquitoes out ; tin cans or other receptacles containing water and lying about 
 the yard, barnyard and streets, should be gathered up and carted away to the 
 dumps. 
 
SPRING CLEANING 
 
 1139 
 
 To prevent the development of mosquitoes in dumps the rubbish should 
 be treated with crude petroleum or coal oils. 
 
 Where swamps exist within a given radius of a home, they should be 
 drained. Where there are filthy cesspools they should either be filled up or 
 treated with some sterilizing agent, as lime. 
 
 It may be necessary to treat the swamps with crude petroleum or coal 
 oil. If it is necessary, it should be done. 
 
 Flies carry disease germs on their feet, gathered from feces, sputa, dead 
 
 Virginia Health Bureau. 
 
 Fin. 4S2. — Window Ventilator. 
 
 animal matter and infected discharges. The germs they deposit on the 
 food over which they crawl or the moist surfaces of the body are often the 
 starting point of a serious epidemic of some one of the many contagious 
 and infectious diseases. 
 
 Spring cleaning then should ha^e regard for placing the home and 
 outhouses in such condition as will reduce the fly-breeding places. All garbage 
 cans or containers should be thoroughly cleaned, repaired and equipped with 
 an appropriate and practical cover. This will make it easier for the housewife 
 or other person wno wishes to deposit garbage or other waste material therein 
 and insure proper protection of such waste material against exposure to 
 flies. 
 
1140 THE HOME 
 
 Manure boxes may become a serious menace to public health, as they 
 furnish an ideal place for flies to breed. In their construction, therefore, re- 
 gard should be had for the exclusion of flies, insects and rats. 
 
 Manure bins should be carefully cleaned and in the rural communities, 
 manure piles should be hauled away, since they are often within the field of 
 some watershed from which the family well may draw some of its water 
 supply. 
 
 Where it is possible and practical the manure boxes, cellars, pig pens, 
 chicken houses and the inside of outhouses should be whitewashed. Lime 
 should be sprinkled freely about the area. 
 
 Flies and mosquitoes must especially be guarded against as they are 
 the most common carriers and dispensers of disease producing germs. After 
 the house has been thoroughly cleaned and refuse containers thoroughly 
 sterilized and rendered sanitary flies and mosquitoes should be further 
 guarded against by proper screening of the house. Dr. Eosenau has said : 
 
 "When the matter is generally understood it will be a greater reproach 
 to the housewife to have mosquitoes and flies in the house than bedbugs." 
 
 House Doctor Needed. — M. L. H. writes: "Our house contains a living 
 room and three bedrooms on one floor, an attic above, and a basement 
 containing a dining room, kitchen, and two rooms used for storerooms. In 
 one of these shoes in a short time are covered with blue mold and in the 
 other room tins and pans rust quickly. The dining room and rooms above 
 have been decorated twice in three years. A whole side of paper and putty 
 coat will come of together. The decorator says it is on account of the 
 dampness. A furnace heats the rooms very well except in severe weather, 
 but it does not heat the kitchen, where we have a gas range for cooking 
 and a coal range for heating. The floor always strikes up through the feet 
 cold and clammy, although there are rugs all over it. The grandmother 
 puts on alaskas to go to the kitchen. A jelly-like substance oozes up 
 through the cracks of the hardwood floor in the kitchen, so the decorator 
 said he had better give it two coats of paint. That was during the ex- 
 tremely hot weather last summer. It was over three weeks before the sec- 
 ond coat could be put on, and that was even longer in drying. The dec- 
 orator said the boards were so wet on the other side they could not absorb 
 the paint. In the corner near the sink the floor seems so cold we have 
 boards on the floor and covered with carpet. We thought the pipes must 
 leak, but the plumber says that is impossible. Could we require the land- 
 lord to take up the floor and examine conditions below f Is it unhealthy 
 to live in such a house, and are we laying the foundations for rheumatism?" 
 
 Eeply. — Yes, you are laying the foundation of ill health, and probably 
 of some infection like rheumatism. 
 
 Your house needs a house doctor — first to diagnose and next to cure. 
 At the beginning it should have had a house doctor to prevent, for pre- 
 ventive house medicine is as much better than curative house medicine, 
 as preventive medicine is better than curative medicine for folks. 
 
 The jelly-like substance which oozes up is mold. Molds are certain to 
 grow in such a house. Continuous sunlight would be required to prevent 
 it. 
 
 The trouble with the house is that the walls and floors are not insulated. 
 Ground water travels up the walls. A six-inch cement basement floor 
 with a hard finish, a layer of impervious material — slate, lead, vitrified 
 
THE HOME 1141 
 
 brick — above the ground in all walls which reach the ground, deadened 
 floors and room walls in which there is deadening and on which there is a 
 hard finish — such would be a correspondence course diagnosis and treatment. 
 
 Space in Tenements. — J. I. F. writes: "Referring to your article on 
 housing, I venture to suggest that in addition to sanitarians, architects, 
 and political economists, whose counsel is to make effective committee 
 work for letter homes, the advice of several practical women would he 
 of invaluable aid. My own experience in poor neighborhoods, as a 
 settlement resident, visitor, etc., tell me that from the house (home) 
 keeper s point of view several things besides light and air and good plumb- 
 ing are essential. 
 
 "I believe it necessary and practical to have a certain amount of shelv- 
 ing in the kitchen, and, as I know that every inch of space is paid for by 
 the tenant, this shelving need not take extra space, but can be made sightly 
 by corresponding to the plate rack in costlier homes, and hooks can be 
 attached. 
 
 "Above the second floor, the home that has not some little porch where 
 a baby buggy may be placed, or a little child, properly guarded, may play, 
 is by that much incomplete for the mother. She must hold the little one 
 or give her time by taking it to the ground floor, or else intrust its care, 
 frequently, to some one too young for that responsibility. 
 
 "The wall space in many new buildings could be better arranged by plac- 
 ing windows and doors in juxtaposition, so that currents of air could cool 
 the rooms on hot days and purify them in all seasons. 
 
 "Finally,! believe that, through agitation, it might be possible to induce 
 some builders of tenement property to put up buildings as we see them on 
 modest streets in the Humboldt Park and Logan Square neighborhoods, 
 on the checker board plan — one or two houses at the rear end of the lot 
 and the next touching the building line. This arrangement secures light, 
 air, and garden space, and I believe is capable of much improvement, so 
 that the landlord can be assured of a fair return on high-priced property. 
 
 "While conditions are not so bad as in New York, they are in great need 
 of improvement, and I hope we shall soon see some tangible results and 
 that women will be allowed to help in solving these problems/' 
 
 Eeply. — This letter contains many valuable suggestions. It is pub- 
 lished in order that they may be more widely circulated. 
 
 Safe but Wasteful. — R. C. writes: "Will you kindly tell me if a sta- 
 tionary porcelain tub. not in a basement, is a safe ice box, when kept abso- 
 lutely clean? Should the stopper be left out?" 
 
 Reply. — It is safe enough. The stopper may be kept out. It will waste 
 ice. Much of the cold will be used up in chilling the air of the room. 
 
 Sunlight in Bedrooms. — E. M. writes: "Are bedrooms with northern 
 exposure, that never have the sunlight, any less healthy than those that do, 
 provided they are well ventilated from the outside?" 
 
 Eeply. — Bedrooms which get no sunlight are not as healthful as those 
 which do. If the ventilation and cleanliness standards are raised high 
 enough the harm from lack of sunlight is negligible. If the sunshine 
 standard goes down and the ventilation and cleanliness standards do not go 
 up to a compensating degree the harm is material. A bedroom getting no 
 sunlight will be safer if it has plain walls without moldings or shelves, 
 
1142 THE HOME 
 
 doors and windows without projecting frames, rounded corners, hardwood 
 floors and simple furnishings. The windows should be thrown up and the 
 room aired out during some part of the daytime. They should be open 
 during the hours of sleeping. 
 
 Poor Lighting in Hotels.— Mrs. TT 7 . J. G. writes: "1. Are there laws in 
 Illinois governing the amount of light to he furnished guests in rooming 
 houses and hotels? A man not long ago complained of his head aching and 
 eyes feeling strained on account of the poor light in his room while read- 
 ing (studying) evenings. The lights in the parlor and office, he said, were 
 better, but these places were too noisy for one to read or study in. 2. Is it 
 not a fact that such conditions need to be remedied?" 
 
 Reply. — 1. There are no such laws. The laws of competition do not 
 even cover the case. One of the prominent monthly magazines had an 
 article on this subject a few months ago. It was written from the stand- 
 point of the traveling man. One of the complaints was of the universally 
 poor lighting of hotel rooms. The lights, he said, are never where they 
 are needed. 
 
 2. Yes. 
 
 Cleaning the Sink. — E. T. W. writes: "Kindly inform a young house- 
 keeper how to keep the sink and toilet always clean and what to use. Some- 
 one says to dissolve a little copperas and pour down twice a week. Is that 
 good?" 
 
 Reply. — I do not think copperas would help much. The first necessity 
 is that outside parts be kept as clean as possible. For this purpose hot 
 water and soap, particularly the soaps having an excess of alkali, suffice. 
 Pipes from sinks clog with chilled grease and dirt. What is needed to cut 
 this is heat and alkali — hot water and lye soap or some of the other very 
 alkaline soaps. If any part of the clogging is from the growth of moldy 
 slimes strong ammonia cuts it. Clean out the grease and dirt and anti- 
 septics will not be needed and their use will not help. Some precipitates 
 composed of grease and salts from the water can be cut best with a sand 
 soap. For bath tub stain a cloth moistened with kerosene works very well. 
 For toilet discolorations alkali soaps and ammonia are usually efficacious. 
 Sand soaps are frequently needed ; sometimes plenty of alkali soap applied 
 with a stick or an old case knife will be necessary. If the flush is not force- 
 ful enough or the traps do not keep full and odors result the plumber must 
 be called in. 
 
 No Sunlight in Bedrooms. — S. J. writes: "That new idea that perfect 
 health cannot be had without sunshine in bedrooms is incorrect. If you 
 are not healthy do not blame it on account of having no sunshine in the 
 bedroom. I know a family who had sunny bedrooms, but the members were 
 sick and consulted doctors and used all kinds of medicines. Then they 
 moved into a building where they had no su?i in their bedrooms, and at the 
 same time bought a book called 'The Nature Cure,' and also read the Chi- 
 cago Health Report, written by Dr. W. A. Evans, and are still reading Dr. 
 Evans' writings, and not only reading but living thereafter, and the result 
 is perfect health without doctor and medicine. How did the members of 
 .said family cure themselves without sunshine in their bedrooms and with- 
 out doctor and medicine? They sleep with their windows open at top and 
 bottom all the year round, without heat in the bedroom, and, as they get 
 
THE HOME 1143 
 
 out of bed they throw the bedding over the back of the bed and leave the 
 room with the windows still open for hours, and dress in a heated room. 
 After the bed is well aired they close the windows and open the door to 
 the heated room, and when the bedding is warm the bed is made up. In 
 the summer the bedding is brought out in the sun a couple of times a week. 
 And they drink plenty of water at about the same temperature as the body 
 the first thing in the morning and the last at night, get plenty of regular 
 sleep and bathe at least once a week, and only eat and drink what agrees 
 with them three times a day, and sparingly at that. Laugh heartily the 
 first thing in the morning and the last at night, and don't kick or grumble; 
 it hurts. It is said cleanliness is next to godliness, and I believe it. Be 
 good to yourself and you obey God." 
 
 Reply. — The plan is most excellent. 
 
CHAPTER LXI 
 
 Ventilation — Heating — Humidity 
 
 VENTILATION 
 
 VALUE OF FRESH AIR 
 
 Ship stokers, iron and steel workers, furnace men, and some others 
 must do their work in places where the air is sizzling hot. Bakers and 
 cooks work where the temperature is higher than is healthy. Such men 
 suffer from heat exhaustion and heat cramps, sometimes one feature pre- 
 dominating and sometimes the other. 
 
 The affected man seldom has the high fever of sunstroke. On the other 
 hand, the temperature may be below normal and the skin pale. The muscles 
 are unable to get rid of the waste — lactic acid — and they spasmodically con- 
 tract or become sore. The usual attack lasts a few days and then recovery 
 ensues. Rarely is it fatal. Most men who suffer from it feel lassitude, a 
 muscular soreness — "a touch of muscular rheumatism" — whereupon the man 
 loafs on his job for awhile and gets well about as mysteriously as he got 
 sick. 
 
 No workman can afford to work in a hot place where there is no provision 
 for keeping him well. Just as certainly no employer can afford to work his 
 men in a place where the air is hot and wet and still. 
 
 I have sometimes wondered why iron is made in sheds and why foundries 
 always have broken windows. There's a reason — and the small boy goes free. 
 
 It has been found that besides heat two other qualities of engine room 
 air are harmful — high humidity and stillness. A wet bulb temperature above 
 85° F. causes the workmen to have fever. It is important to watch the 
 ordinary or dry bulb thermometer. It is more important to watch the wet bulb 
 thermometer. 
 
 I wonder how many foundries, rolling mills, engine rooms, kitchens 
 and bakeries have wet bulb thermometers. And yet the readings of this 
 instrument will furnish a good index of how much work a man will do in 
 a day as well as some sort of a rough index of how many sick days he will 
 have and how many years' labor. 
 
 If the air is both hot and wet its harm still will be decreased if it is 
 kept in circulation. If the air next the workman's skin and nose, after it has 
 taken up as much heat, moisture, and bodily waste as it can, is replaced 
 however by fresh air ready to take up its load the workman will suffer less 
 harm. 
 
 Surgeon Fiske of the United States Navy told the Congress on Hygiene 
 that in our haste to build the White Squadron we forgot these things and that 
 our sailors suffered heavily. Now our battleships are being provided with 
 
 1144 
 
VENTILATION 
 
 1145 
 
 ducts and fans capable of throwing a great volume of air into the hold and 
 the efficiency rate of the sailors has risen. 
 
 VENTILATION AND EFFICIENCY 
 
 Not long ago the chief surgeon of a certain railroad (who is the only 
 employee with any information on sanitation) came in to see me with blue 
 prints of the division superintendent's office at a certain point on his road. 
 
 I- = :=G 
 
 Fig. 483. — Diagrammatic Sketch of Various Provisions for Ventilation. A, Sash win- 
 dow with Hinckes-Bird's arrangement. B, Hopper sash-light falling inwards. C, Louvred 
 outlets. D, McKinnell's ventilator. E, Sheringham's valve. F, Tobin's tube (showing 
 valve open). G, Ellison's conical bricks. H and I, Grid ventilators below floor joists. 
 (From "Hygiene and Public Health," by Drs. L. C. Parkes and H. R. Kenwood, London, 
 H. K.. Lewis, Philadelphia, Blakiston, 1911.) 
 
 What was originally one large room on the second floor had been cut up into 
 about a dozen smaller rooms. 
 
 Incidentally I want to say that a large part of the insanitary premises to 
 be found everywhere is the result of making over a house so that it can be 
 used for a purpose not contemplated when the house was designed. 
 
 These rooms each have 2,000 to 3,000 cubic feet of space and each is 
 occupied by three or four men. Each room has outside windows and those 
 on the corner have outside windows on two sides. The use of "tissue" makes 
 it necessary to keep the windows down both summer and winter — that is to 
 say, strong currents of air blow "tissues" around and the men solve the 
 current question by keeping the windows down. 
 
 On the east side of the building are the toilet rooms and these communi- 
 
1146 
 
 VENTILATION— HEATING— HUMIDITY 
 
 cate with the hall by a door and transoms. When the wind is from the 
 east the odors are carried into the offices. 
 
 The rooms are heated by steam which circulates in pipes arranged along 
 the outside walls below the level of the window sills. The amount of air 
 space per person is 400 feet in some instances and 800 in others. In this 
 estimate no allowance has been made for the space occupied by furniture 
 and fixtures. 
 
 There are no records to show the temperature or humidity of the room 
 
 Fig. 484. 
 
 -The Position of Inlets and Outlets, and Their Relation to the Air Currents 
 
 in a Room. 
 
 or any part thereof at any time. The men complain quietly that they are 
 uncomfortable and logy and they think the ventilation conditions make 
 against health though they could not say just what proof they had of their 
 conclusions. 
 
 The above condition is so commonplace that it is scarcely worth while 
 using the white paper needed to print it on. There are thousands of similar 
 places. Having started the recital, I may say there are hundreds of thousands 
 of men and women who could have supplied the details and wound up by 
 saying : 
 
 "We know all about such places ; we work in them." 
 
 Had I said then that the employer loses money on every person forced 
 to work in such a place the multitude probably would have replied that 
 they gave honest service and they could not see where they could have ac- 
 complished more — which is just the point, 
 
VENTILATION 
 
 1147 
 
 A full day's work cannot be done and the man who falls short cannot 
 see how he could have done more. He could not. The heavy, still, hot, 
 humid, foul air took the snap and eagerness out of him. He did less and was 
 satisfied. The (say) 5 per cent clipped off of efficiency by bad ventilation 
 bulks larger than any other loss suffered by the railroad. 
 
 The problem of ventilating exists by reason of the problem of tempera- 
 ture. When there is no temperature problem there is no ventilating problem. 
 Under a few circumstances the problem of ventilation is complicated by the 
 problem of cooling; under most circumstances, and particularly in the winter 
 time, the problem of ventilating is a problem of heating. 
 
 In the summer time the maximum comfort is secured by raising the 
 windows. Thus without thought or special planning ventilation takes care 
 of itself. As a result colds 
 are few, pneumonia is at its SB 
 lowest, scarlet fever, diph- 
 theria, measles and smallpox 
 inconsequential as compared 
 with the winter — the season 
 of poor ventilation. 
 
 In the cold weather, un- 
 less there is planning, the 
 maximum comfort is secured 
 by closing the windows. 
 
 The principal reason for 
 heating a room is to heat the 
 air. The people are makers 
 of heat, not users of it. They 
 make enough heat to heat 
 their bodies and to heat all the air breathed in. 
 good stoves for the air of the room. 
 
 The inside walls are just about neutral. They sometimes feed a little 
 heat to the room; they sometimes take a little heat from the room; but they 
 never affect the temperature much one way or the other. 
 
 If the house has a snug basement the floor soaks up a little heat from the 
 room. If the boiler is under the floor the floor is a source of some heat. 
 Nevertheless, the floor is just about neutral. 
 
 The outside walls lose much heat on cold days. They stand midway 
 between the cold of the outdoors and the warmth of the indoors. On the 
 outside the air is trying to cool the wall down and on the inside the air is 
 trying to warm it up. 
 
 How much of a tax the outside wall is to be on the heat of the inside 
 air will depend upon its thickness and the material of which it is composed. 
 The parts made of glass will be a great tax; the parts of brick, mortar 
 and plaster will be less so. But much more of a tax than the outside wall 
 is the incoming air. 
 
 In a room (from the heat standpoint) you have the floors, ceilings and 
 inside walls as about neutral, the people as credits and the outside wall and 
 the incoming air as debits. The problem of heating is to add enough steam, 
 hot water, hot air heat or direct radiation to balance the account. 
 
 Fig. 485. — Window Ventilator with Deflector. 
 
 In addition, they are fairly 
 
1148 VENTILATION— HEATIN CI— HUMIDITY 
 
 It is important that the heat should be applied where it is needed. Above 
 all it is needed where the cold air comes in. Second in importance is that 
 it is needed where the cold walls are. As outside walls always leak some 
 and usually leak a great deal the heat is needed near the outside walls. 
 
 As the windows are the coldest part of the wall it is proper that the heat 
 should be under the windows. So far our railroad friends are right — they 
 string their heat in pipes around the walls. 
 
 However, the chill that comes from the walls is of small consequence as 
 compared with the chill from the incoming air. Therefore the really im- 
 portant point is so to place the heat that the incoming air is warmed before it 
 comes in contact with the people. 
 
 Nor is it necessary that all of it should be thus heated. If 80 per cent of 
 it be heated it will rapidly warm up the small amount that comes in cold. 
 
 Cold air is heavy and warm air is light, Cold air falls to the bottom 
 two feet of the room. 
 
 It happens that that part of the room is inhabited by that part of the 
 body which has least cold resisting power. 
 
 The legs are masses o^ muscle. Most of the heat of the body is made 
 up of muscle. When a person is' walking the legs are the twin stoves. When 
 a person sits quietly the legs are cold stoves. When one sits quietly at a desk, 
 studying or keeping books, much of the blood is short circuited out of the 
 legs and the cold stove becomes colder still. Now, when cold air pours in 
 through the windows and falls on the lowest two feet in the room we have 
 cold, almost bloodless feet, bathed in cold air. 
 
 I have seen as much as ten degrees difference between the temperature 
 of the air up next the ceiling and that next the floor. A difference of six 
 degrees between the temperature of the air around the head and that around 
 the feet is not unusual and that adds to the short circuiting to which allu- 
 sion has just been made. 
 
 If the room is cold all over it may not be uncomfortable but there is 
 no escape from discomfort when one's head is in a temperature of 70° and 
 one's feet at 60°. 
 
 We hear a lot about drafts. About all there is to the draft proposition 
 is indicated in the above idea. Moving cold air is somewhat more chilling 
 than still cold air. 
 
 In the series of rooms the amount of air space per person is ample if 
 there is provision for supplying them with plenty of air properly warmed. 
 Ten times as much space would not be enough with no provision for supplying 
 fresh air. A tenth as much space would be enough if the provision for 
 supplying fresh air were perfect. 
 
 It is better, of course, that people should not be closely crowded to- 
 gether. If they are not badly crowded the ventilation can be rather poorly 
 provided and not much harm result, whereas if they are jammed up close and 
 the ventilation is poor the harm is great. 
 
 As space costs money why would it not be good business judgment to 
 provide a good air supply and put ten people in a room uncomfortable and 
 unhealthy under present circumstances when four occupy it? 
 
 So far as this particular office is concerned the plan would be to conduct 
 the cold air from the window to the coils along the walls and to discharge 
 
VENTILATION 1149 
 
 the air in such a way that it would have to pass over the coils before it escaped 
 into the room; then to have some electric fans somewhere to draw the foul 
 air out of the rooms. 
 
 The best place in that suite of offices is in the windows of the toilet 
 rooms. Exhaust fans located at those windows would make the toilet rooms 
 an area of low pressure and would induce a flow of air from the offices to 
 them. 
 
 To supply the low pressure thus induced in the offices air would flow 
 into the rooms from the outside, thence over and through the heat coils. 
 
 Perhaps one set of exhaust fans would not be enough. That is a point 
 for the fan man to work out. It would have to be determined by how well 
 the house is shielded against the wind, how free is the communication between 
 the rooms and such questions. 
 
 A better arrangement still would be fans to exhaust the foul air and 
 other smaller fans at the inlet windows to pull in the air and send it just 
 where it is wanted. With the force that the small inlet fans develop the 
 incoming air could be both warmed and cleaned before it is discharged into 
 the room — a point that is worth considering in a railroad office. 
 
 Under such a plan the air down near the floor would be but a few 
 degrees lower than the air next the ceiling. It would be but a degree or 
 two lower than at the head zone. In consequence the room would be com- 
 fortable. 
 
 Of more consequence is the fact that the men would be less liable to 
 colds, coughs, neuralgia and rheumatism. They would do more work in a 
 day and the number of men to each room could be increased. 
 
 From time to time the windows can be thrown open and the rooms blown 
 out. Nothing takes the place of that. When it is done several times a day 
 the men feel better, are healthier and can do more work. 
 
 To chill and freshen all the air in a room, the occupants meanwhile 
 standing up or otherwise exercising for a few minutes, is a different matter 
 from the constant letting in of a little cold air which immediately falls to the 
 floor and stays there. 
 
 Whatever method of ventilation is employed there must be arrangement 
 for periodic blowing out. If any system does not allow of this procedure there 
 is no further need of discussing that system. This one point alone is 
 enough to condemn it. 
 
 Finally, these offices should be equipped with thermometers and hy- 
 grometers. The chief clerk should arrange to have an hourly humidity and 
 temperature record kept. This record should be placed on the desk of some 
 responsible official every morning. This bit of bookkeeping is essential. 
 
 ERRORS IN VENTILATION 
 
 The first ventilation laws were based upon the cubic feet of space per 
 person without any regard to air changes or the condition of the air. 
 
 The next step in the evolution was that requiring a certain volume 
 of air per person per hour. 
 
 The next step is to combine the space requirement with a volume of air 
 requirement and to add other provisions such as that the temperature shall 
 
1150 VENTILATION— HEATING— HUMIDITY 
 
 be kept within bounds, the humidity within limits, the carbonic acid 
 gas below a certain percentage and the dust under control. 
 
 It is because ventilation practice has not applied these last provisions 
 that it has failed. 
 
 One of the most frequent statements which we hear of ventilation 
 jobs is : "We put in 2,000 cubic feet of air per person per hour." A number 
 of years ago the British Parliamentary Commission on Ventilation reported 
 that it did not make so much difference how much air you put into a room 
 as it did how and where you put the air in. And now the Chicago Com- 
 mission on Ventilation comes forward with this: 
 
 "Besolved, That the putting of a given volume of air per hour per 
 person into a room does not necessarily constitute ventilation." 
 
 The demand that a given volume of air must be put in a room for 
 each person was arrived at by mathematical calculation as to the amount of 
 air needed to dilute the carbonic acid gas produced by the occupants to a 
 point less than what was supposed to be the harm point. 
 
 The ventilating engineer discovered a long time ago that when he had 
 to remove odors or excess of heat or steam he must remove it as directly 
 as possible; and he devised all his apparatus on that basis. But carbonic 
 acid gas was supposed to be different somehow and instead of trying to remove 
 it directly the effort was to dilute it. 
 
 Almost as an essential part of the plan of dilution there came the loca- 
 tion of the outlets at the floor. However, this last provision was largely 
 based upon an error in physics. 
 
 The ventilating engineers were told to take the foul air out of the room 
 low down because carbonic acid gas was heavier than air and settled to the 
 floor. Thirty years ago books on physics made this statement. They in- 
 stanced foully ventilated rooms in which dogs toppled over while men sur- 
 vived, the reason being that the dogs were breathing two feet from the 
 floor while the men took their air from five feet up. Such statements 
 found their way into books on hygiene and then ventilating engineers based 
 their practice on them. 
 
 The fact is that gases do not settle out. Carbonic acid gas tries to diffuse 
 evenly. When men are breathing in a room the carbonic acid gas is slightly 
 in excess of the ceiling and near the outlets wherever they are. But remove 
 the men from the room or stop all air currents and within ten minutes the 
 carbonic acid is evenly distributed. 
 
 Now, having the outlets near the floor does keep the floor warmer 
 and does keep the coal bills down, other things being equal. But bad ventila- 
 tion is too high a price to pay for warm floors and lowered coal bills, 
 especially as there are other and better ways of getting these results. 
 
 It is essential that the public should understand that the present method 
 of ventilation is both inefficient and unnecessarily expensive. 
 
 Now I shall explain the reason for this last statement. If one were to 
 write a ledger account of room heat he would enter the occupants and heating 
 as large credits, the floors, ceilings, and inside walls as very small credits, or 
 even as small debits. The large debit item is air, though windows and out- 
 side walls are of some consequence. 
 
 It costs to heat 2,000 to 5,000 cubic feet of air per person per hour but 
 
VENTILATION 1151 
 
 when the principle of dilution is abandoned the quantities required are 
 lessened. Winslow says 700 cubic feet per person per hour is enough. The 
 new Chicago ordinances in some instances call for as low as 350 feet. In 
 addition a good mechanical engineer will arrange methods of using the 
 surplus heat of the outgoing, hot, vitiated air to warm the incoming air. 
 
 When the principle of dilution is abandoned and the effort is made 
 to remove the foul air as directly as possible the amount of air required 
 will drop to less than half of what it now is and the cost of ventilation will 
 drop proportionately. 
 
 If the quantity of air used is not the test of efficiency, what is ? The per- 
 centage of carbonic acid gas, the temperature, the humidity and possibly 
 its harmfulness as determined by the method used by Eosenau of Harvard — 
 the quality rather than the quantity of air. 
 
 For the next shortcoming of ventilation the hygienist is less respon- 
 sible; that is the stillness of the air — its freedom from drafts and currents. 
 Some hold that "draft cranks" are responsible for the demand that ventila- 
 tion shall be free from any appreciable air movement. It would be fairer, 
 however, to say that the public sentiment responsible for this requirement 
 is due to insufficient study of the problems of temperature and velocity of 
 the air at the inlets. 
 
 As a result of this demand ventilating engineers strove to produce a 
 morguelike stillness, only to learn that "still air" is dangerous. What they are 
 now told is that the air must be kept on the move; that where fans are 
 needed in summer they are needed in winter; that moving air is com- 
 fortable provided it keeps within a certain number of degrees of the tempera- 
 ture of the human body. 
 
 The stock statement as to ventilation is: "We introduce so many thou- 
 sand feet of washed and tempered air and the room is free from drafts." 
 
 As to washing the engineer has made good. He can and does reduce the 
 dust and bacterial content of the air in a very satisfactory manner. In- 
 cidentally I may say that when he is called upon to remove the dust within 
 the room made by manufacturing processes located therein he succeeds. 
 
 If tempering means humidifying or drying the air the people have so 
 recently begun to think of humidities that the engineer has rarely planned 
 to control them. 
 
 But "conditioning" is the term usually applied to humidity, and "temper- 
 ing" is used as meaning heating or cooling. 
 
 So much for the past. What of the future? 
 
 It is bright, of course. Given the proper principles by the sanitarians 
 the mechanical points will be solved without great delay; given proper stand- 
 ards in law and public sentiment mechanical ventilation will be better done; 
 and when better done it will be more universally employed. 
 
 The following principles are now pretty generally accepted by sanitarians : 
 
 1. Air which moves with force enough to be felt is as necessary for health 
 as it is for comfort, both in warm and cold weather. 
 
 2. Air which is higher in temperature than 70° is always harmful except 
 when it is kept in active motion. 
 
 3. Air which is above 10 relative humidity is uncomfortable when either 
 hot or cold. When above 85 and the temperature is high it causes the occu- 
 
1152 VENTILATION— HEATING— HUMIDITY 
 
 pants to have fever and later heat prostration. Air which is lower than 50 
 in humidity is both uncomfortable and unhealthy. 
 
 If-. Dusty air is to be avoided. The dust in air is harmful chiefly by rea- 
 son of the bacteria found therein. Inorganic dusts are more harmful; organic 
 dusts less so. 
 
 5. When reasonable efforts are made to prevent admixture of foul and 
 fresh air the amount of air per person per hour can be lower than 1,000 
 cubic feet with comfort and safety even when the occupants are engaged in 
 manual labor. 
 
 6. Carbonic acid gas is quite harmless in any quantity ordinarily liable 
 to be found in air. The amount in a room is to be considered as a measure 
 of the pollution of air in the room rather than as a source of pollution. 
 
 7. The foulest air in a room is in those sections toward which the 
 currents of a room are flowing but within a few minutes after the air becomes 
 quiet its composition is uniform in all parts of the room. 
 
 8. That there are substances in air which do harm, possibly through 
 an anaphylaxis, certainly through some generalized intoxication; but these 
 substances have not been discovered any more than the poisonous substances 
 in other excretions have been. 
 
 9. That within certain limits sunlight, air and space are compensatory. 
 We are sometimes justified in lowering the standards of one provided simul- 
 taneously we elevate the standards of the others. 
 
 WHY VENTILATION FAILS 
 
 Winter is the season when interest centers in the bad air diseases in every 
 part of this country where there are marked seasonal changes in tempera- 
 ture. More than half the people are intermittently suffering from colds. 
 At least one out of ten has a cough; many are sick from pneumonia and 
 large numbers are contracting consumption. 
 
 About one-third of Chicago's deaths are due to bad air diseases — 
 almost 10,000 a year — and whether they come from Omaha, Fort Wayne or 
 rural Iowa the figures tell the same story. 
 
 These deaths in one way and another are brought about by foulness 
 of the air. At that, the story told by the deaths from bad-air diseases 
 leaves a large part uncovered. There must be added the figures of inefficiency 
 and secondary costs as well as the indirect contribution from bad air to 
 the disabling forces of other harmful conditions. 
 
 It has been said that the drinking of bad water does three times 
 as much harm in indirect ways as it does directly in causing typhoid. It 
 would be no exaggeration to say that bad air does five times as much harm 
 indirectly as it does in bringing about deaths from pneumonia and consump- 
 tion. 
 
 The air problem is a big one — big in the harm which it does and big in 
 the measures which are demanded that it may be met. 
 
 There is need for pure outside air. This is being met by anti-smoke 
 campaigns of many different sorts. 
 
 But outside air is about uniformly bad at all seasons of the year. There- 
 fore so much of the rate from bad air diseases as is represented by fluctuation 
 
VENTILATION 1153 
 
 between seasons must be the result of circumstances which fluctuate. 
 This brings us to ventilation, for "inside air is good in summer and bad in 
 winter. 
 
 So many places are poorly ventilated that a man can count himself 
 lucky if he goes a week without getting into some uncomfortable and un- 
 healthy air. The ordinary man at the very best will get into some such place 
 for a part of each day. The farmer who reads this statement no doubt thinks 
 it true enough of the city man but not of himself. On a below-zero morn- 
 ing the ventilation is just a little worse in the farmhouses of Iroquois County, 
 Illinois, than in the tenements of Chicago for the former are snugger and 
 warmer. Certainly, the ventilation of the average working place in Wis- 
 consin is worse than in Chicago, for the air campaign is working better 
 here than there. 
 
 I am sure that conditions are better than they have been and the 
 promise is for a steadily progressive improvement. The Chicago deaths from 
 bad air diseases were 750 fewer in 1911 than in 1907 in spite of a gain of a 
 quarter million in the city's population. 
 
 If good ventilation could become universal the bad-air disease deaths 
 would be cut to less than half of what they now are — say a saving in Chicago 
 of 5,000 a year, a greater saving than has been accomplished by the campaigns 
 against yellow fever, malaria, plague, smallpox and typhoid fever combined. 
 
 From hotels, stores, offices, factories, schools, churches, and homes, from 
 one end of the line to the other the same story is coming back — a mechanical 
 fulfillment of requirements with usually a gain in comfort, though there are 
 many exceptions and usually a loss in health and efficiency — mechanical 
 figures which show results but balanced by an almost universal public opinion, 
 founded on experiences, that the results are not good. This public opinion 
 is confirmed by chemical and statistical data. 
 
 Plainly, those theories about ventilation which work out when they are 
 being tested do not in practice bring about healthy conditions. The fact is 
 that the ventilating engineer has not made good. To say this baldly will 
 not accomplish as much as will analyzing the reasons for the condition and 
 putting on each party concerned his share of the blame. 
 
 Conditions must be quickly righted, for the public and legal demand 
 must be met. The hope for speedy righting lies in careful analysis rather 
 than in unthinking condemnation. 
 
 The combination which passes on ventilation is about as follows: the 
 people, demanding that houses be heated and ventilated; the sanitarians, lay- 
 ing down certain health requirements and setting certain ventilation stand- 
 ards; the heating and ventilating engineers under the control of architects, 
 sometimes in accord and sometimes in rank discord, trying to meet those 
 demands. 
 
 The first trouble came from the people. They knew almost nothing 
 about ventilation but they had pretty definite ideas about heat. The pro- 
 fession to which they appealed was known as "heating and ventilating engi- 
 neers" and, quite naturally, thought was concentrated on heating to the 
 neglect of ventilation. 
 
 There is no more exact science in practical operation than that of heat- 
 ing. A heating engineer can tell to the third decimal point about evapora- 
 
1154 VENTILATION— HEATING— HUMIDITY 
 
 tion, radiation, conduction and convection and can install a plant and obtain 
 the results on which he has figured. 
 
 Eadiation is placed in a room to keep it warm, not to heat the radiator, 
 not even to heat the corner in which the radiator is located; therefore, one 
 would conclude that methods of dissemination of heat would have been one 
 of the earlier research studies of heating engineers. 
 
 When we learn that they have not comprehensively studied air currents 
 as a means of getting efficiency from radiation we are quite prepared to learn 
 that they have not so studied them in relation to ventilation. 
 
 The second part of the responsibility for the poor development of ventila- 
 tion rests on the architects. Houses should be as artistic as possible; they 
 should be built of proper material and along proper engineering lines; they 
 should have their interior space divided in such a way as to preserve the 
 economies; they should be properly drained. But infinitely of greater 
 importance than any of these is the necessity that they should be properly 
 lighted and ventilated. 
 
 Certainly the architect has not given these values to the different points. 
 I am sure every other feature has had the right of way over ventilation. 
 
 He has allowed the sewage ducts to crowd the air ducts into such 
 twists and turns that efficiency was impossible. He has sacrificed air to art, to 
 beams, to everything. 
 
 In his office there is a well developed art corps and a large retinue of 
 structural engineers but a poor ventilation equipment — of men and materials. 
 And yet buildings are made to live in and good air is much more important 
 to life than those things which the architect has given right of way over it. 
 
 Architects must assume a large part of the blame for abandoned or useless 
 ventilation systems and for houses without provisions for Ventilation. 
 
 The third party of the quartet of responsibles are the sanitarians. The 
 ventilating engineer- has been told to put a certain volume of air into a 
 room at a certain temperature and he has done so. As a general proposi- 
 tion he has solved the problems which were put up to him. Then why is 
 it that the places in which he has installed ventilation are not ventilated ? 
 
 The answer is that the problems put up to the engineer were not proper 
 problems, or were based upon inexact or misleading information. On his 
 mechanical side he has made good. His work fills the specifications as set forth. 
 
 The principle of dilution of bad air as a means of ventilation; the plan 
 to hold carbonic acid gas below one part in 1,000 by dilution procedures; the 
 2,000 to 4,000 feet quantity standard; the high temperature level; the dis- 
 regard of humidity; the incorrect ideas about drafts; the wrong teaching 
 about variation in temperature; all these are basic points responsibility for 
 the error of which must be laid at the door of the sanitarian. 
 
 The ventilating engineer, being in a sense a sanitary engineer and in 
 addition being the capstone of the structure, has been hurt the worst. That is 
 to say, he has suffered because there is not the demand for ventilation that 
 there should be. 
 
 VENTILATING OFFICES, SCHOOLS AND STORES 
 
 Some time ago a correspondent wrote that a group of men occupied 
 an office in which the air, for purposes of ventilation, came in through a 
 
VENTILATION 1155 
 
 transom. The air was cold and one of the five objected to the cold air on 
 his head and wanted the transom kept closed. Such a situation is one 
 of great difficulty. On the one hand, here are four men who want fresh air 
 and, on the other, one is harmed by the cold air striking him. 
 
 First, as to the claim of the man who wanted the transom closed. 
 Cold air coming in contact with the body takes heat away from it. Especially 
 is this true if it strikes the skin with some force. If the person affected is 
 a good heat maker, with a skin not oversusceptible to cold, no particular harm 
 is done. 
 
 People vary, though, so much in these particulars. Some are cold — 
 neurasthenics who can get up a shiver over any sort of draft. Most of 
 their trouble is imaginary and springs from their generally self-centered 
 and selfish makeup. However, there are people who are genuinely harmed 
 by cold air blowing on them in such a way as to abstract heat faster than 
 they can make it. When men are quiet they will get uncomfortable if 
 the air which strikes them at a low velocity is lower than 50° or if that which 
 strikes them with a higher velocity is colder than 60°. 
 
 This means that where a room is fairly well filled with men and women 
 the air which enters must be somewhat warmed . before it strikes anybody — 
 that is, in any climate north of Memphis. 
 
 Transom ventilation will not work unless there are lights enough close to 
 the opening to warm up the air before it gets to anybody. 
 
 A few years ago Mr. Mitten of the Street Eailway Company of Chicago 
 put an opening in the front of the car roof. Theoretically it was all right 
 for it provided air enough; practically it did not work because the air was 
 too cold. On the same principle deck sashes (the side. window lights near the 
 ceiling) usually seen on street and railroad cars are of little service. Usually 
 they do not ventilate at all. When they do the air is so cold that nobody 
 tolerates it. 
 
 So in this particular office the man who objected to the transom had 
 much of right on his side. But the other men had more of right on 
 theirs. 
 
 Either the air must be warmed before it gets to the occupants of the 
 room, the occupants must move around enough to keep warm by making heat 
 or else they must dress differently. 
 
 Some way must be found to satisfy each group, for each is right. 
 
 The proper way to ventilate an office is to draw air through the outside 
 walls by means of ducts leading to radiators placed under the windows — 
 cleaning, warming and moistening the air as it comes through. Fans 
 located in the attic should be used to empty the foul, warm air from the 
 rooms through openings at the ceilings on the inside walls. This is effi- 
 cient as well as cheap to install and cheap to operate. 
 
 But offices are as they are and most people who occupy them must do 
 the best they can with a bad situation. If the room is ventilated by present 
 systems what can be done in addition to setting different standards? 
 
 1. The windows must be well stripped. 
 
 2. Storm sashes must be used. 
 
 3. The room must be blown out several times a day, at least one window, 
 and better more, having been arranged so as to make this possible. 
 
1156 VENTILATION— HEATING— HUMIDITY 
 
 4. Fans must be employed to keep the walls and windows warm 
 and the air agitated. 
 
 5. The air must be cleaned by air washers or cheesecloth. 
 
 6. Steam must discharge from the radiators into the air of the room. 
 If the rooms are ventilated by windows: 
 
 1. Deflectors must be used. 
 
 2. The radiators under the windows must go at full head. 
 
 3. Fans must be used to keep the floor zone warm. 
 
 4. Steam must blow into the room. 
 
 5. The air must be cleaned by cheesecloth. 
 
 6. The room must be blown out several times during the day. 
 
 7. A ventilating fan connected with a window intake and discharging 
 through the radiators is highly desirable. 
 
 In all schools and offices the following requirements must be met: 
 
 1. The temperature must keep below 70°. 
 
 2. The difference between the temperature 1 foot and that 6 feet above 
 the floor must not be greater than 2°. 
 
 3. The humidity must be as high as 50. 
 
 4. The air must be kept moving. 
 
 5. It must feel fresh. 
 
 6. It must be clean. 
 
 The methods which apply to offices apply equally well to schools and 
 dry goods stores. 
 
 REMEDIES FOR POOR VENTILATION 
 
 The great majority of us must continue to live and work in places 
 which are poorly ventilated. Is there anything which can be done without 
 much cost or change in method to improve things? 
 
 The first thing to do is to find out what the conditions are and then 
 to discover means of remedying those which are most objectionable. The 
 temperature can be taken at several different places in the room ; the humidity 
 can be measured likewise in different places. A fair idea of the amount 
 of dirt can be had from noticing sheets of white paper after exposure. 
 
 If the air as it is taken into the intakes is dirty the best method of 
 cleaning it is by washers; but when these are too expensive fair results 
 can be had from cheesecloth used as an air filter. The cloth should be fitted 
 into wooden hoops like those used in embroidering and can be changed as re- 
 quired. 
 
 When air is heated it must be humidified. This will require from two 
 to 200 gallons of water according to the space ventilated. It is a small 
 room which requires so little as two gallons a day in cold weather. Steam 
 from the radiators, hot water coils in pans of water, large flat pans on 
 radiator coils or on top of hot-air heaters are required. 
 
 The temperature of the water must be kept over 120° ; there must be 
 square feet of evaporating surfaces instead of inches if the humidifier is to 
 rise above the level of fakedom. Large wet sponges placed in the air cur- 
 rents give results. So do growing plants if they are plentiful enough. 
 
 If the floor zone is cold, warm it by throwing warm air into it with 
 a fan. If the incoming air is more than 100° use a fan to mix it with the 
 
VENTILATION 1157 
 
 cool air of the room. Above all cool it by blowing it against the cold windows 
 and walls. 
 
 When the air is heavy and the occupants begin to grow drowsy and list- 
 less open the windows and blow out the room. 
 
 TEMPERATURE OF INCOMING AIR 
 
 Whenever the temperature of a room is over 68° and the space is fully 
 occupied by lightly dressed people the temperature of the incoming air must 
 never be lower than 60° and it is wisdom to heat it several degrees higher — 
 say to 63° or 64°. 
 
 Nothing is more common than to see an elaborate ventilating plant with 
 openings so placed as to give the workers an abundance of cool, fresh air, 
 but so plugged that they give no air, hot or cold, good or bad. The men 
 who were chilled by the cold incoming air plug the openings, sometimes with 
 boards as in the Chicago postoffice, but more frequently with wadded news- 
 papers. 
 
 I remember one basement corner in which the temperature of the room 
 was over 90°. A man stood there without a shirt, his bare body covered 
 with sweat. The ventilating duct had an opening right over his head but 
 he had plugged it because the air at 60° chilled him. 
 
 He was right. It was safe, as well as more comfortable, to take his 
 chances in that basement without air. 
 
 When cold air flows into a room it rolls to the floor and the warmer 
 the room the straighter it goes there. 
 
 When radiators are having difficulty in keeping the room warm or the 
 foot zone is cold the best way to increase the efficiency of the heating ap- 
 paratus is to have fans blow the warm air from around the radiators to those 
 parts of the room most in need of heat. Many of the failures of mechanical 
 ventilation arise from the fact that the ducts deliver cold air into a warm 
 room, repeating the very shortcoming which in the first place caused the owner 
 to supplant window ventilation with mechanical devices. 
 
 If there are boilers or machines near the ventilated room causing it to 
 heat to more than 75° the temptation is to use cool air to ventilate and to 
 cool. Such a plan is wrong. 
 
 A wiser plan is to insulate the boiler rooms so that they do not heat 
 near-by workrooms ; or else to give the hot rooms a separate outlet system and 
 to run the inlet ducts along this in such a way as to save heat. 
 
 On the other hand, the temperature of the incoming air should not be 
 higher than 80° when it strikes the occupants unless it is blowing with 
 considerable force. 
 
 A large part of the complaint against hot-air systems is because they 
 deliver air in the room in cold weather at 118° to 130° — and that is cer- 
 tainly unhealthy. To be at its healthiest air should flow into the room 
 between 65° and 75°. 
 
 LIMITATIONS OF GRAVITY VENTILATION 
 
 What is gravity ventilation? When ventilation is done without fans, 
 the moving force being differences in the temperatures of inside and out- 
 
1158 VENTILATION— HEATING— HUMIDITY 
 
 side air, the system is called gravity ventilation. The usual illustration 
 is ventilation by means of open windows. 
 
 Warm air is lighter in weight than cold air. Whenever the air in a 
 room is at 70° and that outside is at zero strong currents will blow in and 
 out. When there is 70° difference the force is considerable; but when the 
 difference is but a few degrees the ventilation declines until there is but 
 little air movement. When the atmosphere gets warmer than 50°, the room 
 being 70°, open windows do not give much air. If on the other hand 
 the room temperature falls to 50° or below (as in sleeping rooms at night) 
 windows do not take in much air unless the atmosphere is below freezing 
 temperature. 
 
 Further limitation is put on gravity ventilation by the force of wind 
 currents. Of course, it is gravity which causes winds; but there is a wide 
 difference between the warming agencies of a room 12' x 12' and those of 
 1,000,000 square miles of ground. A current flowing in through a window 
 at a rate of two miles an hour would be called speedy. A wind of less than 
 six miles an hour is not much wind. 
 
 When the wind is blowing more than ten miles an hour into gravity 
 outlets such openings always will act as inlets. When such a wind is blow- 
 ing into gravity inlets they will carry enough air to chill the room. If the 
 wind blew steadily from one direction it might be possible, with moderate 
 winds, to adapt inlets and outlets to them; but anyone who has watched the 
 steam and smoke of a city knows that the winds eddy and swirl without 
 regularity as to force or direction. 
 
 And, finally, the chief limitation of window or gravity ventilation is in 
 the uneven temperatures in different parts of the room, especially at different 
 levels above the floor. If the cold air as it came into a room would mingle 
 freely the difficulties would be lessened — but it does not. It settles near the 
 floor and (as human legs below the knees are easily chilled) complaints are 
 numerous and insistent. The attention of occupants is diverted, they waste 
 time and energy; eventually, they put down the window and gain comfort, 
 even though it is less healthy for them. Window ventilation is not adapted 
 to factories, schools or offices where there are many employees — certainly not 
 when the weather is very cold. 
 
 EFFECTS OF WIND ON VENTILATION 
 
 Houses are most ventilated and most uncomfortable on windy days. 
 When the wind is blowing thirty miles an hour it is exerting a pressure of 
 4.5 pounds a square foot. In consequence every crack on the wind side of 
 the building takes in cold air at a high velocity. This air blows out the dirty, 
 foul air and simultaneously it blows out the heat. On a still day the windows 
 and walls warm the air next them but on a windy day the warmth is blown 
 away and cold air takes its place. 
 
 It is for this reason that rooms cannot be heated satisfactorily on windy 
 days. 
 
 Winds affect ventilation so much that no plan will work that is not 
 adapted for changes in wind force and direction. When the air of a room 
 is 68° and the outside air is 28° the difference in temperature will pull air 
 
VENTILATION 1159 
 
 into the room with some force but it is inconsiderable as compared with the 
 force of a thirty mile wind. 
 
 It is for this reason that open windows on the lee side of the building will 
 act as outlets on a windy day — the outside area is one of low pressure. An 
 ordinary ventilating fan delivers air with sufficient force to overcome wind 
 pressure under ordinary circumstances but even using them outlets will some- 
 times act as inlets. All in all, on windy days houses take in a great deal 
 of cold air on their wind side and but little on their lee side; and even heat- 
 ing and airing requires careful planning. 
 
 VENTILATION BY WINDOWS 
 
 The gravity method of ventilation or, in other words, ventilation by ordi- 
 nary windows, is excellent for sleeping rooms in a northern climate during 
 January, February, and March. It is all right for living rooms where there 
 are but few occupants. For instance, in a 12' x 12' room ventilated by 
 windows a woman can sew or read with comfort, since she can change her 
 position to such parts of the room as are comfortable. It is all right for 
 rooms where the occupants can be warmly clad — and the best example is 
 sleeping rooms — but it is not adapted to workrooms where the workers must 
 work without wraps, overshoes and gloves. 
 
 Because much of the school work can be done thus clad it is fairly well 
 adapted to that. About 10 per cent of school children gain more from 
 studying in rooms with open windows and the temperature at 55° than they 
 lose from having to wear wraps and heavy foot covering and work with hands 
 encased in mitts. 
 
 It is not adapted to offices, ordinary schools, stores, workshops, churches 
 or theaters. 
 
 In fact, in the Chicago climate in midwinter gravity ventilation is of 
 limited use. 
 
 Since differences in atmospheric temperature, difference in the direction 
 and velocity of the wind (to say nothing of lesser agencies such as sunshine 
 and cloud) make such a difference in results a broad margin must be left 
 when window ventilation is used. This means inefficiency. A room in which, 
 with proper ventilation, there is space enough for forty people cannot be 
 occupied by more than ten people when there is window or gravity ventila- 
 tion. Every feature spells waste — waste of space, waste of equipment, waste 
 of effort, waste through inefficiency. 
 
 And yet, mechanical ventilation of offices, factories, and stores is usually 
 so unsatisfactory that window ventilation is the lesser evil. Certainly in all 
 mechanical systems there is need of periodic flushing by opening the windows. 
 
 The cure for this bad situation, leaving aside bedrooms and a few such 
 places, will not be through window ventilation. It will be through more scien- 
 tific and at the same time more practical mechanical ventilation. 
 
 THE PHILOSOPHY OF FANNING 
 
 Scientists, trying to find what caused the ill effects of air, have con- 
 ducted many experiments along many different lines. None is more inter- 
 
1160 VENTILATION— HEATING— HUMIDITY 
 
 esting and conclusive than those of an Englishman, Leonard Hill. Most 
 of Hill's writings have been issued within the last five years, so his conclusions 
 are not out of date. 
 
 Hill placed small animals in a sealed box with no port holes, no venti- 
 lating ducts — just solid walls of glass. Small electric fans were so placed 
 as to keep the air well churned. No fresh air could come in, no foul air 
 could get out. 
 
 You remember the alarming stories in our school physiologies about 
 badly ventilated rooms, where the carbonic acid gas gradually increased until 
 all life was snuffed out — the Black Hole of Calcutta, the ships in storm and 
 all that grewsome lot? 
 
 Well, these observations of Hill shot these stories full of holes for he put 
 men in sealed rooms and kept them comfortable and healthy without ventila- 
 tion by using plenty of fans. He duplicated the box conditions on a large scale, 
 using a room instead of a box and men instead of small animals. 
 
 There are other factors to be considered besides air movement but Hill 
 did a valuable piece of work in showing how necessary it was that the air 
 around us be kept on the go. 
 
 Now anything that works practically is right theoretically. We some- 
 times hear that a thing may be right in theory but not in practice — which' 
 statement is untrue. If a thing is wrong in practice its theory is wrong 
 and vice versa. 
 
 What is the theory that accounts for the wholesome effect of mov- 
 ing air? 
 
 The human skin keeps at about 98° Fahrenheit, the air in touch with the 
 skin at about 95°. The air in a room is usually in the eighties and seldom 
 passes 92°. Therefore, fanning blows the hot air away from the skin and puts 
 cooler air in its place. When room temperature gets to 96°, if it ever does, the 
 next the skin air gets to 98° or over. The human body is a furnace. 
 
 The statement is about true that the weather is never so hot but that 
 the use of a fan feels pleasantly cool. 
 
 In addition, the skin sheds body waste into the air that lies against 
 it. Hence fanning blows away chemically dirty air and replaces it with chemi- 
 cally cleaner air. Therefore, there is philosophy in fanning — all varieties, 
 from electric to palm leaf. 
 
 For the same reasons a drafty room is a healthy room — a windy city is a 
 healthy city. 
 
 OZONE 
 
 Clean, fresh, circulating air is a great purifying agent, one of the best 
 known. Health authorities are agreed on that point. About one-fifth of the 
 air is oxygen and oxygen is powerful in changing the character of the things 
 with which it comes in contact. 
 
 Air that is all oxygen is a better oxidizer than air one-fifth oxygen. 
 Again everybody is agreed. Ozone is an especially active form of oxygen, 
 about three times as active as ordinary oxygen. This is an established fact. 
 
 Every health authority advocating better ventilation drums these facts 
 into the people. Certain manufacturers of ozone machines twist these known 
 
VENTILATION 1161 
 
 facts to convince people that ozone machines should be installed in offices to 
 purify the air therein. 
 
 The most dangerous of all fallacies are those which are founded on estab- 
 lished and recognized facts. A man must be extremely well informed to know 
 at what point in the twist the fact ceases to be a fact. 
 
 In consequence, ozone machines are found in many offices. In fact, a 
 .few years ago one was installed in the Chicago city hall and it took a 
 fair amount of testing by the health department to prove to the chief of 
 the department in which the machine was that the apparatus was of no 
 value. 
 
 About all that was investigated then was whether the machine did any 
 good. The conclusion was that it did not. The money which it cost was 
 wasted. 
 
 Eecently the ozone machines as ventilating devices have been studied by 
 Professor Jordan of the University of Chicago and independently by the Cali- 
 fornia Board of Health. They came to the same conclusions. 
 
 Ozone will kill typhoid, pneumonia, diphtheria, consumption and other 
 germs out it will not hill these germs until the percentage of gas in the air 
 is so strong that it will Tcill guinea pigs. In fact, in the experiments the 
 guinea pigs died long before the germs did. 
 
 They did not try it on men because that would have been murder. But, 
 having found out the strength that kills germs and guinea pigs they cut way 
 below that at a point where germs would not be disturbed and had men 
 breathe air containing those strengths. 
 
 Some of the men got drowsy; some went to sleep while at work; some 
 had headaches; some had colds; some got sore throat. 
 
 Air containing a moderate amount of ozone is unfit to breathe. It makes 
 the breathers sick long before it kills disease germs or destroys odors. 
 
 On the other hand, the odor from the machine hides the odors of the air 
 foulness; and in modern times intelligent people bathe rather than dope with 
 perfume. 
 
 LIVING ROOMS 
 
 In a house heated by fireplaces it is easy to decide what shall be called 
 living rooms. In a house heated by steam, hot water or hot air people sew, 
 do light housework and read all over the house. Comfort determines where 
 the occupants stay. 
 
 In the winter the room must be warm enough to be comfortable for a 
 person doing light physical work and lightly clad. This means a temperature 
 of 65° to 70°. 
 
 Living room temperatures are usually too high. Seventy-five degrees is 
 almost an accepted standard. An excellent wet and dry bulb thermometer for 
 determining humidity has 65° to 75° marked as the limits of proper room 
 temperature. 
 
 Ninety per cent of the flats in Chicago at 6 o'clock in the evening have 
 a temperature during the winter months that is higher than 80°. 
 
 When the outside temperature is below 30° the ventilating air in an 
 ordinary living room should not blow directly on the occupants of the room. 
 It will take heat from their bodies faster than thev can make it when sitting 
 
1162 VENTILATION— HEATING— HUMIDITY 
 
 quietly. The first necessity is that the wind be deflected. On some days this 
 is all that is required ; on others it must be warmed somewhat. 
 
 Eadiators should be placed in front of windows. It is advisable to have 
 the bottom of the window below the top of the radiator or else provide a 
 separate opening below the window leading air through the radiator. 
 
 Living room humidity should be somewhere around 50°. 
 
 Probably the reader never saw a humidity measurer and yet a measure 
 of humidity is just as necessary for comfort as a measure of temperature. 
 
 Most of the condemnation of flats by those who think of causes is due 
 to the dryness of the air in them. When air is heated it must be watered or 
 harm comes. If the steam radiator blows steam into the room the humidity 
 will be raised; or there are many types of water cans made to hang against 
 the radiator coils. 
 
 Pans of water set on the radiator or elsewhere in the room are of great 
 service. 
 
 FOR FRESH AIR DUCT 
 
 The Federal system of heating and ventilation, after laying down its 
 Federal heat unit as a standard of computation for the heating of houses, 
 proceeds to cite standards for the more usual of the unusual conditions. Of 
 such are the variations to be made to provide for the heating requirements 
 made necessary by windows already noted. 
 
 Another standard of variations has been worked out for climates that are 
 unusually cold or unusually warm. When the wind blows from the north 
 or west at the rate of twenty-five miles an hour the demands on the heating 
 increase 20 per cent. Nothing is added to the needs by an east wind blowing 
 fifteen miles an hour and south winds blowing five miles an hour and less 
 actually help the heating 5 per cent. 
 
 In a more general way wind blowing thirty-five miles an hour increases 
 the heat needs 40 per cent, and forty-five miles an hour 60 per cent. 
 
 All this information will be of value in making people comfortable. 
 What will be of greater value will be the detailed instruction on those points 
 that have more to do with their health. 
 
 For instance, there is this injunction : "No furnace should be installed 
 without a fresh-air duct." 
 
 The weight of the system's authority is thrown against recirculation of 
 air. A fresh-air intake is provided. This is equipped with a dust screen. 
 
 The air then passes under one baffle and over another and then into ducts 
 leading to the combustion chamber. 
 
 The intention is that the duct be eliminated by the screens, baffles and 
 dust collectors so that the air as it reaches the heating chamber, is cleaned 
 and somewhat warmed. 
 
 Around the chimney from the furnace is a second, or air, chimney. 
 The heat of the smoke heats the air in this chimney and thus foul air is 
 drawn from the house as the air chimney receives the foul-air ducts which 
 lead from the rooms. 
 
 The dust filter screens in the fresh air inlets are accessible, removable 
 and cleanable. 
 
 In order to cure the usual dryness of old style furnace heat insistence 
 
 
VENTILATION 1163 
 
 is put on humidity standards, and furnaces are equipped with humidifiers. 
 
 The standards provide for a relative humidity between 50 and 70. 
 
 On the practical side instructions are given as to the amount of water 
 to be evaporated to accomplish these results. 
 
 VENTILATION OF THE BEDROOM 
 
 Whoever thinks the agitation for bedroom ventilation ends with the win- 
 ter time is mistaken. When the outside temperature is higher the air rushes 
 in through every crack. When the temperature outside and inside is the 
 same or within twenty degrees of the same the window openings must be 
 large to get results. 
 
 To get high grade air, sleeping out and special ventilating arrange- 
 ments are needed in the summer as well as in the winter. As a further 
 consideration, some of the people who shrink from the cold of outdoor sleeping 
 in winter feel like going out when the spring time comes on. 
 
 The toggery for sleeping out differs a little from that for sleeping in. 
 The art of sleeping out differs a little from that of sleeping in. 
 
 1. Sew a layer of building paper on the springs and over it a strong piece 
 of unbleached muslin or canvas. This not only prevents the cold from com- 
 ing up underneath but also keeps the paper in place. 
 
 2. Place an unbleached muslin cover over the mattress and a pad on top 
 of it; then cover with a white cotton sheet tucking it in at the head and 
 sides. 
 
 3. Cover three-fourths of the bed, lengthwise, with a heavy woolen 
 blanket, part of it extending over one side; put another one in like manner 
 on the other side of the bed. Place pillow at the head. 
 
 4. Place a double flannelette sheet, five and one-half or six yards in 
 length, over the bed with the closed end at the foot. Turn in the sides of 
 this sheet (allowing enough room to sleep between) and letting the under 
 part of the sheet extend over and around the pillow. 
 
 5. Fold over the flaps of the two blankets and tuck them in. 
 
 6. Place one or two double blankets over all, tucking in well at the sides 
 and foot of the bed. Fold back the upper part of the flannelette sheet over 
 the blankets. 
 
 7. Place a khaki or canvas cover over the entire bed. 
 
 The windows should be raised from the bottom and lowered from the top 
 when you are retiring. If there are two raise one and lower the top of another. 
 The one raised should be toward the side from which the wind is blowing. 
 The lowered one should be on the other side of the room. If the room has 
 a window or windows on only one side at times ventilation will have to be 
 assisted by leaving the transom open or by leaving the door open a few 
 inches and providing an open window either on the wind side or on the 
 lee side elsewhere in the house. 
 
 The temperature of the occupied sleeping room should not go above 60° 
 Fahrenheit during the winter time. There must be an appreciable air move- 
 ment through the room. This is necessary in the winter. It is absolutely 
 
1164 VENTILATION— HEATING— HUMIDITY 
 
 necessary in the summer. When the outside temperature is so great that the 
 sleeping room can no longer be kept below 65° it becomes necessary to have 
 "blowing" air in the room — air moving enough to be felt by the occupants. 
 
 The water of condensation in the radiators is liable to freeze during 
 cold weather. There are two ways to prevent this. One is to keep a head 
 of steam during the night and to turn the radiators on full enough to 
 keep the water cleared out. The other is to have a vacuum return system 
 and then to shut off the radiators at night. This is the cheaper plan 
 in the long run. 
 
 If the radiators are turned off the room gets its heat from the bodies 
 of the occupants and from warm walls, floors, and ceilings. In cold weather 
 deflectors throw the air in a window in such a way that it does not strike the 
 bodies of the occupants with an unpleasant force. 
 
 We have given some details as to bedroom methods because we think the 
 main thing is that the bedroom should be a cold room and the main thing 
 in a cold room is to know how to be cool and comfortable. 
 
 Put Up Windows. — B. T. writes: "I occupy rooms near the center of 
 the city. These consist of a bedroom, bathroom., and large sitting room, 
 the cubic contents of which is about 7,500 cubic feet. During the day the 
 rooms are unoccupied and always have plenty of air circulating through 
 them, and, in the winter months, the temperature rarely rises above 68 to 
 70 degrees. Owing to the noise, it is impossible to accustom myself to sleep 
 with the windows open. The window area, both front and rear, is very 
 large, and, even when the windows are closed, a great deal of air comes 
 through, and I fancy much more than I breathe. Will you kindly inform 
 me whether, provided at the time of retiring the air is thoroughly fresh 
 and new, any serious injury will result from the continued practice of 
 sleeping in quarters of that size with the windows closed, all the rooms 
 being thrown into one? The writer takes a great deal of open-air exercise, 
 but must confess he does not sleep at times quite as well as he would like. 
 Is not the theory of the necessity for absolutely fresh air one which can be 
 carried to an extreme in some cases?" 
 
 Reply. — You must either raise your windows in your present location 
 or move where the noises will not disturb you so much. You must not sleep 
 in rooms without some window opening. Evidently your rooms are in 
 good condition when you go into them at night. The old idea that you can 
 dilute still air enough to make it harmless is pretty generally abandoned 
 now. 
 
 The volume of air which you describe in the second paragraph of your 
 letter — to wit: 7,500 — would not be particularly harmful during the first 
 three hours of occupation. The authorities who based their calculations on 
 dilution said 3,000 to 4,000 cubic feet of air an hour was required. 
 
 You are correct as to the large amount of window leakage, especially 
 during cold weather. Your windows are scarcely loose and leaky enough 
 to supply more than half the deficiency. If you make use of storm sashes 
 you will not get much aid from window leakage. 
 
 Fresh air does harm when it abstracts heat faster than the body can 
 make it. Under all other circumstances it does good. Put up your win- 
 dows if you have to move. 
 
 Deflectors for Open Windows. — P. B. K. asks a definition of deflectors 
 spoken of for open windows. He asks how they are made and used 
 
VENTILATION 1165 
 
 Reply. — The ordinary window ventilators are deflectors. There are 
 many of these on the market. If you wish to make one proceed as follows : 
 Take a piece of glass as long as the window is wide. The glass should be 
 twelve inches wide and one-quarter inch thick. A board of these dimen- 
 sions can be used instead of glass. Make a frame for this deflector. Set it 
 just inside the sash on the window sill. The frame should be so built that 
 the deflecting glass or board can be set parallel with the window pane — that 
 is, perpendicular — or that it can be moved out at the top for a space of four 
 inches. The deflector then can be set parallel to or at an angle to it. The 
 space on the sill between the window and the deflector should slant out so 
 that rain would drain out of and not into the room. 
 
 Suggestion on Ventilation. — W. B. L. writes: "1. 1 Relieve that the best 
 way to heat and ventilate a room is to use indirect radiation, taking cold 
 air from the outside, passing it through a radiator underneath the -floor 
 and having the radiator as low and as wide and long as they are made, to 
 give the required amount of radiation; placing a water pan on top and 
 admitting heated air to the room by an opening in the floor in front of the 
 windows; the air to be taken out of the room by openings in the walls at 
 floor level on the outside wall of the room. In this way the heated air 
 would enter the room, rise along the outside wall, traverse the ceiling to 
 tlie bach wall, descend along that, cross the floor to the outside wall, and 
 go out, giving thorough circulation to the air. The natural draft could be 
 used or electric fans; the latter would, of course, give a positive action. 
 2. Please refer m& to several of the best modern works on heating and 
 ventilating." 
 
 Reply. — 1. The ventilating method suggested by you would be moder- 
 ately well adapted to offices and schoolrooms. To try to carry the air back 
 to the outside wall would be a mistake. Air in the open can only be made 
 to do a few simple things. In the installation suggested by you there 
 should be these modifications: 
 
 The air should enter at several places. 
 
 A large part of it should enter near the outside wall. 
 
 The outlets should be on the outside wall. 
 
 The outlet ducts should have openings near the ceiling and also near 
 the floor. 
 
 An exhaust fan would be necessary to care for the rooms on the lee 
 side of the building. 
 
 To take the air through the walls and let it flow through the radiators 
 would be cheaper, simpler and more effective. 
 
 The floors are warm in buildings several stories high. The radiation 
 underneath the floor would fit a one-floor school building. 
 
 2. Heating and Ventilating Magazine, 1123 Broadway, New York; Car- 
 penter, Hoffman, Raber and Allen. 
 
 Special works : Wilson, "Air Conditioning" ; the British Parliamentary 
 Reports ; MacFie, "Air and Health" ; Shaw, "Currents" ; Parkes and Ken- 
 wood, "Hygiene." 
 
 A magazine giving much space to ventilation is Human Engineering, 
 Cleveland, O. 
 
 Sleeping Room Regulation. — R. M. B. writes: "Will you please advise 
 the proper method of ventilating a furnace-heated sleeping room occupied 
 by two adults and a six months old baby. As the baby sleeps alone in his 
 
1166 VENTILATION— HEATING— HUMIDITY 
 
 crib we are anxious to know if it would be injurious to him if the tem- 
 perature got down to 1+0° ." 
 
 Reply. — Furnace heat delivers air in the room at a temperature of 118° 
 to 130°. When the windows are thrown open the hot air goes straight out 
 without heating very much. Fasten a twelve to eighteen inch board 
 across the bottom of the windows so as to deflect the incoming air upward. 
 Raise your window about one to two feet from the bottom. Leave the top 
 up. In this way you should succeed in keeping the temperature at 50° to 
 55°. Forty degrees is too cold for the baby. 
 
 Regulation Is Necessary. — J. H. writes: "Will you kindly tell me what 
 kind of heat you think the better for health, hot water or steam? We live 
 in a steam-heated apartment, and my baby has had bronchial trouble all 
 winter. I have been told it was due to the steam heat, and that hot water 
 would be better for him, as it is more regular. Our apartment gets too hot 
 when steam is put on, and if we shut off the radiators we freeze before 
 steam is put on again. It is cold during the night. On the very chilly 
 nights baby took an extra cold each time." 
 
 Reply. — Practically, there is not much difference between them. Hot 
 water heat is more even, but with steam heat it is easier to humidify. 
 Properly regulated with thermometers and humidifiers and aided by wise 
 use of windows either can be made satisfactory. Without such regulation 
 and aid neither can be made satisfactory. 
 
 Ventilate Room. — B. B. R. writes: "I have been accustomed to an un- 
 usual amount of fresh air in my bedroom, but since my baby came, being 
 obliged to have her sleep in the same room, I have had only one window 
 open about three inches. The baby is 5 weeks old and healthy. What is 
 the lowest temperature she could stand?" 
 
 Reply. — The baby can stand as much cold as the mother. She should 
 be warmly wrapped. Ventilate the room better and the baby will thrive. 
 
 Sleeping Out of Doors. — Miss M. R. is in perfect physical condition. 
 She started sleeping out of doors last summer and wants to know whether 
 she shall keep it up through all sorts of weather including rainy and damp 
 nights. 
 
 Reply. — Yes, if the sleeping place is properly arranged so that the 
 sleeper is comfortable. Otherwise, no. If the porch is deep enough or 
 screened or if the bed is covered by a rainproof covering dampness of the 
 air or rainy and snowy nights should not deter. 
 
 Window- Ventilated Office. — R. G. works in an office that is ventilated 
 by windows. He says that the warmer the room gets the colder his feet 
 get. Why is this? 
 
 Reply. — Cold air goes to the floor. The warmer the air in the room the 
 more quickly the cold air gets to the floor. The more quickly it gets there 
 the warmer it is when it gets there. The hotter the air is where the head 
 and shoulders are, say five feet from the floor, the colder will one's feet and 
 legs be in air one foot from the floor. When the room ventilation is 
 through windows and the room temperature is 78° one's feet will feel 
 colder and the air near the floor will be colder than when the temperature 
 of the room is 68 °, 
 
VENTILATION 1167 
 
 How to Make Deflector. — J. E. L. writes: "In your article today on 
 ventilation you say windows in ~bedrooms should be supplied with deflectors. 
 Kindly explain how to make and how to put them on properly. Also, is it 
 sufficient ventilation in winter to let in the air by having the lower sash 
 closed on a board, thus allowing fresh air to come in between the two 
 sashes, as is often done?" 
 
 Reply. — There are many deflectors on the market. To buy one of these 
 is usually more satisfactory than making your own. To make one take a 
 piece of glass or a piece of board twelve inches wide and of a length equal 
 to the width of the window. The thickness should be one-quarter to one- 
 half an inch. 
 
 Make a frame for this. The frame fastens at the bottom of the window 
 frame inside the lower sash. The inside of the deflector should be three 
 inches from the wood of the window sash frame. The top of the deflector 
 should have four inches of play. It should be arranged to catch with the 
 perpendicular of the deflector parallel with the window pane and about 
 four inches therefrom. It should also be arranged to catch with the de- 
 flector at an angle with the window pane, its top being eight inches there- 
 from. 
 
 Closing the lower sash on a board allowing air to come in between the 
 two sashes is satisfactory in unoccupied rooms. If one or two windows in 
 a room can be so fixed and the number of people in the room is below five 
 it will be satisfactory in cold weather. In warm spring weather or medium 
 weather in spring and fall there is not enough difference between the room 
 temperature and the outside temperature to pull in air in sufficient quan- 
 tities. The opening is too small. 
 
 Sleeping in a Draft. — Mrs. E. E. writes: "Should one sleep or sit in a 
 draft? My husband claims one cannot get a- change of air in a sleeping 
 room without a draft. He and I have had many arguments about sleeping 
 in drafts. I am against it." 
 
 Reply. — Everyone should sleep in moving air. When air moves strongly 
 enough it is called a draft. If the air is cold its movement is felt when it 
 is going only a few feet a second. When the air is warm its movement is 
 not felt until it gets much faster. No two people call the same thing a 
 draft. A force of air movement which one person objects to is pleasant to 
 another. A force which in the summer is a most pleasant breeze in winter 
 is a horrid draft. A force of wind which one exercising in the open air 
 thinks exhilarating is unpleasant to the same person sitting in a room. 
 
 The rule is : Sleep in air which is moving just as much as you can 
 stand without being chilled. Do not stay in any air current which chills 
 you. If you chill easily try to train yourself by exercises, cold baths, 
 massage and exposure to stand more draft without chilling. It is fine for 
 you if you can stand it. It is bad for you if you cannot. 
 
 Both of you are right — he in his theory and you in your custom. But 
 you had better change your custom gradually. 
 
 How to Ventilate a Room. — "Salutaris" writes: "Are the effects on 
 health deleterious where there is no way to cause a current of air to pass 
 through a room, no transom or door on the other side? Can you suggest 
 any method for proper ventilation for such a room?" 
 
 Reply. — I take it that you have a window on one side of the room. 
 If you will raise the lower sash two feet from the bottom and lower the top 
 
1168 VENTILATION— HEATING— HUMIDITY 
 
 sash two feet from the top you will get good results in weather below 40°. 
 When the atmospheric temperature rises much above 40° the house tem- 
 perature will not move much air. 
 
 Ventilation. — N. B. G. writes: "If the occupants of a furnace-heated 
 building, having inside air supply drawing in part from rooms occupied by 
 a tuberculosis patient 'are in no danger/ it is reasonably assumed that this 
 method of furnace air supply is not unhealthy. Were it unhealthy the oc- 
 cupants would be in danger. How then can the foregoing be reconciled to 
 the definite statement that 'recirculated air is unhealthy' when dealing out 
 advice on furnace installation?" 
 
 Reply. — If you will refer to the letter in question you will see that the 
 writer was asking whether consumption germs would be dried, picked up 
 by the air currents, carried from one part of the house to another and then 
 infect healthy people. The reply was that there was no danger. There is 
 a difference between the carrier action of air and the unhealthfulness. Air 
 is frequently unhealthy when it is not a transporter or carrier of disease 
 germs. There are two tendencies in the country as regards ventilation 
 view. One is a lessening fear of air as a germ carrier ; the other, a growing 
 fear of bad air as a producer of unhealthfulness. These tendencies are not 
 contradictory. 
 
 Outdoor Sleeping. — Earnest Inquirer writes: "1. What is your opinion 
 on sleeping out of doors? 2. Do you believe it is good or bad to sleep on a 
 north porch, exposed to the lake in cold weather or damp weather? A 
 member of my family is a crank on the subject and it worries me ex- 
 ceedingly." 
 
 Eeply. — 1. I believe in it. 
 
 2. Depends on the party and on the facilities. Some people are bene- 
 fited by sleeping on a north porch in Chicago without effective wind shields ; 
 others are not unless they have facilities for shielding themselves against 
 winds, storms, light, and noises. The outside sleeping cranks are nearer 
 right than the draft cranks. 
 
 Open Windows in Winter. — S. T. T. writes: "It is time to write 
 something about leaving windows open at night so as to sleep in brisk, 
 fresh, early winter air." 
 
 Reply. — You are right. I begin by publishing your admonition. 
 
 Drafts and Colds.— E. P. N. writes : "Some 'fresh-air fiends' and 'draft 
 cranks' are having a tug of war in a certain club as to whether, during the 
 cold season, the windows are to remain open or be closed. An answer to 
 the following questions would be appreciated : 1. How does impure air cause 
 colds, coughs, et cetera? 2. How do drafts cause colds, coughs, et cetera? 
 3. When a window is open six inches at the top and bottom is the resulting 
 cold air really a draft? I believe I have heard of some methods of warm- 
 ing the air before it enters the room, but in every room I have been in so 
 far (as in the case of the clubroom in question) it is simply a case of 
 choosing between open windows, fresh air, and a draft (if it be true that 
 in a room without the method mentioned you are bound to cause a draft 
 by opening the window) and closed windows, impure air without a draft. 
 I have never yet opened a window in the winter time when three or four 
 persons were in the room without someone crying out, 'Where is that 
 
VENTILATION 1169 
 
 draft coming from?' Then the poor window is discovered open and imme- 
 diately closed. If. In case you must have draft in order to get fresh air 
 in the ordinary buildings at present are not the colds, et cetera, caused by 
 drafts in order to get fresh air less severe as well as less frequent than those 
 caused by impure air the result of closed windows? 5. In a room twenty-five 
 feet by fifteen feet, with twelve people in it is the opening of one window 
 six inches from the top and six inches from the bottom too much, too little, 
 or about right? I wish to get an idea of about how quickly the room 
 becomes actually dangerous. Of course, some are so fond of fresh air that 
 they aim to sleep, study, and work in rooms with the air as nearly as 
 possible like that of outdoors. But, on the other hand, there are some who 
 admit the force of the fresh air arguments, but open the window about 
 1-1,000,000 of an inch and contend that that much is sufficient to keep 
 the air from being poisonous." 
 
 Reply. — 1. Colds and coughs are due to infections. Impure air (a) 
 transports bacteria, (b) lowers resistance. 
 
 2. By chilling one portion of the body drafts lower resistance. 
 
 3. In cold weather, yes; in warm weather, no. Every man is his own 
 judge of drafts. A current of air strong enough or cold enough to be 
 objected to is called a draft by the man who objects to it. The speed of 
 the air, its volume, the difference between the temperature of the air of 
 the room and the incoming air — all these are factors, but .the determining 
 factor is the man who is passing judgment. 
 
 4. (a) If all the air is heated as it enters the room it can be introduced 
 in large quantities without causing complaint of drafts, (b) Yes. 
 
 5. Too little in warm weather; too much in cold weather, especially if 
 the window faces the wind. A room 25' x 15" inhabited by twelve people 
 cannot be ventilated by windows in cold weather without complaint. The 
 "fresh-air fiends," as described by you, are exceptionally well off. One 
 can get on with less air without being greatly harmed. This is as 
 definite as I can be in the space available. 
 
 Kitchen Air. — J. D. S. of Kewanee writes: "Is it healthy to take air 
 from the kitchen of a dwelling where all the work in cooking and other 
 housework is done and pipe it to the furnace in the basement, and thence 
 to the sleeping and other rooms?" 
 
 Reply. — Kitchen air is about as healthy as any inside the house. It is 
 too hot and too moist and that makes it bad for cooks but these conditions 
 can be rectified before it reaches the living rooms. Kitchen odors are not 
 unhealthy but the family would object to having them sent all over the 
 house. 
 
 For Well- Ventilated Cars. — W. B. R. writes from Shermerville, III: 
 "I wish to suggest that one car on each suburban train should be a 'fresh- 
 air car for men and women. It should be sufficiently ventilated to keep 
 the air pure and supplied with no more heat than the other cars. When any 
 of the numerous persons who now object to seeing a few ventilators open 
 happen to get into this car they can be invited to move into the next car 
 instead of interfering with the proper ventilation, as they usually are able 
 to do under present conditions" 
 
 Reply. — The suggestion is good. It would take the railroads several 
 years to change their cars so they could be properly ventilated. In the 
 
1170 VENTILATION— HEATING— HUMIDITY 
 
 meanwhile they might have one car that was healthy and comfortable for 
 some people and uncomfortable for others and the remainder of their cars 
 unhealthy and comfortable for some and uncomfortable for others. Cars 
 can be ventilated so as to be both healthy and comfortable for the great 
 majority of people. 
 
 The present railroad car ventilation is about the limit of pigheaded- 
 ness. Nearly four years have elapsed since the Master Carbuilders' Asso- 
 ciation published a report showing the inefficiency and unnecessary cost of 
 present methods and suggesting new methods. One railroad, the Penn- 
 sylvania, acted on the report. Up to date it has made no impression on 
 the general run of passengers. 
 
 More Ventilation. — F. C. writes: "For years I have had a weak throat 
 and difficulty in talking at any length. Last winter I lost my voice for six 
 weeks. Have had many colds which always terminated in severe coughs. 
 I have no cold now, but cough at intervals. 
 
 "I do not have long coughing spells, but cough a little at times in 
 order to clear my throat. The entire trouble seems to be in the throat. 
 Is there any danger of tuberculosis? 
 
 "I am and have been a stenographer for years. I have no other symp- 
 toms, good appetite, and am not losing flesh. I am always extremely tired 
 in the morning and never feel normal until after breakfast. I walk to and 
 from the office, one and one-half miles each way." 
 
 Reply. — People who are tired in the morning have usually slept too 
 much or slept in a badly ventilated room. If you sleep in a well venti- 
 lated room you ought to have fewer colds. Your letter suggests that you 
 have an area of chronic infection in your nose or some sinus leading 
 from it and that this infection occasionally spreads to your nose and 
 larynx. If this is true your colds will recur until this focus is cleaned 
 up. Your letter does not suggest tuberculosis. 
 
 Ventilating a House. — W. B. writes: "I should like to have you describe 
 a common-sense, practical method of ventilating thoroughly an ordinary 
 two-story, six-room, hot water-heated residence, during the winter months. 
 We have two boys, 5 and 2 years old respectively, who must spend some 
 time indoors during the day in bad weather, and the problem is to give 
 them the best hygienic conditions and still not subject them to the danger 
 of colds through drafts from open windows, etc. If plenty of outside air 
 is admitted is the humidity sufficiently high or would you advise using 
 water pans through the house? Would 60 on the hygrometer be a good 
 point at which to keep the interior humidity and, say, 68° tempera- 
 ture?" 
 
 Reply. — I do not think you will be able to get the humidity of your 
 house up to 60 except in the cold bedrooms. 
 
 Throw the windows of the bedrooms wide open. Fasten a blanket 
 across the foot of the bed or use a screen so as to keep the wind from 
 blowing straight on the boys. Keep the temperature at 45° to 55°. The 
 humidity will keep at 60 or over without any help from humidifiers. 
 
 Have them dress in the bathroom with the thermometer at 75°. Pay 
 no attention to the humidity in this room. 
 
 Keep the temperature of the living room at 68° and the humidity 
 as near 60 as possible. You probably cannot get it higher than 40. Use 
 pans of water and every other aid possible. Four times a day have the 
 
VENTILATION 1171 
 
 boys play some lively game and while they are doing so throw open the 
 windows and drop the temperature to 60°. The humidity will come up to 
 50 for a short while. 
 
 There are few days bad enough to make it advisable to keep the boys 
 in for all the day. Even babies over three months of age should be out at 
 least two hours practically every day in the year. 
 
 Air the House Well. — G. H. F. writes: "Please advise me what liquid 
 of strong, pleasant odor will counteract the smell of varnish, still not in- 
 juring or affecting its properties or ingredients" 
 
 Reply. — Varnishes are sometimes dissolved in wood alcohol the fumes 
 of which are poisonous. Get rid of the odor by opening the windows and 
 airing the house well. 
 
 To Insure Pure Air. — W. N. K. writes: "Is there any device or appli- 
 ance which one can wear while traveling to reduce the intake of con- 
 taminated air, etc.?" 
 
 Reply. — I know of no such device nor would one be practicable. 
 
 The better way is to build and operate railroad and street cars so as 
 to facilitate the outflow of contaminated air and the ingress of fresh air. 
 Cars are generally badly ventilated. Agitate for ordinances and laws forc- 
 ing better car ventilation. 
 
 Method to Be Avoided. — H. J. B. writes: "What is your judgment as 
 to installing a hot air furnace with two registers in each room, one to take 
 the air from the room and the other for hoi air to return? These jobs are 
 frequently put in without talcing cold air from the outside. The claim is 
 made that there is great economy in not talcing the air from the outside." 
 
 Reply. — The practice is one of recirculating the air. It saves money, it 
 is true, but in my opinion at the expense of health. Some recirculation is 
 compatible with health but no research work has determined just how 
 much* and certainly in practice no effort is made to adjust the recircu- 
 lation on the basis of health. 
 
 -My advice is, until this matter is fully determined, to avoid recircu- 
 lating hot-air furnaces as « one would avoid a man with smallpox. 
 
 Bad Air in a Basement. — T. R. says he is employed in the basement of 
 a wholesale house where the air is bad. He asks, "Will a five-mile walk and 
 deep breathing while walking 'overcome' the bad air absorbed in the lungs 
 during the day?" 
 
 Reply. — A five-mile walk and deep breathing will overcome much of the 
 effects of bad air absorbed during the day, by reason of working in the 
 basement of a wholesale house where the air is bad. At the same time 
 it is doubtful if it will overcome it all. My advice to you is to find 
 employment in a better ventilated place. 
 
 Coughing in Theaters. — J. H. R. writes: "Every time I attend a theat- 
 rical performance I am annoyed by persons all through the theater who 
 cough incessantly. I never am troubled this way, and so I write to ascer- 
 tain the cause of it. Perhaps it is the imperfect ventilation." 
 
 Reply. — The reasons are several. In the first place the ventilation is 
 poor. Several hundred people crowded together in one room make a lot 
 
1172 
 
 VENTILATION— HEATING— HUMIDITY 
 
 of heat. The illumination makes additional heat. The audience gathers 
 quickly and disperses quickly. This adds to the troubles of the manage- 
 ment. All in all, theater ventilation is usually a poor job. There is a 
 tendency to cough engendered by hearing others cough. Much more im- 
 portant than the last is the coughing excited by laughter. A farce comedy 
 is a better cough stimulator than a mild melodrama. Until we recog- 
 
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 out/et 
 
 ^' x l \ \ \ ^ ll 
 
 / / / / y / j i 
 
 / / 
 
 // ;S 
 
 / y 
 
 W 
 
 '/, 
 
 J yV/'r?doW 
 
 Oistfef 
 
 N 
 
 
 if 
 
 \W 
 
 \ 
 
 
 
 — ^?%^\ 
 
 5s 
 
 ^1 
 
 Window. 
 
 /rr/ef 
 
 Michigan Public Health. 
 
 Fig. 486. — Influence of Closed Windows on Room Air Current on a Cold 
 Day. Hot-Air Heat. 
 
 nize colds as contagious and preventable a person will be a little better off 
 if he will stay away from the theater from January to May. The coughing 
 prevents him from hearing, so what's the use? 
 
 Church Ventilation. — L. C. F. writes: "Kindly print something in 
 regard to ventilation of churches. Ours is a small church with windows 
 close to the pews on either side and at the back of the choir loft. The 
 windows are always let down from the top on both sides, or on one side and 
 
HEATING 1173 
 
 back of the choir, thus making everyone in the congregation sit in a 
 druftr 
 
 Eeply. — About the only thing you can do is to warm the air before it 
 gets to the people. One way to do this is to put deflectors on the windows 
 so that the air goes to the top of the room and is partly warmed by admix- 
 ture with the warm air before coming in contact with the people. This 
 method works fairly well on moderately cold days. A better plan is to 
 place deflectors and ducts so that the fresh air is sent through the 
 radiators. This can be fairly well done without electric fans but the 
 service is much more efficient when small electric fans (one-eighth horse- 
 power, for instance) are used. Drafts of themselves are not harmful. The 
 temperature of the air in a draft may be so low that it robs the body of 
 heat a little faster than the body makes it. Under those circumstances, a 
 draft does harm. 
 
 HEATING 
 
 Those who contemplate reading this series of articles will do well to 
 remember that the ends sought and the methods used must vary with the 
 season, the climate, the business and with special conditions. 
 
 In writing them I have had in mind the usual conditions which pre- 
 vail in Chicago during the cold weather of midwinter. It follows that they 
 will not fit so well when the weather gets warmer nor can they be applied 
 without adaptation when the proposition is to ventilate a house in a climate 
 which is much warmer or more humid than that of Chicago. 
 
 In the main the principles involved vary widely according to the at- 
 mospheric temperature, the amount of wind and its velocity and the rela- 
 tive air humidity. 
 
 I cite some illustrations: In very cold weather the air is too dry; in 
 warm weather it is too wet. In cold weather the house temperatures are 40° 
 to 80° higher than the air temperatures; in warm weather they are 20° 
 less. In cold weather fans are used to create drafts of warm air; in warm 
 weather, of cold air. In Mississippi the woodwork swells in winter and 
 shrinks in summer; in Illinois the reverse is true. Effort is necessary to 
 humidify the air of schoolrooms and flats; on the other hand, laundry, 
 bakery and packing house ventilation requires that the air be dried. 
 
 The most important point, however, for the reader to bear in mind is 
 that individual problems require individual treatment. Correspondence ven- 
 tilation is like correspondence medicine in that it becomes harmful when it 
 is carried beyond its limitations. A given ventilation problem must be care- 
 fully studied and the remedy devised to suit the conditions found. 
 
 The general principles laid down form the basis upon which to build. 
 They do not constitute the whole of the building. 
 
 HEALTHFUL HEATING OF HOUSES 
 
 Before winter begins the shop windows have displayed rows of trained 
 batteries in the nature of stoves, ranges and heaters of all kinds announcing 
 the battle royal to be fought with Old Man Winter. Gradually these bat- 
 teries, Shiny Black, Lustry Bright and Batter Big Chest, are distributed to the 
 
1174 VENTILATION— HEATING— HUMIDITY 
 
 houses of our citizens. Once more mere man asserts his superiority, mounts 
 a step ladder to prove it, gets the stove piped and confers upon himself a sooty 
 mark of distinction while the real master, the lady of the house, watches 
 it all with a directing eye. Outside is heard the heavy trudging of horses 
 pulling a wagon brimful of coal. Last but not least, the janitor is becoming 
 more officious. Everything shows preparedness to fight with heat and 
 fervor the onslaughts of Winter. 
 
 There are many methods of heat each having its advantages and dis- 
 advantages. The great advantage of heating by open fires is that ventilation 
 is added. The disadvantage is that it heats the room unevenly. The outside 
 walls are always cold and the floors are usually so. The fire must have air, 
 and the incoming air is necessarily cold. Arrangements can be made to 
 deflect it but none can be made to heat it. Open fireplace heating is adapted 
 to rooms occupied by a few people — for example, sitting rooms. 
 
 Open fireplaces in which gas is burned are open to another objection. 
 Frequently rather ornate gas logs are used. The gas flows from a small pipe 
 into a larger space and there escapes from many openings. Frequently 
 these openings are more or less obscured by asbestos. In consequence un- 
 burnned gas nearly always escapes and in a short while the odor in the 
 room is appreciable. 
 
 The remedy is easily applied. Gas logs should be simple and plain with 
 a small number of openings and those in such plain view that a point 
 from which gas is escaping into the room could not be overlooked. Occa- 
 sionally heating is done by a gas burner which has no chimney or flue 
 attached. This is always to be condemned. When gas burns it is not 
 destroyed. It is merely changed into other gases and these are almost as 
 harmful as the original gas. 
 
 And finally those who make use of open-fire heating whether they use 
 coal or gas should remember that unless the windows are raised or the 
 ventilators are opened the air of the room speedily gets into a harmful 
 condition. This happens more quickly than where there is steam or hot- 
 water heating and lack of ventilation. 
 
 The conclusion is that for rooms occupied by but few people and with 
 ventilators and windows sufficiently used open-fire heating is excellent. In 
 the milder climates, say south of a line through Memphis and in the South- 
 west, its advantages are great enough to overcome its discomforts. This 
 is true of its use in houses and small halls. It can be adapted .to school 
 use in California, the Southwest and in the South beyond Montgomery, Ala- 
 bama. 
 
 HEATING THE HOUSE 
 
 Heating by hot water has its advantages and disadvantages. It is an 
 economic method of heating' as compared with heating by open fireplaces. 
 In fact, it is easy to demonstrate that the saving is great enough to more 
 than pay for the cost of installation and upkeep in the lifetime of the plant. 
 
 It is to its disadvantage that it does not make ventilation a necessity. 
 As we have seen, however, this advantage of the open fireplace is not what 
 it seems, since there is no way of warming the cold air and in the effort 
 
HEATIXG 1175 
 
 to stop the stream of cold air along the floor, doors and windows will be closed 
 and cracks will be chinked. 
 
 As a means of keeping the floor warm, hot-water heating is midway 
 between hot-air heating and open-fire and stove heating. 
 
 In hot- water heating the temperature of the coils is never so hot as 
 steam coils get at times. This is something of an advantage though not a 
 great one. 
 
 To my mind, the great drawback of hot-water heating is the difficulty 
 of humidifying. To remedy this defect three methods have been employed. 
 
 Pans are placed on the radiator. These do not evaporate enough 
 moisture. By the use of wicks, towels and evaporating bricks the amount of 
 evaporation may be materially increased. 
 
 Fountains are employed to throw a fine spray of cold water into the 
 air. Steam evaporated in a special vessel in the firepot is discharged at some 
 advantageous point in the room. 
 
 The satisfactory humidifier used by Dr. Bryce discharges steam into 
 an air intake. 
 
 Heating by steam has the economies of hot-water heat. It allows 
 the placing of the heat under the windows and against the outside windows. 
 Thus wall chill as well as window chill is provided against. The leaking 
 air is promptly warmed. The temperature of the chilled air is raised. 
 
 Its advantage over hot-water heating is in the greater ease with which 
 humidifying is done. Steam from the radiators can be used to moisten 
 the air in the room. 
 
 Direct-indirect heating: This term is employed to designate heating 
 where fresh air is taken into the room behind the radiator coil and, having 
 been warmed, is discharged into the room. It is. therefore, a method of 
 heating combined with a method of ventilating. As a heating method 
 it has the great advantage that the incoming air distributes the heat through- 
 out the room. 
 
 PROBLEMS OF HEATING 
 
 An important question to decide is whether it pays to keep a building 
 heated all the time or to let the heat die down when the building is not being 
 ■used. On this subject there are a multitude of opinions. Many of the men 
 holding opinions have investigated or observed conditions to some extent and 
 base their opinions on what they have observed. That they should hold such 
 contradictory opinions points to the probability that under certain circum- 
 stances it pays and in others it does not. 
 
 The opinions are determined by the point of view of the holders. The 
 man who has to hustle out of bed on cold mornings to make the fires no 
 doubt would advocate keeping the house heated all the time. Those who 
 stay in bed until the house warms up might think differently about it. 
 
 The problem is one of heating both the walls and the air. The air with 
 efficient heating methods is quickly heated, but it must be promptly changed. 
 The walls heat slowly but when once heated if they be well made they 
 remain warm. 
 
 The time required to heat a building depends on its exposure, the snug- 
 ness of its walls and windows, the materials of which the walls are composed, 
 
1176 VENTILATIOX— HEATIXG— HUMIDITY 
 
 and some other items. A large building with thick walls may require twenty- 
 four hours to heat up. That the time required can be accurately calculated 
 is shown in two articles in the Heating and Ventilating Magazine, one by 
 Tea and the other by Donnelly. 
 
 If the fires are to be allowed to die down, for example, in schools on 
 Saturday and Sunday or in churches during the week the heating plant must 
 be built larger than where the fires are to go all the winter. Wolf says this 
 excess should be 10 per cent for a sheltered building heated in the daytime 
 only; 30 per cent if the building is greatly exposed. The increase must be 50 
 per cent in churches cold for several days on a stretch. 
 
 Mr. Mackay, a ventilating engineer, says : "It takes more coal to raise the 
 temperature in a building than it does to maintain it." 
 
 Professor Allen says that at the University of Michigan they burn 100 
 tons of coal a day in a 3,000-horse-power plant. As the result of experiments 
 they found it took about one ton more of coal to maintain heat in the buildings 
 over Sunday than to allow them to go cold and then reheat them. In 
 discussing Professor Allen's paper Mr. Weinshank said that in designing the 
 heating for a building he always added an excess of 30 per cent in radiation if 
 the building was to cool down at night. He thought a church saves coal by 
 keeping its building warm all the week and as proof he cited two churches — 
 one heated on Wednesdays, Saturdays and Sundays and the other heated 
 all the time. The one heated all the time used less coal than the other. Pro- 
 fessor Allen's method of comparing was much more accurate than that of his 
 critic. But one point made by Mr. Weinshank must be taken into account. He 
 said: "Any heating apparatus operated intermittently also suffers greatly 
 from wear and tear." 
 
 TYPES OF HEATING 
 
 Gas Heaters. — A bathroom should be a little warmer than the average. 
 In order to make this possible, small gas heaters are in common use. The 
 same type of heating apparatus is used to a limited extent in bedrooms in 
 cold climates for a short while morning and night in the spring and fall. In 
 the gulf states such heaters are used in bedrooms for an hour or two morning 
 and night during the warmer days of midwinter. 
 
 Gas heaters of this type are generally without any chimney or pipe to 
 carry the colorless, odorless smoke to the outside air. Where built in this 
 fashion they are just about as vicious a device as is known in civilized 
 society. 
 
 By a rough sort of calculation, when a foot of gas is burned two cubic 
 feet of oxygen, that is ten cubic feet of air, is used up and three cubic feet of 
 carbonic acid gas is made. One can readily see that a gas stove running a few 
 minutes in a closed bathroom makes the air unfit to breathe. As the tempera- 
 ture of the air quickly gets over 80° and as the water in the tub evaporates 
 rapidly and soon brings the humidity of the room to 70 an impossible com- 
 bination is brought about. Fat men, men with bad hearts, men disposed to 
 faint, presently become dizzy. Unless the window is raised or something else 
 is done the man faints. If he faints and falls in the water he drowns. 
 
 When this type of heater is used in a bedroom the conditions are not so 
 bad. The room is larger, the walls are less snug, the humidity and the 
 
HEATING 117? 
 
 heat are less. Such use kills nobody outright and used for a few minutes to 
 moderate the temperature does no material harm. 
 
 In many cities the ordinances require that such heaters shall have a stove- 
 pipe leading to the outside air. Such pipes carry off much of the carbonic acid 
 gas and prevent some of the overheating. Let us say they cut the danger in 
 half. 
 
 For use as bedroom heaters a gas stove is made with some water carried 
 in pipes in the back or baffle plate above the flame. The statement of the 
 selling agent is that this water moistens the air in the room. As a gas heater 
 rapidly adds heat to the air and does not add moisture the air in the room 
 speedily becomes very dry. Whenever heat is added to air a proportionate 
 amount of water must be added or the air becomes unfit. 
 
 The need is present but the remedy offered by the selling agent is no 
 remedy at all. By what magic water in closed pipes can become water in air 
 deponent sayeth not. As the water in the pipes cannot be heated much above 
 212° and the carbon flame is much above that figure the net result of the use 
 of this type of apparatus is the precipitation of solid particles from the un- 
 burned gas as soot, some of which goes to soil the walls and curtains and some 
 to soil the lungs. 
 
 If the manufacturer will provide an escape valve so that the steam from 
 the coils will escape into the air of the room there will be some gain from 
 the coils — enough to offset the harm from the increase in soot. 
 
 Gas heaters without stovepipes in bathrooms should be made unlawful 
 everywhere. Gas heaters with or without pipes are allowable in bedrooms 
 where they are in use for not to exceed fifteen minutes on condition that the 
 room be aired soon afterwards. 
 
 The height of folly is represented by the gas logs with asbestos whiskers. 
 I suppose this monstrosity was devised by some poetic soul who thought 
 it pretty. They are sold to esthetic souls who think they are esthetic. To 
 my mind they are gas exuding, dust catching monstrosities and punish- 
 ment for installing one should be hanging. 
 
 Gas flows from a small pipe into the wider logs, thence it issues by a 
 hundred holes. Through some it goes with force and volume and burns 
 readily ; through others it oozes too feebly to flame. As the openings are 
 covered with asbestos the only available proof of the air pollution is the odor. 
 If the asbestos were absent the leaking pores could be detected and the flame 
 be turned higher or off entirely. On the other hand, gas logs without asbestos 
 whiskers would fall into disuse at once. Xobody who knows that customarily 
 a quarter of the holes "do not burn" installs them or uses them. 
 
 Open Fireplaces. — Heating by open fireplaces is inefficient and most un- 
 economical. It is advocated because it carries with it automatically ventila- 
 tion that is fool proof. The ventilation afforded by open fireplace heating 
 is not good ventilation — in fact, it is bad ventilation- but bad as it is no fool 
 can make it horrid. If the windows are leaded in, the doors chinked, the 
 walls made impermeable and no ventilation ducts are open the fire will not 
 burn. In that sense, the ventilation attendant on fireplace heating is fool 
 proof. The same cannot be said of the prevailing school, church, factory and 
 office ventilation. 
 
 The old fireplace burning great wooden logs did well enough when fuel 
 
1178 VENTILATION— HEATING— HUMIDITY 
 
 cumbered the earth and the more you burned inside the house the less you 
 had to burn when you cleared the new ground. The coal grate is not so 
 wasteful but it is wasteful enough. Much of the heat goes up the chimney. 
 The fireplace is located on the inner wall and that part of the room is nearly 
 warm enough without a fire. On a cold day a good hot grate fire may warm 
 a room for a distance of about ten feet. The balance of the room will be too 
 cold for comfort. Persons in the outer two-thirds of this zone will be warm 
 on one side but the rest of their bodies will be chilled beyond all comfort 
 by the cold air flowing from the outside toward the fire. Especially will 
 the occupants surfer from cold feet. 
 
 Obviously, fireplace heating is not adapted to schools, offices, factories, 
 stores or other rooms where the floor space is fully occupied. The heating 
 is not good enough. As the fresh air pours in in cold streams and flows 
 in such streams along the floor, not getting comfortably warm until it gets 
 ready to leave the room by the chimney, it cannot be said such ventilation 
 is or can be satisfactory. The best that can be said is that ventilation such 
 as it is cannot be wholly done away with. 
 
 Stoves.— Stoves have some advantages and some disadvantages as com- 
 pared with open-fire heating. They are less cheery ; and I suppose that every- 
 body will agree that something is lost there. A bright, glowing fire has 
 stimulated many a bright fancy and cheered many a drooping spirit. 
 
 Stoves tlo not stimulate room ventilation as much as open fires do. On 
 the other hand, they have certain advantages. Being placed, as they usually 
 are, toward the center of the room they heat much more efficiently than 
 do open fires. They are much less wasteful of heat, particularly when 
 the stovepipe is used to heat other rooms or other portions of the same room. 
 
 They do not heat the outside walls and the floors as well as do proper 
 steam and hot water heating apparatus but they heat them better than open 
 fireplaces do. As the fire in a stove is located inside the room they make for 
 ventilation more than does hot water, hot air and steam heating. If the air 
 is let in the room the fires burn better and thus in an indirect way, stove 
 heating if properly managed helps ventilation. 
 
 If, however, the cold air is unpleasant to somebody and the air intakes are 
 closed stove-heated rooms speedily become nuisances beyond compare. 
 
 There is another objection to stove heating which is of consequence 
 enough to require some emphasis. It has been found that when iron gets 
 red hot the combustion gas is in part changed from the slightly harmful 
 carbonic acid to the very harmful carbon monoxid. This is partly the 
 cause of the burnt odor of some bad air. 
 
 Therefore when stove heating is employed the stove should not be al- 
 lowed to get red hot unless the windows are opened wide enough to permit 
 the poisonous gas to escape easily to the outside. Who of us has forgotten the 
 red-hot stove, the burnt odor, the feeling of drowsiness, the soon-coming 
 headache? 
 
 For rooms occupied by a moderate number of persons stoves are fairly 
 well adapted, even as far north as Minnesota. The one-room school probably 
 will have to stick to stoves. 
 
 Can they be installed so as to make them more satisfactory than they 
 now are? Yes, 
 
HEATING 1179 
 
 As at present run they cannot heat the outside walls, they cannot 
 heat the incoming air and they overheat the near-by air. This is more of 
 a load than they can carry. 
 
 The remedy is to conduct at least one-half of the ventilation air through 
 ducts under the floor and to discharge it into the room under and around 
 the stove; to take in some fresh air through the windows; to let out the foul 
 air at the windows; to use the windows on the wind side of the building 
 for an accessory air intake and the windows on the lee side of the room for 
 air outlets. Thus will the disadvantage of stove heating be overcome. The 
 stove will not overheat. The temperature of the air next the walls will be 
 increased, wall chill will be lessened, the air for ventilation will be warmer 
 and more tolerable. 
 
 If the air is freshened by opening the windows periodically small 
 schools, small halls, railroad stations, farmhouses and small homes in towns 
 and cities can be ventilated by stoves without discomfort and harm as far 
 north as Canada. 
 
 Stove heating is much more economical than open fireplace heating. 
 It takes less coal and is more easily cared for. The first cost is small. 
 The fire using less coal than the open fireplace likewise uses less oxygen out of 
 the air. 
 
 Having the fire in the center of the room is an advantage as compared with 
 a fireplace on an inside wall. A pan on the top of the stove will evaporate 
 a good deal of moisture. It is somewhat easy to carry the stove-pipes through 
 upstairs rooms and in this way to get a good part of the heat out of the smoke 
 before it is discharged to the outside air. 
 
 The disadvantages of stove heating are several. It heats the outside 
 walls poorly. In consequence the air in the room is liable to be too hot and 
 the walls too cool. The desk space next the walls is liable to be too cold ; that 
 close to the stove too hot. The iron stove wall gets red hot at times. It is 
 well established that dusty air coming in contact with red-hot iron becomes 
 scorched. The dust particles are charred. Some ammonia is formed and 
 some excess of a poisonous gas called carbon monoxid is formed. 
 
 Some of the effects of ordinary stove heating are overcome in certain 
 systems by jacketing the stove and providing evaporation pans. The jacket- 
 ing lessens the overheating of the space near the stove and circulates the air 
 around the room. 
 
 Stove heating does fairly well for county schools and other places where 
 the requirements are full occupation of the floor space and slight cost of 
 installation. If fresh air can be brought into the room into the jacket 
 and warmed somewhat before it is distributed it stands to reason that more 
 of it will be allowed to enter than if it comes in at zero or thereabouts. 
 In such schools there should be hourly registration of the temperature and 
 humidity. 
 
 Hot-Water and Steam Heating. — The great advantages of these 
 types of heating are efficiency and economy; and yet there are disadvan- 
 tages. It is possible to heat well with these methods and have no ventilation 
 at all. 
 
 Our ideas of heating and ventilation have been inherited from the old 
 days of fireplace heating. In those days the heating of a room by an open 
 
1180 VENTILATION— HEATING— HUMIDITY 
 
 fire started currents of incoming air which, without planning for it, gave 
 a moderate amount of ventilation. The more loosely the house was con- 
 structed the better the involuntary ventilation. We are prone to carry 
 over our ideas of heating and ventilation into our modern quarters. 
 
 Heating with steam and hot water can be done without any ventilation, 
 and the more ventilating done the more expensive heating becomes. In fact, 
 speaking broadly, in our modern, closely built houses heating is needed to heat 
 the air for ventilation, the outside walls and the windows. The occupants 
 make more than enough heat to heat themselves, the inside walls, floors, 
 and ceilings. Therefore the temptation always is to reduce the size and 
 number of windows, to cut down the outside wall space and especially to limit 
 the air taken in. 
 
 Until better ventilation practices prevail these should be held as legiti- 
 mate arguments against steam and hot-water heating. This is doubly true 
 since heating engineers and manufacturers of heating apparatus have so 
 signally failed to do their duty toward the ventilating side — for in trade 
 and professional parlance "heating and ventilating'' are coupled. 
 
 Another disadvantage of heating by these methods is that the air is 
 too dry. This can be remedied by allowing steam to escape from the radiators 
 into the dry air. It can be accomplished less well with steam or with hot 
 water by using the radiators as evaporators. 
 
 A great advantage of these methods is that they allow the heat to be 
 radiated at those places in the rooms where it is needed, that is, near the 
 windows and otherwise along the cold walls. 
 
 Another point which with a little planning could always be taken 
 advantage of is that the ventilation air could be introduced into the room as 
 moderately warmed air. This is especially necessary if the room is to be 
 occupied to its full capacity. 
 
 The advantage claimed for hot-water heating is that the air is more 
 moist than in steam or stove heating. In hot-water heating the air comes 
 in contact with coils that are 170° Fahrenheit and below. Fluegge demon- 
 strated that when dust was heated to more than 160° it became offensive. 
 It was singed and distilled and there resulted some ammonia, some carbon 
 monoxid and some other substances less harmful but more offensive. This 
 cooked odor and feel some people try to avoid by keeping the heating ap- 
 paratus free from dust, while others adopt the less troublesome procedure of 
 putting in hot-water heating. 
 
 A great advantage of hot-ivater heating is that the air leaves the heating 
 surface at a fairly low temperature. The authorities are generally agreed 
 the air should not be brought into a room at a temperature higher than 160°, 
 and some of the bed of them say the temperature should not be higher than 
 104°. Hot-water heating meets this requirement well indeed. 
 
 We commonly hear it said the air in hot-water heating is less dry than 
 with other methods of heating. A part of this opinion is purely psychological ; 
 a part of it is based on material differences. If the air contains a certain 
 quantity of moisture, enough to give a relative humidity of 70, the relative 
 humidity can be dropped by raising the temperature of the air. The amount 
 of water in the air remaining the same, the air would be comfortably moist 
 when it was cold and uncomfortably dry when it was hot. 
 
HEATING 1181 
 
 Another advantage of hot-water heating is that the heat coils can be 
 placed under the windows and around the outside walls — locations where 
 heat does the most good. 
 
 So much for the advantages of hot-water heating. Now for its dis- 
 advantages. 
 
 One, and the most important one, is that it is not a ventilation pro- 
 cedure. Hot-water heating can be well done without ventilation. Most people 
 do not know that heating and ventilation are two procedures which are 
 frequently combined but which, nevertheless, are two procedures. The average 
 man thinks that when one is attended to the other is also. 
 
 A system of heating that does not necessitate ventilation sometimes 
 leads to bad conditions. When a room is heated to 70° and the outside air is 
 at zero there will be some ventilation regardless of what is done to prevent. 
 In spite of thick walls, air space and heavy wallpaper, air will filter through. 
 The saying is "Walls breathe." In spite of well-made windows the cracks 
 leak. But this is not sufficient ventilation to keep the air right. When the 
 heat is by hot water the ventilation cannot be made fool proof. 
 
 Another objection is the difficulty in evaporating enough water to keep 
 the humidity at 50 in hot-water-heated rooms. In hot-air heating the evapo- 
 rating pan can be set over the firebox; in steam heating steam can be 
 discharged into the room from the steam coils. But I know of no way 
 to evaporate enough water in hot-water coils to hold the humidity at or 
 above 50. 
 
 Those who advocate steam heat claim that it is highly efficient; that it 
 saves coal and thus saves money; that it heats all parts of the room so 
 well that desfcs can be put next the windows as well as elsewhere and that thus 
 it saves money; that it heats thoroughly, heating the walls as well as the air; 
 that the heating is so thoroughly done that the people are willing to ven- 
 tilate, which means that more people can be put in a room and that thus also 
 money is saved. 
 
 These claims are quite true; and yet some of the worst ventilation 
 of which I know is in steam-heated places, as with hot-water and hot-air 
 heating the heating can be pretty well done without any ventilation at all. 
 
 It is true that when a room is hot and the outside air is cold lots of air 
 will leak in and out even when every window is shut. It is also true, as the 
 Furnace League men say, that it is easier to heat where there is some ventila- 
 tion than where the air is altogether befouled. 
 
 Nevertheless, none of these considerations gives ventilation that measures 
 up to the standards of human needs. It has always seemed to me that the 
 steam-heating men were foolish to have done no work on ventilation since 
 poor ventilation so frequently is found in steam-heated places and causes so 
 many people to "get down on" steam heat. 
 
 The hot-water heaters say that the air next the coils in steam heating 
 gets too hot and smells cooked. The hot-air men say that the air in the 
 lower two feet of a steam-heated, window-ventilated room is too cold; that 
 six feet from the floor the temperature will be 78° and six inches from the 
 floor it will be 68°. 
 
 Both these statements are founded on existing conditions. Yet how 
 easy it would be for the steam-heater men to provide that air be sent 
 
1182 VENTILATION— HEATING— HUMIDITY 
 
 between the coils of the radiators, thus lowering the temperature round about 
 to a proper level and raising that of the air flowing out over the floors and in 
 this way to overcome these objections ! 
 
 Again, how easy it would be for the steam-heater men to provide for 
 noiseless discharge of steam into the air and thus stop that other group that 
 complains that steam-heated apartments are too dry. 
 
 Hot- Air Heating. — The advantage of hot-air heating is that it warms 
 the floors better than any other method. It is an effective method of heat- 
 ing. Furnace-heated houses are usually well heated. In many furnace- 
 heated houses there are several objectionable features: First, the air is very 
 dusty; second, the air is very dry; third, the air is recirculated; fourth, the 
 air enters the rooms at too high a temperature; fifth, the air as it came 
 through the furnace was in contact with iron that was too hot and in con- 
 sequence it smells and feels scorched. 
 
 These are the objections commonly urged against furnace heat. I 
 have insisted upon them more than once. They are valid as against the 
 usual job of furnace heating, yet I have before me a booklet on furnace 
 heating which shows that they are not necessary evils and that no one need put 
 up with them unless he wants to. The furnace men have found a way to cor- 
 rect them. This book convinces me all that is needed for good ventilation is 
 for the sanitary engineers to say what should be done and for the public 
 to demand that it be done. The heating and ventilating engineers will find 
 a way to do it. The name of the book is the "Federal System of Heat- 
 ing and Ventilation." It is a trade publication written by Dr. W. F. 
 Colbert. 
 
 The leading furnace manufacturers of the United States compose the 
 membership of the Federal Furnace League, which has been organized and 
 will be maintained not for the purpose of attempting to regulate the selling 
 prices of furnaces but to work logically and persistently for the accom- 
 plishment of five objects among which are standardization of methods and the 
 education of the public in heating and ventilation. They begin by establish- 
 ing a heating standard which they term the Federal Heat Unit. 
 
 The writer favors hot-air heating over other methods, as he says, 
 whenever occasion offers; but the information given will be of great value 
 even though the reader does not wholly subscribe to some of the conclusions. 
 
 From it we learn that a house of a certain cubic papacity should have 
 a furnace installed of a certain Federal Heat Units capacity with ducts of a 
 certain size; that in calculating the chilling effect of wall space 20 per cent 
 should be added for glass exposure facing north and west, that nothing be 
 added for east glass exposure and that 20 per cent be subtracted for south 
 glass exposure. In addition to the total wall exposure is added one-sixth of the 
 square feet of glass. For example, if a north wall was 10' x 20' and had two 
 windows 5' x 3' the wall space for heating purposes would be figured as 
 follows: 170 feet of wall space plus one-sixth of window space equals 175 feet; 
 window area, 30 feet plus 20 per cent equals 36 feet. This added to the 
 total wall space equals 216 feet. 
 
 Hot-air heating and -ventilation is a form of indirect heating. It is 
 nicely adapted to the heating and ventilation of homes and when certain 
 changes are made it will meet the partial approval of sanitarians. Ordinarily 
 
HEATING 1183 
 
 the woman whose house is heated by hot air compares her comfort with 
 the great discomfort of the stove heating which it displaced and it will 
 take a good deal to get the contrast out of her mind. About as much as 
 she will admit is that the air is too dry and that the apparatus does not 
 work well on windy days. Occasionally she complains that the children are 
 paler and have had more headaches and colds than they did in the old, un- 
 comfortable days. 
 
 Hot-air heating has the great advantage of heating certain rooms well, 
 of holding down wind leakage and of keeping the foot zone warm. The 
 manufacturers have given much thought to their heating and little to their 
 ventilating. Their furnaces heat fairly well but ventilate so poorly that they 
 scarcely deserve to be called heating and ventilating methods. 
 
 The objections to this method are: 
 
 1. In many instances the foul air from the rooms is carried back to the 
 furnace, heated and sent back into the rooms — recirculating it is called. 
 
 2. The air at the inlets is too hot — from 100° to 130° according to the 
 atmospheric temperature. 
 
 3. It is too dry. 
 
 4. The gravity force is not strong enough to work in the teeth of a 
 wind. 
 
 5. The heated air flows most readily in the vertical pipes and least 
 readily in the horizontal pipes; therefore certain rooms are well heated and 
 others poorly. 
 
 Some of these defects can be remedied. For instance, the reason for re- 
 circulating the air is to save heat. A more sanitary method would be to run 
 the intake tubes within the outlet tubes, saving its heat but allowing its 
 foulness to escape. 
 
 The humidity can be raised by placing pans on top of the furnace large 
 enough to evaporate five to ten gallons of water a day. It is not feasible 
 to keep the windows continuously open where heating is with hot air. For 
 this reason periodic blowing out of the rooms is absolutely necessary. 
 
 It is to be hoped that the manufacturers will study their subject so that 
 they can ventilate as well as heat in a manner which sanitarians can ap- 
 prove of. 
 
 Direct-Indirect Heating and Ventilation.— When radiators or other 
 heating devices are placed in a room the heating is said to be direct. When 
 the radiators are placed in air ducts and the hot air is blown into a room 
 the heating is said to be indirect. When radiators are placed in a room 
 and air is drawn into the room through the radiators the heating is said to be 
 direct-indirect. 
 
 Direct-indirect ventilating requires fewer ducts and fewer fans and 
 therefore costs less to install than do the more elaborate mechanical sys- 
 tems. They are likewise more cheaply and easily maintained. There is not 
 the interference with floor joists and beams and sewer pipes that makes 
 the usual mechanical systems so difficult to install. As the effort is to 
 keep the fresh and foul air as much apart as possible the quantity of air per 
 occupant per hour can be reduced to one-half what is required in other 
 methods of ventilation. 
 
 The cost of ventilation, in the main, is due to the heating of the air and 
 
1184 VENTILATION— HEATING— HUMIDITY 
 
 any suggestion which promises to lower the quantity to be heated and which 
 gives results will be in great demand. 
 
 There are a few places where the direct-indirect method has been em- 
 ployed; but without much success. Why have these installations failed? 
 They have placed the air outlets near the floor. The direct-indirect method 
 depends on difference in temperature to move the air. This is force enough 
 on a wind free day provided the warm air is allowed to leave the room 
 at the ceiling. It is not enough if the warm air from the ceiling must 
 come back to the floor to get out. The system will work if the foul air is 
 taken out at the ceiling and fan power enough is used to overcome wind 
 obstacles. 
 
 It is difficult to make air do complicated things after it has found 
 its way into the free space of a room. The systems which depend upon 
 the air in a room taking certain directions do not work in practice. An 
 advantage of the direct-indirect system is that the air moves from inlet to 
 outlet along simple lines. 
 
 Central Plant Heating 1 . — Heating from a central plant is economical. 
 In this particular, heating by isolated units, such as stoves and fireplaces, 
 cannot compare with heating from a central plant. It is also very much more 
 comfortable heating than that by isolated units. As the object of heating is 
 comfort it follows that central plant heating represents efficiency. 
 
 The question always is, How large should the house be to make the greater 
 economy of the central plant more than offset the cost of installing it and 
 the provision for maintaining it? 
 
 There are, though, some advantages outside the first cost. Fire in an 
 open fireplace or a stove will not burn well unless there is air. Where 
 heating is done by steam or hot water or hot-air radiation the heating may 
 be perfect and the ventilation unspeakable. The fire in the basement may 
 be getting a splendid supply of air while the people upstairs are suffocating. 
 If the stove and the people are in the same room they have to take pot luck 
 together. 
 
 There are three kinds of central heating — hot air, hot water and steam. 
 Hot air, as compared with steam and hot water, has some advantages and 
 some disadvantages. It has provision for circulating the heat throughout 
 the room and that is a great advantage. 
 
 It has two marked disadvantages. They are remediable and no man 
 should tolerate hot-air heating unless they have been remedied. The air is 
 frequently recirculated. That is to say, no provision is made for taking 
 in fresh air. Some leaks in and some old air leaks out but the quantities 
 are inadequate and in the main the bad air goes back to the people and 
 round and round in a vicious circle. 
 
 The other is that the air is heated but not moistened. It is low in 
 humidity. 
 
 Lesser disadvantages are these: The heat is put in on the inside wall 
 and in consequence the inside wall is too hot and the outside wall is too 
 cold. The air as it comes into the room on cold days is too hot to be fit to 
 breathe. The system does not lend itself readily to periodic blowing out 
 of the rooms by throwing open the windows. 
 
 Most of these disadvantages can be overcome. A hot-air heating plant 
 
HEATING 1185 
 
 that has corrected them represents a good type of heating and permits of 
 good ventilation. 
 
 Bather than put up with the harm of these things it is better to tolerate 
 the discomforts of stove and open fireplace heating. 
 
 USING HEAT 
 
 The temperature of a room not equipped with fans must not he allowed 
 to go over 70°. When the machinery makes it impossible to maintain a tem- 
 perature below 72° conditions can be made fairly harmless by using fans 
 enough to keep the air in active motion. 
 
 A bedroom must not be allowed to go over 60° and 55° would be a 
 better maximum. An infant's sleeping room should be kept at 65° until the 
 child is three months old. The bedroom of an infant three to twelve months 
 old should be 55° ; after a year 45° to 50°. 
 
 Adults should dress in a room 70° to 75°. 
 
 A living or sitting room should be 65° to 70°, according to the humidity. 
 If the humidity is under 30 a temperature of 70° is required; if the humidity 
 is 50 to 70 a temperature of 65° is proper. 
 
 The same conditions apply to offices and schools. I have nothing to say 
 about factories because factory heating and ventilation are another subject. 
 
 Street cars should not be heated above 60° and a 55° temperature is 
 better; day coaches not above 65°; sleeping cars not above 68°. 
 
 It will be noticed that the temperatures advised range from 45° to 75°. 
 There is a reason in each instance. 
 
 The influence of humidity, of physical activity and weight of clothing 
 must each be considered. Individuality cannot be forgotten. Some have 
 coddled themselves until they have greatly reduced their heat making powers. 
 
 Anyone reading this section so far would be justified in concluding that 
 a given type of room should be kept uniformly at the temperature set for it. 
 Uniformity of temperature is harmful. 
 
 One of the few advantages of open fireplace and stove heating is the lack 
 of uniformity. Men and women who work in offices where the temperature 
 is evenly maintained slow up and presently get sleepy. About once in 
 so often they get headaches. 
 
 The human body needs the stimulus which comes from having changes in 
 temperature. This is one of the great advantages from having the room 
 judiciously blown out from time to time. This, not overdone, will make 
 everybody feel better and the work will show the effect. 
 
 GET THE THERMOMETER HABIT 
 
 In any town there are thermometers displayed here and there in 
 front of stores. The people would be wise if they noted the temperature 
 from time to time. But the thermometer habit which would be most useful 
 would be the indoor thermometer habit. Ten years ago we had a genus 
 called the draft crank. The collapse of this industry must have left a 
 lot of people who are interested in their surroundings, acute-minded people 
 who want to do the right thing and who need something to specialize in, 
 
1186 VENTILATION— HEATING— HUMIDITY 
 
 without a hobby. What better than to get the thermometer habit? Why 
 should they not insist on knowing the temperature of the rooms into which 
 they go? 
 
 It has been proved that high temperatures, over 68°, are harmful. 
 As the temperature rises above that the air around the body cannot clean 
 itself. This being so, should not every house have one or more ther- 
 mometers and should we not get in the habit of noting the temperature several 
 times a day? Should not every schoolroom have a thermometer? Could 
 a teacher do better by the students than by teaching them to read the ther- 
 mometer and then having an hourly temperature record made by some pupil ? 
 
 Our employers have put in registering time clocks. Every employee 
 punches the clock as he goes to work and as he leaves. But there is a 
 difference between sitting at a bench and working. Good ventilation is the 
 speed boss. Cool air is the essence of good ventilation. Employers would 
 make more money if they would spend less on time clocks and more on 
 thermometers. They, too need to get the thermometer habit. 
 
 Thermometers Inaccurate. — P. C. S. writes: "I have heen making a 
 few experiments to ascertain the humidity in my living rooms. I have 
 two thermometers that read alike in the same room. On one of them I 
 have put a silk wick. The bulb shows through the mesh of the wick. The 
 wick is about four inches long below the bulb. I have hung this ther- 
 mometer so that it comes about one inch from water, the wick being in the 
 water, which goes up the wick and moistens the bulb of the thermometer. 
 This thermometer in the room with the dry thermometer at 70° will register 
 from 61° to 63° and will maintain nearly this distance from the dry one, 
 if this one rises or falls six or eight degrees. I wish to inquire what degree 
 of humidity I have in my rooms with this reading. Is it enough for good 
 health at this time of the year? I have hot-water heat. As I took these 
 two thermometers out of doors on a very damp day, the wet one registered 
 35° above zero and the dry one 31/.°. Have you any tables that I can tell 
 just what humidity I have with a given reading of these wet and dry. 
 thermometers? If so, will you please send me some?" 
 
 "Since writing the above I have been evaporating about one quart of 
 water per hour, or fifteen quarts in fourteen hours, by means of pans in my 
 radiators with blotting papers in them. Can put four in each radiator. I 
 have twelve in two rooms. I now find my thermometers are registering 
 64° wet and 68° dry, or within four degrees of one another. This would 
 show too much moisture. Is there any danger with so much moisture — that 
 is, are we more liable to catch cold in this damp atmosphere, or what will be 
 the effect? I can and have reduced the number of tanks in radiators, for 
 I was not running the furnace hard when I got the above evaporation. The 
 rooms are 30 x 18 and llf x 15 feet, two of them with large halls connected 
 with them, ivith open stairway." 
 
 Reply. — A dry bulb reading 70° and a wet bulb 62° means 64° relative 
 humidity. A dry bulb reading 35° and wet 34° means 99° relative humid- 
 ity; 68° and 64° respectively means 78°. I feel certain, however, that your 
 apparatus is not accurate. The amount of water evaporated will not give 
 so much humidity. My guess is that the meshes of your wick are not coarse 
 enough. The Taylor Instrument Company and the Schaeffer-Beudenberg 
 Company, both of Chicago, get out humidity tables. 
 
HEATING 1187 
 
 Care of Thermometer. — Sanitary writes: "Bo you deem it advisable for 
 everyone to have his own clinical thermometer? The reason I ask is that 
 in a great many cases that have come to my notice the doctor simply rinses 
 his thermometer off in a glass of water, dries it with his handkerchief or 
 towel, and puts it back in the case. You no doubt are familiar with the 
 manner in which the average physician handles his thermometer. He 
 generally rinses it off in a glass of water just before using and directly 
 after, and in a great many cases that is all the sterilizing the thermometer 
 gets. Now, then, isn't it possible, knowing as we do that typhoid germs 
 lurk in water, for the thermometer to infect the patient from being rinsed 
 off in the water? In case there were no germs in the water, suppose the 
 patient had a contagious disease of any kind? Isn't it possible that the 
 thermometer would carry the germs and transmit the disease to the next 
 one using the thermometer when said thermometer is cleaned in the man- 
 ner described above?" 
 
 Reply. — An individual thermometer is safer but the risk is not great 
 except in contagious diseases, including typhoid. In such cases, the ther- 
 mometer should at least be washed in formalin solution, bichlorid solution 
 or carbolic solution. 
 
 Stove Is Explanation.— 8. H. B. writes: "Apropos of your remarks 
 recently on the use of gas stoves for heating, could the constant use of 
 a ten-jet heater as the only means of heating a room used day and night 
 account for chronic headaches of the occupant? The extremely severe 
 weather necessitated having the stove lighted all day. A window was kept 
 open at night for ventilation, but in the day time an open fireplace fur- 
 nished the only ventilation, if any. After about three weeks my head 
 began to ache, and almost never ceased, until with the spring weather the 
 stove was no longer used and the windows were kept open day and night. 
 The headache has now almost ceased. Is this situation sufficient to explain 
 the headache?" 
 
 Reply. — It could. It did. It is. 
 
 Answered in three ways to prevent any misunderstanding. 
 
 Treatment of Furnace Heat. — E. M. writes: "Nearly all hot-air fur- 
 naces are supplied with cast or wrought iron pans near the hottom of the 
 hot chamber for the purpose of supplying water for condensing purposes, 
 the idea being that this vapor will be carried into the rooms. Few people 
 know about this or realize the importance of keeping the pan filled. 
 
 "1. These water pans are not in the right place and are not efficient. 
 They should be placed inside the hot chamber. 
 
 "2. Beople who live in furnace-heated houses should place a pan of 
 clean water under the registers every day. 
 
 "3. Outlets inside the inlet incoming pipes will warm the air and 
 interfere with circulation. The outlet pipes should go down separately 
 from the inlet pipes and end in the cold air box, so the outgoing air will 
 help in the draft and pass off into the chimney instead of coming back 
 into the rooms. 
 
 "Jf.. It is customary to supply cold air for the firebox from the front 
 hall, but I have found it improves matters to have a cold air pipe dropped 
 from the attic instead." 
 
 Reply. — 1. The water pans should be placed on the furnace inside the 
 hot chamber as suggested by E. M. 
 
1188 VENTILATION— HEATING— HUMIDITY 
 
 2. The temperature of water in pans placed in the registers would not 
 be high enough for effective evaporation. To place them in the hot-air 
 chamber on top of or close to the furnace is the ideal, to place them in the 
 register ranks second, on the register face, third. 
 
 3. To warm the incoming air by placing the intake pipes close to the 
 outlet pipes will save in heating but will decrease efficiency. The colder 
 the incoming air the more rapidly will it come in. 
 
 4. The plan of taking the cold air from the attic has the advantage of 
 doing away with variation in the force and direction of the wind to a cer- 
 tain extent. The plan of running the outlet back to the firebox has some 
 disadvantages. It will be difficult to make warm air go back down to the 
 basement, and any plan that is based on such a mechanical idea will be 
 found difficult to work. Furnace heating represents a great improvement 
 over grate heating so far as comfort is concerned. 
 
 Keeping Off Frost. — W. S. writes to Tcnow why grocery stores have 
 fans in their windows. Why do some hinds of stores have more frost 
 on their windows than others? 
 
 Reply. — Grocers want their windows to display their goods. This they 
 cannot do when the windows are frosted. Throwing hot air against the 
 window keeps the temperature of the air next the glass above the dew point ; 
 therefore the windows sweat but little and frost less. When windows are 
 chilling a room the same procedure will remedy the difficulty; when win- 
 dows are leaking cold air the same procedure helps though not as much 
 as proper stripping. 
 
 Those stores where the humidity is high have frosted windows unless 
 the windows are fanned or there is a good deal of radiation just below the 
 windows. 
 
 Lunch rooms and laundries are at the head of the list. Then come 
 florists' shops and groceries. Butchers' shops are near the top. Dry goods 
 stores and drug stores are low in rank as humid places. Hardware stores 
 are lower still. 
 
 Furnace May Lack Capacity. — E. C. B. writes: "I have lately had in- 
 stalled in my new residence an underfeed hot-air furnace. It has given us 
 much trouble during the recent cold weather. When the first and second 
 floors were heated to 70° the basement would be up to 90° and 100°. 
 In other words, any degree of comfort in the living rooms was the result 
 of superheated metal below — so hot that the outside jacket of the furnace 
 would be hissing and sizzling. Does not this process lessen the life-giving 
 oxygen? There is no provision for humidity. The furnace does not have 
 the usual water pan in the casing. Our hardwood floors and furniture 
 show the effect of excessive dryness. What remedy do you suggest for 
 greater humidity, more oxygen, and freer air circulation with less heat in 
 the basement?" 
 
 Reply. — Probably your furnace has not capacity enough. Relief may 
 come through storm windows, doors which fit snugly, storm doors, papered 
 walls, and carpeted floors. If this fails a larger furnace should be in- 
 stalled. Air which comes in contact with red-hot iron is unfit. Water 
 inside the hood is the best means of humidifying. Water below the register 
 face in the floor or on the register is a poor substitute but better than 
 nothing. You must blow out your house several times a day. 
 
HEATING 1189 
 
 Would Save Heat. — G. C. writes: "There is an idea that always hobs 
 into my head when I consider the problems of humidifying indoor air, 
 heating, and ventilating. When outside air is cold and inside air warm 
 and moist, the moisture is lost by condensation upon the cold window 
 glass. This condition prevents proper humidification and absorbs a lot of 
 coal. Storm windows are objectionable, as they restrict ventilation, can- 
 not be kept clean, are expensive, unsightly , and considerable bother, both 
 in winter and summer. Why not fit the ordinary window sash with double 
 glass, leaving one-quarter of an inch or one-half an inch of airspace as a 
 thermal insulator between the two panes of glass? If this space were 
 made airtight the glass surface within it would remain clean and the 
 indoor surface would not act as a condenser and heat absorber. The sav- 
 ing in fuel would, I think, more than offset the expense. Also in extremely 
 hot weather the outside heat could be more effectually shut out." 
 
 Reply. — The method would save heat. It would not help much with 
 humidity. 
 
 Keeping Warm at Night. — Athber writes: "I am 61 years young and 
 in robust health. I occupy a large room on the second floor at the south- 
 west corner of a detached house. There are three large windows in the 
 room, one at either side of my double bed and one below the foot of the 
 bed. The last window I use for ventilation at night. My habit is to have 
 the lower sash up as far as it will go, which gives an opening of four feet 
 wide by three feet high. The last two nights I have been miserably cold. 
 The first of these nights I had it open the full measure, and the last about 
 halfway up. The room has a polished oak floor. The bed is made up as 
 follows: Upon a box frame mattress is a forty-pound hair mattress, a 
 layer of heavy manila paper between the two mattresses, two four-pound 
 single blankets, a padded cotton comforter, two sheets, a six-pound blanket, 
 a wool-filled comforter, and another six-pound blanket. Last night I placed 
 a rug on the floor under the bed so as to prevent the wood floor from 
 drawing the heat out of the bed. Seldom do I use all the top covering 
 above named, but during the last two nights all of it did not keep me warm. 
 I have always been under the impression that I required less bed covering 
 than is usual. Each morning upon waking the thermometer was about 
 35 degrees in the room." 
 
 Reply. — A man sixty-one years old cannot stand cold as well as when 
 he was younger however well he may feel. I suggest that you raise the 
 temperature of your room to 40°. You can do this by having more heat 
 in the surrounding rooms and the room below. You might hang a com- 
 forter on the bed posts between you and the window so as to stem the wind. 
 
 I notice that you have a paper blanket between your mattresses but 
 none over you. Put a paper blanket between the comforter and the top 
 blanket. You can add a third blanket if necessary. 
 
 When the temperature outside is below 15° always put a hot-water bottle 
 or electric heater between the sheets ten minutes before you go to bed. 
 
 If these suggestions do not suffice get a sleeping bag. The larger 
 drygoods stores carry them. 
 
 Outside Air Necessary. — Reader writes: "We are advised by a furnace 
 man in order to save fuel, to have both fresh air intakes to the furnace 
 come from inside instead of one from outside, trusting to opening doors and 
 windows each day to air off the house. He cites hot water and steam heat 
 
1190 VENTILATION— HEATING— HUMIDITY 
 
 as having no direct outside air. Is it right from a health standpoint as well 
 as economical?" 
 
 Reply. — The air supplying the furnace should be taken from the out- 
 side. To run the intake pipes through the basement so as in some measure 
 to preheat the air is proper. But the air as it comes to the furnace must 
 be outside air. Recirculated air is unhealthy. "Whether the heating is 
 done by hot air or by steam heat there must be air from the outside. 
 
 Storm Window Problem. — A. F. P. writes: "Do you think it wise to 
 put on a storm window that has an opening in the framework of only about 
 2x6 inches? My bedroom has the lake exposure, being two blocks from 
 the shore, and the wind has full sweep. The question arises whether I 
 should have the window put on or suffer on some bitter cold nights which 
 we are likely to have. I contend it is better to be able to throw open 
 wide the window, but, because the room is small, it is less easy to get 
 away from the breeze than if the room were larger. There is an outdoor 
 transom in the room, but the air from the top strikes me more than from 
 the bottom, and, again, the size of the room makes it impossible for me to 
 be far removed from the direct breeze. On the other hand, some winter 
 nights are so cold that a storm window would afford considerable protec- 
 tion, but the landlady will provide only the one with the small slide." 
 
 Reply. — A bedroom should not have storm windows. The heat should 
 be turned on and the windows should be left enough open to keep the 
 temperature of the room during sleeping hours at or around 50°. The 
 humidity should be around 70. A humidity anywhere between 60 and 
 80 is proper for a bedroom during the night hours. 
 
 So much for the use of the room for sleeping purposes. If you can 
 sit in some other room in the house the problem of your sleeping room is 
 easy. If you must use it as a sitting room I suppose you will be com- 
 pelled to have the storm sash and the small opening but do not have the 
 sash put on until Christmas and have it taken off by March 1. If you 
 keep your room temperature as high as 70° on days when the outside tem- 
 perature is lower than 10° above a lot of air will come in through the 2' x 6' 
 opening except when a strong west wind is blowing. I judge your room is 
 on the east side of the house. A strong west wind will always cause your 
 transom to act as an inlet and your window as an outlet. 
 
 If you are employed during the day and spend no more than four 
 waking hours a day in your room again the problem is easy. Equip your- 
 self with a good warm wrap, woolen stockings and slippers of wool-lined 
 sheepskin. Use these and do without the storm window. 
 
 Cold Sleeping Quarters. — W. B. J. writes: "Is a lower temperature 
 than 30° not as good as from 30° to 50°? For instance, the writer 
 had constructed a room or inclosed porch at the rear of his residence 9x9 
 feet exposed on three sides, containing two windows on each of the three 
 sides 2x5 feet, which are on hinges and can be kept open any distance 
 desired. Naturally the temperature in such a room is the same as it is in 
 the open air. Would you consider such a room in which the temperature 
 goes below zero at times injurious to the occupant?" 
 
 Reply. — The sleeping arrangements described by you are most ex- 
 cellent. The room will not be injurious. On the contrary, using it will 
 make you sleep better, feel better in the morning and do a better day's 
 work as well as make you less susceptible to colds, pneumonia and con- 
 
HEATING 1191 
 
 sumption. A lower temperature than 30° to 50° for a person prop- 
 erly equipped is advised unless there are individual difficulties. 
 
 Have Fresh Air Enter. — W. G. writes: "Some months ago you cau- 
 tioned your readers not to have a gas water heater in the bathrooms, 
 unless it is connected with a chimney, saying that there had been deaths 
 traced to that practice. 1. I wish to know if it is not equally true that the 
 burners of a gas range would be also unhealthy, unless there was a hood 
 over tjie burners and connected to a chimney. 2. Does the contact of the 
 hot gases with the cold water pipes generate a by-product, different from 
 that which arises from the fire of an open range? If so, what is it? I 
 know of some recent instances when people were made sick and one of them 
 fainted from using a hot-water heater not connected with the chimney. 
 Hence I wish to know about the gas range, so as to take whatever precau- 
 tions are necessary to be safe." 
 
 Reply. — 1. Yes. The danger is not as great because the room is better 
 ventilated. 
 
 2. It prevents complete burning of the gas. Thus the air of the room is 
 fouled by some unburned gas, some little soot (or unburned carbon) ; the 
 oxygen is used up and carbonic acid and a little carbon monoxid are poured 
 into the air. Use a stove with a flue or chimney. See that fresh air 
 enters through the windows. 
 
 Proper Heat for Flats. — W. A. N. of Urbana, III., writes: "Will you 
 kindly inform us what is considered the proper temperature for a steam- 
 heated fiat building? We keep our house from 70° to 7-4° from 7 a. m. to 
 10 p. m. and some of our tenants complain of being cold. I tell them that 
 most doctors advise 68° to 72°. Am I about right or not?" 
 
 Reply. — Sixty-five to 68° is right for all the rooms except the bathroom 
 and the dressing room. These should be at 72°. Bedrooms after 10 o'clock 
 at night should be kept below 55° and better still below 50°. If your ten- 
 ants complain of cold when the temperature as shown by a wall thermome- 
 ter is at 74° two conditions exist — either the air is too dry or the room air 
 six feet from the floor is 74° or over with the room air six inches above the 
 floor under 70°. 
 
 Recirculating System Bad. — J. M. R. writes: "Which is the best heat- 
 ing system — steam, hot-water, or hot-air furnace? You said in one of 
 your articles that the humidity of steam-heated rooms is too low, and the 
 air is too dry, which is correct? Is hot-water heat any better? What do 
 you think about a hot-air furnace properly installed and with two cold-air 
 returns, one for outside air and one for inside® The inside should be used 
 when we have stormy weather." 
 
 Reply. — Most of these questions have been answered in this chapter. 
 The hot-air recirculating system is bad. 
 
 Keeping Warm Problem. — L. W. L. writes : "Can out-of-doors sleeping 
 and living in cold rooms be carried to such an extent that the body cannot 
 supply sufficient heat?" 
 
 Reply. — Sleeping and living out of doors does not interfere with the 
 heat producing functions of the body. If anything, these are stimulated. 
 The problem of keeping warm while outdoors or sleeping outside resolves 
 
1192 VENTILATION— HEATING— HUMIDITY 
 
 itself into one of muscular activity during the day and sufficient covering 
 during the night. The body will produce more heat when sleeping out in 
 the cold well covered than it will in an overheated room indoors. 
 
 Correcting Furnace Trouble. — A. E. P. says that E. C. B.'s furnace 
 trouble was due to an improper arrangement of the cold-air intakes. Last 
 winter he had trouble keeping his house warm. He studied the air intakes 
 and this winter readjusted them. In consequence he has had no trouble 
 keeping his house at 68° to 75° this winter in spite of the cold weather. 
 - Last winter he used twelve tons of hard coal, this year (to February 15), 
 seven, to heat a twelve-room house. He thinks a water pan inside the hood 
 of the furnace will rust it. 
 
 Reply. — A way can be found to keep up the humidity and prevent 
 rusting. Inside the hood is the best plan for the water pan. 
 
 Not As Healthy. — F. J. W. writes: "Please state whether in your 
 opinion the heat from a gas stove is as healthy as the heat from a coal 
 stove where there is not any steam heat, ventilation being secured by 
 open windows at the top and bottom?" 
 
 Reply. — As they are usually built, no. If there is a pipe to the out- 
 side and there is never any gas odor it will do. 
 
 Steam Heat Itch. — 8. H. writes: "I have lived in steam-heated flats 
 for the last eleven years. Every year, as soon as the steam is started, I 
 have the most intolerable itching and burning of the skin. My 3-year-old 
 boy is affected in the same way. It does not seem to be hives — at least, 
 there is no breaking out. Bathing seems to make it worse. I have rubbed 
 myself with olive oil and cold cream, without any benefit. Of course, I 
 suppose it is due to the excessive drying of the air by the radiators, which 
 are nearly all low, and putting pans of water on them is out of the ques- 
 tion. Lately I have been putting wet blankets on them. Will you suggest 
 something for me to put on my skin? You have mentioned an instrument 
 for measuring the humidity of the air. I have forgotten its name. I 
 should like to get one. What I cannot understand is that, of all the people 
 whom I know who are living in steam-heated flats, I have never heard 
 anyone complain of suffering as I do." 
 
 Reply. — Several have written to me complaining of itching of the kind 
 described by S. H. We know that it is a disorder from which many 
 people suffer. It begins in the autumn and keeps up until the heat- 
 ing of flats is stopped the following spring. Frequent bathing is of 
 service but nothing is of much avail except to get out of steam-heated 
 quarters. 
 
 S. H. is right. It is due to low humidity. The average relative humid- 
 ity of a steam-heated flat after the weather gets cold will not be far from 
 25. At 75° F. each cubic foot of air wants about 10 grams of water. It 
 has about 2.5 grams. In trying to get the balance it dries the skin so as 
 to produce this itching. What is of more consequence, it dries the throat 
 and lungs so as to produce a proneness to colds, sore throat, pneumonia 
 and consumption. It does no good to use oils. The remedy is : 
 
 Change climate so as to get rid of the need of artificial heating, or 
 
 Change quarters by finding a living place where the air is more 
 humid, or 
 
HUMIDITY 
 
 1193 
 
 Change the temperature of the room to say 60° when the air will not 
 be so thirsty for water, or 
 
 Change the humidity by having a stream of steam blowing into the 
 room or by having evaporating devices on the radiator. 
 
 HUMIDITY 
 
 FROSTED WINDOWS 
 
 As you go along the street in winter you will notice that some of the 
 windows are clear and others covered with frost. Some of those which are 
 clear are so because of fans which blow the warm air of the room against 
 them, others because of large radiators beneath them, others 
 because of double windows with a clear space between them, 
 and still others are free from frost because the air in the 
 rooms is so dry that it has no moisture to deposit. 
 
 Nothing is more frequent than to have janitors object 
 to humidifying the air of the rooms because it makes the 
 windows sweat and frost. That may be all right from the 
 janitor s point of view but it is all wrong from the point 
 of view of the woman who is to breathe the air. And 
 whose say should go? 
 
 When air is at 72° and has 50 per cent humidity it 
 is not far from right. If anything chills it to 52° the dew 
 point is reached and the water of the air precipitates on 
 the cold surface. On a cold day the window glass is far 
 below this temperature and it follows that if there is not 
 water on the glass there was little in the air — too little 
 for the health of human beings. 
 
 Of this you can be certain: the house where the win- 
 dows do not sweat and frost is not fit for human habitation. 
 The school with clear windows is wasting the taxpayers' 
 money, the teachers' time and the pupils' health. The 
 office with clear windows is a place where employees have 
 more than the average of colds, pneumonia and minor 
 infections. 
 
 When the weather gets warm sweating windows have not the same 
 significance. At that season they mean humidity which is too high for 
 comfort and, in some measure, for health. In midwinter beware the house 
 that has not frosted windows. 
 
 And what is the objection to frosted windows? None that I can see. 
 They soften the light and make it even better for purposes of illumination 
 than the direct rays of the sun. I have never heard any objections to sweat- 
 ing windows and walls that had any force to them. Of course, if the 
 moisture on the walls is so extreme as to cause the paper to loosen, that is 
 a different matter. But walls which chill enough to sweat like that are 
 too cold to be sanitary. 
 
 Fig. 487. — Hygrom- 
 eter Composed 
 of Wet and Dry 
 Bulb Thermom- 
 eters. 
 
1194 
 
 VENTILATION— HEATING— HUMIDITY 
 
 METHOD OF HUMIDIFYING 
 
 Recently Dr. Peter Bryce of the Canadian interior department de- 
 scribed for me a method of humidifying a house heated by hot water. 
 He has used the method for several years in his own home and has had no 
 difficulty in maintaining a humidity of 50 and even a little above. Incident- 
 ally he has had no difficulty in keeping the ferns growing in the house in 
 healthy condition. 
 
 In his hot-water heater there is an evaporation chamber. This is fed 
 from a tank located a few feet from the heater. The tank is of the type used 
 in toilets. 
 
 It is provided with a float valve of the type used in toilet tanks. This 
 
 pIT^" 
 
 flocr^? Cold Air Inlet 
 
 lafTl 
 
 
 City Water 
 
 -Suppty Tank 
 
 ^Inlet tc Reservoir 
 
 Heater 
 
 Hepterv 
 
 ■:>:jr: - ;,\<^ 
 
 --.-•/-; 
 
 ■Section through fresh 
 . Air Inlet and Ducts. 
 Expansion Pipe 
 utlet For Steam 
 
 Point where/ 
 fresh Warmed 
 Air and 5team 
 Mingle on Way 
 to feqister 
 
 t ;fF^r?f' : --.^7r -_ ^--T^-r-TT^^-v--',^-^- ,<t^ ; - 
 
 Fig. 488. — Bryce Method op Humidifying a House Heated by Hot Water. Steam is gen- 
 erated in the firepot of the water heater. The steam is discharged into the air intake. 
 The steam discharge pipe runs for some distance in contact with the air pipe before discharging 
 into it. ('Domestic Engineering.") 
 
 valve regulates the feed from the tank to the evaporating pan. From this 
 pan there is a duct which carries the steam to the rooms. 
 
 Somewhere along the way this duct is joined by the fresh-air duct. 
 The fresh-air duct lies on top of and in contact with the steam duct. The 
 fresh-air duct is divided by a vertical partition into two ducts except for 
 a short distance. One of these ducts we will call A, the other B. 
 
 The fresh air flows along a duct to the end of the partition, then around 
 the end into duct B, then along duct B to an opening into the steam duct. 
 The object of this arrangement is to warm up the fresh air before it mixes 
 with the steam. 
 
 If the ducts are long enough to warm the air in the length of a single 
 tube the partition can be omitted so that the air is not carried around 
 a sharp curve with the consequent mechanical difficulties. The mixture 
 of steam and warm air then flows directly into the rooms. 
 
 It is to be understood that this is a ventilating arrangement. The 
 heating is done by hot water in coils. As a ventilating arrangement it 
 does not do away with the possibility of using the windows to freshen the 
 house air from time to time. 
 
 In 1887 Dr. Bryce read a paper before the International Congress 
 
HUMIDITY 1195 
 
 of Medicine on the harm done by dry house air. At that early date he 
 recognized that ordinarily heated house air dries out the mucous membrane 
 whereupon these structures permit the germs of colds, pneumonia and con- 
 tagion to get by. 
 
 Since he devised this method of humidifying he has checked its efficiency 
 with an hygrometer. His opinion that it furnishes a solution of the prob- 
 lem of humidifying a hot-water-heated house is worthy of belief. 
 
 Sometimes we are told that humidifying the air will save coal. This is 
 not true. Kimball says: 
 
 "A simple calculation will demonstrate that, approximately, four times as 
 much fuel is required to evaporate the water required to produce 50 per 
 cent humidity at 68 degrees as is saved by reducing the temperature from 
 76 to 68 degrees." 
 
 WHY FLOWERS DIE 
 
 When a woman has bought a nice fern in a pot of good, black dirt 
 she wants to have it live. She places it in her sitting room and takes pride 
 in its care. Presently she is distressed to find it dying. In her eagerness 
 she may visit a florist to discover how he succeeds in keeping his plants alive 
 while she fails. 
 
 If she goes to his greenhouse she will find the temperature around 70° ' , 
 the humidity around 90, the ground fairly moist, and the plants getting some 
 sunlight every bright day. When she goes back she finds that her plant is 
 in air which is at 80° , with a humidity of 20, and maybe sunlight does 
 not strike it. If she modifies the conditions her plant will live; otherwise it 
 will not. She can bring the temperature as low as 70° . She cannot bring the 
 humidity up to 90 but she can bring it up to kO or 50 and she can give her 
 fern some sunlight on days when the sun is shining. 
 
 Now people should have flowers in their offices and living rooms. They 
 are esthetic and pretty and add to the charm of one's environment. Deep 
 down in the heart of man there is a desire to see things live and grow. But 
 these are of small importance as compared with the next three points. 
 
 Where there are animals plants are needed to maintain an atmospheric 
 equilibrium ; a city in a garden, a factory in a park, a house with flowers repre- 
 sent wisdom from the health and efficiency standpoint as well as from the 
 esthetic. 
 
 Plants take up moisture from the ground and feed it to the air through 
 their leaves; they condition the air for human occupation; and, finally, 
 whether they thrive or die is a gauge by which the fitness of rooms for 
 habitation can be determined. When rooms are so bad that flowers will 
 not live in them wise people will move out. It is said that when rats 
 are seen leaving a ship it is time for the passengers to get on rafts — when 
 flowers die it is time for the occupants to get wise. 
 
 WET BULB THERMOMETERS 
 
 The humidity of the air is measured by an instrument called a hy- 
 grometer. The instrument advised consists of tivo thermometers set side 
 by side. The bulb of one of these is surrounded by a loosely woven wick. 
 
1196 VENTILATION— HEATING— HUMIDITY 
 
 This wick draws water from a near-by cup so that from the surface of thisi 
 bulb water is evaporating continuously. 
 
 This thermometer is called the wet bulb thermometer and its companion 
 the dry bulb. 
 
 From the difference between the reading of these two thermometers the 
 humidity of the air is found on a table attached to the instrument. There- 
 fore, when one uses this kind of a hygrometer he has two thermometers at 
 his service — one of the ordinary kind called the dry bulb and one of a kind 
 new to him, the wet bulb. 
 
 Under ordinary office conditions in January he will find that the dry 
 bulb thermometer registers about 16° higher than the wet bulb, say 72° 
 and 56° respectively. 
 
 In talking about temperatures we always speak of the temperature shown 
 by the dry bulb thermometer. Now, a group of physiologists are saying 
 that the thermometer we ought to go by is the wet bulb. If we do we shall 
 have to get new notions about temperatures altogether. Their argument 
 is that the human body is a wet bulb and not a dry bulb. A man evaporates 
 one or two pints of sweat from the skin every day. Therefore he is a 
 wet bulb. 
 
 On this basis the temperature of the room is 56° instead of 72°, as he 
 thought. Somehow he felt a little cold but it could not be — the thermometer 
 read 72°. 
 
 If a man were to fall in a pond and go around with his wet clothes 
 on he would be a wet bulb. As it is he is only a slightly moist bulb. Tc 
 figure him on the same basis as the wet bulb is to overstate the case. 
 
 A compromise somewhere down the line, say about half way, would hii 
 it off — such as to say that the temperature of the room for anything that is dry 
 is 72° and for anything that is wet 56°, while for everything about as moist 
 as a man it is 64°. 
 
 There is no doubt at all that the discomforts of extremes of temperature 
 are better measured by the wet bulb than the dry bulb thermometer. 
 
 It is when the wet bulb thermometer shows over 70° that men keel over 
 in laundries, in kitchens and in some factories. It is when the wet bulb ther- 
 mometer shows under 56° that the throat dries out and colds are contracted, 
 that the skin dries out and winter itch develops. 
 
 If a person can only afford one thermometer a wet bulb will tell him 
 more than a dry bulb; yet he ought to have a dry bulb as it is what every- 
 body refers to when they speak of temperatures. 
 
 The fact is, everyone should have both. It would pay to save in some 
 other direction. 
 
 A PRACTICAL SUGGESTION 
 
 The suggestion relates to a method of humidifying air in a room 
 heated by steam. On the market there are several devices which are to be 
 attached to the radiator for the purpose of allowing steam to escape. The 
 practice is to attach this device to the far end of the radiator, the end at which 
 the steam leaves the coils. 
 
 One objection to these devices is that when several of the coils are 
 filled with water, as often happens with poorly installed heating plants, 
 
HUMIDITY 1197 
 
 water escapes from the humidifier. The far end of the radiator is the water 
 end. When the water condenses in the coils that end catches most of it. 
 When the steam is turned on it blows the water from the forward coils to 
 those at the far end. 
 
 The suggestion is that the humidifier be attached at the front end — 
 the end where the steam enters, the end where you turn the steam on, the 
 dry end. Generally the radiator coils have a plugged opening in this first 
 coil. It has threads ready for the threads of the humidifier. By attach- 
 ing the humidifier at this end water will not leak from it. 
 
 Professor Shepherd of the Chicago Normal College and a member 
 of the Chicago Ventilating Commission reported the results of his investiga- 
 tions to the International Congress of School Hygiene. He found that proper 
 humidity was most essential for the welfare of students and that ordinary 
 schoolroom ventilation methods do not give proper humidity. In fact, 
 schoolroom air generally is well below 30 per cent humidity, less than half 
 of what it should be. 
 
 The comfort zone of the pupils under investigation was found to be 
 fixed by temperature and humidity. One end of the comfort zone was 64° 
 Fahrenheit and 55 per cent humidity. The other end was 70° Fahrenheit 
 and 30 per cent humidity. 
 
 With a close, snug house we cannot have a humidity higher than 20 
 on a cold day without some form of humidifier. Humidifying a room heated 
 by a stove, hot air or steam is not a difficult matter. How to do it is 
 now generally known to those who are manufacturing heating appliances. 
 It is up to the consumer to see that he gets proper apparatus. 
 
 DRY AIR 
 
 Now is the winter of our discontent 
 
 Made glorious summer by this sun of York. 
 
 Shakespeare tells us that Richard III (Act 1, Scene 1) thus expressed 
 himself after the triumph of the White Eose faction. Converting winter into 
 summer did not stop with the days of Eichard III. Suns of York, now called 
 radiators, hot-water pipes and hot-air flues, are converting winter into summer. 
 Most people spend the greater part of the day in winter in hot air — air 
 that is hotter than room air in summer. 
 
 In summer they take their warm air in the open. In winter they take 
 it in closed rooms. In summer the hot air was heated while in contact with 
 lakes, rivers and wet ground. In winter it is heated while in contact with 
 iron pipes and dry walls. 
 
 The following figures are taken from an article by McCurdy in the 
 Heating and Ventilating Magazine: 
 
 "With atmospheric pressure at approximately 30 ins. and the tem- 
 perature at degrees Fahrenheit, a cubic foot would hold 0.481 grains of 
 moisture; at 32 degrees F., it would hold 2.113 grains of moisture; at 60 
 degrees F. it would hold 5.745 grains; and at 70 degrees F. it would hold 
 7.98 grains. 
 
 "Vapor or space at degrees F. and 50 per cent relative humidity would 
 
1198 VENTILATION— HEATING— HUMIDITY 
 
 contain approximately 0.2-1 grains of moisture per cubic foot. This vapor, on 
 being heated to 70 degrees F., would still contain its absolute humidity 
 of 0.24 grains of moisture per cubic foot, but its relative humidity would 
 drop from 50 per cent to 3 per cent, except as the air passages and skins of 
 pupils became water jugs which were continually emptying water from 
 the bodies of the pupils into the air of the room. 
 
 "Air at 32 degrees F. and 50 per cent relative humidity would con- 
 tain approximately 1.056 grains of moisture per cubic foot. This air, on 
 being heated to 70 degrees F., would then have a relative humidity of 13 
 per cent unless moisture was added from the pupils, walls, or fixtures in the 
 rooms." 
 
 This summer air in winter time is drier than the air of Arizona or any 
 other dry region in this country. It dries out the skin causing winter 
 itch; it dries out the hair causing baldness; it dries out the nose causing 
 colds; it dries out the tonsils causing enlarged glands; it evaporates mois- 
 ture from the skin so fast as to make us feel cold even when the air is over 
 70°. 
 
 If we are to have this summer in the winter time let us duplicate the 
 entire process. Let us have some rain; or by some sort of device bring the 
 humidity of the room air up to the summer standard. 
 
 The first step is to know. To have thermometers exposed here and there 
 is an excellent idea, To have hygrometers exposed just as abundantly is 
 just as good an idea. 
 
 For several years I have advocated hygrometers in the schoolrooms. 
 I have not heard of anybody putting the plan in practice but somebody will 
 before long. In time it will become universal. 
 
 When the people learn the facts they will proceed to remedy the bad 
 conditions. Humidifiers are on the market. They are not so well developed 
 as heaters but the engineers have not been working on the problem so 
 long. At the present time there are several types of humidifiers on the 
 market. 
 
 The man who insists will get a humidifier in his hot-air furnace. The 
 indifferent man will not. The man who insists will get humidifiers on his 
 radiators. 
 
 Not until the air is properly humidified will the winter of our discontent 
 be made glorious summer. 
 
 GET THE HYGROMETER HABIT 
 
 If you will turn to the weather report on the first page of almost any 
 newspaper you will find the temperature and the relative humidity among 
 the items of information. By a relative humidity of 90 is meant that the air 
 contained nine-tenths as much moisture as it would hold at that temperature. 
 In hot weather when the humidity is over 90 the days seem much hotter 
 than the temperature shows they are. In cold weather with the same relative 
 humidity the days seem colder than they are. 
 
 When the relative humidity is around 70 conclusions drawn from your 
 feelings jibe with what the thermometer says about it. The discomfort of 
 the climate of the lake cities is due to their high humidities. It is by reason 
 
HUMIDITY 1199 
 
 of better humidities that inland cities — for example, Minneapolis, St. Paul, 
 and Denver — have the advantage of us. 
 
 But the purpose of this section is to tell of indoor humidities. The 
 Commission of Labor of New York has found that the following trades usually 
 work in places with a harmfully high humidity: Printers, clothing makers, 
 bakers, pearl button makers, cigar makers and laundry workers. The list is 
 incomplete. Discomfort, harm and lowered efficiency come from working in a 
 place with a high humidity. Artificially heated schools, offices, some stores 
 and all living rooms have a harmfully low humidity ranging from 50 down 
 to 10. 
 
 So while we are getting good habits let us get the hygrometer habit. Hy- 
 grometers are cheap and almost as easily read as thermometers. Bedrooms 
 should have them but they are more needed in living rooms. Schoolrooms- 
 certainly should have them. Offices are much more in need of them than 
 of registering clocks. All factories and workshops should be equipped with 
 them. 
 
 Then, when they are installed, somebody should make a record of what 
 they show. The manager of a factory or large office should have the records of 
 temperature, humidity and absences from sickness placed on the desk every 
 day. In larger and better organized plants these records should be supple- 
 mented by efficiency data. 
 
 RAIDING THE HUMIDITY 
 
 Much the best thing to do to raise humidity is to have a steam jet dis- 
 charging steam into the room. This can be done by removing the small vent 
 and substituting for it a tube long enough to discharge the steam away from the 
 wall and to prevent water from blowing into the room. Steam discharging in 
 this way makes a noise and, occasionally, results in odors. If the radiators are 
 so arranged that the condensation flows back to the basement the tendency to 
 squirt water is reduced to a minimum. 
 
 Ordinary pans of water on the radiators help but little. The evaporation 
 from them cannot possibly raise the humidity more than ten points. Humid- 
 ifiers help but little. The water surface exposed to the air is not large enough. 
 
 Next in efficiency come kettles of water setting on the stove. More 
 steam will escape from the spout of a tea kettle than will rise from a pan 
 one by two feet. 
 
 Next come growing flowers. If several boxes of growing flowers be 
 kept in the room and the soil kept as wet as they will stand soil evaporation 
 and plant exhalation will add much moisture to the air. 
 
 Next comes a sprinkling fountain. A small spray nozzle can be attached 
 to an ordinary tap and turned on just strong enough to get a fountain 
 effect; or a small electric fountain can be installed. It will seldom be neces- 
 sary to go to the expense of a more elaborate fountain. 
 
 Next come large coarse sponges placed in pans of water. There should 
 be several of these, a dozen in an ordinary sized flat. The cheaper, coarse- 
 grained sponges serve best. The closer they are placed to the heat and the 
 more the air circulates over them the better. 
 
 Next come pans of water. These should be kept on the radiators and 
 
1200 VENTILATION— HEATING— HUMIDITY 
 
 near the intakes. The pans should present the largest possible surface to 
 the air. Pans which are less than one foot wide and two feet long do not 
 do much good. By using two such pans and placing them on the radiators, 
 the humidity can be raised about ten degrees. 
 
 Lastly comes the use of patent humidifiers. These hang on the radia- 
 tors and the water in them gets approximately as warm as the radiator coils. 
 
 Arrangement for Humidity. — H. B. W. writes: "Relative to your re- 
 marks from time to time as to keeping the humidity of the air in living 
 rooms at a certain point, I have found that common lard pails suspended 
 in hot-air registers on sticks (laid diagonally across the air ducts) will aid 
 materially, provided water is kept in them. My experience is that they 
 need to he filled about twice in three weeks, although this would probably 
 vary according to the heat coming up from the furnace. At any rate, the 
 scheme has this to recommend it — it costs nothing and will certainly do 
 away with a large percentage of the dryness caused by hot-air heat." 
 
 Reply. — There are several kinds of hygrometers. The one best adapted 
 to household, office, and factory use is composed of a wet and a dry bulb 
 thermometer. A dry bulb thermometer is an ordinary thermometer. When 
 this reads 70° and the wet bulb reads 63° the humidity is 68. A dry bulb 
 reading of 70° and a wet bulb of 62° means 64 humidity; 61° means 60; 
 60° means 56; 59° means 52; 58° means 48; 57° means 44; 56° means 40; 
 55° means 36; 54° means 33; 53° means 30; 52° means 26. 
 
 A great many people write that they are surprised at the low humidities 
 which they are discovering. Some of these relate to living rooms, some 
 to offices, and a few to factories. 
 
 In the natural course of time the humidity of rooms will get lower as 
 the winter progresses. By January the walls will be dried out and the fur- 
 naces and boilers will be harder pushed. The room humidities will cer- 
 tainly average ten degrees lower than at the present time (November, 
 December). 
 
 More people are asking how the humidity can be raised. 
 
 When an ordinary living room temperature is kept at 70° it is difficult ' 
 to bring the humidity above 40. If there is steam heat a jet of steam dis- 
 charging into the air can be so arranged as to bring the humidity to 70. 
 The objections are the odor and the noise. 
 
 If there is no steam water can be evaporated by humidifiers, pans of 
 water, wet towels and wet cloths, fish bowls, fountains, tea kettles on the 
 stove and so on. 
 
 The greater the evaporating surface and the warmer the water the 
 greater the evaporation. The stronger the air currents over the water the 
 more effective the evaporation. 
 
 With improvised evaporators it is almost impossible when the tempera- 
 ture of the room is 70° to get the humidity on a cold day over 40. 
 
 Cold bedrooms and cold schoolrooms are different. When the windows 
 are thrown open and the temperature is 55° the humidity will be around 
 70 without, the use of any humidifiers. 
 
 Ideal Humidity: — T. L. D. writes: "What is the ideal humidity for 
 living and sleeping rooms, and how can it best be obtained and regulated?" 
 
 Another writer asks what is a hygrometer. Still another asks what 
 type is recommended, 
 
HUMIDITY 1201 
 
 Eeply. — The ideal relative humidity is 70. A sleeping room should 
 have at least one window wide open. Under these circumstances the 
 humidity takes care of itself. A living room should have a temperature 
 of 68° F., as shown by the dry bulb or ordinary thermometer, and a wet 
 bulb thermometer recording 61° F. Seven degrees difference in the wet 
 and dry bulb thermometer readings means a relative humidity of 67. To 
 get this humidity it is necessary to expose vessels of water in the room, to 
 use some of the humidifiers, of which there are many on the market, or to 
 have a small nozzle attached to the steam radiator in such a way that 
 steam will blow into the room. 
 
 What is a hygrometer? There are four types in use; the wet and 
 dry bulb hygrometer, the sling hygrometer, the hair hygrometer and the 
 small cheap weather indicators. Of these the wet and dry bulb is to be 
 preferred. They are not patented. They are made by different people and 
 can be had at any instrument store. The apparatus is really a thermometer 
 and a humidity measurer combined. The dry bulb thermometer costs $1; 
 a fairly good hygrometer consisting of two thermometers, water carrier, 
 wick and tables costs $2.25 to $2.50. A person owning a hygrometer needs 
 no additional thermometer. 
 
 Dry Air Explanation. — W. H. S. writes: "Dry air in a room, I am 
 told, irritates the lungs. Dry air in the higher altitudes is a tonic and is 
 healthful — or something like that. I have asked several physicians, but 
 so far have received nothing more than that it seems to be so. I get no 
 reason for the difference. If you think it worth while please explain." 
 
 Eeply. — The common way of putting this question is: If dry air in 
 the arid regions is good why is dry air in a schoolroom or office bad ? The 
 answer is : The dry air of an arid region is good for one condition — con- 
 sumption. It is not good for the skin or for the general run of disease. 
 
 The air in the arid regions is never so dry as is the air of the school- 
 room. In Arizona the humidity is usually around 50; in the schoolroom 
 it is around 20. 
 
 In the arid regions all the air is dry. In a moist climate where only the 
 schoolroom air is dry the person spends several hours a day in air around 
 20 and the balance of the day in air around 90. Where the outside air 
 has a temperature of 40° or below and a humidity of 90 and the inside 
 air a temperature of 70° or above and a humidity of 20 or below, the 
 mucous membranes of persons passing from the one to the other condition 
 are put under great strain. 
 
 Bad Air Effects. — F. C. P. writes: "1. What are the bad effects of air 
 lacking moisture? What amount of water should be evaporated daily in a 
 room 16' x 16' with ten-foot ceiling, heated by hot water? 2. What is the 
 best, quickest, and simplest method of supplying moisture in air? It seems 
 almost impossible to evaporate a large quantity by simply letting water 
 stand. 3. Are there quicker methods and what are they? If. Is there an in- 
 strument for measuring the moisture in air? 5. Could you name any medi- 
 cal work treating fully on the moisture in air question?" 
 
 Reply. — 1. Dries out the skin and mucous membranes. In this way it 
 predisposes to colds and enlarged glands. It causes winter itch by drying 
 out the skin. 
 
 2. One to three gallons. The amount will depend on the temperature 
 and humidity of the outside air. 
 
1202 VENTILATION— HEATING— HUMIDITY 
 
 3. In rooms heated by hot water use the Bryce method. 
 
 4. Yes; wet and dry bulb thermometer. It is called a hygrometer. 
 
 5. "MacFie on Air." 
 
 Between 50 and 70. — W. B. writes: "What is the right humidity of 
 air in living rooms? Can you give a simple and inexpensive way to keep 
 the different rooms upstairs and down at the right humidity for children 
 and others compelled to live indoors?" 
 
 Reply. — It should not go below 50 nor above 70. A hygrometer shows 
 the humidity as a thermometer shows the temperature. How you can 
 humidify depends on how you heat. The method is to evaporate several 
 gallons a day for a small dwelling and to arrange it so that the evaporated 
 moisture stays in the rooms. If the heat is by furnace the water pans 
 must be in the air chamber over the firebox. 
 
 Peril to Picture Operators. — T. T. writes: "Kindly inform me as soon 
 as possible as to the sanitation, ventilation, and health fulness of the oper- 
 ators' booths in moving picture theaters." 
 
 Reply. — About the worst ventilated places in town are the moving 
 picture theaters. There are some exceptions to this statement. The 
 booths are much the worst place in the hall from the sanitation stand- 
 point. The reasons are: 
 
 1. The booth is in the gallery where the air is hottest and filthiest. 
 
 2. The heat of the light makes the booth hotter still. 
 
 3. The films are inflammable. 
 
 4. The films usually have some specks on them and the consequent 
 flashing, when added to the dancing of the pictures, is ruinous to the eyes 
 if kept up long. 
 
 5. The visitor stays an hour or two and then goes. The operator stays 
 there several hours and is back the next day. For these reasons the 
 "sanitation, ventilation, and healthfulness" are about as bad as bad can 
 be. Quit the business and go into something safer. 
 
 Should Have Hygrometers. — Mrs. L. T. Le B. writes : "I am anxious to 
 have your opinion concerning the ventilation and general atmosphere of 
 the public schools of our town. So many pupils complain of headache and 
 bad colds are so prevalent that it seems to me that present conditions in 
 that regard may be the cause. The schools are ventilated by the fan system 
 with closed windows. 1. Do you not think that the windows should be 
 opened at the noon hour, which is between sessions, or even more often? 
 The janitors in all our public buildings are against airing, saying itns hard 
 to raise the heat afterward. 2. -Now, regarding humidity, the schools are 
 heated by steam, with no receptacles for water on the radiators. Do you not 
 think that pans of water should be attached to every radiator? My child is 
 only one of many who return from school with a headache and feeling gen- 
 erally debilitated. Hearing so many complaints I have tried to find out the 
 cause and it seems to me that dry, foul air may be the reason." 
 
 Reply. — 1. Yes. 
 
 2. Yes, though they will not help much. Not enough water will be 
 evaporated. A better plan is to allow steam to discharge from the radiators 
 into the room. A fan system does not give ventilation sufficient for health 
 and as usually installed is productive of just the kind of ill health described 
 in your letter. 
 
HUMIDITY 1203 
 
 I wish you could persuade your school authorities to equip your schools 
 with hygrometers and then to have hourly observations recorded showing 
 the temperature and humidity. With this information in hand your board 
 will be in a position to plan improvements and you will be equipped with 
 information on which you can stand in demanding improvements. 
 
 Have Humidifier Attached. — W. G. writes: "I have steam heat in my 
 house, and have a hygrometer. However, I am ignorant of what the proper 
 humidity should he, and the table with the instrument fails to tell. As my 
 radiators are closed ones, I cannot admit moisture from them through an 
 air valve, as was recommended by you some time ago. I notice that dishes 
 placed on radiators do not seem to produce much effect. A concern in 
 New York is making small fountains run by a little electric motor and 
 pump, throwing the water in a spray a foot or more into the air and con- 
 tinuing as long as the current is turned on and the basin contains water. 
 This is made primarily for ornamental purposes, but if run for an hour 
 or so a day, would it provide the proper humidity f I do not know where 
 to find anything made for steam radiators to provide humidity." 
 
 Reply. — Around 50 is the best humidity, all things considered. A 
 steamfitter could attach a humidifier to your radiator. I have had no 
 experience with the spray device but my offhand opinion is that it would 
 give you enough humidity. 
 
 Dry Air and Moist. — J. V. N. S. writes: "I see you seem to hint that 
 dry air is unhealthy, and the same may be said of a dry climate. Are not 
 those cities situated in a dry climate the healthiest? I should like to see 
 the proof that moist air is healthier than dry air. My residence is a two- 
 story brick house, fairly large, with a basement. It is heated with hot 
 air. The first two years, water was kept in the furnace boiler, damaging 
 paper, curtains, and furniture in the rooms. For forty years my house 
 has been heated without water in the boiler. My family has breathed the 
 driest air that it was possible to make, and it would be difficult to find a 
 healthier family. I have not had the appearance of a cold for more than 
 two years. From cellar to garret, we have endeavored to keep the air in our 
 house as pure as the air out of doors." 
 
 Reply. — A dry climate is better for certain diseases than a moist one. 
 On the other hand a moist climate is better than a dry one for other 
 diseases. The dry climate of the West is better for consumption than the 
 moist one of Illinois. 
 
 However, a distinction should be made between the effects of dry 
 outside air and dry inside air. If you have been going around out of doors 
 in an atmosphere with a relative humidity of 90 and then go into a 
 house where the relative humidity is 25 you will suffer from the change. 
 The inside humidities which do harm are those that are under 50. There 
 is no climate where people live which has a humidity as low as this. 
 
 On the other hand, if the air in a room has a humidity over 70 it is 
 distinctly bad. My contention is that healthy air is air which is not too 
 wet and not too dry. The humidity of inside air must not be more than 
 forty points lower than that of the outside. 
 
 You have been fortunate in escaping colds but it would not be possible 
 to draw any conclusion as to why you have escaped them without knowing 
 more about you and also more about the humidity in your house. For all 
 that your letter conveys the humidity may be pretty high. 
 
1204 
 
 VENTILATION— HEATING— HUMIDITY 
 
 Good Compromise Humidity. — J. W. S. writes: "We have a pan of 
 water two and one-half by six feet in each fan of our schoolroom, which 
 is kept boiling by means of steam pipes, and all this vapor goes along 
 with the air into the schoolrooms. We are thus able to increase the humid- 
 ity in our schoolrooms from 12 to 18 per cent above what it would be if 
 
 Louisiana Health Almanac. 
 Fig. 489. — Kentucky Type Privy with Septic Tank. 
 
 the vapor were not added. On the cold, clear days the highest per cent 
 of humidity we are able to get by this method is about 1/.5. Will you kindly 
 tell me what should be the per cent of humidity in our schoolrooms? I be- 
 lieve we can increase our humidity by increasing the size of our evaporating 
 pans in our fan rooms." 
 
 Eeply. — The humidity should be 70 but 45 is a very good compromise. 
 Your walls would sweat disagreeably if you went much higher; that is, if 
 you heat by hot air introduced on the inside wall. Shallow pans of water 
 kept boiling by steam pipes constitute an excellent method of raising 
 humidity. You are doing well. 
 
 Radiators and Humidity. — M. E. R. writes: "Will you kindly explain 
 how you fixed your radiator to keep up the humidity, a matter to which 
 
HUMIDITY 
 
 1205 
 
 you made reference some days since? We have hot water heat, and have 
 several galvanized iron cans that hang on the hack of the radiators, hold- 
 ing water which evaporates so slowly that I think they are inadequate. 
 I am anxious to hear of something better." 
 
 r>-tV ■ 
 
 yARMTJLZl l*\__ 
 
 .<&. 
 
 J^ ^^^ ^i^J^^ >sre^ -E^fegj 
 
 l^rx 
 
 *lz PLANK F« 
 I SyPPOST OF PLOi'R 
 
 
 &* 
 
 WN ON 
 
 Virginia Health Bureau. 
 Fig. 490. — Specifications for Kentucky Type Septic Tank. 
 
 Reply. — M. H. E. is right. The amount of water that can be evapo- 
 rated from an iron can is far from being enough. I bought for my radiator 
 
1206 VENTILATION— HEATING— HUMIDITY 
 
 a wood wheel air valve at a quarter or thereabouts. I screwed off the 
 small valve on the side of the radiator and screwed this on its place. When 
 I want to increase the humidity I turn the small wooden wheel and steam 
 blows into the air. When there is enough I turn it off. The objection is 
 the noise it makes. The engineers say that if everybody did this the 
 janitors would be compelled to watch the water in the boilers more closely. 
 
 There are several methods in use designed to overcome the short- 
 comings of this simple arrangement. In one group are the silencers de- 
 vised to prevent the noise. Another apparatus is one to prevent the lower- 
 ing of the water in the boiler. 
 
 At the Lane Technical High School (Chicago) the engineer, Mr. Stoltz, 
 humidifies the air by the following method : He has built two galvanized 
 iron tanks, each 60"xl8"xl8", in the hot air chamber. In each tank he has 
 placed sixty feet of one-half-inch brass pipe through which steam circulates. 
 The water in these tanks is kept at a constant level by the float valve. In 
 cold weather these two tanks evaporate 750 gallons of water a day. 
 
 The morning I was there the water in these tanks was boiling actively, 
 and a cloud of steam was rising and entering the air duct. The teachers 
 tell us the relative humidity of the schoolrooms is around fifty. They 
 say the air is pleasantly moist and pleasantly warm. Mr. Stoltz tells us 
 that he finds it easier to heat the school satisfactorily since this apparatus 
 was installed. 
 
 Call in Steamfitter. — C. S. writes: "What sort of humidifier would 
 you suggest for use on a radiator heated by 'atmospheric pressure'? It is 
 really steam heat carried from a central heating plant, but there is no 
 possible way of allowing the steam to escape into the room. Since in- 
 stalling this system I find that whereas our hot water plant kept us com- 
 fortable at 70° this heat must be 75° or I am chilly. Is it possible for the 
 difference to be caused by the different systems?" 
 
 Reply. — Your steamfitter can fit a steam discharger into your radiator. 
 A room in which the air is humidified is more comfortable at 70° than 
 one in which the temperature is 75°, but the humidity is wrong. How- 
 ever, on this point hot water heating offends just as much as does steam 
 heating. If the placing of coils is such as to heat the room unevenly the 
 occupants will complain of the cold at 75°. If the heating is even they will 
 not complain at 70°. 
 
 My guess is that the coils are not so well placed as in the old installa- 
 tion. Maybe the house is older and more cold air leaks in; so in conse- 
 quence your head is in air at 75° and your feet in air at 60°. 
 
 Plan to Increase Humidity. — P. W. A. F. writes: "Your articles con- 
 cerning humidity in dwelling houses have received my careful attention 
 and I fully realize with what difficulty the person who desires to humidify 
 his rooms which are heated by hot water radiation is confronted. The follow- 
 ing plan, I believe, will greatly aid the conditions in the average dwelling. 
 
 "This is the placing of a rather deep yet long, narrow pan between 
 each radiator and the wall and filling this pan with water. 
 
 "A large evaporating surface is then secured by suspending a sheet of 
 some absorbent material, such as loosely woven table padding, so that one 
 end is immersed in this tank and the other end extends nearly to the top or 
 the radiator and throughout its length. I shall be glad to have your opinion 
 of this plan, for I intend to put it into operation." 
 
HUMIDITY 
 
 1207 
 
 Reply. — Depends on the surface and how hot the water gets. If it 
 evaporates one to two gallons of water a day it will give excellent results 
 for an ordinary-sized living room or office with one or two occupants. The 
 simplest test is to measure the amount of water evaporated. 
 
 Virginia Health Bureau. 
 Fig. 491.- 
 
 -Cheap Sanitary Dry Earth Bucket Privy. 
 
 visw- 
 
 Efficient Humidity Plan. — X. Y. writes: "For the benefit of your 
 readers who are trying to solve the humidity problem in hot water heated 
 houses, I have thought you may be interested in a scheme which seems 
 efficient if not elegant. Underneath the radiators are placed shallow gal- 
 vanized pans, as large as the setting of the radiator will allow. (Under 
 our low radiation the surface area is 12x50 inches.) From these water 
 pans wicks are carried up between the radiator sections. For wick ma- 
 
1208 VENTILATION— HEATING— HUMIDITY 
 
 terial we find the ordinary paper towel sheets, loosely rolled, most satis- 
 factory, as they can be renewed at practically no expense when dust-clogged. 
 The amount of evaporation can be controlled by the nmuber of wicks. 
 With no wicks there is practically none, but with a goodly number we 
 have at present even with a high relative humidity out of doors a daily 
 evaporation of between three and four gallons in four rooms so fitted. 
 Whereas before installation the house humidity was about 30, we now have 
 an average of 1^3 or JfJf. with great mucous membrane comfort." 
 
 Reply. — This is very efficient. 
 
 Humidity by Pans. — H. L. 0. writes: "Is it necessary to have hot 
 water pans on hot water heat radiators to obtain correct humidity?' 
 
 Reply. — It is necessary to do something. Pans will help, though you 
 will need more moisture than they will furnish. 
 
 Use the Hygrometer. — D. D. S. writes: "Will you be so kind as to 
 outline an easy method of approximating humidity percentage? Can suf- 
 ficiently accurate results be obtained if barometric pressure is ignored? 
 If so, will you state what difference in degrees between wet and dry Fahren- 
 heit thermometers will indicate less than 50 per cent saturation, the 
 temperature (dry) being from 68° to 70°?" 
 
 Reply. — The wet and dry bulb thermometer combination called a 
 hygrometer is the simplest instrument which I can recommend. 
 
 Yes, barometric readings may be ignored in considering humidities. 
 When the dry bulb reads 70° any wet bulb reading less than 59° means less 
 than 50 relative humidity. 
 
 Room Needs Moisture. — E. H. writes: "The temperature of our rooms 
 does not go above 72° and there is constantly a window open from the 
 top about six inches in every room. The windows are never frosted in 
 weather about 16 or more degrees above zero, although in below zero 
 weather they are frosted. Is the humidity too low?" 
 
 Reply. — A room kept at 72°, with ventilation through a window down 
 six inches from the top, will need moisture. A room kept at 55° and ven- 
 tilated through wide open windows will not require additional moisture. 
 
 Humidity Should Exceed 40. — T. F. 8. writes: "I have a 'hair 
 humidometer in my office, and such a day as today — February 2 — I have 
 difficulty in keeping the humidity of my office so that it will register as 
 high as 35°. Even when placed outside my window, 150 feet above the 
 sidewalk, the humidometer registers only 31 degrees. Is it necessary to 
 have the humidity of the room higher than the outside air?" 
 
 Reply. — Hair hygrometers are seldom accurate. The government re- 
 port shows that the relative humidity at 7 a.m. on February 2 was 57 per 
 cent and at 7 p.m. was 43. Keep your room humidity at 40 to 60. In 
 Chicago in winter the outside humidity is usually higher than that. 
 
 To Make a Hygrometer. — W. C. E. writes: "Can a hygrometer (the 
 wet and dry kind which you have mentioned) be made by me from two 
 ordinary thermometers? I have two thermometers, and would like to have 
 the hygrometer. If this can be done, will you please tell me how it may 
 be done and how to read it?" 
 
HUMIDITY 
 
 1209 
 
 *£=^= 
 
 AVen+ 
 
 
 c 
 
 ^ 
 
 ^5 ewer 
 
 2^~-f/ag Stone / v^™ 
 
 ^mmdm^mir^^ 
 
 Fig. 492. — Leaching Cesspool Constructed of Field Stones. 
 
 Reply. — Take a small lamp wick, sew one end around the bulb of one 
 of the thermometers, put the other end in a small cup of water. Stop 
 in some instrument dealer's and get a table of relative humidities as shown 
 
 *5ewer+ 
 
 
 Agricultural drain 
 tile pipe 
 
 sptrips of far paper 
 laid over -fops of Joints 
 
 /-/ol/ow brick 
 /a/d radially 
 
 Manhole frame and cover 
 
 Virginia Health News. 
 
 /?////. 
 
 | era | □ □ 
 
 no 
 
 a □ \/-7 
 
 /!□□ 
 
 a □ 
 
 °°WJ 
 
 ]□□!□□ 
 
 an 
 
 □ □ \/ 
 
 |OD 
 
 □ □ 
 
 □ □IX 
 
 Derails of Hollow Brick 
 
 Fig, 493, — Hollow Brick Cesspool with Overflow into Agricultural Tile, 
 
1210 
 
 VENTILATION— HEATING— HUMIDITY 
 
 by the difference between wet and dry bulb. When the dry bulb is at T0° 
 and the wet bulb is at 62° the humidity is about right. 
 
 Humidity Discussed. — Mrs. W. B. writes: "Please tell me how hot 
 water radiators can he fixed so there will be enough humidity in the room." 
 
 Reply. — I do not know any satisfactory way to humidify the air of 
 a room heated by hot water. Pans attached to the radiator do not furnish 
 enough moisture. Perhaps some reader will propose a plan. 
 
 Air Too Dry. — Reader writes: "I have been bothered this winter with 
 an itching on my body. No breaking out is visible until the skin has 
 
 / monfrofe 
 
 
 
 
 
 
 
 
 T/ghf manho/e 
 
 PnA 
 
 
 
 
 
 
 
 
 -w 
 
 
 a 
 
 Q 
 
 t> . 
 
 ■ &. 
 
 
 
 & 
 
 &. 
 
 ■* ' * ^ '1 
 
 r 
 
 H 
 
 DOSING TANK 
 
 3"av/orr>otic siphon ■ 
 ft tvil/t /s' drawing 
 depth 
 
 T ^ r - 
 
 Tank and siphon chamber 
 borh 2' wide inside 
 
 California State Bulletin, May, 1916. 
 
 Fig. 
 
 494. — Concrete Septic Tank and Dosing Chamber Attached, for 
 Household of Not Over 10 Persons. 
 
 been rubbed or scratched. Then little white pimples are raised and itch 
 terribly. What is the trouble and what can I do for it?" 
 
 Reply. — The air in your living room is too dry. Get a hygrometer. 
 Add humidity to the air until the hygrometer shows over 40 constantly. 
 At that time the itching will disappear. Otherwise it will persist until 
 the heat is turned off in the spring. 
 
 More Humidity Needed. — 0. A. C. writes: "Is our furnace man right 
 when he says we do not get the heat we should have because of the two- 
 quart pails suspended in several registers? He insists the small water pots 
 in furnace are sufficient." 
 
 Reply. — No. Two pails of water suspended in the registers will not 
 use up enough heat to affect the temperature. Neither will they evaporate 
 enough moisture. They help but do not suffice. 
 
 Itching from Air Too Dry. — J. C. has an itching of the skin which 
 nearly sets him crazy. He wants to know what he can do. 
 
 Reply. — You are living in air which is too dry. See that the humidity 
 of the rooms gets up to, say, 70°. 
 
h- 
 
 on 
 
 -i 
 
 L 
 
 U 
 
 o 
 
 K 
 
 N 
 
 i, 
 
 cq 
 
 1211 
 
1218 
 
 VENTILATION— HEATING— HUMIDITY 
 
 Dirt Bands on Ceiling. — Mrs. R. W. wants to know why the ceiling 
 of her room is striped with alternating bands of light and dark and why 
 this is more plain near the radiator than elsewhere. 
 
 Eeply. — The plastering is put on over laths. The wooden laths are 
 better conductors of heat than the air spaces between them. Therefore 
 the plaster over the laths is colder than that over the spaces. 
 
 The water in the air precipitates at the colder zones and the moisture 
 
 catches the dirt out of the air. 
 
 Design jfe* Pit Peivy 
 
 ffawp' 
 
 The dirty band marks the location 
 of the lath, the clean that of the 
 space. 
 
 The space over the radiator 
 shows this more plainly because 
 the hot air from the radiator flies 
 straight to the ceiling, carrying 
 dust and sticking it there. 
 
 Winter Itch Cure.— M rs. M. W. 
 
 writes: "Last winter my husband 
 and I somehow acquired what we 
 thought was winter itch, but what 
 our physician declared was plain, 
 dirty, old itch. The skin looked 
 perfectly healthy, but itched vio- 
 lently in spots, and, after scratch- 
 ing, would look red and like goose 
 flesh. It traveled all over the body 
 {except the face), but, as a rule, 
 seemed to be active in only a com- 
 paratively small area at one time. 
 After several weeks it developed 
 (at the base of the fingers only) 
 in rather hard flesh that scaled off, 
 always accompanied by the violent 
 itching, but on the rest of the body 
 it continued in the form first de- 
 scribed. We tried various salves, 
 etc., which relieved temporarily, 
 but did not cure. It finally left 
 us with the coming of the warm 
 weather last June. It has reap- 
 peared on me with the first cold 
 weather this fall, simultaneously 
 with the wearing of last winter's union suits, but not on my husband, 
 who has not yet put on heavy underwear. Is this a parasite or a skin 
 condition? We wear cotton underwear; perspire normally; bathe often. 
 Is there any relief?" 
 
 Reply. — You have winter itch, I should say. This condition results 
 in part from the warmer, more irritating underwear. Much the more 
 important cause is dry air. No local treatment, except frequent bathing to 
 remove the dead skin, is of service. 
 
 The remedy is water. Drink more of it to increase the amount of per- 
 spiration. Above all, put more water in the air of your rooms. Get a 
 
 North Carolina Health Bulletin. 
 Fig. 496. 
 
HUMIDITY 1213 
 
 hygrometer and keep the humidity of your rooms up to 50 or above and 
 your itch will stop. 
 
 Your husband does not stay so closely at home and in consequence his 
 itch is lagging a few weeks. It will get him before Christmas. 
 
 Winter Itch Treatment. — W. K. F. writes that after suffering from 
 winter itch for many years he found a cure. It is glycerin, one part; water, 
 eleven parts. The lotion is applied hot twice a day. He does not use soap 
 during the winter, hut cleanses his skin with the glycerin mixture. The 
 skin is not to he dried with a towel after using the mixture. 
 
 Reply. — The cause of winter itch is dry air. The remedy is humidify- 
 ing the air of houses and offices. Awaiting the time when the underlying 
 condition shall be remedied it is well to use this or some other palliative. 
 
CHAPTER LXII 
 
 Garbage 
 
 HOW TO DISPOSE OF GARBAGE 
 
 The least important part of the garbage problem is garbage disposal; 
 yet it is the part on which most thought lias been put. Aside from the 
 financial end of the question nobody is interested much in garbage disposal 
 except the people who live near the locations where the garbage is disposed of. 
 
 They sometimes object to being made a dumping ground for the 
 balance of the community. They say it ruins the value of their property; 
 that it breeds flies ; that it causes foul odors ; and that it raises their sickness 
 rates. They work themselves into hysterics. To them garbage disposal 
 
 Fig. 497. — The Pit Privy, Simplest Form. This 
 illustration shows how a sanitary privy may be 
 had with even a simple watertight box by digging 
 a pit and placing the box, with a proper cover, 
 over the pit. When the pit is nearly full, an- 
 other should be dug and the box moved over it. 
 Care must be taken to heap up the dirt around 
 the box, so that water will not get into the pit. 
 When the box is removed to a new pit, the old 
 one should be filled with earth raised in a mound 
 over it. This is necessary to keep the pit from 
 becoming a sinkhole. 
 
 Virginia Health News. 
 
 has a vital interest. To the balance of the community it has only a financial 
 interest. 
 
 Six methods of garbage disposal are made use of : 
 
 1. Garbage dumps are the least to be commended and at the same time 
 are the most frequently made use of. There is some advantage in filling in 
 low places. Sometimes such places become pools of water. In such pools mos- 
 quitoes may breed and children may drown. There is a wee bit of (usually far- 
 fetched) argument in favor of filling in such low places. But they can 
 be filled in with household rubbish and, particularly, with ashes, cinders, 
 sweepings and excavation dirt with economy and advantage and no harm 
 will result from such procedure. 
 
 1214 
 
HOW TO DISPOSE OF GARBAGE 1215 
 
 A scientific study of levels and the use of city wastes other than wet 
 garbage in relation thereto would be well worth the while of any community. 
 A city could save millions by buying up gullies, clayholes and marshes and 
 offering builders, rubbish collectors, and producers of ashes free use of such 
 spaces for dumping purposes — and make millions thereby. Boston has tried 
 it; Cleveland has made gullies and "washes" into school sites and hospital 
 grounds to great advantage. 
 
 On the other hand, garbage dumps are always fringed by a half-mile or 
 more of territory in which the baby death rate is scandalously high. Garbage 
 dumps seem somehow to breed scandals of as many hues as Joseph's coat. 
 Graft is thick in, on and around them. They are about as harmful as 
 graft breeders as they are as fly breeders. 
 
 The men who advocate garbage dumps say that flies can be kept down 
 with antiseptics and black dirt. It has been proved that fly larvae, hatching 
 out under six feet of black dirt, will burrow to the surface. The layer of 
 black dirt or sand over garbage is never more than a few inches thick. 
 
 The fly killers and fly repellents used on garbage dumps are ineffective. 
 Even if results could be accomplished with these chemicals the amount 
 which would have to be used would make the cost prohibitive. 
 
 Why speculate? The swarms of flies that hover around and are dissemi- 
 nated from dumps constitute the best possible evidence that dumps are 
 fly breeders. The odor from a dump is of no health consequence. There 
 is nothing to be said in favor of garbage dumps that would appeal to any 
 thinking person. 
 
 DUMPS 
 
 However, I know of no American city without dumps. Some have fairly 
 \vell kept dumps and of others the less said the less abusive one is. A dump, 
 r o be an unmixed blessing, must receive nothing except excavation ma- 
 terial, wrecking material and ashes. Such dumps secure drainage, banish 
 mosquitoes, and improve appearances. 
 
 Dumps that receive street sweepings are moderate fly breeders. Street 
 sweepings have a fair fertilizer value, and it is wasteful as well as insanitary 
 to put this material on dumps. 
 
 Rubbish dumps are generally fly propagators. In the miscellaneous 
 material which goes on them there is much fly food. Cans are always present. 
 A colony of flies can live a week on the sirup or salmon left in an empty 
 £an. Scraps of bread and other food remnants are certain to find their way 
 into the rubbish. 
 
 On the other hand, flies can only travel a block or two and not so 
 far as that, except as the wind blows them. Food probably never draws them 
 more than 400 feet. 
 
 Therefore, a well kept rubbish dump will furnish a moderate excess of 
 flies to the neighboring houses but it will never people them with swarms of 
 flies as will a garbage or a manure dump. 
 
 Rubbish dumps cannot be treated with crude oil as a fly repellent. As it is, 
 they are afire a good part of the time. If they were oiled they would be a 
 neighborhood menace. To treat them with a copperas solution (two pounds 
 of iron sulphate to a gallon of water) might be feasible but I doubt it. 
 
1216 GARBAGE 
 
 Probably fifty gallons to each ton would be required and that quantity 
 would be prohibitive. To cover with ashes and excavation material would 
 be the best plan. 
 
 Fly larvae will burrow through several feet of soil to escape but that does 
 not greatly concern us in dealing with rubbish dumps. They feed flies ; they 
 do not breed them; that is, not in quantities. Flies will not go through 
 ashes or dirt to feed. A few inches of covering will suffice to keep a rubbish 
 dump in order. 
 
 The great trouble comes from dumps that get store refuse, saloon sweep- 
 ings and kitchen waste. Around such dumps flies swarm. 
 
 The walls in the neighboring homes are black with flies. The cars on 
 the neighboring lines fill up with flies as they pass along the street. The 
 garbage wagons drive away from the dumps carrying loads of flies. 
 
 The near-by children comb the field looking for food. Some of this 
 is for chickens, ducks and pigs, some of it is for human use. Around the 
 dumps two death rates are always high — summer complaint and typhoid. 
 Such dumps should not exist at all. 
 
 Clean-up Day, to have a punch to it, must include plans for the dumps. 
 If a plan for keeping the dumps right could be offered, pushed and adopted 
 in clean-up week it would be enough of itself to make the week worth while. 
 
 GARBAGE REDUCTION 
 
 The idea prevails generally that when garbage is sorted over the articles 
 recovered will be of great value. As a matter of fact, the picking over of 
 rubbish scarcely pays the expense of picking even with the market of a large 
 city at hand and where use is made of the cheapest labor. The picking over 
 of garbage does not pay. Bones and cans are the only two objects it pays to 
 go after. 
 
 2. The use of the reduction method requires that garbage be kept separate. 
 It generally means a long haul. The pure garbage is more offensive than 
 the mixtures commonly disposed of by the destructor method. This method 
 can make use of old and stale garbage. Pig feeding requires fresh garbage 
 and thus, indirectly, a frequent collection is promoted. Garbage reduction can 
 make use of stale garbage, and thus, indirectly, infrequent garbage service is 
 promoted. 
 
 Those are the only disadvantages of the method. It can be operated 
 without odor and without nuisance. The soluble odorous gases can be 
 washed out of the smoke and those that are insoluble can be burned. Its 
 great advantage is that next to the pig feeding method it is the most eco- 
 nomical. 
 
 The greatest value in garbage is its food value. That value is abstracted 
 by pig feeding. The next greatest value is the fat and fertilizer value. 
 That value is abstracted by reduction. In the reduction method the garbage 
 is roasted to drive off the water. The fat is then extracted by percolation 
 with naphtha and the residue is dried and ground into fertilizer stock. 
 The grease is sold for soap and allied purposes and the fertilizer stock is 
 mixed with chemicals to make different brands of commercial fertilizer. 
 
 The Columbus, Ohio, plant clears 54 cents a ton above all operation cost, 
 
1217 
 
1218 GARBAGE 
 
 5 cents depreciation, and 4 per cent interest on the money invested. The 
 cost of collection is $2.10 a ton. The 54 cents earning of the disposal plant 
 therefore reduces the cost of collection to $1.56 a ton to the taxpayers. 
 
 Changes have been suggested which would quadruple the net earnings on 
 the disposal plant. In other words, the disposal plant should make enough 
 on what it sells to pay for the total cost of collection. 
 
 The plant at Cleveland is of an old design, never of the best type and 
 unduly costly to maintain, yet it always earns a goodly sum to pay on the cost 
 of collection and occasionally for short periods the earnings are great enough 
 to pay the entire cost of collection. 
 
 As no city has enough money, as the complaints of poor garbage col- 
 lection service are constantly met with the plea that there is not money 
 enough, no city of large size is justified in foregoing the profits from 
 garbage reduction. However, a garbage reduction plant is expensive to 
 build. It has seemed to me that somewhere around 150,000 inhabitants is 
 the proper dividing line. A city over that size can afford to, and should, build 
 a garbage reduction works. Below that and say down to 25,000 a garbage 
 destructor is proper and below 25,000 a garbage crematory. Of course, these 
 lines are suggestive only. 
 
 BURNING GARBAGE 
 
 3. Garbage is without value as fuel — which does not mean that burning 
 garbage is not a good way to dispose of it. Burning destroys garbage in 
 an inoffensive manner and that is worth paying something for. Just how 
 inoffensive is this method depends upon how the garbage is handled be- 
 fore it is thrown in the fire and how hot the fire is. Of these two factors 
 the first is much the more important. 
 
 Technically, this way of destroying garbage is divided into two methods — 
 cremation, or burning at a temperature of less than 1,200°, and destruction, 
 or burning at a temperature of over 1,200°. 
 
 Garbage quite well drained out will just about burn itself — that is, 
 theoretically it will. Practically, some sort of fuel must be added. If the 
 garbage is cremated somewhere about 300 to 400 pounds of coal is required 
 to burn each ton. 
 
 Sometimes the garbage is cremated on the premises in household crema- 
 tories. In these the temperature of the firebox is less than 1,000°. In con- 
 sequence, the smoke smells. As the amount of garbage burned is small, how- 
 ever, there is seldom complaint of odors. Also, because not much garbage is 
 consumed, but especially because of the freshness of it, there is little or no 
 complaint of odors from the garbage on the way to the furnace. 
 
 The only objection to this method — and it is a valid one — is that garbage 
 disposal in a city can never be an individual matter with any safety and 
 comfort; and if the community is going to dispose of some of its garbage 
 it has the right to have it all. To allow individuals to hold out their grease 
 or garbage for any special reasons puts too heavy a burden on the tax- 
 payers. The courts have held that if the municipality is forced to take the 
 lean it is entitled to take the fat. 
 
 Where a crematory is owned by the municipality sometimes there is 
 complaint of odors when the process is cremation. At temperatures of less 
 
HOW TO DISPOSE OF GAEBAGE 1219 
 
 than 1,200° some of the garbage gases go off unburned. A low temperature 
 crematory is less expensive to build than a high temperature destructor. 
 
 If a community is not large and not rich it will be better for it to save 
 money by building a crematory, finding for it an isolated location. 
 
 4. Garbage destructors burn garbage at a temperature of 1,600° and over. 
 If a good deal of rubbish and manure is mixed with the garbage they require 
 little or no coal. 
 
 Garbage can be destroyed in a good destructor at about 30 cents a ton. 
 The municipality owning a destructor must figure the per ton cost of collec- 
 tion and then add to it about 30 cents for disposal. 
 
 On the other hand, the neighbors do not complain of garbage destructors. 
 The smoke is not offensive. The mixed garbage and rubbish en route to the 
 destructor are not so offensive as straight garbage. 
 
 GARBAGE ON THE SOIL 
 
 5. This method of garbage disposal is made use of frequently but only 
 because the authorities do not know what to do and usually do not know how 
 to go about finding out. Generally speaking, this method develops as part 
 of a contract system and is not community work. In such towns there are 
 garbage collectors who charge from a quarter to a dollar a month to gather 
 and dispose of the garbage of a resident. When asked what they do with 
 the garbage they reply that they plow it into the ground. Sometimes they 
 do; more frequently they put it on dumps. I never have heard of a con- 
 tractor burning this garbage. 
 
 There is an idea that garbage has fertilizer value. As raw garbage 
 this waste harms the soil far more than it helps even when the soil needs 
 many of the chemicals contained in the garbage. It sours the soil. 
 
 Certainly there is never enough fertilizer value in it to pay for the expense 
 of scattering and plowing in the garbage. Plowing will not cover it deep 
 enough to prevent the fly larvae, with which garbage abounds, from burrowing 
 to the surface. 
 
 On top of the inefficiency of this method is the fearful expensiveness of 
 it. When what is paid for garbage collection by a householder during the year 
 is compared with his taxes he finds that garbage is costing him about as much 
 as he is paying for fire, police and health protection together and maybe more. 
 The method has nothing to commend it. 
 
 FEEDING TO HOGS 
 
 6. The food value of garbage is much its greatest value. The only way 
 devised in this country to get the food value from garbage is by hog feed- 
 ing. 
 
 In Denver, Colorado, the profit from the hog feeding pays the cost of 
 both collection and disposal. In Worcester, Massachusetts, it has occasionally 
 done even better than that. 
 
 In some cities the city pays the expense of collection and of the wagon 
 haul, but the contractor pays the expense of the railroad haul. Thus we see 
 that the financial advantage of disposal by hog feeding is great. 
 
1220 GARBAGE 
 
 The objections urged are that the hog pens are offensive and breed flies ; 
 that the hogs are sickly and may contract cholera and tuberculosis. Both 
 cholera and tuberculous hogs are prone to find their way to market. 
 
 Many places now require that the garbage be cooked before being fed. 
 This has always caused the tuberculosis rate to drop, as shown by the govern- 
 ment records. Cholera is successfully prevented by vaccination. 
 
 The pens usually are a nuisance. A careful and cleanly contractor will 
 prevent this. Many will not. 
 
 Land isolated enough for hog feeding yet accessible to the city is hard to 
 find. I expect to see the faults of hog feeding corrected and that method of 
 garbage disposal grow. There are communities to which it is well adapted. 
 
 ST. JOSEPH'S GARBAGE REPORT 
 
 St. Joseph, Missouri, followed the plan of dumping its waste in the 
 Missouri River from its village days until the time when it was stopped by the 
 United States government. It then appointed a commission to study the sub- 
 ject of waste disposal. The recommendations of that commission were : 
 
 1. That the municipal collection of all wastes be established. 
 
 2. That vaults in sewer districts be abolished. 
 
 3. That stable manure be collected and sold. 
 
 4. That the reduction of garbage at a profit in St. Joseph is impracticable. 
 
 5. That an effort be made to cooperate with neighboring cities in the 
 building and maintenance of refuse disposal works but in event of the failure 
 of this effort that St. Joseph's garbage be burned in a destructor. 
 
 6. That a tract of land be purchased for the installation of municipal 
 utilities. 
 
 Scores of American cities have appointed commissions on refuse disposal. 
 Some of these have been most thorough and scientific; others have not gone 
 into the subject deeply. 
 
 Milwaukee, appreciating the variation in the wastes of cities by reason of 
 variation in the manufactures as well as variation in domestic customs, in- 
 cluded in its report the results of a scientific investigation into the values of 
 its wastes. 
 
 In the Boston report there is an analysis of the wastes of that city from 
 which we learn that, expressing the tonnage of market refuse by 1, the 
 tonnage of rubbish would be 1.5, of garbage 8.5 and of ashes 33.3. 
 
 There are so many of these reports now in hand that there is not much 
 need of visiting commissions or testimony taking bodies. Any commissioner of 
 public works can analyze these data and use them as a basis for an opinion as to 
 what is best for his community. 
 
 Practically every commission has reported that the municipality should 
 collect all of the refuse. The Boston report recommends that the community 
 collect the refuse but that a charge be made for collecting the refuse from 
 certain groups. The recommendation relative to stable manure is a good one 
 founded on good economic principles as well as on good sanitary principles, 
 yet I know of no community that has carried it out. 
 
 Cooperative treatment of refuse by cities adjacent to each other has 
 
STABLE MANURE 1221 
 
 not been carried out in this country. In view of the great economic ad- 
 vantages of reduction and the further fact that the first cost of reduction works 
 puts that method beyond the reach of small communities the suggestion of 
 cooperative effort is well worth while. Failing in efforts to cooperate the 
 decision to burn was proper. 
 
 The fourth point decided suggests the advisability of cities' providing land 
 funds, as German cities have done, and using those funds to purchase lands at 
 bargains and then holding them for garbage disposal and other uses. 
 
 STABLE MANURE 
 
 We cannot think of cleaning up without talking about the manure 
 box. It would be like the small boy washing his face and leaving a dirt line — 
 dirty ears and neck. 
 
 Paper in the alley is as nothing compared with the manure box. It's 
 the fly that the whole thing hinges on. The cleaning is to be measured in flies. 
 Flies breed in stable manure. They breed elsewhere, it is true, but the breeding 
 place de luxe is the manure box. Then let the city cleaning plan include the 
 manure box. 
 
 Flies pass through the egg stage and the larva stage to the fly stage in ten 
 days in hot weather. In cold weather it may require three weeks, which 
 means that the manure box which is emptied every week in hot weather 
 and every two weeks in cooler weather does not do much harm. 
 
 The top three feet at least should be emptied. It is in that area that 
 the eggs and larvae will be. 
 
 If the box has a fly hole anywhere on the side all the manure for a 
 foot or more around must be emptied. Practically, this means that the manure 
 box must be made flyproof with a fly screen and that the whole contents must 
 be emptied weekly from May until November. 
 
 Forbes of the University of Illinois says that flies will not breed in manure 
 if it is treated every day with a sulphate of iron spray. He recommends that 
 a solution be made by dissolving two pounds of the iron in a gallon of water 
 and using that amount for each horse each day. 
 
 Old-fashioned lime does no good at all as a repellent. Chlorid of lime 
 or chlorinated lime Howard recommended several years ago ; but I think he has 
 lost faith in it in recent years. 
 
 A few years ago the Jacksonville, Florida, authorities found the ground 
 in dirt floor stables teeming with fly eggs and fly larvae. It was their con- 
 clusion that a dirt floor stable was always a fly breeder. So our city cleaning 
 friends might well look after the stable floors. 
 
 They must not get the idea that automobiles have driven horses out of 
 town. There are nearly 100,000 horses in Chicago and the majority of 
 them are stabled in the most densely populated part of the city. 
 
 The street sweepings while on the street and also while in the side- 
 walk boxes are not fly breeders. They are knocked around too much to 
 appeal to Madam Fly. Rather is the fly in search of the more quiet, more 
 secluded alley boxes. 
 
 It will do but little good to have these boxes emptied during clean-up 
 
1222 GARBAGE 
 
 week and left overflowing and uncovered during the weeks that follow. Clean 
 ing up includes the plans and equipment necessary to keep clean. 
 
 Disposal of Garbage. — E. H. L. (Colorado) writes: "Kindly tell 
 me an effective but simple sanitary way to dispose of garbage in the 
 country." 
 
 Reply. — Garbage can be fed to hogs and chickens and this is a good 
 method, especially in Colorado. If this method is not available or feasible, 
 domestic garbage can be buried. It can be burned in a crematory built 
 of stones after the fashion called "kitchen sink crematories" in the United 
 States army. This is a small pit lined with stones, deeper at one end than 
 at the other, and with a central pile of loose stones reaching higher than the 
 level of the pit. A wood fire is built in the pit. After the stones are heated 
 through, the garbage is fed to the fire at a moderate rate. 
 
 Burning Out Garbage Cans. — V. E. M. writes: "Here is a practical 
 suggestion about garbage cans which you may think useful: We have a 
 sheet iron can, and even after it is emptied it is a great breeding place of 
 flies, etc. I put in a few newspapers and set them afire. The heat destroys 
 germ life and leaves nothing but a few ashes, and it is more effective and 
 less expensive than scalding or the use of disinfectants. Of course one 
 must watch it for a few minutes to prevent the spreading of fire." 
 
 Reply. — The suggestion contained in this letter should have a wide 
 circulation. Offensive cans can be made inoffensive and sterile by burning 
 them out. Where it is allowable to wrap the garbage in paper this is not 
 necessary. 
 
 Burning Leaves. — 67. R. J. writes: "Please tell whether or not the prac- 
 tice of disposing of fallen leaves in the autumn by piling and burning them 
 in the streets tends to spread such contagious diseases as diphtheria, etc." 
 
 Reply. — No. 
 
 Danger Has Passed. — E. 8. writes: "A privy vault, used by a family 
 of five or six persons for three years, was covered with five feet of dirt 
 fourteen years ago. If ever there was any danger to the occupants of the 
 house that was built over it, has that danger passed?" 
 
 Reply. — Yes. 
 
 Garbage as Compost. — B. J. A. writes: "I reserve space in the garden 
 about 6' x 12', on which I dump the lawn mowings and vegetable tops, 
 leaves, and the like. The garbage is dumped, and lawn grass and the like 
 is put on the top of it, but not sufficiently thick to keep the air from reach- 
 ing it, and the result is that the garbage nitrifies but does not to any 
 extent putrefy. Flies when feeding do not dig down into dark places, and 
 I have noted that, even when you can almost see through the covering of 
 the garbage, flies are slow to enter this opening to feed. In the fall I dig 
 this garbage pile and pulverize the contents. Such as does not pulverize I 
 fork over and use to start another pile in some other place, so that the 
 teachings from it are at a different place in the garden during each year. 
 People look at me in astonishment when I show them this sanitary gar- 
 bage heap" 
 
 Reply. — This method is worth trying in towns and villages without 
 proper garbage disposal. If, however, all premises were clean and the flies 
 were put to it for refuse they would go down into these piles. 
 
CHAPTEE LXIII 
 
 Insurance 
 
 EFFECT OF HEALTH INSURANCE 
 
 Eecent figures show a remarkable improvement in German health con- 
 ditions.- The number of deaths from diphtheria was 54,760 in 1893 whereas 
 from 1912 to 1916 no yearly total has been as high as 10,000. Typhoid has 
 fallen from 18,756 in 1875 to 2,000. The tuberculosis rate' is just one-half 
 what it was thirty years ago. 
 
 The death rate of children under one year of age, in German cities, is 
 about one-half what it was ten years ago. For instance, of 100 babies born, 
 the number of deaths at less than one year of age was in Darmstadt in 1903, 
 17.4; in 1910, 9.2; in Dresden in 1903, 19.2; in 1910, 12.8; in Elberfeld, in 
 1903, 16.9; in 1910, 9. 
 
 These improvements are the result of health activities, the most compre- 
 hensive of which was the Bismarck health insurance bill made operative in 
 1892. 
 
 The English death rates also have shown great decrease, though not so 
 great as Germany's. London seems permanently intrenched in its position as 
 the city with the lowest death rate among large cities. As the result of the 
 operation of the insurance bill which became effective a few years ago, London 
 should make an equally satisfactory showing by 1917. 
 
 These reduced death rates, reduced sickness rates and the economic 
 changes with which they are associated are bearing down hard on the practice 
 of healing. When there are not so many to be healed there is not so much 
 for the healer. In this country all of the Christian Scientists, osteopaths and 
 chiropractors, about half of the homeopaths and eclectics and a respectable 
 minority of the so-called regulars are practically always found opposed to 
 health legislation. 
 
 In Great Britain the British Medical Association has indorsed the na- 
 tional insurance bill but it is contending for more remuneration for services. 
 Its members do not believe they should give a man medical service for a year 
 for $1.50. Among the matters to be discussed by the forthcoming meeting 
 of the British Medical Association are better remuneration for physicians in 
 connection with school inspection, care of children, dental work, hospital 
 and dispensary work, consumption and maternity service. 
 
 There is no doubt that the people have the right to health and efficiency. 
 They will always approve measures which bring about these ends. When once 
 the people are informed, such issues make the finest of platforms for political 
 parties — platforms on which statesmen and politicians can stand to advantage 
 with the people. 
 
 1223 
 
1224 INSUKANCE 
 
 It is unfortunate that some divisions of healing find it necessary to op- 
 pose this work. A wiser policy for them would be to back up the proposals 
 but to ask for living conditions under their operation — wiser for them and 
 wiser for the people. On this point Lloyd-George said : "Sweated labor is the 
 worst labor in the world. If you want to get the best out of a man you 
 must pay him a wage which satisfies his reasonable demands. Improve the con- 
 dition of the doctors and you improve the general health of the country. '* 
 This is the present attitude of the American Medical Association and, I think, 
 will eventually be the attitude of the homeopathic and eclectic professions. 
 
 SOCIAL INSURANCE 
 
 The gradual evolution of social insurance is one of the themes of a 
 work by Dawson on "Social Insurance in Germany." In that country, as 
 everywhere else, governmental activities are foreshadowed by the activities of 
 men acting in groups. In Germany the direct forerunners of the insurance laws 
 were workingmen's unions paying sickness and disability benefits. In 1854 
 the Diet passed laws which strengthened these societies and increased their 
 efficiency. One of these laws gave cities the right to pass ordinances requiring 
 people to join benefit societies. 
 
 In 1882 Bismarck forced the passage of a scheme of obligatory sickness 
 insurance. In arguing for the measure he said: 
 
 "It is the tradition of the dynasty which I serve that it takes the part 
 of the weaker ones in the economic struggle." 
 
 The first law passed in Germany does not bear much resemblance to the 
 law as it stands now. Just as the law itself evolved out of the benefit features 
 of the unions so the law changes as experience demonstrates the wisdom 
 of change. 
 
 In many of its provisions the German law is not the equal of the English 
 law. There is a provision of the English law that if a town neglects its sani- 
 tation and in consequence has a high sickness rate the extra cost is assessed 
 against the taxable property of the town. 
 
 Another provision is that if there is a great deal of sickness among 
 the workers in a factory and if it is found the factory is not kept in a sanitary 
 condition the extra expense of insurance must be borne by the owner of the 
 factory. 
 
 There is great agitation in Germany now to use some of the features em- 
 bodied in the English law. Especially are they trying to vary the contributions 
 to the insurance fund according to the degree of healthfulness of different 
 occupations. It is their contention that the insurance rate for the brass 
 industry should be higher than that for some industry that has little tendency 
 to disable men. The extra expense should be divided, in their judgment, 
 between the employer, the employee and the state, as the manufacture of brass 
 is a community necessity and therefore a community hazard and expense. 
 
 Discussions of questions of this type in bringing about the end sought 
 are also incidentally of great service in popularizing information as to the 
 effects of different occupations on health and efficiency. 
 
INDUSTRIAL INSURANCE 1225 
 
 INDUSTRIAL INSURANCE 
 
 In England the cost of insurance is divided between the employee, the em- 
 ployer and the government. In Germany the cost is borne by the employee 
 and employer, the government contributing nothing. As the English system 
 was not adopted until the German had been working for twenty years natur- 
 ally it is an improvement, at least in many particulars, over the plan which 
 pioneered. 
 
 In Germany insurance against illness and dependence in old age is 
 charged for on the basis of wages. Accident insurance is on a mutual basis 
 and varies from year to year. 
 
 The division of cost of sickness and invalidism is divided between employer 
 and employee on the basis of about 6 to 10. A workingman getting $7.50 a 
 week pays 21 cents for insurance and his employer pays 13 cents. For sickness 
 insurance the employee pays about 2.3 per cent of his wages and the em- 
 ployer 1.7 per cent. The cost for insurance to provide for old age and in- 
 validism is about 1 per cent of wages. The cost of this last type of insurance is 
 divided equally between employee and employer. 
 
 For this the service rendered is of many sorts. These health activities are 
 well worthy of note. 
 
 Up to the end of 1910 the amount that had been devoted to the building 
 of sanitary homes to replace tenements and shacks was $75,000,000. Nearly 
 $5,000,000 had been spent in building quarters for single persons; for build- 
 ings for the indirect conservation of public health, $38,000,000; education 
 of the public in public and personal hygiene, $20,000,000. 
 
 In many places these funds have established recuperation or convalescent 
 homes. Since 1899 much energy has been exerted in establishing forest re- 
 sorts. At the present time there are more than one hundred of these. The 
 better known are those near Berlin, Dusseldorf, Munich, Dresden, Leipzig, 
 Cassel, Carlsruhe, Frankfort and Hanover. These resorts are made as in- 
 expensive as possible. The buildings are cheap wooden shacks with shelter 
 benches, chairs and hammocks. A lunch counter serving bread and milk 
 is provided. Generally, the forest resorts are within seven miles of the city 
 on lines of easy communication, and the invalids are expected to reach 
 them in the early morning and to leave for home by night. 
 
 They take care of people with weak nerves, asthma, anemia, mild heart 
 disease and convalescents generally — "those persons in indifferent health who 
 need to rest and recuperate in the open air." 
 
 Charlottenburg maintains what is known as a Holiday Colony for children. 
 
 Much of the activities of the boards is directed toward the lowering of 
 infant mortality. Dawson says the central idea coming to be seen, or seen with 
 increasing clearness, is that men value fair and full use of their faculties more 
 highly than distress benefits. They want healthy life, sound limbs and unim- 
 paired energies, not accident compensation; opportunity and power to work, 
 not infirmity pensions. 
 
CHAPTER LXIV 
 
 Hospitals — Schools 
 
 VALUE OF THE HOSPITAL 
 
 The usefulness of the hospital in this country is not generally understood 
 or appreciated. For one reason or another there seems to be an unwarranted 
 prejudice entertained against it by a large percentage of our people. This in 
 some measure is due to ignorance of its functions. 
 
 There has also been coupled with the name "hospital" in this country a 
 feeling of dislike superinduced, no doubt, by superstition. In other words, 
 when you say the word "hospital" to a number of people "like a duck in thun- 
 der" they seem to lose their mental bearings. 
 
 Let it be said (and to the credit of our people, too) that this dislike for 
 hospitals is being rapidly and fortunately overcome. 
 
 Both the doctor and the layman are beginning to realize that the proper 
 place in which to carry on the fight against the ravages of disease and to lessen 
 human suffering is in the hospital. It is in the hospital that the medical 
 man and the surgeon can do the most effective work in their efforts to elucidate 
 the cause of disease, to discover methods for preventing disease and to apply 
 most scientifically remedies and surgical measures for curing disease and re- 
 pairing fractures. 
 
 "The role which the modern hospital plays in the education not only of 
 the medical profession hut also of the public in general is far reaching and its 
 scope is practically unlimited. The abundance of clinical material which comes 
 under the eye of the physician or surgeon is important in increasing his 
 knowledge of diseases and their treatment." 
 
 The functions of the hospital, however, are not limited to the mere caring 
 for the sick and the injured. The hospital is the center of genuine scientific 
 medical and surgical work. 
 
 Here the latest and most improved methods of caring for the sick and the 
 injured are employed. Here the nurse receives her education in how to 
 conduct a campaign in favor of public health. Here the sanitary engineer 
 goes to get points on how to build and operate public institutions. Here 
 the sanitary physician receives his training in how to prevent the spread of 
 diseases, especially those communicable. 
 
 Here you find the bacteriologist, the chemist, the scientist, actively at work 
 furnishing special knowledge to the statistician as a basis from which he 
 makes up his calculations. Here is the headquarters for that large body of 
 doctors and nurses who compose our sanitary educators and who go about 
 disseminating knowledge of the way disease spreads and the ways in which 
 it is prevented. 
 
 1226 
 
VALUE OF THE HOSPITAL 1227 
 
 This body of missionaries of sanitation constitutes, in my judgment, the 
 most important army of men and women engaged in the modern movement 
 for the conservation of public health. In the campaign against contagious 
 and infectious diseases, particularly tuberculosis, they have disseminated 
 much knowledge concerning the importance of personal hygiene and prac- 
 tical methods of sanitation. 
 
 The anti-tuberculosis movement brought the knowledge of how to fight 
 this particular microbe into the home of the individual. Knowledge of the 
 sanitary disposition of the sputum, of how to make tenements and shops hy- 
 gienic and of what constituted healthy habits of the individual were taught to 
 each member of the home. 
 
 The people were taught that the success of the fight against the great 
 white plague was an individual fight and that the duty of each individual 
 was so to shape his life and habits as not to affect his friends and neigh- 
 bors. 
 
 The credit for setting in motion the machinery which has so successfully 
 carried this knowledge of hygiene and sanitation into the home of the in- 
 dividual is largely due to the hospital. 
 
 It must not be forgotten that these results were not accomplished by 
 merely disseminating information through lecture bureaus, pamphlets and 
 general instruction. 
 
 These doctors and nurses — missionaries — went personally into the field of 
 work and personally taught sanitation and hygiene. 
 
 What they have done to educate people concerning the cause and cure of 
 tuberculosis they have done equally as effectively regarding the cause and cure 
 of other contagious diseases. Of them Bishop Spaulding would say: 
 
 "They are true physicians, waiting upon the miseries of man; like sen- 
 tinels, at their posts they stand, ever ready to bring relief. Xeither dark- 
 ness of night, nor storm, nor contagion, nor pestilence, nor the field of 
 carnage can deter them when duty calls." 
 
 It is through this personal work that much of the information used for 
 making up the vital statistics record, particularly among children, has been 
 secured. 
 
 For some reason or other a fallacy has obtained among the doctors as 
 well as the laity that the hospital is only for surgical and operative cases. 
 This, however, is not true. On the other hand, the hospital is the safe place 
 for a case of typhoid, pneumonia, appendicitis, peritonitis — in fact, any 
 illness of sufficient seriousness to require daily visits by the physician and an 
 attending nurse or where much nursing or attention is required on the part of 
 members of the family or friends. 
 
 Here you find system and regularity in the care of the sufferer and, should 
 an emergency arise requiring the hasty intervention of surgical procedures to 
 foil death, much time can be saved. 
 
 The time element with reference to the conditions when the operation 
 is done is also a determining factor when we come to make up the prognosis 
 of the case. 
 
 No doubt many a life could have been- saved by quick surgical procedures 
 when an operable case reached the crisis had the case been where the opera,- 
 Hon could have been performed. 
 
1228 HOSPITALS— SCHOOLS 
 
 Many surgeons of renown hesitate when asked to operate under the 
 handicap of ill prepared surroundings. 
 
 To operate in a strange place with strange help is unfair to the patient and 
 to the surgeon. His mind should be free to concentrate on what his eye is 
 seeing, his fingers are feeling and his knife is cutting. 
 
 He cannot divide his thought and be just to the patient; and even with 
 the best of oversight strange attendants and strange surroundings not in- 
 frequently mean a break in surgical cleanliness — a chain as weak as its weakest 
 link. 
 
 When sick and in the hospital you are reasonably sure of being efficiently 
 cared for. In the hospital a chart is kept by the attending nurse so that each 
 time the doctor makes a visit he has but to glance over this chart in order 
 to know how his patient has progressed, in order to know the condition of 
 his patient. 
 
 There is then little for the doctor to do save to look at his charts, occa- 
 sionally attend dressings (when the case happens to be a surgical one), and 
 direct the nurse as to the further care of his patient. 
 
 The patient feels more at ease realizing that he is not a burden to family 
 and friends and that every attention possible will be accorded him tending 
 to make him comfortable and well. 
 
 The family, knowing that the sick one will be properly cared for, that it 
 can hear from him at almost any hour of the day or night, soon becomes 
 reconciled to this condition and is far better off, being relieved of the burden 
 of care which would otherwise have been imposed and being better able to attend 
 to its daily duties. 
 
 WHO SHOULD GO TO A HOSPITAL 
 
 Shall an expectant mother go to the hospital ? Yes. Health department 
 reports show that about one-thirtieth of the babies born die during the first 
 twenty-four hours of birth. The death rate during the first week is very 
 high. The newly born babe has but a feeble hold on life and little, seemingly 
 unimportant influences may decide whether the baby will live or not. The in- 
 fection of the baby's eyes which ends in blindness starts suddenly and progresses 
 rapidly. The chance of saving sight is greater in the hospital than outside. 
 
 When it comes to the mother, the death and accident rate among mothers 
 is much less in a hospital than outside. There is less infection, less childbed 
 fever and less danger from hemorrhage. The risk in every direction is less. 
 
 When we consider the trouble in the home, the advantage is on the 
 side of having the mother go to the hospital. The household is spared disar- 
 rangement. One reason for the growth in midwife confinement is the matter 
 of household necessities. When a woman of small means is confined in her 
 home by a physician, provision must be made for the physician, the nurse, and 
 a servant to help out. When the service is rendered by a midwife, the doctor, 
 the nurse and the servant are all rolled into one. In my judgment, the house- 
 hold service advantage is the largest factor in the growing use of midwives. 
 The cure for the situation — and the high death and accident rates demand 
 a remedy — is enough hospitals and dispensaries to care for the maternity cases. 
 And finally, it will be found that a case of confinement costs less in the 
 hospital than at home. 
 
VALUE OF THE HOSPITAL 1229 
 
 Shall consumption be cared for in a hospital? Yes. The chance of getting 
 well is very much better in a hospital than outside. A man who learns that 
 he has consumption will improve his chances materially if he will go at once 
 to a sanitarium. He will get rest and an environment which makes against 
 worry in contrast with his home where things make for worry. He will be fed 
 right. He will get air. He will learn how to take care of himself and 
 others. Learning by doing is better than learning by listening. If his 
 disease is not progressive in type he may be able to finish his cure at home. 
 
 Every case of advanced tuberculosis should be in a hospital. They are 
 safer and happier there. Their chance of cure is greater there than outside. 
 An advanced consumptive kept at home is certain to infect half of his 
 immediate family, although many of them may cure their infection after a 
 short "run down" period. 
 
 Should a case of typhoid fever go to the hospital? Yes. The death rate 
 from typhoid fever in hospitals is lower than outside. In an ordinary epi- 
 demic out of each one hundred cases treated outside hospitals, ninety get well. 
 Out of a similar number treated in hospitals ninety-four will get well — a dif- 
 ference worth considering. 
 
 Aside from the influence on a man's chance of recovery is the question 
 of protecting the community. Typhoid cases cared for by nurses in fly- 
 screened houses where there are good toilet facilities do not endanger any- 
 body. Unless these conditions are met there is a moderate amount of danger. 
 If there is no regard whatsoever for sanitary law there is great danger. 
 
 Shall teething babies be cared for in hospitals? ~No. This answer re- 
 quires some modification. If the choice is between a very poor home and a 
 hospital the answer should be — Yes. If the mother can go to the hospital and 
 breast-feed her baby — Yes. If the wards are refrigerated so that the tem- 
 perature is kept below 75°, if the windows are screened and if the milk is 
 given to the babies from cows on the premises or if it is received at the 
 hospital in less than twelve hours after it has been milked and used in less 
 than twenty-four hours — Yes. 
 
 In between these extremes there are the cases that are to be decided 
 after weighing the sanitary virtues of the hospital and the sanitary vices of the 
 home — each case to be decided individually. The hospital baby death rate 
 is very high. In the old-style hospital it was nearly 100 per cent. The 
 more modern ones are showing lower death rates but their rates are still above 
 those of babies in reasonably good homes. 
 
 Shall ordinary illness be cared for in a hospital? Yes. The home is for 
 the well. The hospital is for the sick. The home is planned to care for a well 
 man with a high degree of efficiency. When it comes to caring for sick men 
 its efficiency is low. If a home can care for a sick man efficiently then cer- 
 tainly there is great waste in its care of the well. A home that has a great 
 excess of room, of space, of everything, can care for a sick man — not well but 
 passably well. But see the habitual waste of such a place. 
 
 The chance of recovery in a home is less than in a hospital. If the illness 
 is mild and recovery is certain this does not make much difference. The sick 
 one is disturbed more by worry, noise and domestic disarrangement; but no 
 vital harm is done. If the illness is violent and life hangs in the balance the 
 advantage of the hospital over the home may be enough to determine the issue. 
 
1230 HOSPITALS— SCHOOLS 
 
 In our thought of the sick member we must not overlook the well. The 
 breadwinners can stand the extra strain much better when the sick one is in a 
 hospital. It is presumed the home is what it ought to be in this phase 
 at least — the place where the workers-out can be at ease to recuperate from the 
 burden of one day and to prepare for the trials of the next. Usually illness 
 places an extra strain on the workers-out and the mother in charge of the 
 house. Generally it is poor judgment to load them with this extra strain, espe- 
 cially as the alternative — hospital care — gives the sick person greater comfort 
 and a better chance of recovery. 
 
 The above is the sensible way to look at hospitals. Eventually it will be 
 the way everybody will look at them — rich and poor alike. If everybody 
 thought this way now there would not be beds enough for the sick. The 
 percentage of beds to population will probably grow about as fast as sentiment 
 demands. Before many years towns of 5,000 and even thickly populated 
 rural districts will have hospitals. 
 
 CASES OF CONTAGION IN HOSPITALS 
 
 Should every case of contagion go to a hospital? To this question there is 
 but one answer — Yes. There are certain conditions under which the need 
 is most imperative. For instance, contagion developing in a hotel must 
 go to a hospital, however strong is the inclination otherwise. The demand 
 is almost as great where the case is in a flat building or in a house where 
 several families live on the same floor or in the same building. If several 
 families use the same toilet facilities, as is the case so frequently in poorer 
 homes, the disease always spreads if the case is left in the home. 
 
 Certain diseases are more easily spread than others. Smallpox in a city 
 cannot be left in the home with safety. Measles is about as certain to 
 spread when left in the home as is smallpox. Scarlet fever and diphtheria 
 are much less catching and frequently no spreading follows the leaving of a 
 case in the home. 
 
 Spinal meningitis and infantile paralysis are not so dangerous but that 
 they can be left at home during the disease ; but after convalescence is estab- 
 lished it is highly desirable to carry the patient to the hospital or convalescent 
 home and leave him there until he is safe. 
 
 Whatever the form of contagion the sick one stands a better chance in 
 the hospital than at home. There never was a home good enough or provided 
 with enough nurses or enough doctors to make it as good a place to be sick 
 in as a good hospital with the special nurses and special physicians that 
 money can buy. When it comes to comparing a crowded home with a hospital 
 the advantage is all on the side of the hospital. The parent who keeps his 
 child sick with contagion at home is not fair with his child. He increases 
 his chance of dying at least 10 per cent, and sometimes much more. That is a 
 pretty big price to pay for sentiment. 
 
 Should surgical cases be cared for in a hospital? Again the answer is 
 yes. The emphasis of the answer depends on circumstances. If the case 
 is one where infection must be strenuously avoided the answer is emphatic. If 
 it is one where accidents are liable to happen or emergencies to arise, emphati- 
 cally yes. 
 
SCHOOLS 
 
 1231 
 
 If the case is one where life is to hang in the balance, where everybody 
 must work at high efficiency or death will result, emphatically yes. Other 
 types of cases permit more leeway. There are times when one or another 
 consideration may make it wise to keep the patient at home. But even 
 in these the burden of proof should be on the home. 
 
 SCHOOLS 
 
 SCHOOL EFFICIENCY EFFORT 
 
 A book well worth one's while is Miss Denison's "Health of School 
 Children." In this book she says: "The chief reason that national and 
 large local groups of physicians interested in school health have not been 
 more effective is that they have not yet appreciated the value of lay coopera- 
 tion." 
 
 Since the development of the public school system parents, physicians, 
 and everybody have been disposed to unload the child on the school teacher. 
 
 California State Board of Health Bulletin. 
 
 Fig. 499. — Typical Sewage Disposal by Subsurface Irrigation. 
 
 Not only is mental training expected but physical and moral training as well. 
 The parent has leaned on the school teacher, as everybody knows. 
 
 The physician has been even a worse offender. Nine physicians out of ten 
 know nothing about the hygiene of the schoolroom; have given no thought to 
 posture in relation to development or even to the spread of contagion through 
 the schools. The physician has unloaded on the teacher. 
 
 If one reads the books (of which there is a considerable number) on the 
 different phases of school hygiene he will note that most of them are written 
 by teachers. The few from the pens of medical men are written by such as 
 are not working at their trade; none of them at least is practicing curative 
 medicine. 
 
 Now it is a fact that the physical care of the child limps along, lame 
 and halt, while the mental care goes by leaps and bounds. The reason is a 
 lack of public interest. As it is on the shoulders of the teachers that the burden 
 falls Miss Denison's suggestion should have been tendered the teaching rather 
 than the medical profession. 
 
 In addition Miss Denison estimates that the people of the United States 
 spend $10,000,000 a year in helping out the schools. This money is put 
 out for school lunches, school playgrounds, open-air schools and a thousand 
 activities supplementing work done out of public funds, 
 
1232 HOSPITALS— SCHOOLS 
 
 For instance, business men of Columbus, Georgia, contributed $10,000 
 for kindergartens. A bequest of $120,000 provided Oshkosh, Wisconsin, with a 
 manual training school. Two million dollars was bequeathed to help out the 
 Muskegon, Michigan, schools. One thousand dollars was given to the Eacine, 
 Wisconsin, school library. The outdoor schools of Chicago are aided by the 
 Elizabeth McCormick Memorial fund — and so on through a long list. 
 
 The style was set by Benjamin Franklin who bequeathed $500 as a 
 fund the interest on which was to be used to help out the Boston schools. 
 
 Anyone who reads this book by Miss Denison will be astounded to know 
 how much is being done; also to know how differently it is being done. 
 
 No two communities are doing exactly the same thing in exactly the same 
 way. This, of course, means that things are being wastefully done. 
 
 If there were a standardized method of procedure and every town trying 
 to do something for school hygiene would follow these standardized methods 
 a dollar would go twice as far. 
 
 A great many million dollars have been expended on the ventilation of 
 school buildings. This ventilation has been all right from the engineering 
 standpoint yet all wrong from the health standpoint because the only sani- 
 tary standards for ventilation are forty years old. 
 
 A New York woman has given a sum of money to be expended in es- 
 tablishing sanitary standards of ventilation particularly for schools. While it 
 will not be possible to have a report at Buffalo from the commission created 
 for this purpose Winslow, Kimball and perhaps others of prominence are on 
 the board and the machinery will be set going for a wide publication and ac- 
 ceptation of the report when it is issued. 
 
 However, this is only an illustration. Physical examination, control of 
 contagion, school nursing, school feeding, open-air schools, cold-room schools 
 — in each of these there is urgent need of standardization of method. 
 
 Efficiency is the talk of the day. The railroad man wants to know the 
 efficiency of rails, tires, engines, cars — everything. The business man will 
 take time from his business to study efficiency in salesmanship or in some 
 other department of his business. He will employ efficiency engineers and 
 permit them to come and go as they please through his affairs. 
 
 In fact, efficiency makes an impression on the impassive mind of the 
 business man where sickness rates, disease rates and death rates are impotent. 
 
 It has always seemed to me that the business mind is of the show-me 
 type and efficiency engineering from beginning to end is on a show-me plan. 
 These other arguments are not easily reducible to the show-me basis and in 
 consequence they do not lend themselves readily to argument for business since 
 business is on a competitive basis. 
 
 It is not difficult to prove the loss of efficiency in school children. Chil- 
 dren are taught in classes of about forty. Of this forty about five are so im- 
 possible that the teacher sets the pace without regard to them. At the top 
 are about two who are rapidly passed on to higher grades. 
 
 There remain about thirty-three for whom the pace is set so that the 
 weakest ten in the group can keep up. That means that the top fifteen could 
 go much faster than they do ; could learn much more thoroughly as well. When 
 they are held back to the pace of the low ten they are working at low 
 efficiency. 
 
SCHOOLS 1233 
 
 This condition is recognized by the teacher. She works extra hard in an 
 effort to bring the pacemakers, the low ten, along as rapidly as possible. She 
 is presently in a state of chronic fatigue. She works at low efficiency. 
 
 Of the millions of money spent for education much the larger part paid 
 from current funds is for teachers 5 salaries. In the Hoboken budget exhibit 
 there was a diagram showing that about 70 cents out of each dollar went for 
 teachers' salaries. 
 
 Therefore, when teachers work at low efficiency, the taxpayer is hard hit. 
 
 The school teacher does not work at low efficiency because she wants to. 
 Her anxiety to get results that are impossible is partly responsible for her 
 low efficiency. 
 
 In fact, the cause is beyond her direct control. She sits at one end of the 
 line compelled to mold minds whose incapacity for molding at an efficient rate 
 has been determined by factors at the other end of the line. She must mold 
 the clay as it is furnished her. Is there anything she can do ? 
 
 These facts are unknown to the community in general. The fathers are 
 too busy with their business and the mothers with their homes. Xobody has 
 ever told the taxpayer about these wasted millions. 
 
 Nobody (speaking with as much authority as the school teacher) can tell 
 him about the waste. She knows and the parents know she knows. They will 
 listen to her. 
 
 As Miss Denison says, the matter will never make a public appeal until it 
 gets away from the professional societies ; until the to-be-helped rather than the 
 helpers feel it their concern. 
 
 The child is unable to learn because of his physical condition. 
 
 He may have too much thyroid or too little, too much or too little of some 
 other gland, or he may have bad teeth or be a mouth breather or a catcher or a 
 snuffler — any one of these or many other conditions may be responsible for his 
 predicament. But here lies the cause in three cases out of four. And 
 why not ? 
 
 We have known for centuries that in the years from seven to seventeen 
 the mind must be looked after. Certain exceptional brains will travel through 
 those years without control and direction and will acquire power as well as 
 training. Those are the exceptions. 
 
 The average brain left undirected in those years travels toward the 
 penitentiary or poorhouse, or into the group of untrained labor. These facts 
 are so well established that education is compulsory. 
 
 The changes in the body between seven and seventeen are as important as 
 those in the mind. If it is necessary for the welfare of society that this enor- 
 mous educational machine should be supported to train the mind is it logical 
 that the body should be wholly uncared for? If it be argued that that can 
 be left to the parent, the home and the child the answer is that education can 
 be left to the same agencies. 
 
 When education is left to these groups unaided the percentage of unfit 
 minds increases though many minds come out all right. Is it not logical 
 to assert that when the physical side is left to the same agencies unaided' the 
 percentage of the unfit is increased, even though a great many come out 
 all right? 
 
 Under a better system is it not probable that we shall get after a while 
 
1234 
 
 HOSPITALS— SCHOOLS 
 
 a better idea of what is physically right just as our present standard of a 
 trained mind is much higher than that of half a century ago ? 
 
 If the mind and the body are Siamese twins and the developed, trained 
 
 Illinois Dept. of Public Instruction. 
 
 Fig. 500. — McCabe Drinking Fountain Attached to a 
 Pump. 
 
 twin is being held back by the untrained one shall we bring up the halt one 
 or shall we lame the other one? 
 
 There is no use trying to run the halves of the machine at different 
 speeds. Education must not go back. 
 
 The child is an egoistic parasite. The schools train him out of egoism and 
 somewhat out of parasitism. Eubbing up against other children gives him a 
 chance to find himself. 
 
 The demand for efficiency is increasing. The public schools will find 
 that the burden put on them in the future will be much increased. 
 
 This half of the machine cannot slow down. The other half must be 
 speeded up. That is not possible when the years from seven to seventeen are 
 not made use of for the perfection of the machine. 
 
 The condition to which it can be brought by home and parental and in- 
 
SCHOOLS 
 
 1235 
 
 dividual care will not allow of any more speeding up. It is like trying to use at 
 speed ball bearings where two-tenths of the balls are imperfect. It cannot 
 be done. It is unreasonable to think that it can. 
 
 (From Water-Supplies, by Thresh) 
 
 Iowa Bulletin. Dept. Public Instruction, Springfield, III. 
 
 Fig. 501. — Homemade Filter for Do- Fig. 502. — Antiseptic Tank or Chemical System 
 mestic or School Use. for One-Room Schools. 
 
 To proceed further on our present lines does not commend itself to 
 Yankee horse sense. 
 
 SCHOOL HYGIENE 
 
 This is what Dr. Corlin wrote the Michigan Board of Health to show 
 what bad school conditions could do : 
 
 "Numerous hale, ruddy, little pupils, five, six, seven and eight years of 
 age have entered with much ambition for their first school instruction. As I 
 have had my own children among them and others to treat, I have watched 
 the effect of their condition and surroundings and know whereof I affirm. 
 In this building, on a small scale, I have seen Darwin's theory of the 
 survival of the fittest tested, and its correctness demonstrated. 
 
 "Year by year, this school is constantly crowded beyond its healthful 
 capacity, notwithstanding that the weaker ones are continuously compelled 
 to drop from the ranks and remain at home to recruit their exhausted energies. 
 
 "A little boy who, during a period of four years, was confined in one 
 of these rooms accomplished no more than could easily have been done in 
 two years' time under suitable and healthful surroundings. 
 
1S36 HOSPITALS— SCHOOLS 
 
 "Because of the vile air of this room, he was permitted by his father 
 to attend but one and a half hours each morning and afternoon, and, even 
 so, he could attend the school for no more than eight or nine successive weeks, 
 because of resulting sickness, from which a few weeks' absence from school 
 never failed to restore him. 
 
 "He was finally sent to a more distant and, from a sanitary point of view, 
 a better school, and, in a clean, light, and airy room, where he attended 
 regularly and without interruption, improved in physical health and accom- 
 plished much more in his studies than at any previous time." 
 
 To which Professor Woodbridge adds: 
 
 "The hardest worker in a school-room is the teacher. The character of 
 a teacher's work is as susceptible to the debilitating and blunting effects of 
 environment as is that of the scholar. Whatever affects the teacher's working 
 capacity correspondingly affects the productive work of the pupils." 
 
 Compulsory education is all right. It has been upheld by the courts. It is 
 backed by public sentiment. However, compulsory education is a misnomer. 
 The laws should be known as compulsory attendance laws. 
 
 Education implies something more than attendance. Children who are 
 not in good physical condition do not get much educational benefit from 
 attendance. If the hygienic conditions are extremely bad they may be griev- 
 ously harmed by compulsory attendance. 
 
 The burden put upon the teachers by bad school hygiene is great. 
 
 SCHOOLROOM VENTILATION 
 
 Schools are usually well lignted Dut poorly ventilated. In fact, they 
 usually surfer from too much rather than too little light. Nor have I ever 
 been able to see much danger from schoolroom dust. But when it comes to 
 ventilation including regulation of temperature and moisture, conditions are 
 bad. They are unfit for grown people to stay in, to say nothing of 
 children. It is the fault of ventilation methods which are overdeveloped on 
 their mechanical side. They are so bad hygienically because they are so 
 good mechanically. Why ? 
 
 All school ventilation by a mechanical system is based on the idea that the 
 carbonic acid gas of a room is poisonous and we must add enough diluting 
 air to keep its percentage down. We know now that carbonic acid gas is 
 nearly harmless. Eosenau has shown that there are harmful chemicals in air 
 that has been breathed; but not even this alters the opinion that the proper 
 plan is to remove and not dilute. 
 
 A ventilation system which is based on the dilution of breathed air is in- 
 efficient and at the same time expensive. It is wasteful because it requires 
 2,000 cubic feet per person per hour while if the temperature is kept down, 
 the humidity up, and the rooms are blown out from time to time a much 
 less quantity gives much better results. 
 
 Mechanical systems are faulty for a second reason. The air is too still 
 and too uniform in temperature. Hill proved that still air is harmful; 
 Pfliigge's pupils that air uniform in temperature is harmful. 
 
 The teacher can watch the temperature and humidity of the room with 
 profit to herself and with no material increase in her trouble. Let there be a 
 
SCHOOLS 1237 
 
 wet and dry bulb thermometer in each schoolroom. Make it the duty of one 
 student to make an hourly reading of each. From these readings the 
 humidity can be determined by the chart which is a part of the hygrometer 
 equipment. The temperature of the schoolroom must not be allowed to rise 
 above 70°. The humidity must not be allowed to fall below 50. 
 
 How these requirements are to be met is the problem of the engineer, 
 not the teacher. But if she will be insistent enough that these requirements 
 are met she will be able to teach with far less effort than now. In addition, 
 from time to time let the rooms be aired and the temperature lowered by 
 opening the windows. The blowing that is good for sick air is the blowing 
 that can be felt. 
 
 These are easy and worth while things. The doing of them adds but 
 little to the teacher's burdens. On the other hand when they are successfully 
 done they lighten the teacher's load. Attended to, three o'clock comes earlier 
 in the day, Saturday gets nearer Monday and June gets in speaking distance 
 of October. 
 
 Of course, in time the entire method of school ventilation must be made 
 over from cellar to garret. The hygienists must lay down new standards 
 and the ventilating engineers must meet them. 
 
 Improvement of Ventilation. — The Chicago Ventilation Commission 
 has indorsed the following propositions: 
 
 1. In a mixture of air containing carbonic acid this gas does not settle 
 out and rest near the floor. 
 
 2. The dilution method of ventilation is ineffective and uneconomical. 
 
 3. The putting of a given volume of air into a room does not necessarily 
 constitute ventilation. 
 
 4. Ventilation is better done by air currents than by dilution. 
 
 Anyone acquainted with the present methods of ventilation knows that 
 the theories of the ventilation system now employed are the direct opposite 
 of these conclusions. It would be strange if the practice founded on wrong 
 principles should be right. Therefore, we are prepared to find the practice 
 faulty. 
 
 The principal faults of the Chicago practice are the following: 
 . 1. The temperature is not properly controlled ; is not properly observed ; is 
 not properly taken; is generally too high. 
 
 2. The humidity is not properly observed ; is generally too low. 
 
 3. The air in the room is too still. 
 
 4. The inside walls are too hot, the outside walls and windows are 
 too cold. 
 
 5. The air as introduced in the room is too hot. 
 
 6. There is no provision for blowing out the room by putting the windows 
 up. 
 
 Discussing these points in order: 
 
 1. Pfliigge has demonstrated that high temperature is the most harmful 
 agent in air which is harmful. It is now quite well accepted that in watch- 
 ing ventilation the main thing to watch is the temperature. The schoolrooms 
 have a temperature which, theoretically, is fixed at 72°. But where is the 
 thermometer placed? The outside walls are many degrees colder than the 
 inside; the places near the hot air intakes are much hotter than any other 
 
1238 HOSPITALS— SCHOOLS 
 
 place in the room; the temperature varies in the different levels above the 
 floor. 
 
 Does the thermometer show the average temperature of the room or the 
 temperature of some point lower or higher than the average ? The theoretical 
 temperature is four degrees too high. 
 
 Suggested remedy : 
 
 (a) Set the official temperature at 68°. 
 
 (b) Furnish every room with a thermometer which can be moved to 
 different parts of the room, that an average may be struck. 
 
 (c) Have the children or a child make an hourly record of the tempera- 
 ture in the room. 
 
 2. Air more than 70 per cent saturated with moisture is very oppressive 
 when it is hot and very chilling when it is cold. Air less than 50 per cent 
 saturated with moisture dries the skin, nose, throat and bronchial tubes and 
 causes infection when the air contains dust and bacteria. 
 
 The humidity of the inside air should be within twenty points of that 
 of the outside air or harm will result. Keep this point clearly in mind. If the 
 outside air is at 32° F. and the percentage of saturation with moisture is 100, 
 and if this air be heated to 132° and no water added to it or taken from it it 
 will be about 3 per cent saturated with moisture. Such air dries up the 
 tissues. 
 
 Says MacFie : "The living matter of the body contains about 80 per cent 
 of water, and, on the water in its composition, its vital activity depends. 
 Abstract the water and dry up the tissue, and its vitality is arrested or 
 destroyed. In man, the loss of about 10 per cent of his body water means 
 death." 
 
 The present plan takes in ordinary outside air and dries it by heat. No 
 moisture is added. To make it healthy moisture should be added almost in 
 proportion as heat is added — say as 4 is to 5. No observations on room 
 humidity are made. 
 
 Suggestions : 
 
 Wet steam should be turned into the heating chambers. 
 
 Every room should be equipped with a hygrometer. 
 
 The children, or a child, should make an hourly record of the humidity. 
 
 3. Leonard Hill has proved that air cannot be healthy unless it is moving 
 with a good deal of velocity. As it strikes the body it must have force enough 
 to blow the foul air away. It must clean the breathing zone, the air around 
 the head. It must clean the air around the body under the clothes — Sedg- 
 wick's "aerial envelope." 
 
 Still air is deadly. The present method aims to give the air a morgue-like 
 stillness. The hot air, frequently around 130°, is introduced about eight 
 feet above the floor. Theoretically the air blows across the room next the 
 ceiling, diffuses to the floor and gently leaves by an exit near the floor line. 
 The object is to do away with air currents. 
 
 Suggestion : 
 
 Equip the schoolrooms with electric fans to run during the winter. Fans 
 are a source of comfort during the summer ; they are a source of health during 
 the winter. 
 
 4. Inside walls are always warm when the building is warm. If a person 
 
SCHOOLS 1239 
 
 could not get rid of the Iteat which he made and kept on making heat at 
 the average rate he would reach the boiling temperature, 212°, in thirty-six 
 hours. Fifty children in a schoolroom make a great excess of heat. 
 
 The inside wall and the children are two factors requiring no heat. The 
 air for ventilation and the outside walls are two factors requiring heat. The 
 radiation in a room should always be near the outside walls. 
 
 The present method keeps the inside walls too hot; and at the same time 
 the outside walls are so cold that they sweat and frost if the relative humidity 
 of the air in the room goes over 50. Therefore, either the outside walls 
 and windows will be constantly wet or else the relative humidity of the air 
 of the rooms must be so low that it is unhealthy. 
 
 Suggestions : 
 
 Set the fans so as to blow air against the windows as the storekeepers 
 now do. 
 
 If there are no fans it is better to tolerate the window and wall sweat- 
 ing than to try to keep the pupils healthy with the overdry air now fur- 
 nished. 
 
 5. Air which comes in contact with a human being should always be under 
 95°. If hot air is kept moving rapidly and the relative humidity is kept around 
 70 the harm is greatly diminished. Air entering the Chicago schoolrooms 
 on a very cold day will range from 115° to 130°. It is very harmful if it 
 touches any teacher or child. 
 
 Suggestion : 
 
 Every precaution should be taken to deflect this air so that it strikes no 
 one until it is greatly cooled. The present methods accomplish this about 
 as well as it can be done. The only remedy is in a radical change in the 
 methods. 
 
 6. All are agreed that blowing out is the most effective method of 
 cleaning. When the children return to the schoolroom from play they are 
 making heat in great excess. If the room is over 68° they get overheated 
 and sweat. 
 
 Suggestions : 
 
 All schoolrooms should be blown out during each play period. The 
 children should return to a room in which the temperature is at 60°. 
 
 The intervals between blowings out should not be longer than four 
 hours. 
 
 If the ventilation system cannot adjust itself to periodic blowing out of 
 the room that of itself is enough to condemn the system. 
 
 The above suggestions are applicable to the present installations. None 
 of them except the fans will cost much money. A combined thermometer 
 and hygrometer can be had for about twice the cost of a thermometer. In the 
 main, the suggestions call for some retraining of the school engineers and 
 that is about all. 
 
 When new schools are built they should be heated and ventilated along 
 the following lines : 
 
 1. Eadiation placed along the outside walls. 
 
 2. Air intakes through the walls back of the radiators. 
 
 3. Air outlets located on the inside wall near the ceiling. 
 
 4. Outlet duct: in the attic equipped with exhaust fans. 
 
1240 
 
 HOSPITALS— SCHOOLS 
 
 5. Provision for discharge into the room of enough saturated steam to 
 maintain the relative humidity at 50 to 70. 
 
 6. Provision for enough radiation to keep the room temperature at 68° 
 F. and the temperature of the outside walls high enough to permit of a 
 humidity of 60 to 70. 
 
 7. Windows which can be raised. 
 
 Illinois Dept. of Public Instruction 
 
 Fig. 503. — Perspective of Modern One-Room School. 
 
 Such a system can be installed for much less than the present cost of 
 installation. It will do away with the present elaborate heating and mixing 
 chambers. It will reduce the expense of installation of ducts much below 
 its present rate. It will mean a smaller fan cost. 
 
 The volume of air to be handled need not be 1,800 cubic feet per pupil 
 per hour. So large a quantity was demanded for the present system because 
 of the mistaken method of ventilation by dilution. This can be reduced two- 
 thirds. This will save enormously in the cost of heating. It will save in 
 the volume of air to be handled and therefore in the cost of fan installation 
 and maintenance. 
 
 On windy days the rooms on the windward side would require no exhaust. 
 The fan work would then be limited to the rooms on the lee side. These items 
 would much more than offset the cost of a steam or hot water installation. 
 Besides, it would cost less to heat and humidify when the temperature was 68° 
 
SCHOOLS 
 
 1241 
 
 than to heat and not humidify where the temperature was kept at 72°. 
 
 Heating and Ventilation of the One-Room School. — The one-room 
 school generally stands exposed to the wind. Its walls should be well insulated 
 and its windows well chinked and provided with storm sashes. There should 
 be deadening beneath the floor because at best the floor will be cold. The 
 temperature of the room must not go above 68° and the wet bulb must stand 
 as high as 56°. The room must be blown out by opening the doors at least 
 three times during each day and the children must come from play into a room 
 with a temperature of 60°. 
 
 We will assume that the room is heated by a stove located toward the 
 
 
 |H i 
 
 Illinois Dept. of Public Instruction. 
 
 Fig. 504. — Showing Stairway to Basement. 
 
 center. The stove must be jacketed so that air flows between the jacket and the 
 hot iron wall. It must be set close to the floor and be provided with perfora- 
 tions in the jacket to suck in cold air from the floor zone and warm it up. 
 Fresh air should be taken through pipes which lead from underneath the house 
 to the jacket and space around the stove. These ducts should be provided 
 with dampers. 
 
 Outlets provided with dampers should open through the roof or into an 
 unused attic where there is one. At least one outlet should be around the 
 stovepipe to get the lift of the heat in the pipe as a means of emptying the 
 foul air from the room. If it is necessary to economize fuel some of the fresh 
 air can be brought in through a tube within or alongside the stovepipe so as 
 to use some of the waste heat of the smoke to preheat the fresh air. 
 
 In order to moisten the air the upper part of the stove should be occupied 
 by a water pan several feet square. The water must be near the boiling point. 
 Gallons must be evaporated each day — say ten to twenty — enough to keep the 
 humidity over JfO. 
 
 To clean the air cheesecloth filters should be placed in the intake pipes, 
 
1242 
 
 HOSPITALS— SCHOOLS 
 
 These consist of two frames arranged like an embroidery frame. Into this 
 frame a fresh piece of cheesecloth can be inserted. 
 
 The standards for country school ventilation are: 
 
 Temperature, 68°, 
 
 Foot zone temperature, 65°. 
 
 Wet bulb temperature, 56°. 
 
 Clean air. 
 
 Clean floor. 
 
 Air freshened several times a day. 
 
 Teaching in Cold Air. — It was inevitable that the teachers and pupils 
 made anemic and listless by the warm, dry air of mechanically ventilated 
 
 Illinois Dept. of Public Instruction. 
 
 Fig. 505. — A Less Expensive School House. 
 
 schoolrooms should become discontented. When the school inspectors found 
 such a train of enlarged glands and recurring colds as their statistics show 
 this discontent started a demand for better school ventilation. From this de- 
 mand three offshoots have crystallized: 
 
 Teaching in rooms where the windows are periodically opened. 
 
 Teaching in open-window rooms. 
 
 Teaching in opon-air schools. 
 
 Each of these is suited to a certain type of child and unsuited to others. 
 For the average child in a cold climate the first is adapted. For the child 
 that has glands, is a mouth breather or catches cold easily the second is better. 
 For the tuberculous child and the child from a home where there is active 
 tuberculosis the third has been worked out. 
 
 A procedure so simple as opening the windows is best carried out accord- 
 ing to a plan. I know of none better than to throw them wide open for 
 the last five minutes of all recess periods and for one minute each hour during 
 the teaching periods. The janitor can shut down his fans during these periods, 
 or the teachers can place a board over the ventilation inlets and outlets if heat 
 cost is complained of. 
 
 Children returning from play to a schoolroom will cough and show other 
 evidence of discomfort if the room is warmer than 60°. 
 
 When the windows are thrown open all parts of the room are of the 
 
SCHOOLS 
 
 l?A?> 
 
 same temperature. People complain not of the cold rooms but of the cold 
 places in a warm room — the floor, next the windows, near the doors. A 
 general room temperature of 60° where the windows are open wide is not so 
 liable to cause complaint as in a room in which a window is raised a little way. 
 Open-window rooms and open-air schools require unusual teaching ar- 
 rangements and are needed for none but unusual children. 
 
 FOBtZH 
 
 Tt-oocs CL**** 
 
 Illinois Dept. of Public Instruction. 
 
 Fig. 506. — One-Room School. 
 
 Cold-Room and Open- Air Schools. — The temperature of cold-room 
 schools should not go below 55° even in the coldest weather. It should not 
 go above 60°. There should be enough radiation to maintain this temperature 
 where the windows are wide open. The children should wear their coats, 
 woolen gloves and caps in the schoolroom. 
 
 School lunches are not especially needed in open-window schools. Most 
 school children would learn faster if they were better fed but this need is 
 not materially greater with open-window school children than with the gen- 
 eral run. 
 
 The temperature of open-air schoolrooms is that of any sheltered, shady, 
 outside area. Children attending outdoor schools must have special clothiug. 
 
1244 HOSPITALS— SCHOOLS 
 
 special food, special rest hours and special medical attention. They wear felt 
 boots, woolen mitts and a flannel oversuit with hood. They are given three 
 meals a day. 
 
 LUNCH AT 9 A.M. 
 
 1 glass of milk, cold or hot, with bread; or 
 
 1 bowl of soup and bread. 
 
 DINNEK AT 12 M. 
 
 2 glasses of milk and bread and butter. 
 1 bowl of soup. 
 
 Meat — beef or mutton. Sometimes fish or eggs. 
 
 Vegetables — potatoes (one), peas or beans. (Green vegetables when 
 possible.) 
 
 Dessert — Fruit, raw or stewed, or pudding. 
 
 LUNCH AT 3:30 P.M. 
 
 1 glass of milk, bread and butter and occasionally jam, jelly, or molasses. 
 
 After lunch they should be required to rest by lying down for one hour. 
 
 They should be weighed periodically, measured, and examined at stated 
 intervals. 
 
 In spite of the physical handicaps of the cold-air students — for none 
 out moderately subnormal children are given this special treatment— -they grow 
 fatter and become rosy; their enlarged glands subside; their disposition to 
 catch cold decreases. From the educational standpoint it pays, for they 
 learn fast and attend regularly. 
 
 The per capita cost of the open-air school is too high to make it avail- 
 able for the ordinary run of students. 
 
 The per capita cost of open-window schools is not much above the 
 average except in those cases where, for special reasons, special medical and 
 nursing service is given and free lunches are supplied. 
 
 MEDICAL SCHOOL INSPECTION 
 
 Children of school age are undergoing rapid changes. They double in 
 size and weight within a few years. Their bodies take on new shapes. 
 Their brains increase in volume and improve in texture. The change in 
 mental capacity from that of the first grade student to that of the fourth 
 year high school student is no greater than the change in the physique during 
 the same years. 
 
 A few years ago there were people who did not believe in education. 
 There are some now, but they are few. 
 
 The mind of the child, during education, needs the supervision of 
 teachers — so much practically everyone now concedes. It is just as inevitable 
 that everybody should eventually see that the physical side of school children 
 needs control and direction. 
 
 School life is essentially social. In that lies its great educational 
 strength. In part is this true of book education. Especially is it true of 
 education in life, in self-discovery, in perspective, in meum and tuum. 
 
SCHOOLS 1245 
 
 It is impossible to conceive of advantages without disadvantages. Some- 
 thing for nothing is impossible. When children congregate, colds, measles, 
 scarlet fever, and other contagion will invariably come along. 
 
 In the country where gossip is a pretty fair school inspector contagion 
 depletes the schoolrooms somewhat. In the city, where gossip is not worth 
 much as a moral agent, uninspected schoolrooms average less than 90 per cent 
 full. 
 
 Partly full schoolrooms mean inefficiency. In other words, the taxpayer 
 is not getting all he is paying for. 
 
 And then, periodically, an epidemic sweeps along. If there is no school 
 inspection the schools must close. If there is school inspection they can 
 be kept open. To close the schools means waste of the taxpayers' money. 
 
 Teachers say classes could get on much faster if the students all attended 
 regularly and all were in good health. Ask any teacher if this is not so. 
 If the mouth-breathing child, the child with the snuffles, if any .neglected 
 child is holding the class back, whose liberty is being interfered with? If 
 the class is being held back by such children — and any teacher will say so — 
 is not the taxpayers' money being wasted? 
 
 In Chicago there are not seats enough to take care of all the children who 
 want to go to school. There would be ample if the children were all bright 
 enough to have the classes push along rapidly and if nobody failed to make 
 grade. 
 
 Mrs. Young tells us that repeaters — children who fail to make grade — 
 cost Chicago $200,000 a year. Now, everybody is agreed that bad eyes, bad 
 teeth, bad throats, bad physical condition generally, are responsible for more 
 than 90 per cent of the failures to make grade. It does not seem right 
 to throw this great burden on the taxpayer if there is any way to prevent it, 
 and everybody knows there is a way to prevent it, and that way is through 
 care of the health of the children. 
 
 And yet there are those who would encourage a small minority in fasten- 
 ing these burdens on the majority ! 
 
 Benefits of School Inspection. — A few years ago we closed our schools 
 to stop epidemics. Now to stop an epidemic we keep the schools open and con- 
 trol the epidemic through school inspection. It has even been proposed that 
 epidemics in vacation season be met by opening the schools and providing in- 
 spection. 
 
 It costs a good deal more to close the schools than it does to maintain 
 a temporary inspection for contagion and besides, inspection is much more effi- 
 cient. Under the old plan we would fumigate the house and thereby kill 
 any lonely bacillus that might be hanging around. Then we would bring 
 back the school children and have one scarlet fever scaler come in with a 
 million contagion germs in his throat. 
 
 Now we know that it is people, not things, that we must watch. And this, 
 of course, adds greatly to the responsibility of the already burdened grade 
 teacher. If the school has a well executed medical inspection and good school 
 nurses the teacher can keep her mind on teaching her pupils. If she has 
 neither of these she stands on guard alone and she must divide her mental 
 energy. 
 
 I think there is no question that if there were no school children there 
 
1246 HOSPITALS— SCHOOLS 
 
 would be little scarlet fever or diphtheria— certainly little diphtheria. 
 Wherever the school children are vaccinated there is no smallpox. At least 
 there is so little that health officers do not worry about it. The control of 
 diphtheria is coming near enough within range to allow us to say, "When there 
 is no danger of infection of school children then there will be little diph- 
 theria." 
 
 Since the teacher stands on guard at the point where the enemy is going 
 to strike she must not sleep at her post. She must learn to draw common 
 sense conclusions from sore throats, snuffles, rough skins, fevers, headaches, 
 absence from school and stories of sickness at home. Many of her conclusions 
 will be mistaken but the guard must sound the alarm even though the danger 
 is finally found to be imaginary. 
 
 If the school is the usual means by which contagion is spread should it 
 not be one of the agencies by which it is controlled ? Or, to put it differently, 
 if the community by its practices makes the school a spreader of contagion 
 is it not up to the community to establish practices that will make the 
 school a means of controlling contagion ? 
 
 The teacher has a selfish interest in this matter. She is more liable 
 to contract contagion than is the average member of the community. 
 The sentinel is always in danger. 
 
 Dr. Luther Gulick told the National Education Association that before 
 many years anemic, physically below par children would be sent to school 
 to get well — an outgrowth of the practice of using the schools to control 
 contagion. 
 
 Medical Inspection in Chicago.— In Chicago the inspection of school 
 children consists of several parts: 
 
 1. Inspection to exclude contagion — a service performed by the Health 
 Department. 
 
 2. Inspection to exclude minor communicable conditions such as lice, 
 itch, and some other skin conditions — service performed by the health de- 
 partment through medical inspectors and nurses. 
 
 3. Inspection, examination, and special attention to markedly defective 
 children ; for example, the blind, deaf, crippled and markedly subnormal — 
 service by the board of education. 
 
 4. Dental inspection of school children and dispensaries for relief — service 
 by philanthropy under direction of the dental society. 
 
 5. Physical examination of the school children with advice given the 
 parent that treatment would be beneficial— -service formerly performed by 
 the health department medical inspectors and nurses. 
 
 6. Bequest that parents have their children examined physically at the 
 beginning of the school year and that the results be forwarded to the school 
 board — request made by the board of education; blanks furnished by the 
 board. 
 
 Services Nosi 1, 2, and 3 have been a part of the school routine for 
 about four years and No. 4 for about two years. 
 
 One spring the National League for Medical Freedom advertised its 
 opposition to Nos. 1 to 5 inclusive. This opposition was to the expenditures 
 of public money for the compulsory examination of school children. Forced 
 to tie up its opposition in some way ' with medical treatment the League 
 
SCHOOLS 
 
 1247 
 
 declared the intent of the authorities to be at some time or other to com- 
 pel treatment. Inferentially, the treatment, when the time came to give 
 it, would be compulsory and would be given by one school of medicine to the 
 exclusion of all others. 
 
 The League has a wonderful nose for fear. It has a wonderful capacity 
 for foreseeing what may happen some time or other, of which it proceeds to 
 get afraid. 
 
 Illinois Dept. of Public Instruction, 
 
 Fig. 507. 
 
 The following fall the board instituted No. 6 — a recommendation that the 
 parent have the physician of his choice examine his children — whereupon the 
 League came out with a circular condemning that recommendation. 
 
 As I have understood these Freedomites the freedom of the family to 
 employ whom they pleased was just what they wanted. Now, when they get 
 what they want, they are "agin" it. When government goes ahead on a con- 
 structive policy, they are "agin" it. If government modifies the policy to give 
 the Freedomites the freedom asked for, they are "agin" that. 
 
 They defy the government to jump any quicker than they can. Nobody 
 can hop on their rock any quicker than they can hop off. They are the 
 
1248 
 
 HOSPITALS— SCHOOLS 
 
 champion hoppers. In comparison a flea is a puling paralytic. As a matter 
 of fact, they switch their argument as they deem it expedient to do so, holding 
 fast, however, to their fundamental position. 
 
 They do not believe in physical perfection or physical imperfection; in 
 physical efficiency or physical inefficiency; in contagion or immunity; or in 
 any of those things. They believe that talking about these "errors" creates the 
 conditions found. On this they base their opposition to school inspection. 
 
 
 Illinois Dept. of Public Instruction, 
 
 Fig. 508. 
 
 This they hold unchangeably. This makes a perfectly proper line of cleavage. 
 Those who believe in that way should oppose school inspection. Those who 
 believe otherwise should support it. 
 
 Work of the School Inspector. — As the work is now divided the school 
 inspectors are divided into two groups — those who inspect for contagion 
 and those who examine for physical defects. The first group examines the 
 children to discover smallpox, scarlet fever, diphtheria, measles, whooping 
 cough and a few diseases of lesser consequence. When a case is diagnosed 
 as one of contagion the child is sent home and a quarantine is established. 
 
SCHOOLS 1249 
 
 The inspectors do not treat cases. They are prohibited from taking any part 
 in the treatment of any case. Their duty is to see that the rights of the 
 community are protected. 
 
 In the cases of ringworm, itch, lice and similar mild communicable 
 conditions they make the diagnosis and instruct the nurse what to do. At one 
 time it was the custom to exclude these children from school after advising 
 the family to have a physician tell them what to do. It was found the plan 
 did not work. The parents would not call a doctor for a simple condition 
 like lice. They would do nothing and the children just stayed out of school 
 indefinitely. 
 
 Each school physician does a certain amount of vaccinating in his 
 schools. A few years ago the Illinois Supreme Court decided that Chicago 
 could not have compulsory vaccination unless the city council passed an 
 ordinance requiring it; that the health department, acting under the general 
 police power of the cities and village acts, could not require it. This is what 
 those called the anti-vaccinationists usually refer to as a decision against 
 vaccination. The decision was given long enough ago for its effects to 
 begin to show. There were some cases and some deaths among school chil- 
 dren from smallpox last winter — the first in many years. The vaccinating 
 is done on those whose parents want it done. About 99 per cent of the chil- 
 dren are vaccinated. 
 
 When children have been out of school for several days the school inspector 
 must pass upon them before they are allowed to mix with the other children. 
 This is a brief statement of the work of the medical inspector for contagion. 
 
 The examiner for physical defects examines the eyes, ears, nose, throat, 
 mouth and teeth of the child. The clothes are not removed. In a general way 
 deformities,, poor muscular development, anemia, heart and lung diseases are 
 guessed at from the history and from general appearances. A report of the 
 findings (with recommendations) goes to the parents, another to the school 
 and a third to the health department. 
 
 If a parent sees fit to neglect his child there can be no compulsion. The 
 examiner does not treat the children. If the child is defective and as a result 
 the teacher finds teaching is difficult she must do the best she can, since the 
 parent cannot be forced. If other children are held back by this child 
 they must put up with it. The parents cannot be forced. If this dull 
 child helps to overcrowd the schoolroom and keeps the other children from 
 getting an education it cannot be helped. If such children increase taxes 
 it cannot be helped. 
 
 The school inspector can exclude contagion — beyond that his work is 
 wholly advisory. 
 
 What the Parents Have a Right to Expect from School Inspection. — 
 Parents as a group have a right to demand : 
 
 1. That contagion will be less than in uninspected cities of the same size 
 in the same climate. 
 
 2. That epidemics will be more than twice as far apart as before school 
 inspection. 
 
 3. That it will never be necessary to close the schools for contagion. 
 
 4. That each generation will grow up stronger than its predecessor. 
 
 5. That there will be fewer deaf, fewer hunchbacks, fewer cripples. 
 
1250 HOSPITALS—SCHOOLS 
 
 6. That eventually the schools shall be properly ventilated. 
 Every parent has the right to expect : 
 
 1. That his child shall have fewer colds, fewer coughs, fewer sore throats, 
 less rheumatism and less heart disease than prevailed before inspection. 
 
 2. That his child shall go through his school life without ever having been 
 in danger of smallpox or of losing a day from this contagion. 
 
 3. That his child shall go through school life without having diphtheria. 
 
 4. That his child's chance of scarlet fever shall be reduced to one out of 
 six ; of measles and whooping cough to less than before school inspection. 
 
 5. To be told when sore throats are due to diphtheria and when to ordinary 
 bacteria. 
 
 6. That his child shall not get lice or itch or ringworm in school, or, if he 
 does, that school inspection shall correct the condition promptly. 
 
 7. That his child shall have headaches rarely or never; not be tired at 
 night or listless or pale and flabby looking. 
 
 8. That his child shall not become a mouth breather or get to be lantern- 
 jawed. 
 
 9. That his child shall want to play, enjoy play and know how to play. 
 
 10. That his child shall make at least one grade a year and every year 
 or so an extra grade. 
 
 11. That if his child be feeble-minded or deaf or blind or crippled or 
 tuberculous he shall be cared for by special teachers in special schools and in a 
 special way. 
 
 The parent should support his child in school, requiring him to make 
 little if any money during the school years. 
 
 That is about what the law says and it is good sense and good judgment 
 as well. 
 
 If the parent is forced by law to keep his child in school for six hours a, 
 day five days a week for ten months a year for eight years he lias the right to 
 insist that the schoolroom be well ventilated ; that contagion be kept out of. the 
 group; and that the school do everything it can for the physical welfare of the 
 children to the end that they study better, learn faster and grow up in strength. 
 
 Parents, demand your rights! 
 
 Exclusions from School. — The New York health department recently 
 has revised its rules for excluding children from school on account of con- 
 tagion. 
 
 Children suffering from diphtheria are excluded for at least one week 
 and are not readmitted until the throat and nose are well and cultures are 
 negative. The certificate of health for readmission must come from the 
 health department. Children from the same family residing at home can 
 be readmitted to school at once if quarantine is well kept and throat cul- 
 tures are negative. 
 
 If quarantine is not kept all children from the family are excluded 
 until the quarantine is raised. If children are removed from the infected 
 home they will be readmitted to school if cultures from their throats show 
 no diphtheria bacilli. 
 
 Cases of scarlet fever are excluded for at least five weeks or until the 
 skin has stopped shedding and all discharges from the nose and throat and 
 all cough has stopped. Elsewhere in the report the statement is made 
 
SCHOOLS 
 
 1251 
 
 that it is very doubtful that peeling has anything to do with the spread 
 of scarlet fever. 
 
 Nevertheless, the authorities do not feel certain enough of their ground 
 to rule that peeling can be disregarded and attention concentrated on the 
 nose and throat discharges. 
 
 DDODUnD 
 QDDODQD" 
 
 School £ooaa 
 
 D.n.nnnon 
 
 D-DDDDDD 
 
 : <&.-o- v gr 
 
 
 S^7 1 
 
 in 
 
 •FlR^ffLODRPLAM 
 
 Illinois Dept. of Public Instruction. 
 
 Fig. 509 
 
 When the scarlet fever germ has been discovered and studied we may be 
 able to shorten the exclusion period of some cases to one week, as with 
 diphtheria, but that time has not yet arrived. If quarantine is kept those 
 children in the family who previously have had scarlet fever are allowed to 
 remain in school. 
 
 Children of the family who have had scarlet fever but who have been 
 removed from the house where the case, occurred are allowed to return to 
 school after five days if in the meantime no scarlet fever has developed 
 among them. If they continue to. .reside at home . they will be excluded from 
 school until the cases .are. officially. .'"discharged.;,.: . • ■ ■ ..,•.... -•• • 
 
1252 HOSPITALS— SCHOOLS 
 
 In measles the patient is excluded from school until five days after 
 the appearance of the rash at which time (if the cough and all discharges 
 have disappeared) he can return to school. Those children who already have 
 had measles can continue attending school if quarantine is kept. 
 
 As the incubation period of measles is fourteen days children removed 
 from the home where a case is found are not admitted to school for fourteen 
 days after the removal. In German measles the child is excluded from school 
 for one week and admitted upon a certificate from the school doctor. 
 
 In whooping cough the child is excluded until the whoop has entirely 
 stopped, say in from six weeks to two months. In mumps the child is excluded 
 until the swelling has disappeared. In chicken pox the child is excluded until 
 the scabs have disappeared. As this disease is so liable to be confused with 
 smallpox the rules insist on an inspection by the school doctor. 
 
 The School Nurse. — The report of the Committee on Medical Inspection 
 of Schools to the Section of Preventive Medicine of the American Medical Asso- 
 ciation gives the following as the work of the school nurse : 
 
 "School nurses are assistants to the staff. Their field work is essentially 
 as follows: 
 
 "To assist members of the staff in the skilled examination of pupils and 
 otherwise as assistance is needed. 
 
 "To assist teachers in making preliminary surveys of their pupils and 
 in giving initial examinations, notifying parents of essential needs of 
 pupils, etc. 
 
 "Visiting parents and in all justifiable ways establishing effective co- 
 operation between home and school. 
 
 "Further, the function of the school nurse is that of the social educator 
 in the field of hygiene. As such the work of the school nurse is one of 
 high order. 
 
 "The staff of experts, the teaching force of the schools and school nurses, 
 working from the standpoint of education, form an educational corps to 
 secure the effective cooperation of home, school, and school authorities in 
 meeting the requirements of the physical and mental health and growth of 
 pupils. When educational means fail the law must remedy instances of 
 neglect of health and growth of children." 
 
 When a physical examination has been made and the parents have been 
 told what should be done but a small part of the work has been accomplished. 
 Cornell's experience is that only a small percentage of the parents will accept 
 the advice given. The percentage will vary according to the neighborhood. 
 Some neighborhoods take care of the children better than others. Some 
 inspectors are much more successful in getting work done than others. 
 
 The nurse goes to the home, gets hold of the parent, talks over the 
 whole matter and often takes the child to the hospital, dispensary or physician. 
 Some nurses can persuade every parent to have his child cared for ; others are 
 less successful. 
 
 School Inspection for Abnormal Children. — In order that unusual chil- 
 dren may be more accurately studied and the proper treatment given them 
 Dr. MacMillan of the Child Study Department of the Board of Education 
 (Chicago) established a series of averages, "norms" or measuring rods, by 
 closely examining 8,000 children. The examination covers the following points : 
 
SCHOOLS 1253 
 
 1. Age. 
 
 2. Height — standing and sitting. 
 
 3. Weight. 
 
 4. Endurance and persistence. 
 
 5. Motor ability and strength. 
 
 6. Lung capacity. 
 
 7. Head measurements — the length, breadth, circumference, estimated 
 cubic dimensions — internal and external. 
 
 The physical examination goes hand in hand with a mental test covering 
 the following points : 
 
 1. Acuteness of senses — sight, hearing and touch. 
 
 2. Perception, sensitivity to likes and differences. 
 
 3. Memory. 
 
 4. Association. 
 
 5. Types of thinking. 
 
 6. Types of learning. 
 
 7. Range of information. 
 
 The normal having been established, those reasonably near it are cared 
 for in ordinary schools and by the ordinary teaching methods. Those 
 far away from the norm line are specially studied and sent to the 
 group in which they belong where, sometimes by one method and sometimes 
 by another, such mental and physical treatment as they need is received. 
 
 In a group of fifty children there will be found about thirty-five of nearly 
 the same ability and strength, five may be unusually bright and ten may be 
 unusually retarded or below the average. 
 
 When a boy fails in his studies the temptation to blame him is strong. 
 If he fails to pass from one grade to another at the end of his school year 
 his mother (and maybe others) is disposed to blame the teacher. Now, some- 
 times the boy should be blamed and sometimes the fault lies with the 
 teacher but with our old hit and miss method injustice was the rule. Is it 
 not fairer to study the student closely and then measure both him and his 
 teacher by the result of the study? 
 
 It has been more than two centuries since we burned women, thinking 
 them witches because of some departure from the normal. It has been half a 
 century since we punished the insane. 
 
 It will be some years before we fully understand that the abnormal child 
 is so because of the sins of his ancestors or because of the contagion, bad hy- 
 giene or bad nutrition of his earlier years; that the wise and economical thing 
 to do is to study him from the mental and physical standpoint; and, finally, 
 that school funds are saved by proper attention to the physical side of the child. 
 
 The provision made by the Board of Education of Chicago for the dis- 
 tinctly unusual child is the best in the world. It is done in a bureau called 
 the Bureau of Child Study. Its field is that large group of children who are 
 so much out of the ordinary that they cannot be cared for in the ordinary 
 schoolroom in fairness to the fifty children there and certainly not in fairness 
 to the unusual child himself. 
 
 In this bureau unusual children are grouped as follows : 
 
 1. The abnormally bright — about five hundred a year of this type are ex- 
 amined. It may seem paradoxical to treat these children in a bureau for sub- 
 
1254 HOSPITALS— SCHOOLS 
 
 normals but experience has shown that while they are abnormally clever on one 
 side of their make-up they are dull or deficient in some direction. They are at 
 least so exceptional as to demand individual attention. 
 
 2. Those with speech defects, stammerers and stutterers particularly. 
 For these there are four special teachers. 
 
 3. With hearing defects. For these there are thirteen centers. 
 
 4. With eye defects — the blind and those with especially poor vision. For 
 these four centers are now established. 
 
 5. Crippled children. For these there are now two centers. Certain 
 cases are cared for in town and certain others in the country. 
 
 6. Truants and incorrigibles. For truants there are now three centers. 
 The function of these is to take care of the truants and to prevent them 
 from developing into the group termed incorrigibles — the group cared 
 for at the Parental school. 
 
 7. Subnormals. In this connection is meant the lowest grades of minds 
 still subject to improvement through education. This group extends to 
 those who have to repeat a grade more than once, to those who are able 
 to get no farther than the third grade by the time they have reached fourteen 
 years of age. For these there are thirty-two special rooms. 
 
 These defects are not due to chance. Most of them are inherited; many 
 are acquired through contagion in early childhood, through summer com- 
 plaint in babyhood, through neglected colds resulting in ear infections, 
 through drinking milk from diseased cows. Many result from insanitary 
 homes. . 
 
 Chicago has found it economical as well as humane to establish a separate 
 department for such children, to group them properly and teach them in the 
 right way. It saves money and gets results. 
 
 If a city or town has no such department it is wasting money. It 
 can be certain that the defectives in its school population are in about the 
 same proportion as in Chicago. Of course, a country school must handle 
 all of its children together, sound and defective, and put up with the economic 
 waste and inefficiency ; but it pays a town having a school population of more 
 than a thousand to divide the children into two groups — average and unusual. 
 When the school population gets over five thousand the unusual group should 
 be still further subdivided and proper treatment given. It is wise — it is just — 
 it pays. 
 
 FEEDING THE GROWING GENERATION 
 
 Many mothers, earnestly concerned about the growth of their children, 
 call our attention to many instances of underfeeding and failure of growth 
 and proper development. They ask for information as to the kind and 
 amount of food their boys and girls ought to get. 
 
 The infant has found many champions, but the growing youngsters, 
 from 7 to 14 years old, find themselves beset and hemmed in by a multitude 
 of don'ts about eating that would dishearten any child were it not for the 
 healthy and imperative command of the growing body that makes the child 
 see the food only and not the don'ts. There are not lacking narrow, dys- 
 peptic, vinegar-hearted individuals who are afraid Young America will eat 
 up the earth. 
 
SCHOOLS 1255 
 
 The healthy child wants to know nothing about the schemes of raising 
 it on a nickel or 8 -cent ration a day and getting along on the leavings of 
 such a ration the next day. The healthy child wants and ought to get four 
 or five meals a day. It wants and needs plenty of milk, eggs, meat, tread, 
 and outter. It should get it. It wants and needs vegetables, fruits, soups, 
 jellies, and other wholesome and simple foods. 
 
 The weight of the child is u better guide to the amount of food it should 
 get than the age. Children of different ages but of the same weight require 
 the same amount of food. 
 
 The following dietary for a child of 10 is offered, not to be followed in 
 every case but rather as a suggestive guide: 
 
 BREAKFAST 
 
 1. Four ounces of bread or a roll. 
 
 2. One ounce of meat. 
 
 3. Butter. 
 
 4. Cup of milk. i 
 
 NOONDAY MEAL 
 
 1. Plate of soup. 
 
 2. Four ounces of meat. 
 
 3. Vegetables. 
 
 4. Sauce. 
 
 1. Bread or roll. 
 
 2. Milk or cocoa. 
 
 3. Preserves. 
 
 1. Cup of milk. 
 
 2. One egg. 
 
 3. Some meat. 
 
 4. Bread. 
 
 Fruits, jellies, etc., may be added to each meal. If the child wants more, 
 let him have it; if it is too much, he will let it alone. 
 
 "The foundation and first condition of a diet is a definite minimum 
 amount of proteids, fats, and carbohydrates, capable of sustaining the body 
 and insuring a gain in weight." 
 
 During infancy more food is required in proportion than during child- 
 hood; during childhood the relative amount of food required is greater 
 than in adult life. The reason is that growing children not only have to 
 replace the constant wear and tear of tissues but they also have to build 
 bone, make muscle, store up nervous energy, and fortify the system against 
 strain and disease. 
 
 Underfed children fall easy victims to acute and chronic diseases, have 
 weak mentality, and lack the firm, courageous spirit of self-reliance. Don't 
 let chronic underfeeding pass for gentility. In feeding growing children, their 
 needs and appetites should be consulted and not ours. 
 
 Babies and adults usually are overfed; children usually are underfed. 
 Be generous with the loaf. 
 
 AFTERNOON MEAL 
 
 SUPPER 
 
1256 HOSPITALS— SCHOOLS 
 
 ATTENTION TO NEGLECTED CHILDREN 
 
 On first thought anyone would say that if a school teacher, having noticed 
 one of her pupils was not progressing in his studies, had sent him to a school 
 physician for examination and the examination had shown that the child 
 was a mouth breather, had poor teeth or poor eyes there would be no trouble 
 in getting the parents to put the child in good physical condition. One 
 would think that upon receipt of a note from the teacher or the physician 
 they would at least go to some physician to see what he thought about it. 
 
 What are the facts? 
 
 Cornell's "Health and Medical Inspection of School Children" gives 
 many instructive tabulations regarding the relative efficiency of different 
 methods of interesting the parent. Intelligent notices written by a good 
 inspector to parents in good neighborhoods secure treatment in one case out 
 of three in eyestrain and one case out of two of the nose and throat difficulty. 
 
 The average inspector s notice secures attention in about one case in -five. 
 An indifferent inspector sending out formal, impersonal notices can get help 
 for only about one child in twenty. Written notices to foreigners usually ac- 
 complish nothing, since they cannot be read by those who receive them. 
 
 If there is a neighborhood dispensary the chance that the notices will 
 be heeded improves materially. When the notice fails to secure help for 
 the needy child the school nurse or a social visitor follows it up. She gets 
 results from one visit in a little more than half the cases seen. 
 
 A comparison between the results of school inspection in two groups 
 of 750 children each — one without nurses, the other with — shows that the 
 percentage heeding the advice as to defective vision rose from 25 to 80 
 per cent; hypertrophied tonsils, 18 to 65 per cent; adenoids, 14 to 72 per 
 cent; defective teeth, 20 to 92 per cent. 
 
 In more than half the cases of this series where the parents paid no 
 attention to the note from the school physician they were persuaded by the 
 school nurse. 
 
 Another idea of the difficulties may be gleaned from the following 
 report on 129 Kussian Jewish and Italian children needing glasses. On 
 advice given at the school by the inspector and nurse 18 secured glasses; 
 on one visit by the nurse, including 17 cases escorted to dispensary, 42 secured 
 glasses; as the result of repeated home visits by the nurse, including 12 cases 
 escorted to the dispensary, 48 secured glasses. A total of 108 results and 21 
 failures. 
 
 Medical inspection without a nurse follow-up service scarcely pays. 
 
 LARGER USE OF THE SCHOOLS 
 
 In addressing the National Educational Association Professor Ward of 
 Wisconsin advocated making the schools the voting places and the school prin- 
 cipals the election clerks. This was but a part of his argument that the way 
 to democracy lay in the use of the schoolhouse for all sorts of political and 
 social functions. 
 
 It does not seem fair to charge the entire cost of the school system against 
 the kids. They use the equipment for but a few hours during the day, 
 
SCHOOLS _ 1257 
 
 a few days during the week and for only ten months of the year. Would 
 it not be fairer to devise a way to have the grown people use the buildings, 
 libraries, halls, gymnasiums and swimming pools for the rest of the time and 
 then split the cost between the kids and the grown-ups ? 
 
 Whenever it is proposed to pay the teachers better salaries up bobs the 
 statement that half of the taxes and half of the bond returns now go to the 
 schools. It would take some of the force from this argument if the schools 
 were made use of as a center of diversion, entertainment and education for 
 the grown-ups. 
 
 We need moving pictures. They have gripped the public. Through them 
 we can teach health, morals, history, geography, science, life. The privately 
 owned places but partly fill the bill. Why not use the schools? 
 
 We are all agreed that health is better than it was ; but it still is not what 
 it should be. In America it cannot be greatly improved by coercion, legis- 
 lation or government control. Improvement must and will come through 
 education. But of whom ? Both children and adults. Then why not use the 
 schools ? 
 
 At this meeting of the teachers it was evident that the tendency is 
 strongly toward a use of the schools for many community purposes. On 
 Wednesday there was a rich program on recreational, social and civic op- 
 portunity through the schools. It was valuable both because it told what is 
 being done and what should be done; but it was more valuable in that it 
 brought out the trend of the times in bold relief. 
 
 The next morning Professor Ward pointed out the enormously expensive 
 mistake made in Chicago twenty years ago when the playground system 
 was vetoed by the board of education and was forced thereby to grow up 
 apart from the schools. That afternoon Professor Allyn told the plan by 
 which Westfield, Massachusetts, and several other places had used its school 
 laboratories to purify its food supply, and so far from hurting the schools 
 as such it greatly improved them — an example that should be followed by one 
 hundred towns within a night's ride of Chicago. Several speakers, prominent 
 among whom was a Gary school teacher, told of similar activities. Professor 
 Shephard told of some valuable related work in the Lucy Flower High School 
 in Chicago. Professor Works, formerly of Madison, Wisconsin, told of how they 
 made botany practical at Menominee and Professor Eandall of Brooklyn of 
 methods of making physics a study of service. 
 
 It was plain that many schools are not in favor of what Allyn calls the 
 pupil-alone policy. When men hurrahed about vague political propositions 
 the old brass band method was well enough but this is the dawn of the 
 health age — the age of men. As I see it, the use of the schools by adults 
 is a necessary part of the program of the new democracy. I don't see how 
 anybody who attended these meetings could be of any other opinion. 
 
 SCHOOL LABORATORIES 
 
 One of the recommendations of the Standards Commission of the New 
 York Mill Committee was that school laboratories examine specimens of 
 market milk chemically, bacteriologically and for dirt. 
 
 There are few communities with less than 50,000 inhabitants that have 
 
1258 HOSPITALS— SCHOOLS 
 
 laboratory facilities for their health departments. On the other hand, even 
 country communities have some laboratory facilities in their schools. To 
 teach chemistry and bacteriology by teaching milk testing gives just as 
 good training as though the analyses were of substances interesting to 
 nobody. 
 
 Simple milk analyses are simpler than the usual run~of laboratory tests. 
 A fair percentage of the farmers now own small Babcock testers and test their 
 milk for fat. This test is not too complicated for grade school pupils. 
 
 The dirt test is still simpler. In fact, it is so simple that it can be used 
 as one of the initial exercises given to familiarize the pupils with glassware 
 and methods. 
 
 A bacterial count is easily within the reach of high school pupils and, 
 possibly, of grammar scholars. It does not require a microscope. It does 
 require a magnifying glass, culture media and certain glassware. The equip- 
 ment for milk work does not stand in the way nor does technical skill. Thus 
 we see that neither the cost of equipment for milk nor the technical skill 
 required for milk tests stands in the way of using the school laboratories for 
 milk control. 
 
 The guinea pig test for tuberculosis should be easy in a school that teaches 
 biology. It requires little equipment and little skill. 
 
 So much for the possibilities. What would be the gain? A good many 
 baby lives could be saved and the milk business could be put on a much less 
 precarious basis if the school laboratories would supplement the health depart- 
 ment work. If the people knew that their milk was being examined their 
 confidence in it would grow. The use of milk responds to fluctuations in 
 public confidence. At least such an effect would come as soon as publicity had 
 forced the insanitary dairies to clean up — and nobody should want it to 
 come sooner. 
 
 In high schools the cooperation between local school laboratories and 
 health departments could go even farther. Such laboratories could examine 
 sputum for consumption, blood for typhoid and possibly cultures for diph- 
 theria. Any properly run laboratory sterilizes sputum before it is examined. 
 They do this to safeguard the health of the workers. This precaution taken, 
 there is no danger. 
 
 The Widal test for typhoid fever is even less dangerous. The drop 
 of blood sent in for test contains no bacteria. The equipment for these two 
 tests can be bought for a hundred dollars. 
 
 If there is carelessness there is some danger from diphtheria, yet there is 
 no question but that making such examination in the school laboratory would 
 mean less diphtheria in town. For instance, if the Centralia, Illinois, school 
 laboratories examined throat cultures the diphtheria outbreaks in those schools 
 would be farther apart and easier controlled than under the present system 
 wherein the cultures must go to Springfield. If the school administrators 
 assert that the program is too large why not undertake a single part of it — 
 say milk examination, or better still, examinations for contagion among school 
 children ? 
 
SCHOOLS 
 
 1259 
 
 VILLAGE SCHOOL HYGIENE 
 
 In Minnesota Dr. E. B. Hoag is concentrating on rural and village 
 schools. The plan of the state board of health is to have the rural schools in- 
 augurate and carry out school inspection. It is true that they have a plan for 
 
 \ 
 
 ENTRY 
 
 Win. 
 
 w 
 
 w 
 
 w 
 
 Heater 
 
 o 
 
 CHIMNEY 
 
 W 
 
 
 Boys 
 
 Illinois Dept. of Public Instruction. 
 
 Fig. 510. — Inexpensive Cloakrooms, Entry, and Fuel House. 
 
1260 
 
 HOSPITALS— SCHOOLS 
 
 large cities like Minneapolis, St. Paul and Duluth — a plan that calls for 
 medical officers and school nurses. They have another plan for towns large 
 enough to employ school nurses. 
 
 The plan upon which they are now laying most stress is one for non- 
 
 Fig. 511. 
 
 
 □ □ □ □ □ □ 
 
 DDDDDD 
 
 DDDDDD 
 
 dDDDDDD 
 
 DDDDD 
 
 Illinois Dept. of Public Instruction. 
 
 n 
 
 a 
 
 
 L *&***"* 
 
 Fig. 512. — Showing Old Style Country School House and Manner in Which Such a One 
 may be Modernized at Small Cost. The improvement suggested does away with the 
 platform and the double desks. It provides a vestibule and two coat rooms in front, a fuel 
 room and library at the side. The lighting is from the left and the rear and is perfect. 
 
SCHOOLS 1261 
 
 medical health surveys to be made by the teachers. This plan is for communi- 
 ties that feel they cannot afford either school physicians or school nurses. 
 
 The essence of their plan lies in this statement: No community need wait 
 for the employment of a medical officer in order to begin sensible health obser- 
 vation of school children. 
 
 The plan consists in having written answers to a series of simple questions. 
 Some of these questions may properly relate to simple matters of schoolroom 
 hygiene. Some of them relate to conditions of the pupils themselves. Some of 
 the questions can be answered by the teacher and some by the parent; but 
 most of them are designed to be answered by the pupil. 
 
 The questions, therefore, are simple and the answers called for express 
 the pupil's point of view. The teachers can translate that to the point of view 
 of the sanitarian. 
 
 The state board furnishes the questions and answers. Dr. Hoag travels 
 about the state visiting schools, installing the system and unraveling the 
 snarls that arise in its operation. 
 
 Under the head of Sanitary Survey of Schools such simple questions are 
 asked as: 
 
 "Is damp sweeping practiced? Are all windows thrown open at recess? 
 Are parents notified of physical defects ?" 
 
 Under the head of Personal Hygiene and Physical Condition are such 
 simple questions as: 
 
 "How often do you have headache? Do you snore? Do you breathe 
 through your mouth? How many colds have you had since school opened?" 
 
 Professor Wood of Teachers' College, Columbia University, says there is 
 something wrong with 15,000,000 of the 20,000,000 American school children. 
 Many of these troubles are in schools that cannot hope to have an elaborate 
 school inspection. A large percentage of them the pupil can and will tell 
 about in his own way if given a chance. 
 
 SAFEGUARDING THE HEALTH OF THE COUNTRY SCHOOL TEACHER 
 
 Will you write an article to help country school teachers living without 
 city conveniences to keep well? E. P. B. 
 
 The above request is abstracted from a recent letter. In replying the 
 emphasis will be put upon the "how" phase of the question. The questioner 
 had in mind the teachers who teach in country and small town schools 
 where the buildings are' poorly equipped ; where there are but few conveniences, 
 comforts, or safeguards; where the equipment cannot be greatly changed; 
 where the water comes from wells, the heat from stoves or hot air furnaces 
 and where in bad weather the children bring muddy shoes and wet overclothes 
 into the schoolrooms, and where the schools are not connected with sewer 
 systems. 
 
 The question is : What can the teacher do to keep herself healthy ? 
 
 I am starting with the assumption that the hundreds of thousands of 
 teachers know that the percentage of ill health among teachers is somewhat 
 high and want to do what they can to rectify it. They are asking the ques- 
 tion "How ?" That question we shall try to answer. 
 
 I should say that first in importance is nerves. In an article written 
 
1262 HOSPITALS— SCHOOLS 
 
 for that most intelligent group, the school teachers, it is not necessary to go 
 into minor details. Nerves results from poor mental methods. The cure 
 for nerves is mental training. 
 
 To every explosion there are two factors — the irritating party and the 
 irritated party. The teacher works all day trying to control the irritating 
 party. She will not succeed unless she devotes some part of the day to 
 training the irritated party. 
 
 I have just read a booklet that I think would be of great aid to teachers. 
 It is called "Calm Yourself." It is sane, good-natured, poised, clear, scientific, 
 and simple ; and it sells for 50 cents. Another excellent book is Arnold Ben- 
 nett's "Human Machine." For years I have had benefit from Osier's "Essay 
 on Equanimity." 
 
 Poise can only come as the result of training. Bennett sets aside a half- 
 hour a day for this self-training. This is enough if the teacher will carry 
 its influence on throughout the contacts of the working day. 
 
 We must not lose sight of the fact that the best training of the irritating 
 factors is the influence of a poised, irritated factor. A teacher who has 
 always been tired and cross and learns how to be tired and good-natured 
 will find it much easier to control the tired and cross children. 
 
 The "how" of poise is a matter of training one's mind so that good 
 mental habits replace the faulty ones. There is no other way. This should 
 not prove difficult to mental trainers — school teachers. 
 
 The exceedingly hard days for the teacher and the pupils are the bilious 
 days. Biliousness is usually due to constipation. Therefore, one of the 
 "hows" is how to avoid constipation. 
 
 The teacher should keep a pitcher of water and a glass on her desk. She 
 should drink from half a gallon to a gallon during the school day. It will be 
 better if she makes no particular effort to keep the water cool. It should be 
 taken in sips every few minutes during the day. 
 
 She should keep fruit on her desk and eat one or two pieces during 
 the day. In the main the fruit to eat is apples, but these should be varied 
 with pears, peaches, bananas, oranges, limes, turnips, carrots and radishes. 
 The fruit should be washed, then wrapped in clean paper and thus kept in 
 the desk. Some of it should be eaten unpeeled. Bananas, lemons, limes, 
 and (for most people) oranges should be peeled. This should be supplemented 
 by such a change in the food at home as will tend to prevent or overcome 
 constipation. 
 
 It has been noticed that contagion is worse in the spring than in the fall. 
 In large cities where they plat out diagrams of contagion they find that the 
 curve starts low when the children come together in the fall, that it gradually 
 rises through the winter and that it peaks in the spring. 
 
 With some forms of contagion this rule does not always hold true 
 in the country schools. For instance, a country school may have a run of 
 measles in the fall and be free in the spring. The reason is that country 
 communities are commonly free from measles and when by accident the 
 contagion gets in in the fall it spreads. The city harbors measles all the 
 time and the law of growth is not subject to the same exceptions. 
 
 The reason for this gradual rise in the sickness line is that carriers of 
 colds, pneumonia, diphtheria, scarlet fever and other forms of contagion 
 
SCHOOLS 1263 
 
 come into the schools. There is a gradual spread with a gradual rise in severe 
 illnesses. 
 
 The point to it is that mild illnesses bear a relation to severe illnesses. 
 Their relation to contagion is well proved. In fact, it is easy to demonstrate 
 it in schools provided with nursing, inspection and laboratory service. 
 
 The teacher catches some disease from the students. The "how" of the 
 situation is as follows: Let her keep her own record of the children's ills. 
 In this record she should enter such minor ills as headaches, sore throats and 
 colds. For this purpose she can devise her own blank. Possibly she will find 
 it to her advantage to make use of the scheme of health survey of pupils got 
 up by Dr. Hoag, blanks for which are on the market. 
 
 The teacher will not be highly susceptible to contagion. In this day 
 practically all of the teachers worth saving are vaccinated and are, therefore, 
 in no danger from smallpox. Most of them have had ordinary forms of con- 
 tagion. Some have not. 
 
 Alertness will serve to protect the teacher and her school. In time she 
 will be able to suspect from the record of colds scarlet fever or diphtheria; or 
 from ,the record of diarrheas to uncover a chain of atypical, typhoids. 
 
 Tuberculosis in children is rarely contagious. If it is open, it is harmless. 
 If the child has discharging glands of the neck or a consumption with sputum 
 there is some danger to the teacher. If such children remain in school the 
 teacher must see that the sputum or pus is burned. 
 
 The schoolroom must be provided with a hygrometer. The usual form of 
 hygrometer is also a thermometer. A record of the temperature must be 
 kept. This record should show the temperature in different parts of the 
 room, at different distances from the window and at different levels above the 
 floor. 
 
 The temperature of the rooms should not go above 68°. This is easy 
 enough if the floor is kept warm and the windows are tight. The usual com- 
 plaint of cold is due to uneven temperature in the room — a temperature of 75° 
 at the head level and of 65° at the feet level, a temperature of 80° around the 
 stove and of 60° next the window. 
 
 If the school is in a town where there is electric current during the 
 school hours electric fans will remedy this defect. The air next to the skin 
 is about 90°; the air next to the window may be 55°. Obviously, then, in 
 winter time the fans should not play directly on the people. They should play 
 on the radiators or stove or the inside wall. 
 
 If fans are not possible what can be done? I am assuming that the 
 heating system is in and cannot be changed. The windows must be periodically 
 opened and the room blown out. It is better to keep the room at 55° to 60° 
 even if the children must continuously w r ear their wraps than it is to keep 
 the head in air at 75° and the feet at 65°. 
 
 If the teacher's feet are cold during the day let her provide herself with 
 moccasins made of sheepskin tanned with the wool on, the wool on the inside. 
 Such moccasins are on the market. 
 
 Let her keep the humidity about 50. This means about ten degrees 
 difference between the readings of the w T et and dry thermometer. This means 
 frosted windows on a wintry day. There is no health in a school where the 
 windows, if single, do not frost on a wintry day. 
 
1264 HOSPITALS— SCHOOLS 
 
 If the room is heated by a stove a large water pan on the top of the 
 stove will furnish moisture enough. The pan must set flat enough on the 
 stove to keep the water close to the boiling point. Gallons of water will be 
 required, as one who watches the hygrometer will soon learn, and any ar- 
 rangement that does not provide gallons to be evaporated will be ineffective. 
 If the room is heated by hot air a water tank must be set in the hot air 
 chamber above the dome of the firebox. 
 
 To keep down dust Miss Morris of the Louisiana Board of Health 
 recommends "dustless sweepers, dust cloths wrung out of kerosene for each 
 schoolroom and oiled floors." 
 
 Write to your state board of health about the water supply. Tell them the 
 depth of the well ; whether it is cemented or cased ; how far away the well is 
 from privies, the schoolhouse and other sources of soil pollution; the type of 
 the soil and the direction of flow of ground water (if known) ; whether the 
 water rises during rains and falls during drought; and the taste of the water. 
 The state board will either examine the water or else it will tell you whether 
 water from wells of the type of yours is safe or not. 
 
 Water used by a group, say the school children, to be safe must be purer 
 than water used by a single family. If the water is unsafe let the teacher 
 make it safe by ( 1 ) heat or by ( 2 ) chlorid of lime. Place the water in a kettle 
 on the stove, bring the temperature to 160° and hold it around there for twenty 
 minutes. Put it in a clean bucket and allow it to cool, the more quickly the 
 better. Water heated in this way will contain no live typhoid or diarrhea 
 germs and it will not be so flat as boiled water. 
 
 To sterilize water with lime: Have the druggist prepare a solution of 
 chlorinated lime, one level teaspoonful to four cupfuls of water. Use lime 
 from one-pound tin cans. Keep the bottles corked well. One teaspoonful 
 of this solution added to a two-gallon bucket of water will sterilize it. The 
 taste of chlorin will disappear after the water has stood twenty minutes. 
 
 For the ordinary school yard privy should be substituted the McCormack 
 type recommended by the Kentucky Board of Health. This consists of an 
 ordinary cheap, flyproof frame house. The contents go into an under- 
 ground septic tank, 6'xo'x5', and the run-off is through forty feet of unglazed 
 tile. If the soil is a loam, a sand or a gravel this tile is laid underground. 
 If the ground is clay the tile should come to the surface and the effluent 
 should flow in contact with the air. 
 
 Eecesses are good for children. This truth is molded into custom. The 
 recesses are good for the teacher. Custom has not recognized this truth. 
 
 The teacher will do well to get a bit of fresh air at each recess period. 
 For her short essay out of doors she will be better off if she does not wrap 
 up too much. Warm covering for her hands, feet and head and the ordinary 
 schoolroom clothes are about enough. In a few minutes her heat making 
 apparatus will be equal to the strain. 
 
 A dozen deep breaths will serve to distribute the blood heat well and keep 
 the skin warm. To move about briskly not only makes heat by burning up 
 muscle but it distributes the heat to those parts of the body where cold is 
 appreciated. 
 
 As the teacher's work is mental, unless systematic effort is made her 
 muscles will grow flabby and soft. The powers of muscular conformation will 
 
SCHOOLS 
 
 1265 
 
 also suffer. Therefore, the wise teacher will devote some time each day to 
 muscular exercise. 
 
 Some teachers will find a way to go into a cold room, preferably a 
 heated room with wide open windows, and use some form of rubber cord 
 or weight exercise for fifteen minutes a day. Those who cannot do this 
 can exercise while teaching 
 reading, taking part in ordi- 
 nary conversation, or riding 
 to and from school. 
 
 The muscles can be ex- 
 ercised by having them pull 
 against each other quite as 
 well as by having them pull 
 against a weight. With the 
 hand lying quietly in the lap 
 every muscle of the arm, fore- 
 arm, and hand can be made 
 taut. Wherever in the body 
 there is a group of muscles 
 there is also an antagonizing 
 group. When these two 
 groups pull each against the 
 other each is exercised and no 
 change in posture results. 
 
 The teacher must go to 
 sleep at night in a cold room. 
 In order to be comfortable 
 she must provide herself with 
 high, warm slippers and a 
 warm wrap. She must pro- 
 vide her bed with plenty of 
 covering. But these require- 
 ments having been met, at 
 least one window must be raised to the full 
 must be below 50°. 
 
 She must not neglect her minor ills. She must remember that colds are 
 contagious. She must keep her distance from children who have contagion of 
 one form or another. If, perchance, she contracts a cold she must not 
 neglect it. And finally, let her have a care for the comfort of her feet 
 and her eyes. 
 
 Heating Schoolrooms. — W. B. writes: "Noticing a few days ago in 
 your department some allusion to the heating of and fresh air in school 
 buildings, I am impelled to inquire how long is required to empty an ordi- 
 nary schoolroom of bad air — that is, how long should the half-dozen win- 
 dows with which the average room is provided be kept open to allow the 
 escape of all the bad air in it? Being a member of a school board with a 
 number of buildings under its care, it often happens that this teacher or 
 that has ideas concerning heating and ventilation that do not correspond 
 with the ideas of janitors or of members of the board. Recently a teacher 
 
 Virginia Health Bulletin. 
 
 Fig. 513. — Jacketed Stove for Heating and Venti- 
 lating One-Room Schools. 
 
 The room temperature in winter 
 
1266 
 
 HOSPITALS— SCHOOLS 
 
 sent word to a member of the board that her schoolroom was too cold, and 
 that unless something could be done at once school would have to be dis- 
 missed for the day. Investigation showed that the janitor had livened up 
 
 Dept. of Public Instruction, Springfield, 
 
 Fig. 514. — Double-Flue Chimney Ventilation. A, foul air escape; E, fresh air intake; 
 D, door which controls supply of air to the furnace. 
 
 his fire at 6 a.m., leaving the windows open for fifteen minutes. Then 
 the windows were closed, and by 8.30 the rooms were warm enough for the 
 opening of school. But at the hour named the teacher arrived and imme- 
 diately raised all the windows and left them open for fifteen or twenty 
 
SCHOOLS 
 
 1267 
 
 minutes. When 9 o'clock arrived, Die time for the opening of school, the 
 rooms were still cold, it being an unusually cold and windy day. Then the 
 complaint was made. The super- 
 intendent of schools, a member of 
 the board, and a plumber appeared 
 at the schoolhouse at about the 
 same moment. The janitor was 
 away on an errand. When the lat- 
 ter functionary returned, the three 
 others had succeeded in raising 
 the steam pressure in the boiler 
 from five pounds to fifteen, with 
 steam blowing out of the safety 
 valve 'at the rate of forty miles 
 an hour! The janitor expostulated 
 that it was not possible for him 
 to heat the entire landscape sur- 
 rounding the school building, but 
 that if instructions were given 
 teachers as to the length of time 
 windows should be left open and 
 some restriction made as to when 
 they might be opened, he would 
 still undertake to warm the build- 
 ings, if the supply of coal did not 
 give out, and he would do it with 
 five pounds of steam. Is it not a 
 fact that the demand for fresh 
 air which we read about so much, 
 and some people talk about all the 
 time, is overdone? People who 
 know something about physics 
 know that the tendency of heat 
 to go upward will prevent the 
 proper warming of a room if the 
 windows are opened for fifteen 
 minutes every half hour or so. If 
 you can, please tell us how often 
 and for how long a time windows 
 should be opened in a room hold- 
 ing, say, forty pupils." 
 
 •^ 
 
 Reply. — The length of time 
 will depend on the wind and the 
 temperature. Three to five min- 
 utes three or four times a day is 
 ample. It is best to have these 
 periods come when the children 
 are at recess. 
 
 The temperature when the chil- 
 dren are in the room should be 
 68° F. When the children come in from play the temperature should be 
 60° ; fifteen minutes later it should be 68°. Cold school rooms should have 
 a temperature of 55°. The windows in such rooms should be wide open. 
 
 Dept. of Public Instruction, Springfield, III. 
 Fig. 515. — Single-Flue Ventilation. 
 
1268 
 
 HOSPITALS— SCHOOLS 
 
 It is quite evident that in the school concerning which W. B. writes 
 nobody has made any observations or given much thought to either heating 
 or ventilating. In that, however, this school is not peculiar. 
 
 Help for Teacher's Nerves. — E. writes: "How would you prevent 
 nervous prostration, if forced to breathe continually the contaminated air 
 of a public school kindergarten, and have the care of fifty children, morn- 
 ings and afternoons? The ventilation of the schools is said to be 'perfect/ 
 which is of course a fallacy. Mrs. Young forced the janitors to open the 
 
 Dept. of Public Instruction, Springfield, III. 
 
 Fig. 516. — Construction of a Double-Flue Chimney. A, foul air flue; B, chimney 
 tile; C, opening into foul air flue; D, door which controls supply of air to the furnace. 
 
 windows twice a day, but that is quite insufficient in a crowded room, and 
 it only takes a few days or weeks to produce a perfect lassitude and weak- 
 ness. 
 
 "Now I do not want to give up my profession, and I want some physical 
 force. I never weigh more than 100 pounds and have continual difficulty 
 in keeping built up. After a long vacation, I feel better for a little while, 
 then begin the fight all over again. Can you recommend any course of 
 treatment, or exercise, that might mitigate my trouble?" 
 
 Reply. — The air of schoolrooms in Chicago and elsewhere is far from 
 what it should be. The method is not perfect nor even approximately so. 
 It is too warm, too dry, too dusty, too still and not freshened often 
 enough. 
 
<3 
 
 Dept. of Public Instruction, Springfield, III. 
 
 Fig. 517. — Heater with Jacket Not Reaching the Floor. This cut illustrates how the 
 door controlling the supply of air to the furnace should be placed to take in the air 
 from the outside, from within the room or from both. When the door is open it closes the 
 outside opening and opens that from the inside. The air is then all taken from the room. 
 When the door is closed the air is all taken from the outside. When the door is part way 
 open, the air comes from both outside and inside. 
 
 1269 
 
1270 HOSPITALS— SCHOOLS 
 
 You are evidently not in good physical condition and are justified in 
 going to some trouble to get things bettered. We assume that you are 
 anxious to teach in this climate. If you can get exchanged to an open-air 
 school do so. If that is impossible try for a cold-room school. 
 
 If you must remain where you are proceed as follows : Buy a depend- 
 able thermometer. Buy a wet and dry bulb humidity measurer — a hy- 
 grometer. Keep an hourly record of the temperature in your schoolroom. 
 Do not let it go over 65°. Take the temperature of the room at different 
 places. Keep a record of the humidity. Keep this up to 50. Expose 
 enough water around the room to keep the humidity up. 
 
 Open the schoolroom windows and blow out the room several times 
 during each day. When the room begins to get close and stuffy give the 
 children some kindergarten play and while they are moving about air out 
 the room. 
 
 You are evidently undernourished. Eat all that you are now eating and 
 add two glasses of buttermilk to each meal. When you begin to tire of 
 this stop it and take a glass of sweet milk with each meal and one 
 at bedtime. Drink a pint of cream a day as a further variation in your 
 milk diet. 
 
 Finally you evidently need mental calm. You are probably a worrier. 
 You need equanimity ; Christian Science, mental science or the Emmanuel 
 teachings will help you here. 
 
 Purpose of School Inspection. — Mrs. J. S. G. writes: "1. Will you 
 inform us just how medical inspection in schools should be conducted in 
 order to be effective? How frequent should the inspection be? How 
 thorough should it be? 2. Have those people who object to it any legal 
 right to do so? Has the school board the right to enforce such people to 
 submit to it? 3. How is it arranged in the Chicago schools? I live in a 
 small town near Chicago, where we hope soon to establish medical inspec- 
 tion in our schools, and am anxious that it should be a success" 
 
 Reply. — 1. I cannot answer this question in the space at my disposal. 
 Read Gulick and Ayres, Cornell or Hoag, or the Chicago health depart- 
 ment report for 1911. Possibly you could get them from your public 
 library. 
 
 2. School inspection is for two purposes: to exclude children bearing 
 contagion from school and to discover physical defects. Sometimes the 
 school inspection in operation in a town applies to the first of these, some- 
 times to both. 
 
 3. In the Chicago schools both forms of inspection are practiced. 
 
 Systematic Play for Both. — Mrs. E. McC. writes: "My boy is nearly 
 10 years old, more than the average in height and weight, and in the fifth 
 grade. He stoops over so much that his head seems to come from his chest. 
 I am constantly reminding him of standing up straight, which he does 
 for a moment and then forgets. Please advise me what to do for him, 
 also about my daughter. She is 15 years old, but is always taken for 
 18 or 20. She has headaches almost all the time, and doctors claim they 
 do not come from her eyes. She also suffers from extremely cold and wet 
 feet, winter and summer, and her hands are always cold. Would woolen 
 stockings help to keep her feet warm?" 
 
 Reply, — 1. Have your boy go to the nearest park or playground gym- 
 nasium and get the director to lay out some play and work for him. Even 
 
SCHOOLS 1271 
 
 if his spinal column naturally tilts forward proper play, persisted in, can 
 straighten it a good deal. 
 
 2. As to the warm stockings and mitts — yes. Systematic play should 
 help her too. 
 
 May Be Due to Dry Air. — G. A. H. writes: "There is a rash or itch 
 prevalent among school children in my vicinity that is quite distressing 
 to the little folks, and even some of the larger ones have been slightly af- 
 fected. There is hardly anything noticeable on the skin, not even redness. 
 Sometimes a small red pimple is seen, something like scarlet fever rash, 
 but does not make the shot-like feeling under the skin. The children 
 do not itch so much in the morning or during the day, but at bedtime and 
 afterwards they will scratch almost continually and wake themselves up. 
 Their health is fine. The arms and legs seem most affected. Can you 
 suggest a salve or liquid preparation that will relieve this condition, and 
 also be inexpensive?" 
 
 Reply. — There are two or three kinds of skin diseases which are com- 
 monly spread by school children. Control of these is one of the advantages 
 gained from having school nurses. 
 
 G. A. H.'s description does not fit these. It is smallpox, not scarlet 
 fever, which makes "a shot-like feeling under the skin." Nevertheless, this 
 description does not read like scarlet fever. 
 
 My advice to you is to have the city physician exclude scarlet fever and 
 the skin diseases frequently spread at schools. If it is not any of these 
 then it is due to dry air in the schoolrooms. 
 
 It will get better as the rooms are better ventilated in April and will 
 stop as the windows are opened in May. 
 
 The cure is to increase the humidity of the air in the school. Salves 
 will not do the job. 
 
 Have Windows Opened. — E. A. R. writes: "I am a high school girl, 
 15 years of age. Sometimes during the day my throat gets full of slime 
 and I can hardly talk, at least not as I should talk. Is this catarrh? What 
 ought I do to prevent it? Will you please tell me if I am small and thin 
 for my age. I am 5 feet 2 inches tall and weigh 95 pounds/' 
 
 Reply. — I cannot tell why your throat gets full of slime. Stay in the 
 open air all you can ; get your schoolroom windows up during recess time ; 
 get them wp on all warm days. If this does not relieve your huskiness 
 have your throat examined. You are a little undersized. 
 
 School Session too Long. — A. M. writes: "Will you please state your 
 opinion of a high school session of four hours and three-quarters in forty- 
 minute periods of recitation and study, with no break for lunch, gymnas- 
 tics, or other form of relaxation?" 
 
 Reply. — It is wrong from the health standpoint. Four hours and three- 
 quarters of concentration is bad for the adolescent, both mentally and 
 physically. It is bad pedagogically. The proper system provides for short 
 study periods, with intervals of play and manual training — the Gary 
 system. 
 
 Let Boy Remain in School. — Anxious Mother writes: "I have a 13- 
 year-old son attending private school where recently diphtheria has de- 
 veloped and they have had sixteen cases in quarantine, isolated of course. 
 
1272 HOSPITALS— SCHOOLS 
 
 Two of these were from the hall my hoy is in, using the same study hall 
 and dormitory. They tell me they have quite a few cases of tonsillitis that 
 are watched carefully and throats examined each morning to determine if 
 they develop diphtheria germs. Antitoxin is administered if such is the 
 case, and they are sent to the isolation hospital on the university grounds. 
 In the event of a diagnosis of diphtheria the parents are notified. But 
 should I wish to go into quarantine to he with my hoy it would he for- 
 hidden, and no parent is allowed to he with a child during his isolation. 
 They tell me the law forbids it. I do not wish to appear overanxious nor 
 to interfere with my youngster's studies unless necessary for his good. I 
 am really not thinking he will take diphtheria and would not consider 
 taking him out of school on a chance of his developing it, except for the 
 thought that were it to happen I should he denied going to him. They 
 suggest, realizing my uneasiness, antitoxin heing administered to him to 
 eliminate the chance of his taking it, and tell me that should another 
 case develop in the hall from which most of the cases came they would 
 ask permission of the parents to administer antitoxin to every child in 
 the hall. Will you tell me as a physician just what course you would take 
 if you had a child situated as mine is? He is an only child and this is his 
 first year away from home and diphtheria is the only child's disease through 
 which I have not cared for him." 
 
 Reply. — Leave the boy in school. Five hundred units of antitoxin 
 would be entirely safe and would make the boy immune for a month. 
 This is probably unnecessary but it is advised in part to ease your mind. 
 The school is proceeding most wisely and will no doubt hold the epidemic 
 down. The only additional procedure to be advised is to culture every 
 sore throat in the hall from which the cases came. 
 
 As you do not mention the state I can not say whether it is illegal 
 or not for you to go into quarantine with the boy. It would not be in 
 Illinois. In fact, parents are sometimes allowed to go with their children 
 to the diphtheria hospital in Chicago. 
 
 When antitoxin has been used and proper precautions are taken the 
 risk is slight. This privilege occasionally helps the child. Its chief func- 
 tion is to calm the parents. 
 
 Let Him Play with Children. — Mrs. M. A. L. writes: "My hoy, nearly 
 5 years old, has always been well. He is large and strong, and bright, but 
 seems extremely nervous. It appears to he more imagination than nerv- 
 ousness. For instance, he will he playing out in the yard, perfectly con- 
 tented, when all of a sudden he will begin to cry. When I ask him the 
 reason it will be some foolish fear. He is afraid the wind will blow papa 
 away; that the house will catch fire, or something equally foolish. He 
 sleeps well from 7 P. m. till 5.30 a. m., hut tells me of the strangest dreams 
 he has had. He is alone a good deal, as I am busy with the hahy. But 
 he has a big yard to play in and a playhouse. I never allow him to play 
 with other children. 1. Do you think I ought to let him run the streets 
 with the other hoys? He seems happy and contented till he gets a notion 
 like those mentioned, then he commences to cry. What treatment do you 
 suggest? 2. Would circumcision help? 3. Is it dangerous? 4. What effect 
 will it have if I don't have it done (in after life, I mean)?" 
 
 Reply. — 1. This child's mentality and spirit require the best of train- 
 ing. Left to himself he will certainly grow up a confirmed neurasthenic. 
 As soon as he is old enough get him in a kindergarten run by teachers who 
 
SCHOOLS 1273 
 
 know something about the psychology of children. Be extremely careful 
 in home training. Try to establish poise and balance and banish fear. 
 Have him play with wholesome children as much as possible. Encourage 
 him to compete in games. 
 
 2 and 3. No. 
 
 4. None. 
 
 School Inspection Barred. — H. J. writes: "1. Is physical examination of 
 school children in cities of 7,000 or 8J000 population practicable? 2. Do 
 many such towns have anything of the hind? I am led to ask these ques- 
 tions by the attitude of the school board of my city toward any form of 
 medical inspection. Several months ago a woman member of the board pre- 
 sented a resolution providing for inspection, but it was buried in com- 
 mittee, and all efforts to revive it have been futile. Later the same member 
 offered a plan for medical examination that would be without cost to the 
 board. (Every physician in the city had promised to give some time to 
 the work, without pay.) This also was rejected. Now, only recently the 
 women's club of the city, having made some money by the sale of tubercu- 
 losis seals at Christmas time, offered to pay the expenses of a visiting 
 nurse for a month, planning for her to give talks on hygiene to the chil- 
 dren and their mothers. The offer was refused point blank, and the women 
 were told to 'mind their own business, and not butt in.' 3. What possible 
 objection can there be to this work? k- Does it scare the children and 
 their parents? Is it a kind of slumming project — looking after the chil- 
 dren of the 'common people'?" 
 
 Reply. — 1. Yes. 
 
 2. No. 
 
 3. School inspection is for two purposes : (a) To control contagion ; (b) 
 to increase the learning capacity of the average student. That it is a good 
 investment every one with experience knows. Those without experience 
 can know it from reading Gulick or Cornell. Nevertheless school inspection 
 is objected to because it costs money. There is no other objection worth 
 considering. 
 
 4. No. 
 
CHAPTEE LXY 
 
 Sex Organs of Woman 
 
 THE FEMALE SEX ORGANS 
 
 The essential sex cell in the female is the ovum. It is the cell which, 
 when properly fertilized, develops into the child. The organ which produces 
 these cells is called the ovary. The ovary, therefore, is the essential sex 
 organ in the female. The other female sex organs exist for the purpose of 
 serving the ovum. 
 
 The ovaries, two in number, are located deep in the pelvis on each side 
 of the uterus. When the female child is born her ovaries are filled with 
 immature ova. These lie quietly in the ovaries until puberty is approaching. 
 Beginning with puberty and from that time until change of life, from time 
 to time, the ovaries discharge an ovum or more than one, the process being 
 known as ovulation. In some girls a few ova mature and are discharged 
 before puberty and in some women a few are discharged after the change 
 of life but these are the exceptions. The rule is that the discharge of ova 
 begins at puberty and stops at the menopause. 
 
 MENSTRUATION 
 
 At twenty-eight-day intervals (in women between puberty and the meno- 
 pause) menstruation appears. At this time the blood vessels of the uterus 
 fill with blood and the membranes lining the uterus and the fallopian tubes 
 swell. Some of the blood oozes from the congested vessels and finds its way 
 
 v 
 
 Fig. 518. — Female Reproductive Organs (two-thirds the natural size), as Seen from Behind. 
 u, upper part, and c, neck of uterus (in section); v, upper part of vagina; od, fallopian tubes 
 (left one cut off) opening into cavity of abdomen at fi; o, right ovary; po, h, accessory ovarian 
 structures; I, 11, lo, supporting ligaments. 
 
 1274 
 
MENSTBTJATION 1275 
 
 into the interior of the uterus. This blood, with a few of the cells lining the 
 uterus, is what is known as the menstrual fluid. 
 
 The amount of fluid lost at each menstrual epoch varies from two to 
 fourteen ounces. • The average duration of the flow is about three days. 
 
 At the time of menstruation the mammary glands or breasts enlarge 
 slightly, there is a feeling of heaviness in the pelvis, there may be a little 
 aching in the hips, there is some congestion of the female generative organs 
 and in most cases an ovum is discharged from the ovary and slowly makes 
 its way down a fallopian tube, thence into the uterus. 
 
 While ovulation and menstruation usually go hand in hand they 
 do not always do so. As has already been stated, in some cases ovulation 
 takes place before puberty; in other cases, it occurs after the menopause. 
 Sometimes an ovum is discharged between the menstrual periods. 
 
 Therefore, all that we can say is that there is some relation between ovula- 
 tion and menstruation. Ovulation is one of the determining factors in men- 
 struation but it is not the only one and just how it acts, or why, no one knows. 
 
 NORMAL MENSTRUATION 
 
 In the average woman menstruation appears once in every twenty-eight 
 days. However there are many exceptions. Some women menstruate once a 
 month; others once in three weeks and others once in five weeks. If a woman 
 is free from other symptoms the fact that she menstruates at too short an 
 interval, too long an interval, or even at irregular intervals, need occasion 
 no alarm. 
 
 As the time for menstruation apj; coaches a woman becomes somewhat 
 nervous, her breasts swell somewhat, she has a feeing of heaviness or bearing 
 down in her pelvis and perhaps she notices that a slight discharge precedes 
 the flow. None of these symptoms means that there is any disease present. 
 Any one of them can be moderately exaggerated without indicating the 
 existence of any condition which calls for investigation. 
 
 The flow varies in amount. Women generally describe it in terms of 
 napkins. But that is not very dependable since one woman will wear a napkin 
 until it is thoroughly saturated while another will change as soon as her 
 napkins become slightly soiled. To put it rMflierently, the amount of flow 
 varies from two to fourteen ounces. Or to state it another way the flow is 
 free during from two to seven days. These wide variations mean that there 
 is nothing that is very fixed about the amount or the duration of menstrua- 
 tion. It does not matter so much as women think. One often hears such 
 prophecies as these: "She does not menstruate freely enough; that cannot 
 be good for her;" or "She menstruates too freely (or too long); that is 
 bound to be pulling her down." The fact is that these prophecies, predic- 
 tions and plain statements of fear are not justified. A woman's menstrual 
 habit is normal to her. In nine cases out of ten she is too free or not free 
 enough, as compared with the average woman, because that is the natural 
 way for her. 
 
 Medicines to make her flow more freely or less freely, as the case may 
 be, do no good and it is well for the woman that they do not. It is best for 
 the woman that she continue her menstrual habit even though she flows 
 
1276 
 
 SEX ORGANS OF WOMAN 
 
 less freely, or more freely, for a shorter time or for a longer time, than some 
 other woman. 
 
 At the end usually of three days the amount of flow begins to lessen. 
 The discharge of blood stops and a light discharge of mucus replaces it. 
 Then all flow stops. Such is normal menstruation. 
 
 Biologically, it is not a well-established function. No animal lower than 
 a monkey menstruates. In monkeys the function scarcely exists. In female 
 savages, menstruation, Reed tells us, is by no means well established. Among 
 highly civilized races it is most prominent but not even in them does men- 
 struation pursue a fixed course. Therefore, an individual woman can men- 
 struate differently as to amount, time and symptoms from the average woman 
 without the difference indicating that she is abnormal. 
 
 HYGIENE OF MENSTRUATION 
 
 It is well to begin the menstrual period with the bowels open. Probably 
 no cause of menstrual disturbance is as productive of symptoms as is con- 
 stipation. The bowels should be in order all the time but if the menstrual 
 period finds the large intestine full a saline purge or an enema is justified. 
 
 Not only should the napkins be changed as frequently as cleanliness may 
 demand but there should be no hesitation in taking local neutral baths 
 (neither hot nor cold). In fact there is no harm in taking a general neutral 
 bath, a neutral foot bath or a neutral sitz bath if it is desired. 
 
 Fig. 519. — Section of Female Pelvis Showing Location of Organs. A, the pubic bone; B, 
 the bladder; C, the vagina; D, the rectum; E, the perineum. 
 
 If there has been exposure to cold or the clothes have been wet by rain 
 it is advisable to take a hot mustard foot bath (a tablespoonful of ground 
 mustard to two gallons of water) or a general warm bath, and then go to 
 bed and remain there for several hours. Cold baths and cold plunges during 
 menstruation are not advisable. 
 
MENSTRUATION 1377 
 
 The amount of exercise taken during menstruation need not be less nor 
 more than is the daily habit. 
 
 As soon as menstruation has stopped a local bath should be taken. It is 
 the custom of married women to take a cleansing douche of tepid water at 
 the end of menstruation. This custom is all right. Probably it is not best 
 for the unmarried to follow this custom. 
 
 SCANTY MENSTRUATION 
 
 Within a year after puberty a woman establishes her menstrual habit. 
 She may menstruate but very little but that is her habit and it is, therefore, 
 not significant of any disease. 
 
 But there are certain conditions which produce scanty menstruation and 
 which call for some attention. 
 
 Overfat women do not menstruate freely. Sometimes they do not men- 
 struate at all. Fat women are disposed to be sterile, but there are exceptions. 
 Occasionally, a woman who does not menstruate on account of obesity or who 
 menstruates but little will conceive. Scanty menstruation in obesity is due 
 to lack of balance in the secretions of the ductless glands. 
 
 Chlorotic women are very apt to have scanty menstruation. One theory 
 is that this is due directly to the poverty of the blood. The other is that it is 
 due directly to poverty of ovarian secretion — poverty of the blood being an in- 
 direct cause. In chlorosis menstruation is an excellent index of the state of 
 the blood. A return of menstruation indicates improvement and vice versa. 
 
 In various profoundly disabling diseases, scant menstruation is a symp- 
 tom of value, for instance, in advanced tuberculosis, in cancer and in other 
 diseases which profoundly depress vitality. 
 
 Scanty menstruation in one accustomed to menstruate freely is a symptom 
 of some form of constitutional disease. It calls for a careful thorough exam- 
 ination of the blood and other organs. 
 
 AMENORRHEA OR ABSENCE OF MENSTRUATION 
 
 The rule is that menstruation occurs at intervals from puberty to the 
 menopause except during pregnancy. Pregnancy, therefore, is the most 
 frequent cause of absence of menstruation. It is, however, not the only cause. 
 Occasionally, we find a woman who never menstruates at all. In some cases 
 such women are otherwise normal. Some of them have borne children. Not 
 infrequently a woman who has a child at breast and who has not recommenced 
 to menstruate will become pregnant. These two groups of cases show that 
 ovulation may take place without menstruation. 
 
 In some cases of absence of menstruation the trouble is the result of 
 tumors or other abnormalities in the pelvis. 
 
 In amenorrhea or absence of menstruation a thorough examination of 
 the female organs is advisable. In scanty menstruation it is not, unless there 
 is some special indication. 
 
 That worry can prevent menstruation is a well-established fact. The 
 professional abortionists gain their riches from women in whom menstrua- 
 tion has been stopped by fear. A woman is afraid that she is pregnant. 
 
1278 SEX ORGANS OF WOMAN 
 
 Her fear possesses her. The day for menstruation comes. No flow appears. 
 She goes to an abortionist or she buys some tansy pills or cotton root or 
 ergot. She takes a dose and, becoming easy in her mind, the flow appears. 
 She gives the drug credit. The credit is due to the fact that her fears have 
 been allayed. 
 
 MENORRHAGIA AND METRORRHAGIA 
 
 Discharge of blood between menstrual periods is called metrorrhagia. An 
 excessive flow is called menorrhagia. 
 
 Hemorrhage from the uterus not due to menstruation should always call 
 for an examination. // a woman past the menopause has uterine hemor- 
 rhages ever so slight she should be examined at once. In all probability she 
 has cancer and her only hope of life lies in early diagnosis. Next in the 
 line of probabilities is fibroma. A fibroma which causes hemorrhage in a 
 woman past the menopause is not to be neglected. 
 
 Metrorrhagia in a woman before the menopause is very apt to be due to 
 an incomplete abortion. The second most frequent cause is uterine tumor — 
 possibly a rather small one. The third most frequent cause is a moderate 
 degree of anemia. 
 
 Therefore, a woman who has a hemorrhage from the uterus between periods 
 should have an examination. The female organs should be examined for 
 evidence of abortion and for tumors. The blood is to be examined for 
 anemia. 
 
 In a case of menorrhagia the first point to decide is whether or not the 
 free flow of blood is the woman's habit. If it be decided that it is not her 
 habit and that something is to be done for it the first step is to find out the 
 cause. Among the causes are : ( 1 ) tumors of the uterus ; ( 2 ) tumors of 
 some other pelvic organ; (3) inflammations of the uterus or tubes; (4) failure 
 of the uterus to reach the proper size after pregnancy — subinvolution; (5) 
 constipation; (6) malaria; (7) anemia; (8) various diseases causing moderate 
 debility; (9) abdominal tumor; (10) violent emotions. 
 
 The probability is that a given case of menorrhagia is due to some tumor 
 in the pelvis or other disease of the female organs. Therefore, the indication 
 is to have a thorough examination of the pelvis. If the cause is not in the 
 pelvis the most likely cause is distension of the lower bowel with feces. Next 
 in frequency as a cause is anemia of moderate grade. 
 
 Many cases of menorrhagia have been operated on locally and the credit 
 for cure given the operation, when in reality it was due to the thorough 
 cleaning out of the bowels which the woman had while under treatment, 
 or the iron and arsenic, cacodylate, or quinin given after the operation. 
 
 To check a flow which is regarded as much too free quiet in bed with 
 the head lowered and an ice pack over the lower abdomen is advised. A 
 physician may give vaginal injections of ice water but the patient must not 
 do this except under advice. 
 
 For the cure of menorrhagia local treatment should be given where it is 
 needed. If constipation is the cause it must be remedied. If malaria, quinin 
 is to be given. If anemia, iron, arsenic or cacodylate of soda. Ergot and the 
 multitude of patent medicines for female irregularities are useless, or worse 
 than, useless. '.... .:.. .. . .,- ■. ■: 
 
MENSTRUATION 
 
 1279 
 
 DYSMENOREHEA 
 
 Dr. Kristine Mann says that "cramps" is the most frequent complaint 
 of women who seek relief in the rest rooms of large department stores. I 
 am sure that her observation is correct and that among women who do 
 housework, stenography, clerical work and light work of that type, cramps 
 is very much the most frequent symptom complained of. Every day the 
 keeper of every rest room is called upon to do something for cramps. The 
 remedy commonly given is whisky. 
 
 Many female whisky users claim that 
 they got the habit from taking whisky 
 for cramps. 
 
 Another rough and ready remedy for 
 cramps is paregoric or laudanum. This 
 is the origin of some cases of opium habit. 
 
 Dysmenorrhea is important from 
 more than one standpoint. The term 
 means difficult menstruation. This is 
 usually construed as meaning pain during 
 menstruation. The pain may be any of 
 several varieties. A frequent statement 
 is that the sensation is one of cramping 
 in the uterus, the pain being very similar 
 to that of cramping in the intestines. 
 The cause of this variety of pain is spas- 
 modic contraction of the muscles of the 
 uterus. 
 
 On the other hand, what some women 
 mean by dysmenorrhea is merely an ex- 
 aggeration of the heaviness and discom- 
 fort in the pelvis, some of which is felt during menstruation by every woman. 
 Neurasthenic, hysteric or self-centered women are liable to consider and to 
 speak of the sensation as dysmenorrhea or cramps. 
 
 For the relief of dysmenorrhea the best treatment is a hot foot bath and 
 local applications of heat or cold. If the flow is scanty apply an icebag to 
 the back low down. If too free a hot bag to the same point. If necessary 
 give a dose of acetanilid or phenacetin (5 grains) internally or a hot drink con- 
 taining some aromatic such as aromatic spirits of ammonia> or camphor. 
 None of this group of remedies is better than 10 grains of camphor dissolved 
 in cinnamon mucilage water. This can be repeated in an hour. Dr. Mann 
 gives 30 drops of fluid extract of viburnum. Neither opium nor whisky should 
 be taken. Whisky does not relieve the pain except in the sense that it intoxi- 
 cates and thus makes the woman indifferent to pain. 
 
 In some cases the pain can be prevented by 10 grains of salicylate of soda 
 taken three times' a day for a week before the period is due. 
 
 In most cases the sufferer should consult a physician with a view to a 
 thorough pelvic and general examination to be followed by treatment directed 
 against whatever condition is found to be causing the symptom — for dysmenor- 
 rhea is only a symptom. 
 
 Fig. 520. — Pelvic Hematoma. Uterus 
 pushed forward somewhat by blood 
 clot lying in front of rectum. (C. F. 
 Adams, "The Post Graduate".) 
 
1280 SEX ORGANS OF WOMAN 
 
 DIAGNOSING THE CAUSE OF STERILITY 
 
 Duncan tells us that about one marriage out of six is without issue. 
 Seven per cent of the women who marry when between 15 and 19 years of 
 age are sterile. Those women who marry when between 20 and 24 years of 
 age are the most fertile. From the age of 24 the percentage of sterility 
 gradually rises until in women who marry at the age of 50 it reaches about 
 100 per cent. 
 
 Practically speaking, if no children are born within three years after 
 marriage and no effort to prevent conception has been made the marriage 
 will be without issue. 
 
 Lespinasse tells us that 7 per cent of fertile couples have their first 
 child three years or more after marriage. Among wives between 25 and 39 
 years of age this percentage rises to 15.G. 
 
 If a marriage is without issue the fault lies with the husband or wife. 
 The only way to discover which is at fault is to make a careful inquiry. 
 Dr. Lespinasse starts with the husband. He first wants to know whether 
 the husband has had syphilis, gonorrhea, mumps, tuberculosis or profound 
 anemia and what injuries he has had. Next, he is carefully examined. This 
 examination should include necessary microscopic examinations. 
 
 If the husband is found capable of producing children the inquiry is 
 extended to the wife. Is she fat? Fat women are often sterile. Has she 
 anemia? Is she soft and flabby? Has she goiter, or too little thyroid, or 
 too little pituitary secretion? Certain tests show whether there is too little 
 pituitary or thyroid secretion. Has she had gonorrhea or syphilis? 
 
 If the trouble is not with the husband, and the wife is normal in the 
 above particulars, he proceeds to make such other physical examinations and 
 microscopic examinations as are indicated. 
 
 The responsibility for the difficulty can be located in nearly every case. 
 In a very large proportion of cases it can be remedied. Some doctors make 
 the diagnosing of the causes of sterility a specialty. 
 
 Baths During Menstruation. — B. B. writes: "Will you "kindly advise me 
 regarding baths during the period of menstruation? I am used to taking 
 a warm hath every night and a cold plunge each morning. During this 
 period I do without the morning bath, but I take the warm bath at night 
 as usual. I am told that this is a very unwise habit, but I do not know how 
 to do without it. 
 
 "I am thirty-nine, seldom actually ill, but am not strong — that is, I tire 
 very easily. I do clerical work and without the stimulus of a cold bath I 
 do not feel equal to my work." 
 
 Eeply. — It is not wise to take a cold plunge during menstruation. 
 The warm bath at night is all right. 
 
 Change of Life. — O. writes: "I am 53 years old and for the last few 
 months I have hot flushes. At times they make me quite faint. I am con- 
 tinually tired and my legs at times are very stiff and painful. Can you 
 advise me what to do? Do you consider this at all serious?" 
 
 Reply. — You are passing through the change of life. Be calm and 
 everything will work out all right 
 
MENSTRUATION 1281 
 
 Menorrhagia. — P. 8. B. writes: "Will you please advise the proper way 
 of living for a woman suffering from excessive menstruation who is pale, 
 frequently subject to headaches, lacking in endurance and, as a conse- 
 quence, does not take much outdoor exercise?" 
 
 Reply. — I think she should consult a physician. He will probably ex- 
 amine her blood and find her anemic. He will probably find her flabby. 
 In the event that he finds her anemic and flabby he will prescribe a tonic 
 of cacodylate of soda, arsenic, or iron, and tell her that if she wants to 
 get well she must get more out-of-door exercise, eat more vegetables and 
 fruit, drink more water and take less headache medicine. 
 
 Amenorrhea. — A. B. C. writes: "1. Can a woman of 1+0 who has not 
 menstruated for two years become pregnant? 2. Could she consider that 
 she has passed the menopause? There have been none of the usual symp- 
 toms except some nervousness." 
 
 Eeply. — 1. Possibly. 2. No. 
 
 Too Young for Change of Life. — Mrs. W. M. G. writes : "I am a mar- 
 ried woman of 38 and would like to know if the fact that I have missed 
 a period proves I am pregnant or can I be starting the change? I am in 
 good health apparently but have lacerations unattended to." 
 
 Reply. — You are too young for the change of life. Missing one period 
 is not sufficient basis for a diagnosis of pregnancy. 
 
 Normal Menstruation. — A. P. writes: "I am an orphan girl 15 years 
 of age. For the past week I have soiled my clothes with blood. Could you 
 tell me a remedy for such a thing?" 
 
 Reply. — You are menstruating. Girls of your age, and older, men- 
 struate every four weeks. It is normal. That is the way nature works 
 in women. In your body there are two glands called ovaries. These form 
 cells called ova. About once a month one of these ova is discharged from 
 an ovary. Leading from each of your ovaries there is a tube called the fal- 
 lopian tube. The ova travel down this tube to another tube called the womb 
 or uterus. Once every four weeks some blood oozes into the womb and 
 fallopian tubes and then flows to the outside. That discharge of blood is 
 called menstruation. After a few days it stops of itself. During this time 
 you must keep yourself clean and protect your clothing by napkins. 
 
 Can you get your teacher, some relative or some other good woman to 
 tell you all about your sex organs and how to take care of yourself ? There 
 are other questions that you will want to ask and other information that 
 you will need. 
 
 Leukorrhea. — 8. D. C. writes: "Will you kindly indicate the course for 
 a girl of 11 to pursue having constant discharge from ovaries for nearly a 
 year? At times very acute pain and increased discharge. Is it possible 
 for treatments to restore? Must the ovary be removed? General health 
 excellent. Want no examination until condition in a general way is 
 understood." 
 
 Reply. — You have leukorrhea, usually the result of infection. If a 
 general tonic and hygienic living does not cure you in six months, a pelvic 
 examination should be made. 
 
 Very Scanty Menstruation. — T. M. T. writes : "I am a girl 16 years of 
 age and would like to have some advice. I hud my menses when lS 1 ^ 
 
1282 SEX ORGANS OF WOMAN 
 
 years of age and since that time have received them, at intervals of from 
 four to seven months and then only for one day. Please tell me what 
 to do." 
 
 Beply. — I presume you have no other symptoms since you mention 
 none. I presume your general health is good. Probably, therefore, the 
 habit described does not mean that you have much trouble or that treat- 
 ment will change matters much. However, my advice is that you see a 
 physician, preferably a woman. A blood examination may show that you 
 need a tonic. Some local condition needing treatment may be found. 
 
 Leukorrhea. — M. S. writes: "1. I have had leukorrhea for several 
 years. Have taken Quite a lot of aletris cordial without favorable re- 
 sults. Is that usually a cure and would you advise me to keep it up? 
 
 2. Does leukorrhea cause weak spells? 3. If leukorrhea is allowed to run 
 on what will be the result?" 
 
 Reply. — 1. No. 2. Weak spells may be one result of leukorrhea. 
 
 3. Among other results there may be peritonitis or pus tubes. You should 
 see a physician. It is possible that a tonic and leading a more hygienic 
 life may cure you, or you may need some sort of operation or local treat- 
 ment. 
 
 Can Ride Horseback During Menstruation. — A. H. writes: " Kindly 
 advise me whether it is harmful to ride horseback during the menstrual 
 period." 
 
 Reply. — No. 
 
 Scanty Menstruation Not a Sign of Pregnancy. — A. B. Z. writes: 
 "Could it be possible for a woman to be pregnant and her menses come 
 regularly, but not so plentifully, for four months, or is it just shortage 
 of blood?" 
 
 Reply. — I do not think you are pregnant. 
 
 Amenorrhea. — Mrs. D. M. B. writes: "Will you kindly inform me of the 
 seriousness of the condition of a young girl of twenty-one years of age 
 who has not menstruated for over four months? She passes an albuminous 
 substance in her urine, has an enormous appetite and is troubled with 
 constipation. She has lost weight in past year but has suffered no pain or 
 headaches." 
 
 Reply. — I think she should see a physician. Her constipation needs 
 attention. Probably she needs a tonic. 
 
 Complete Recovery After Severe Operation. — S. G. R. writes: "A 
 woman nearly forty years of age wants to know your opinion. She has 
 had her appendix, right ovary and womb removed. Can she expect ever 
 to be well and strong, to do housework as other women? She is extremely 
 nervous and has a floating kidney. Can she expect to live as many years 
 as though this had never been?" 
 
 Reply. — I cannot answer the question as to you because I do not know 
 you. I can only make some general statements as to women in general. 
 The removal of the appendix, right ovary and womb very definitely dis- 
 turbs the relations of the nerves, vessels and all other structures in the 
 pelvis. Therefore, considerable time for readjustment is required. In 
 time complete readjustment can be expected. 
 
MENSTRUATION 1283 
 
 Is Pregnancy Safe? — J. B. writes: "Would you allow a pregnancy in . 
 a woman 20 years of age with a urine showing a trace of albumin and a 
 few hyaline casts? There is no previous history such as scarlet fever, etc. 
 It is not Bright's as there are no symptoms, no swellings; heart is normal 
 in size and sounds as attested by a physician. Blood pressure is normal 
 also." 
 
 Reply. — If the woman will be carefully watched over and if she will 
 lead a thoroughly hygienic life she should pass through pregnancy with 
 reasonable safety. 
 
 When Can Pregnancy Be Diagnosed? — Mrs. E. R. writes: "1. Will 
 you please tell me how soon a physician can tell if a woman is pregnant? 
 2. Can he tell if she is, at two months and a half along, by examining the 
 womb?" 
 
 Reply. — 1. By an Abderhalden, and sometimes by other examination, 
 in the first month. 
 2. Yes. 
 
 Children Desired. — C. W. C. writes : "I write to ash you a question the 
 answer to which I feel sure will be of great interest to many others as well 
 as to myself. I have been married over a year now and, although my wife 
 and I are both anxious for children, we have thus far been completely 
 disappointed. We are both wonderfully healthy to all outward appear- 
 ances and cannot understand what is the matter. Under these circum- 
 stances is there reason to believe that there is something ailing? Should 
 either or both of us consult a physician? Is there reason to believe that 
 some defect exists which prevents one of us from having offspring? Or 
 can we hope that in the natural course of events children will yet come?" 
 
 Reply. — If, at the end of three years, you have no children you can be 
 reasonably certain that your marriage will be without issue unless you 
 have something done. At that time have a physician make a proper ex- 
 amination of you. If you are all right, an examination of your wife 
 should be made. 
 
 There are a few physicians who specialize in this branch. 
 
 Phantom Tumor. — E. M. D. writes: "Will you kindly tell me something 
 about phantom tumors? What causes them? What are the symptoms? 
 And do they leave any ill effects behind? 
 
 "I have been troubled with signs of pregnancy. About the third or 
 fourth month my abdomen will enlarge, then all of a sudden it ends. Dur- 
 ing this time I menstruate very freely and have great pain, otherwise the 
 signs of pregnancy are almost all there. This has happened to me three 
 times. The doctor laughs and says they are phantom tumors. That is 
 all he will tell me." 
 
 Reply. — In phantom tumor the woman persuades herself that she is 
 pregnant. The abdomen enlarges and she has feelings which she interprets 
 as movement of the child, pressure of the child on the bladder and as 
 other indications of pregnancy. A careful physical examination shows 
 that pregnancy is not present. The condition is an illustration of what 
 the mind can do. Also of what it cannot do, for examination not only 
 shows that no pregnancy is present but also shows that there was no evi- 
 dence that should have been interpreted as pregnancy. 
 
1284 SEX ORGANS OF WOMAN 
 
 An Old Husband and a Younger Wife. — L. L. L. writes: "1. A woman of 
 thirty is married to a man past sixty years of age — both perfectly healthy. 
 Is she likely to enjoy the blessings of motherhood? 2. If so, are the chil- 
 dren likely to be weaker, either physically or mentally, than children born 
 to parents who are nearer of an age?" 
 
 Reply.— 1. Yes. 2. No. 
 
 Shall Corsets Be Worn During Pregnancy? — Mrs. G. S. P. writes: "I 
 should like your opinion in regard to a point on which I find that women 
 and physicians with whom I talk and books that I read differ greatly. 
 The point is this — should a pregnant woman wear corsets? By some I am 
 told that to support the abdomen is to weaken the muscles which normally 
 should support the uterus and its contents, while others say that to go 
 without corsets when one is used to them is apt to cause backache and will 
 certainly make the abdomen sag permanently. Now, if a woman is anxious 
 to do the best thing for both her child and herself, would you advise her 
 to wear or not to wear a maternity corset throughout her pregnancy?" 
 
 Reply. — A woman who has been accustomed to corsets should wear a 
 maternity corset during pregnancy. 
 
 What is Safe for a Pregnant Woman?— B. L. M. writes: "1, Is a ma- 
 ternity corset absolutely safe to wear during pregnancy? 2. Is sewing on 
 a machine harmful for a pregnant woman? 3. Is it best for her to read a 
 book on care during pregnancy or is it unnecessary?" 
 
 Reply. — 1. Yes. 
 
 2. No, unless work is excessive. 
 
 3. It is best, decidedly so. 
 
 Shall a Woman 42 Marry? — Miss W. T. K. writes: "A woman of U2, 
 
 fair health but nervous temperament, never married, contemplates mar- 
 riage. 
 
 "1. Is it advisable? 
 
 "2. Is she liable to become pregnant? 
 
 "3. Would not childbirth likely be fatal (no sign of menopause)?" 
 
 Reply. — 1. Yes. 
 
 2. Possible but not probable. 
 
 3. Not necessarily. 
 
 Childbearing and Diseased Ovaries. — A. V. L. E. writes: "Could a per- 
 son, whose ovaries were so badly diseased that it is necessary to remove 
 both of them now, have had a perfectly healthy child eight months ago?" 
 
 Reply. — Yes. 
 
 Shall She Marry? — -5T- Y. Z. writes: "Through ignorance, while a 
 child, I was addicted to that awful habit, self-abuse, but on getting older, 
 about 16 years, I tried and succeeded in breaking myself of this habit. 
 
 "Now, Doctor, what I want to know is will this in any way affect the 
 future generation should I get married? I am now a young woman of 21 
 and adore children but, if there is any possibility of disastrous results, I 
 will immediately give up all hope of marriage" 
 
 Reply. — It will not. 
 
MENSTRUATION 1285 
 
 Care During Pregnancy. — Mrs. R. D. writes: "Will you please answer 
 the following questions: 1. Can a woman that is pregnant sew on the 
 machine without harm to all concerned? 2. If a woman in that condi- 
 tion catches a very bad cold will she keep that cough and cold till after 
 confinement? 3. Is there any danger of having a hemorrhage when cough- 
 ing a great deal? If. Is there any danger of having a miscarriage or 
 hemorrhage when riding in an automobile across very rough roads?" 
 
 Reply. — 1. Yes. 
 
 2. No. 
 
 3 and 4. The danger is not great. 
 
 Consult a Physician at Six Months' Pregnancy. — R. G. R. writes: "My 
 wife has been pregnant for about two months. She feels well in every way. 
 At what month should we consult a physician?" 
 
 Reply. — It would be safer to consult one at three months. However, 
 at six months would probably be safe enough in a case where everything 
 is going nicely. 
 
 Ergot Will Not Cause Miscarriage. — Mrs. R. D. writes: "Will you 
 please answer the following : 1. From what is ergot made or obtained? 
 2. What amount is necessary to cause miscarriage? 3. Is it a poison? 
 That is, can a sufficiently large dose be taken to cause death? If. I read 
 in a book published by a Dr. Hollick in 1850 that it is an absolute impos- 
 sibility for conception to take place after 16 days after the ceasing of the 
 menstruation period. Do you agree?" 
 
 Reply. — 1. A fungous growth on rye. 
 
 2. No amount short of a very poisonous, probably fatal, dose will 
 cause miscarriage. 
 
 3. It is. 
 
 4. While not absolutely impossible it is improbable. 
 
 To Overcome Sterility. — Mrs. M. C. D. writes: "1. I am 30, have been 
 married three years but am very anxious for a child. I have been ex- 
 amined by three different physicians who have said I had no 'female dis- 
 orders.' I am healthy and never suffer with pains of any kind. Before 
 matrimony, my husband was examined and found 0. K. What is the next 
 step you recommend? 2. Can you suggest any tonic which might help me? 
 I know very little about medicine as I have taken but little during my 
 life." 
 
 Reply. — 1. You and your husband should go together to consult a 
 physician who specializes in overcoming sterility. 
 
 2. Nothing in your letter indicates that you need a tonic. 
 
CHAPTER LXVI 
 
 Venereal Diseases 
 
 VENEREAL DISEASE CAN BE BANISHED 
 
 When a way is found to remedy a bad condition, the importance of that 
 condition increases. Society is in a position to end syphilis. It has every 
 tool needed. The germ has been discovered. It is easily found in the secre- 
 tions of the early syphilitic. For the late syphilitic there are laboratory, as 
 well as clinical, tests. The germs are found post mortem in the very late 
 manifestations of the disease — those ten to twenty years after. Therefore, 
 so far as diagnosis is concerned, every phase is covered. This tool is practically 
 perfect. 
 
 The remedies have been found. Preparations of mercury, arsenic and 
 iodids are now thoroughly understood. Improvements may be made in these 
 preparations but such will be velvet. Under their use, spirochetes may disap- 
 pear from the secretions within a week. What the German scientists call "the 
 great sterilization" can be accomplished within a few weeks. 
 
 Unfortunately, the spirochetes are in inaccessible as well as accessible 
 places. Many are well protected against the blood — therefore, treatment must 
 be persisted in. 
 
 The tool treatment is perfect enough for all practical purposes. The 
 need is to use it in full instead of halfway. 
 
 Syphilis can be cured completely and permanently — so as to prevent the 
 twenty-year after effects ; so as to cure the next generation effects. 
 
 On the other hand, the use of the tools is far from perfect. To secure 
 a more perfect use of these tools is the work of the new tool of public and 
 private hygiene — education. When there is popular demand for laboratory 
 diagnosis of syphilis by health departments, they will make such diagnoses. 
 When the patient demands laboratory diagnosis of venereal disease by private 
 physicians, by hospitals and dispensaries, it will be done. This is a part of 
 the work of public education. 
 
 Much of the harm of syphilis results from half -cures — cure enough only 
 to clear the skin and the throat but not cure enough to prevent locomotor 
 ataxia, or insanity, or apoplexy, or premature old age, or blindness, or mis- 
 carriages, or inherited syphilis. 
 
 To secure a more perfect use of the tool cure — to substitute complete 
 cure for half-cure — can be effected only by public education. 
 
 As to gonococcal infections, some of the tools are entirely satisfactory; 
 others are in the way of becoming so. The diagnosis of early cases can be 
 made by the microscope. The method is perfect. It is easily applied. 
 
 For the late cases, there is the microscope test and complement fixation. 
 
 1286 
 
SO-CALLED VENEREAL DISEASES 1287 
 
 Neither is perfect, yet each is valuable. The two combined with the clinical 
 features, in the hands of physicians, make diagnosis satisfactory. 
 
 The cure of gonococcal infections is not perfect. To those who carefully 
 and persistently carry out directions, the results are satisfactory. To those 
 who stop when the symptoms decrease, the results of treatment are not satis- 
 factory. Then the imperfections of treatment are largely due to the patient. 
 No treatment is perfect until it is reasonably foolproof. The treatment of 
 gonorrhea is not foolproof. 
 
 The work for the tool — public education — is twofold. To force labora- 
 tory examination of gonorrheal secretions as a routine procedure; to bring 
 about the handling of gonococcal infections by the health department as in 
 other contagious disease ; to bring about complete cure of gonococcal infections 
 instead of part cures. 
 
 SO-CALLED VENEREAL DISEASES 
 
 This series of articles deals briefly with different phases of the venereal 
 disease question. It will tell the truth, seeking to avoid offense, and striving 
 to make the presentation plain enough to be easily understood. 
 
 We advise that, wherever feasible, girls go to their mothers and boys 
 to their fathers for further information, or better still, that parents discuss 
 these subjects with their children. Family physicians hold an important 
 relationship to these questions. Finally, there are a multitude of excellent 
 books on these subjects, books that speak frankly, the tone of which is 
 thoroughly wholesome. 
 
 These books are of the new style, in that the words employed and the 
 ideas and illustrations used are chosen with a view to being easily understood 
 by men and women of less than average intelligence. 
 
 In so far as the venereal diseases are concerned, conditions are bad. 
 They are bad because the subject has been tabooed. The flood of light that 
 has been turned on everything else has been kept away from this subject. 
 The medieval method has been abandoned as to every other subject. Here a 
 dark jungle island has been left in a sea of light. 
 
 We believe that generalized information will clear out this plague spot 
 as it has the others. 
 
 Venereal diseases should be reported, registered, and controlled from 
 the health departments ; but these departments will not control them for years 
 to come. Occasionally an exceptionally good city health department, such 
 as those of New York City and Detroit, and such as California's among state 
 departments, will attempt to register venereal disease. But the attempt at 
 control does not go beyond registration, with some educational features at- 
 tached. Outside the army and navy this is as far as our government will go 
 in the near future. 
 
 Where is there hope of relief? 
 
 Thousands of people are killed; tens of thousands are made invalids for 
 life. No class escapes. Venereal disease blinds babies; it mutilates innocent 
 women; it lays low the men. 
 
 It is called the "red plague." It deserves the name; it is a plague, and 
 it is stained red. 
 
1288 VENEREAL DISEASES 
 
 When the government fails us what remains ? Education — such a knowl- 
 edge of the facts as will lead to self-government. 
 
 Much of venereal disease can be prevented by greater morality. There will 
 be groups of the young to whom chastity can best be taught by religious teachers. 
 Some of the education necessary to prevent venereal disease is properly 
 the function of these teachers, as other parts must be given by parents ; others 
 by physicians ; others by school teachers ; others by health departments ; others 
 by the drama, and still others by the public press. 
 
 Webster's definition of virtue is "rectitude; strength; efficacy; valor; 
 chastity." It would be a good idea to remove the semicolons and allow 
 strength to flow into the other meanings. The meaning of this suggestion is 
 that it is wise to promote virtue by ending the blindness of virtue. 
 
 The problem of morality is not the problem of venereal disease. With 
 it, however, it has many points in common. Efforts to promote morality will 
 result in bettering venereal disease conditions. 
 
 The venereal diseases should be classed with the contagious diseases. 
 They should be reported at the health departments, and measures for their 
 control planned by health departments. 
 
 Not every venereal infection results from transgression of the moral law. 
 A large part of venereal disease is innocently acquired. Infants' homes, orphan 
 asylums, and children's hospitals find it well-nigh impossible to keep free 
 from venereal infections. If they think otherwise it is because they have 
 never followed the policy of proper examination of their inmates. 
 
 Within the last ten years two up-to-date hospitals in Chicago have had 
 experiences with gonorrhea in children. New buildings had been erected; 
 every detail represented the last word in hospital construction and main- 
 tenance. The intention was to maintain everything so attractively that 
 people with homes would prefer to go to the hospital. Each had provided an 
 up-to-date children's ward. 
 
 Alas ! within a month after opening venereal disease was epidemic among 
 the children. 
 
 A meeting of the hospital superintendents of the city was called by the 
 health department. The upshot of this meeting was that the careful, high- 
 grade hospitals in the city adopted the policy of inspecting children on entrance 
 and sending the gonococcus infected to the county hospital. 
 
 The county hospital, already under great strain in keeping the children 
 in separate scarlet fever, measles and other groups, was further required to 
 divide each group into two subgroups — the venereally infected and those not 
 so infected. 
 
 The superintendents decided that the county could not escape getting 
 venereally infected children in its wards. They were compelled to maintain 
 separate wards, and it was wise for other hospitals to unload the venereally 
 infected children into them. 
 
 The widespread prevalence of gonococcal vaginitis in young girls has 
 existed for a long time. It will continue to exist until a definite policy to 
 prevent it is inaugurated. 
 
 It is not a local condition. There is about as much innocently acquired 
 gonococcal infection amongst young girls and babies in one portion of the 
 country as in another. 
 
SO-CALLED VENEREAL DISEASES 1289 
 
 Nor is the innocent acquirement of gonococcal infection limited to chil- 
 dren. Most of the women suffering from pus tubes are not so suffering as the 
 result of their own immorality, and many of them not as the result of any- 
 body's immorality. 
 
 In order to understand the manifestations of gonococcal infections it is 
 necessary to know something about the germ which causes it. The germ of 
 gonorrhea is known as the gonococcus. It is one of the pus cocci. As a 
 general proposition, we get on comfortably with the pus cocci. They make 
 fairly good neighbors. With some of them we live in peace and harmony 
 all the time. With most of them the lower animals (horses, dogs, chickens) 
 live in complete harmony about all the time. Some of them have but slight 
 capacity to harm and then only for a brief season. 
 
 For instance, a pus coccus, the staphylococcus, will crawl down a hair 
 and get under the skin. Inflammation is set up ; leukocytes rush to the field ; 
 a boil results. Within a week the leukocytes will have whipped out the pus 
 germs, and the boil will be well. 
 
 Other cocci are usually bad neighbors, their peaceful states being rarer 
 than the belligerent ones. The gonococcus, being of the pus germ family, 
 behaves in a similar manner. It has the family traits. 
 
 In its generally known role it produces a violent suppurative inflam- 
 mation. This stage starts after a three-day incubation period. This violent 
 period lasts two weeks. 
 
 In this period there is a good deal of local soreness and swelling. The 
 pus cocci get into the lymph stream and are carried to the lymph glands. 
 
 Occasionally one of these suppurates just as happens in an abscess or a 
 boil. There is some fever and some aching. The toxins of the coccus are 
 circulating* in the blood. 
 
 Then follow the weeks in which the germs are getting accustomed to 
 their neighbors. The suppuration gets less and the swelling passes away. 
 
 This is followed by the stage in which the germ is quite well adapted to 
 its new surroundings. The germs have got into some gland or fold that 
 does not easily clean itself, and there they may lie, quiet and harmless, for an 
 indefinite period. 
 
 The stage of violent infection in the new host is succeeded by the stage 
 of mild, latent infection. 
 
 This tendency to become adapted to its surroundings is what makes 
 gonorrhea hard to control — that is, as a contagion spreading from person 
 to person. As I said before it is this same quality which makes malaria 
 hard to control — this tendency to become chronic, to relapse; this tendency 
 of the parasites to make themselves halfway at home in the blood of a host. 
 
 More than half the men have gonococcal infections at some time or other 
 in their lives. 
 
 A large percentage of the women suffer from such infection. 
 
 A small proportion of the children are infected by it. 
 
 The gonococcus infects the moral about as often as the immoral; the 
 innocent as often as the guilty. 
 
 It produces sterility, blindness, and congenital deformity. 
 
 It kills thousands, maims tens of thousands; disables hundreds of 
 thousands. 
 
1290 VENEREAL DISEASES 
 
 It rarely gets into the blood stream. 
 
 Once an infection occurs, the gonococcus is liable to lurk near the site 
 of infection for years. When its symptoms are cured it is still there and 
 ready to harm; then is the time of the truce of the bear. 
 
 Under a policy of ignoring gonorrhea the community is growing worse 
 infected all the time. The policy of reporting and registering it, as with 
 other forms of contagion, will come slowly. It will crawl with painful, dis- 
 couraging, halting advances. 
 
 In the meanwhile we must hope for escape through education. There 
 are other things we had rather learn about. There is nothing that we have 
 more need to learn about. 
 
 "NO WORSE THAN A COLD" 
 
 A great many boys are of the opinion that a gonorrheal infection of the 
 urethra is "no worse than a cold." They have had several attacks and they 
 have cured each one with a mixture compounded by the druggist, or some 
 advertised injection. In each instance, after a few days of treatment, the 
 discharge has stopped. 
 
 The boy has come to entertain a contemptuous disregard for his dis- 
 order. Sometimes he thinks his method is the best ever, whereupon he spreads 
 the news and recommends it to his friends. Sometimes he thinks he is a little 
 more able to throw off such disorders than the common run of boys. Usually, 
 he thinks the infection a thing of no consequence. 
 
 What has resulted from his treatment is that he has stopped the discharge ; 
 he has not cured the disorder. He has stopped the symptom of which he 
 knew — the discharge. Had he observed more closely he would have noticed 
 that not even that symptom was wholly cured and other less striking symptoms 
 were present. 
 
 Had he talked with those who knew he would have learned that he was 
 just as dangerous as though his main symptom had not lessened. He would 
 have learned that what he supposed to be repeated cases was merely his old 
 case recurring. 
 
 He had been infecting other people, and, to even things up, from time 
 to time he had reinfected himself. 
 
 He had never been cured at all. The treatment that the drug clerk 
 had been selling him and that he had been using on himself had stopped the 
 only symptoms by which he, with his little information, could judge, and, 
 maybe, had made him more dangerous to himself and others than he would 
 have been had he left nature to fight the battle alone. 
 
 He had wasted time in treating a symptom when he should have been 
 treating the infection underlying the symptom. It was as though he had been 
 easing an appendicitis pain with morphin when he should have been having 
 the disease attended to. 
 
 There may have been a symptomatic cure, but there had been no real 
 cure. 
 
 A real cure is not effected until gonococci are no longer present, not alone 
 in the secretions but in the tissues themselves. 
 
VENEKEAL DISEASES AND BLINDNESS 1291 
 
 The disease would not be so widespread were it not for the advertised 
 cures, the drug store cures, the symptom cures. 
 
 VENEREAL DISEASES AND BLINDNESS 
 
 If there were no venereal disease, blindness would not be of great impor- 
 tance from the community standpoint. The blindness of old people is due to 
 cataract; that can be remedied. Blindness can be caused by tobacco, but the 
 blindness from this cause is inconsiderable. The blindness due to the trades 
 that endanger the sight should grow less as the use of proper mechanical 
 devices becomes universal. 
 
 More than half the blindness is due to two infections; of the outside of 
 the eye — the conjunctiva — with gonococcus, and the interior of the eye with 
 the spirillum of syphilis. As the blindness from other causes lessens, the 
 blindness due to these two causes increases. Of these, the gonococcus infection 
 generally occurs at the moment of birth or within a day or two thereafter. 
 
 Some state boards of health and some city health departments now 
 supply physicians and midwives with a small package containing nitrate of 
 silver solution and cotton. The instructions are to wash the baby's eyes with 
 a boric acid solution at the time of the first bath. 
 
 The water used to wash the baby, in case soap and water are used for 
 this first cleansing, is not allowed to come in contact with baby's eyes. Instead, 
 a pledget of cotton saturated in boric acid is used for that purpose. One 
 pledget is used for each eye. 
 
 Under no circumstances is the same pledget to be used for both eyes, 
 nor is a pledget that has been used on one eye to be put back into the boric 
 acid solution. 
 
 Then, in every case, a drop of the 1 per cent nitrate of silver solution 
 is dropped into each eye. The silver solution is strong enough to kill any 
 gonococci in the eye, but is not strong enough to inflame the eye. 
 
 This method should be followed with every baby. It is not enough to use 
 it in the suspected cases. The infection seldom crops out there. It is in the 
 unexpected places that this condition shows. Therefore, the Crede plan should 
 be followed in every case. 
 
 The Germans have been following this plan long enough and carefully 
 enough to cause us to pay attention to them, when they tell us that this 
 measure will prevent nineteen-twentieths of the blindness that comes in 
 infancy. 
 
 Occasionally the gonococcus does not destroy the sight in two or three 
 days, as it does in newly-born babies. Occasionally the germ seems to be 
 mild and to cause an ordinary case of sore eyes, or something a little worse. 
 
 For instance, the little girls who have an innocently acquired infection 
 are not much disturbed thereby. The germ shows little disposition to travel 
 upward and cause pus tubes and peritonitis, as in women. 
 
 When some of the secretion is carried on their fingers to their eyes, 
 rarely does blindness ensue. There is a month or more of sore eyes. 
 
 So the harm done by gonococcal infection of the eyes is not limited to 
 blindness; it is somewhat swelled by milder types of eye disease. 
 
1292 VENEREAL DISEASES 
 
 SYPHILIS 
 
 The gonococcal infection as a rule remains close to the focus of infec- 
 tion. The syphilitic infection speedily travels from the focus of infection 
 to other parts of the body. 
 
 The germ of syphilis is known. It can be found with the microscope. 
 It can be grown on culture media. Eabbits and monkeys can be inoculated 
 with syphilitic secretions. 
 
 The gonococcus is fat and round and biscuit-shaped. The spirillum of 
 syphilis is long, narrow, and wormlike. The gonococcus cannot move of itself. 
 The spirillum is constantly wiggling like a worm and travels rapidly. 
 
 The gonococcus infection stays pretty close to where it starts. It fre- 
 quently gets into the lymph channels, and is carried to near-by lymph glands. 
 It may, though rarely, get into the blood, and be carried to the joints, causing 
 rheumatism, or to the heart, causing heart disease. But when it is carried, 
 it is passively carried, as a chip by a current. 
 
 On the other hand, the syphilis spirillum moves of and by itself, and, 
 in addition, can be passively transported by the blood, or the lymph, or along 
 free surfaces. It wiggles into the blood stream and is carried to any part 
 of the body. 
 
 In the stage of syphilis known as the secondary, the spirilla abound in 
 the blood. The secondary stage is characterized by fever. In extremely bad 
 cases the patient may seem to have measles or scarlet fever. 
 
 I have seen such mistakes made. As a rule the fever and the eruption 
 are mild, and sometimes so mild as to be overlooked. After that stage has 
 passed — a few months after the infection — the spirilla are never in the blood 
 for long. They wiggle in, float around awhile, and then wiggle out. 
 
 It is a mistake to regard syphilis as a blood disease. The blood seldom 
 contains spirilla. If the spirilla stayed in the blood, the disease might be 
 more easily cured. 
 
 The organisms are out in the tissues, around the blood vessels, the lymph 
 vessels, and among the tissue cells. There they live, multiplying slowly and 
 dying off at about the same rate, secreting little poison. 
 
 Syphilis is due to infection with a parasite that has the capacity of making 
 itself much at home in the human body. Within three months of infection 
 it is on neighborly terms with the cells surrounding it. Its harmful activities 
 during a single day are immeasurably small, but, when the day's work is 
 multiplied by 365, and then the product by ten, the harm is no longer immeas- 
 urably small. 
 
 The first point to remember is that syphilis is not a blood disease — in 
 any proper sense. 
 
 The second point is that it is not a severe disease. Its mildness makes 
 it possible for the germs to keep at their job for a long series of years. 
 
 The third point is that the disease is still actively at work when there is 
 nothing to show for it — no eruption on the skin, no ulcers, no mucous patches, 
 and no sore throat. 
 
 In order to handle the disease it is necessary to bear these three points 
 in mind. 
 
THE VENEREAL PERIL 1293 
 
 To cure, it is necessary to kill the germs in the tissues, in which loca- 
 tions they are harder to get at than if they were in the blood. The secondary 
 symptoms, occurring when they are in the blood in numbers, disappear after 
 a few weeks, or even days, of treatment. 
 
 It is necessary to bear in mind the mild nature of the disease in carrying 
 out the treatment. However, the third point is the one of greatest impor- 
 tance. The temptation to consider oneself well — no longer a source of danger 
 to others and out of danger so far as one's own future is concerned — the 
 tendency to think that all's well when the symptoms disappear is strong. 
 
 In malaria, gonorrhea, and rheumatism we have illustrations of diseases 
 that when half cured are even more of a menace than if no part of a cure had 
 been effected. 
 
 Syphilis furnishes the best and most striking illustration of the harm 
 done by confusing cure of the symptoms with cure of the disease. 
 
 After the spirillum has been crippled by a few months of treatment 
 it can still remain in the tissues, crippling them so that ten or twenty years 
 later gummata will be found. 
 
 In the unborn babe the disease can become virulent and speedily ter- 
 minate life, or it may be fairly latent, producing conditions that do not 
 manifest themselves for years after the child's birth. 
 
 The terror of syphilis is due to the lesions which it produces and the 
 symptoms which appear after the disease has seemed to lie idle for years. 
 
 THE VENEREAL PERIL 
 
 The only figures as to the prevalence of venereal disease that are at all 
 dependable are those of the army and navy. All other figures and statistics 
 are guesses, some shrewd, some less so, but only guesses. 
 
 The army finds that venereal disease now disables more men than any 
 other cause. Typhoid fever has been banished from the army and navy; 
 malaria is under control, and venereal disease, as a producer of disability, is 
 without a rival. 
 
 In 1902 the venereal disease rate in the United States army reached 
 162. This means that, during that year, out of each 1,000 men enlisted 162 
 contracted venereal disease. The rate remained around 150 until 1907, when 
 a moderate decline began. 
 
 After several years of experiment and investigation the army surgeons 
 adopted a venereal disease policy in 1910 and, in consequence, the rate 
 rapidly dropped. In 1912 it was 110; in the last quarter of that year it 
 was 91. 
 
 Colonel Kean tells us that the surgeon-general's report showed that in 1911 
 there were 11,211 cases of venereal disease, whereas there were but 3,737 
 cases of typhoid fever, malaria, smallpox, measles, scarlet fever, diphtheria, 
 dysentery and tuberculosis combined. 
 
 The constantly non-effective rate is about 13; out of each 1,000 men 
 thirteen are at all times off duty because of venereal disease. Surgeon General 
 Rixey, in his 1909 report as to the disablement of sailors in the navy from 
 venereal disease, wrote: 
 
1294 VENEREAL DISEASES 
 
 "This class of disease would have operated to render entirely ineffective 
 for over a month three battleships with a complement of 1,000 officers and 
 men each/' 
 
 The navy rate in 1909 was 160. I understand that they are controlling 
 venereal disease after the same plan employed in the army, and that their 
 rates are falling about as rapidly. 
 
 At that, we were several years behind other nations in beginning our 
 fight on venereal disease. The British army rate at its worst was 275. They 
 had driven it down to sixty-six in 1909. The Prussian army in 1909 had a 
 rate of eighteen, and the French army, of twenty-two. No Continental 
 army, not even that of Spain, had a rate much higher than our rate at its 
 worst. 
 
 In an account of morbidity in the army on the Eio Grande, Colonel Kean 
 said that four men from each 1,000 were at all times out of service from 
 venereal disease. Syphilitics were not counted, as the disease in them was 
 latent. 
 
 If there were any way to discover the conditions in civil life it would 
 be found that they do not differ greatly from those in army life. The amount 
 of venereal disease in the army at home is a fair index of the amount among 
 civilians. 
 
 Judged by this standard, American conditions are worse than those of 
 Great Britain, Germany, or France. Are we not called on to do something 
 about it ? 
 
 ADVERTISING DOCTORS— MEN'S DISEASES 
 
 In 1911 Dr. , the men's specialist of Los Angeles, advertised that 
 
 he was the only advertising specialist in that city who was going by his right 
 name. As a matter of fact, a majority of the medical offices are advertised 
 under the names of men who have been dead for years or who never lived. 
 
 When we consult medical directories we find that men of the names used 
 are not graduates in medicine at all, or else they have graduated from the 
 poorest grade of medical colleges. 
 
 Medical methods employed in these offices are either exactly the same 
 as those employed elsewhere, or else they are not up to date. The best that 
 can be said of the best of them is that they employ the standard methods. 
 The statements that they make use of more advanced or more scientific 
 methods, or methods that the regular practitioners know nothing of, are 
 entirely without foundation. 
 
 Then, if the methods used are below the average and behind the times, 
 and the men hired to run the offices and give the treatment are low grade, 
 poorly educated, badly informed, and cheap doctors, how do they take in 
 enough money to pay the advertising bills? 
 
 They have two business methods that take well with people who do not 
 know the ways of schemers. One is case taking and the other the follow-up 
 letter system. 
 
 A good case taker is the keystone of the office. It is his business to 
 scare the victim, talk of the gravity of the case, and to promise a cure. His 
 tribe has created a lot of diseases that have no existence — varicocele, lost man- 
 hood, etc. — bogies with which to frighten. In case there is some disorder and 
 
MEASUBES FOE CONTROL 1295 
 
 the cure does not come as promised, the objecting patient finds himself in the 
 hands of a new case taker. 
 
 The symptoms of venereal disease are easily cured. After a few weeks' 
 treatment, the patient in the hands of an advertising doctor finds himself 
 without symptoms. He thinks he is cured, that the advertising doctor has 
 cured him. 
 
 As to just when he is actually, not symptomatically, cured is a difficult 
 point to decide. It is necessary that the infected man should be advised on 
 this point. He cannot tell for himself. Here he must have somebody whose 
 advice he can accept without question. 
 
 No man can read the wording of the advertisements, no man can pass 
 through the hands of a case taker, no man can read one of those medical 
 follow-up letters without concluding that the advertisers are not to be 
 depended on. 
 
 Why do they hang on? Because nobody has made it his business to 
 inform the people. When people become well informed they will be able to 
 judge. The men's specialists and private disease specialists will have to find 
 other work. 
 
 MEASURES FOR CONTROL 
 
 The rapid improvement in the conditions in the army during 1912 is the 
 result of the policy outlined in a general order, as follows : 
 
 "1. It is enjoined upon all officers serving with troops to do their utmost 
 to encourage healthful exercise and physical recreation and to supply oppor- 
 tunities for cleanly social and interesting mental occupations for the men 
 under their command; to take advantage of favorable opportunities to point 
 out, particularly to the younger men, the inevitable misery and disaster which 
 follow upon intemperance and moral uncleanliness, and that venereal disease, 
 which is almost sure to follow licentious living, is never a trivial affair. Al- 
 though the chief obligation and responsibility for the instruction of soldiers 
 in these matters, rest upon the company officers, the medical officers should 
 cooperate by occasional lectures or other instruction upon the subject of sexual 
 physiology and hygiene and the dangers of venereal infection. 
 
 "2. Commanding officers will require that men who expose themselves 
 to the danger of contracting venereal disease shall at once upon their return to 
 camp or garrison report to the hospital or dispensary for the application of 
 such cleansing and prophylaxis as may be prescribed by the surgeon general. 
 Any soldier who fails to comply with such instructions, if found to be suffer- 
 ing from a venereal affection, shall be brought to trial by court martial for 
 neglect of duty. 
 
 "3. Commanding officers will require a medical officer, accompanied by 
 the company or detachment commander, to make a thorough physical inspec- 
 tion twice in each month of all the enlisted men (except married men of good 
 character) of each organization belonging to or attached to the command. 
 These inspections will be made at times not known beforehand to the men 
 and preferably immediately after a formation. The dates on which the physical 
 inspections of the various organizations are made will be noted on the monthly 
 sanitary reports." 
 
1296 VENEREAL DISEASES 
 
 Colonel Kean, in "The Venereal Problem in the Army and Navy/' says 
 that the campaign against venereal disease in the British army was not the 
 least of the victories of Lord Kitchener. That highly successful campaign 
 embraced four lines of activity: 
 
 1. The new cantonment rules. 
 
 2. The continuance of treatment in cases of syphilis after discharge from 
 hospital so as to prevent recurrence of symptoms. 
 
 3. Putting bazaars out of bounds. 
 
 4. Moral influence — lectures and talks to the men, amusements, etc. 
 The new cantonment rules referred to were rules requiring the reporting 
 
 of venereal -disease and providing proper care for those infected. The insist- 
 ence upon treatment until fully cured applies to gonorrhea as well as syphilis. 
 
 HOW TO KNOW SYPHILIS 
 
 The . first symptom of syphilis is a small ulcer. This ulcer generally 
 begins at the point where the spiral germ entered. It starts three weeks after 
 infection. 
 
 In every case of syphilis, an effort should be made to find out from 
 whom the disease was contracted. The source in any given case may be 
 endangering other people and sometimes there is no suspicion, on the part of 
 the person harboring the germ, of the harm that is being done. 
 
 To investigate a case, fix the date of the first appearance of the ulcer 
 and then review the happenings of three weeks before. Eemember that the 
 ulcer develops at the exact point where infection occurred and nowhere else. 
 
 The ulcer, to begin with, is not an ulcer. The spirochetes are in the 
 tissues and around them a hard nodule forms. Presently the nodule breaks 
 down on the surface and a punched out ulcer appears. This ulcer does not 
 pain greatly, itch or run much. The process is not due to pus germs. There- 
 fore, unless pus germs later infect, there is not much pus or pain or much 
 swelling. 
 
 It is constantly happening that this ulcer is so small and so painless 
 that it is entirely overlooked, or thought to be a fever blister, until the general 
 skin eruption comes on two to four weeks later. Then the person, for the first 
 time, remembers the almost unnoticed, almost forgotten, ulcer. 
 
 The ulcer has hard edges and a punched out appearance that is easily 
 recognized by a physician when typical, but which sometimes is atypical. But, 
 fortunately, within the last few years, the germ has been discovered. It is 
 easily found in the secretions from the ulcer and from the secretions of any 
 secreting patches that develop as secondaries. 
 
 The state and city boards of health are now equipped to examine these 
 secretions. The examination is easier made than is the examination for diph- 
 theria or consumption. If your department of health does not examine secre- 
 tions for the spirilla of syphilis and for the coccus of gonorrhea it is because 
 they have never been stimulated to make them. The venereal problem will 
 not be started toward solution until laboratory examinations for venereal 
 diseases are a matter of daily routine exactly on a par with consumption 
 examinations. 
 
HOW TO KNOW GONORRHEA 1297 
 
 After syphilis has progressed beyond the stage where the secretions will 
 show spirochetes — also called spirilla — under the microscope, there are certain 
 laboratory tests that are reliable, though not so reliable as the spirochete test. 
 One of these is the Wassermann; the other is the Noguchi. These tests are 
 especially valuable in that they give light not only when the rashes are present 
 or the glands are enlarged but also years after when there is nothing to show 
 that infection is present. 
 
 Within the last few years, the spirochetes have been found in the brain 
 in paresis and in various other syphilitic diseases that come years after the 
 original infection. This information is worth a great deal to the physician, 
 but there is no way of proving the case to be syphilis by finding the organism 
 in the tissues during life. In these cases, reliance must be put on the Wasser- 
 mann and jSToguchi tests, supplemented by what is known as the therapeutic 
 test. 
 
 The therapeutic test consists in giving the person under suspicion a course 
 of mercury or mercury and iodid, or of the newer arsenic preparation — 
 salvarsan. If there are symptoms and these get better very rapidly under 
 the therapeutic test, the evidence is sufficient for a diagnosis. 
 
 We have for the diagnosis of syphilis, examination of the secretions 
 for the germ — of greatest value in the early stages — to be done by the physician 
 or by the health departments. Examination of the patient — to be done by 
 the physician. Some communities have dispensaries and hospitals to care 
 for those cases not otherwise able to care for themselves, and protect the 
 community. Examination of the blood by the Wassermann and Noguchi tests — 
 to be done by health department laboratories in some instances and by private 
 laboratories. The therapeutic test — to be done by the attending physician. 
 
 HOW TO KNOW GONORRHEA 
 
 The gonococcus is a pus coccus. The first effect of infection is a sup- 
 purative inflammation. The test that can be depended on in these early 
 stages is the microscopic test. The health department laboratory will make 
 this test. In some communities, the test is a routine procedure. It is made, 
 in large numbers, every day in the year just as diphtheria tests are. 
 
 A little pus spread on a glass slide is all the material needed. The 
 dried pus is just as satisfactory as fresh pus. If your health department is 
 not making the test it is because the people have never asked that it be done. 
 
 See to it that your health department adds laboratory examination for 
 venereal disease to its list of activities. 
 
 In the early stages, the gonococcus not only attacks the mucous mem- 
 branes but it kills off all other bacteria. Therefore, in the pus from such 
 cases, no germs are found except gonococci. After a few weeks other germs 
 are again found in the pus and gonococci are less abundant. 
 
 Microscopic examination of late cases is not so valuable nor so dependable 
 a procedure. 
 
 After the infection has been carried away from the point of entry and is 
 infecting tissues that are remote, diagnosis is more difficult. Illustrations of 
 what is now in mind are gonorrheal pus tubes, gonorrheal peritonitis, gonor- 
 
1298 VENEKEAL DISEASES 
 
 rheal rheumatism. For such cases, there is a laboratory procedure called 
 complement fixation — a pretty fair test and one that helps out a good deal in 
 some hard cases. 
 
 The type of examination made in a segregated district is of no practical 
 value. It is a superficial examination. No microscopic tests are made. 
 
 METHOD IN USE IN U. S. ARMY 
 
 A suitable, easily accessible room in the hospital (or dispensary) at each 
 post will be selected for this purpose, which should be provided with a good 
 light and such medical supplies, basins, and other equipment as may be neces- 
 sary. A competent, properly instructed man of the Hospital Corps, or more 
 when necessary, will be on duty there between retreat and reveille, and will 
 be within call at other hours. 
 
 The procedure in the case of men reporting for treatment will be as 
 follows : 
 
 1. The name, rank, and organization of the soldier, with the day and 
 hour of treatment, should be entered for record on a card furnished for the 
 purpose, which will afterwards be examined and authenticated by the initials 
 of the medical officer. These records should be regarded as confidential and 
 should be kept in a secure place and not shown to unauthorized persons or 
 except upon proper authority. They will not be preserved longer than three 
 months. 
 
 2. The genital organs will be thoroughly washed with soap and warm 
 water. 
 
 3. An injection will be made into the urethra of 4 c.c. of the standard 
 solution of 2 per cent protargol dissolved in glycerin 15 parts, water 85 
 parts. This should be retained in the urethra for three minutes. In individual 
 cases when the protargol solution is found to produce an irritating effect, a 
 20 per cent solution of argyrol may be used. Other solutions or modifications 
 of these solutions will not be used for routine administration. 
 
 4. The entire penis will be rubbed with calomel ointment (30 per cent 
 in benzoated lard), care being taken that the folds of the prepuce and about 
 the frenum are thoroughly covered. If any pimples or abrasions exist about 
 the scrotum or the pubic region, these should also receive an application of 
 the ointment. 
 
 The parts should be then wrapped in a napkin of soft paper furnished for 
 the purpose, in order to protect the clothing. 
 
 A medical officer may for special reasons use other preparations than 
 those above specified, but only when he personally gives or supervises the 
 administration of them. Eeport will be made in such cases of the drugs used 
 and the results obtained, with reason for departure from the routine treatment. 
 
 (Note) Protective packets will not hereafter be issued by the Medical 
 Department, but in view of the fact that the hospital method of prophylaxis 
 will not be applicable to soldiers on passes or furloughs of more than 24 hours, 
 it is recommended that medical officers make the suggestion to the proper 
 military authorities that a protective packet be kept on hand for sale at 
 post exchanges. A tube containing an ointment which is efficient both as an 
 
PROSTITUTION IN RELATION TO VENEREAL DISEASE 1299 
 
 injection and for external application is to be preferred. The following 
 formula has been found efficient : 
 
 Camphor 3 per cent 
 
 Phenol 3 per cent 
 
 Calomel 25 per cent 
 
 Adeps Lanae 35 per cent 
 
 Benzoinated lard 34 per cent 
 
 The protective packet generally known as the A. & N. (Army and 
 Navy) packet is put up by several pharmaceutical firms and can be had at 
 drug stores. 
 
 PROSTITUTION IN RELATION TO VENEREAL DISEASE 
 
 There are many opinions extant as to the percentage of venereal diseases 
 due to prostitution. These estimates place the figures so high that many 
 hold that by regulating prostitution venereal disease will be regulated. These 
 figures are but estimates. 
 
 Some of these opinions are entitled to weight; others have little value. 
 Based on these opinions, health officials have been advised to work for segre- 
 gated, regulated vice as a means of controlling venereal disease. 
 
 Generalizing procedures — dragnet procedures — are in a bad way amongst 
 health authorities now. They began to get results in controlling diphtheria 
 when they quit watching sewer gas and concentrated on the bacillus. 
 
 The trend of opinion amongst health officials is that no shots count 
 except those against the bull's eye. To herd all the women of easy virtue into 
 one part of town as a means of controlling venereal disease is ineffective. 
 In the first place, they cannot be herded. Segregation does not segregate. 
 
 The method of medical inspection does not, and cannot, protect against 
 infection. Even as the plan is worked under such an absolute monarchy as 
 Japan, it does not control venereal disease. Under American government, it 
 causes venereal disease. 
 
 It is proper to search for venereal disease amongst careless people — both 
 men and women — with extra care, and to take adequate pains to control the 
 infected. This plan is followed in Detroit. It is proper to placard houses of 
 prostitution, where venereal disease in highly contagious form exists, until 
 such time as the spreader of contagion comes under control — as has been done 
 in Chicago. 
 
 But it is not proper to inspect women and certify that they are incapable 
 of spreading contagion and will so remain for a week or a month. Nobody 
 can truthfully make that statement as to venereal disease, smallpox or scarlet 
 fever. 
 
 That the health authorities coincide in the above opinions is proved by 
 the official proceedings of the section on preventive medicine of the American 
 Medical Association, June, 1911, and the proceedings of the American Public 
 Health Association, October, 1910. 
 
 No health department in the United States advocates segregation of 
 prostitutes as a means of controlling venereal disease. 
 
1300 VENEREAL DISEASES 
 
 GONOCOCCAL INFECTIONS IN CHILDREN 
 
 Every mucous or purulent discharge from the genitals of a child is a mat- 
 ter for investigation. Infection is the cause in every instance. In most cases 
 the infection is with the gonococcus. 
 
 The microscope will show the organism. It is a good guess that any 
 catarrhal — so-called — vaginal secretion in a child is due to gonococcal infection 
 and is not to be treated lightly. 
 
 The effects in young girls are very much lighter than in mature women. 
 Occasionally, changes are caused which make sterility inevitable. Occasionally, 
 the eyes are infected and sometimes blindness results. Frequently the child 
 is a focus of infection. 
 
 Contagious disease hospitals can prevent the development of gonococcal 
 infections by : 
 
 Systematic microscopic examinations. 
 
 The use of diapers on all children not proved to be free from infection. 
 
 Segregation and treatment of infected children. 
 
 MARRIAGE REQUIREMENTS 
 
 In 1912, Dean Sumner of Chicago announced that he would marry no 
 one in his church unless each party brought him a certificate of good health 
 signed by a physician. Since that time, many ministers have adopted the 
 same rule and many others have indorsed it. 
 
 The opponents of the measure have stated that the examination of the 
 prospective bride and groom will be so superficial as to be of no value in deter- 
 mining the presence of contagion in a condition capable of becoming active 
 under stimulation; that in the latent stages of venereal disease, especially 
 gonococcal infections, there is considerable difficulty in deciding that infection 
 is present. Furthermore, that human eugenics is not developed enough to 
 make expert opinion of great value, while the average run of medical men 
 are not well enough informed on this very new subject to make their opinion 
 of much value. 
 
 To which advocates of the plan reply, that though the plan may have all 
 the shortcomings cited, it is still far better than no plan. It is an initial pro- 
 posal and has the right to be judged as such. It lays no claim to perfection, 
 but it does claim superiority over the entirely uncontrolled procedure for which 
 it is offered as a substitute. 
 
 The opponents argue that those who think themselves sub-standard will 
 not abstain from marrying — they will go to other ministers. To which the 
 answer is that some will, while others will delay marrying until conditions are 
 more propitious. 
 
 But even these arguments pro and con miss the main point. The great 
 gain to moral cleanliness and human welfare from the position taken by Dean 
 Sumner was through the attention attracted to the subject and the contro- 
 versy that his position aroused. 
 
 Havelock Ellis, in his "Task of Social Hygiene," advocates as a positive 
 
INSANITY AND VENEREAL DISEASE 1301 
 
 eugenics procedure the building up of an aristocracy of good blood. By- 
 good blood is meant that the family tree should show freedom from inheritable 
 defects such as feeble-mindedness, drug and drink addiction, insanity, crim- 
 inality, hemophilia, migraine, epilepsy, neurasthenia and other inheritable 
 diseases, and so on through many items. 
 
 The idea of an aristocracy of blood is a positive eugenics suggestion 
 capable of great good. Dean Sumner's proposition is one making for an 
 aristocracy of cleanness in blood. As great as will be its value along this 
 line, its greatest value has been, and will be, in making the subject contro- 
 versial ; in making it a matter of discussion and in keeping it such. 
 
 HOSPITALS AND DISPENSARIES 
 
 An essential for the campaign against venereal disease is a hospital and 
 dispensary system for venereal disease. We now have consumption dis- 
 pensaries, hospitals and sanitaria. We send physicians to homes and we pro- 
 vide hospital care for scarlet fever and diphtheria. Venereal diseases are con- 
 tagious. They affect the innocent as well as the guilty. To control them, 
 there must be hospital and dispensary facilities. It is not enough that there 
 are private physicians. They do not and can not cover the field. 
 
 Many people go untreated, many treat themselves, many are treated by 
 druggists, many are treated by advertising doctors. None of the members of 
 these groups is treated until completely cured. They use the same drinking 
 cups and towels and toilet facilities as well people. Many of them, when half 
 incapacitated, must stay in lodging houses because hospitals do not want them. 
 The conditions for the spread of contagion in lodging houses are excellent. 
 
 It is not enough to insist on complete cure and make -no provision for 
 it. Municipal laboratory diagnosis of venereal disease, reporting of venereal 
 disease, a campaign for education in venereal disease, are all well, but another 
 flank must be provided and that is a hospital and dispensary system. 
 
 INSANITY AND VENEREAL DISEASE 
 
 Justice Hughes says that one-half of the insanity is curable. Using this 
 quotation as a text, Homer Folks writes as follows : 
 
 "One kind of insanity is known popularly as 'softening of the brain/ It 
 is known scientifically as general paralysis, or paresis. It is incurable by any 
 means now known to the medical profession. Those afflicted with it suffer 
 gradual mental and plrysical decay. The very substance of the brain becomes 
 changed. They usually live but a few years. It is now agreed by the medical 
 profession that this disease is caused by an earlier disease known as syphilis. 
 Syphilis is a germ disease. It- is usually the result of immoral habits, though 
 one may get it innocently. Every man and boy should know that by yielding 
 to the temptation to go with immoral women he is exposing himself to the 
 probability of getting this disease, which may result, years after, in incurable 
 insanity. Over the door of every immoral resort might truthfully be written, 
 'Incurable insanity may be contracted "here/- If self-respect, the desire for 
 
1302 VENEREAL DISEASES 
 
 the good opinion of others, the influence of religious training, and the attrac- 
 tions of home life are not sufficient to prevent this kind of wrong-doing, the 
 danger of contracting a disease which may result in incurable insanity should 
 be sufficient. 
 
 a The number of patients having paresis or 'softening of the brain' ad- 
 mitted to State hospitals during the year ending September 30, 1910, was 600 
 men, or 17 per cent of all men admitted, and 263 women, 8 per cent of the 
 women admitted." 
 
 INHERITED VENEREAL DISEASE 
 
 Syphilis can be inherited; gonorrhea cannot be. The syphilis organism 
 can be transmitted to the child by the mother. The organism can infect the 
 mother and not infect the child. The spirochetes in the mother, during the 
 nine months of pregnancy, have been outside the blood stream — pretty well 
 walled off in some isolated area. 
 
 An infected father can infect the mother and thus indirectly infect the 
 child. The spirilla may infect the placenta and thus kill the child, producing 
 miscarriage. The organisms in the child may be so abundant and so poisonous 
 as to destroy its life. 
 
 The organisms may pass into the child and cause inherited syphilis. 
 Syphilitic babies look like old men and women. They are weazened and old 
 in appearance. Sometimes when less profoundly poisoned, the appearance 
 is not greatly altered, but the bones or some of the internal organs are af- 
 fected. Sometimes the infection lies latent until later life — a wait of twenty 
 years or more, as in other forms of syphilis — the spirochetes have been walled 
 off somewhere or other. And then something occurs to permit the escape of 
 the organisms, whereupon the disease takes on an active form. 
 
 The person with inherited syphilis harbors the germ of the disease and 
 is infectious to others in the same way and for the same reasons as are those 
 infected by contact. A case of inherited syphilis is not infectious so long 
 as the organisms are walled off and the disease is latent. When there are ulcers 
 or patches in the secretions of which are organisms, anyone touched by these 
 secretions is liable to be infected — if the point touched is one that can be 
 infected. For instance, any mucous membrane, any lining, is easily infected 
 by contact. 
 
 The skin is not easily infected. The dead layer prevents infection so 
 long as it is unbroken. The skin can be infected whenever there is a cut or 
 scratch that permits the organism to get through this dead layer. The or- 
 ganism can be carried on the skin of the hands to the mouth. 
 
 A baby with inherited syphilis can infect its wet nurse, provided the dis- 
 ease is active in the baby — for instance, if there are patches in the mouth and 
 the nurse has some crack or fissure of the nipple. 
 
 While gonococcus infection cannot be inherited, yet this infection is of 
 importance in certain inheritance relations. It is largely responsible for ster- 
 ility in both the male and female. It may travel to the interior of the uterus 
 in a pregnant woman and infect the placenta, causing miscarriage, or it may 
 produce deformity in the developing child. And finally, the child as it is 
 being born not infrequently has its eyes infected and is blinded therefrom. 
 
CONTINENCE 1303 
 
 VENEREAL DISEASES IN NEW YORK CITY 
 
 During the month of January, 1913, the Department of Health requested 
 7,000 physicians in Greater New York to furnish the department with infor- 
 mation regarding the number of cases of syphilis,, gonorrhea and chancroid 
 that had been under their care in their private practice during the twelve 
 months previous, in order that some idea of the number of cases of venereal 
 disease treated during 1912 might be obtained. Only 2,215 physicians re- 
 sponded to this request, reporting 13,348 cases of syphilis, 24,980 cases of 
 gonorrhea, and 4,431 cases of chancroid, making a total of 42,659 cases of 
 venereal disease treated in the private practice of less than one-third of the 
 physicians of this city within twelve months. The number of cases of syphilis 
 is especially and alarmingly large. A complete census of the cases treated 
 in institutions has been unobtainable up to the present time, but the insti- 
 tutional cases, without doubt, exceed in number many times those treated in 
 private practice. The apparently extensive prevalence of venereal diseases 
 in New York City certainly furnishes food for thought. 
 
 During 1912 the Serological Laboratory of the Department of Health 
 tested 4,585 specimens of blood for syphilis and 545 for gonorrhea, while 
 from January 1, 1913, to June 1, 1913, 5,639 blood specimens were tested for 
 syphilis and 846 for gonorrhea. 
 
 CONTINENCE 
 
 Sooner or later every boy must decide whether or not he will permit 
 himself sexual indulgence of one sort or another, if not with women, then 
 in some irregular way. Every boy must answer for himself the question — 
 Shall I yield to my passions? The answer should be — No. 
 
 The first thought that comes into his head is that sexual activity is 
 necessary for strength and development. He has heard this from somebody 
 and to him it seems rather reasonable. He has been wrongly informed. A 
 part of the sex gland secretion is necessary for strength and development 
 but that part is absorbed directly into the blood and is never mixed with 
 other portions of the gland secretions. Sexual indulgence is not necessary for 
 physical development. 
 
 The next question he asks himself .and perhaps others is — How can a 
 boy keep his passions down ? And, particularly, is there any medicine he can 
 take for the purpose? The answer to the last half of the question is — No. 
 No medicine is to be taken because, in the first place, no medicine given for 
 this purpose has any virtue and, in the second place, it is not proper 
 to be dosing oneself all the time. Taking medicine for this purpose does 
 no good and may do harm. 
 
 The scientists who study the conduct of human beings, as other scientists 
 study the conduct of bugs and insects, speak of those persons who cannot 
 control themselves as the "feebly inhibited." The feebly inhibited have not 
 the force of character, the moral force, the self-control necessary to refrain 
 from outbursts of anger, the desire to get drunk or to take opium. The 
 
1304 VENEREAL DISEASES 
 
 feebly inhibited are not insane, but they are weak, and among them many 
 cases of insanity develop. The condition, feebly inhibited, varies in degree. 
 Some people are able to resist almost every temptation, others can resist 
 some temptations, others can resist no temptation which makes any sort 
 of appeal. 
 
 When a person has no capacity for restraining himself sexually he is 
 clearly feebly inhibited. If he is able to control himself thoroughly, clearly 
 he is not feebly inhibited. In between these two extremes are all sorts of 
 gradations. 
 
 Sexual indulgence then means not that the boy has a strong character and 
 strong will. It means that he has a weak character and weak will. 
 
 If a boy feels himself tempted almost to the point where he cannot 
 resist, can he lessen his desires and increase his resistance? Yes — by right 
 living. Some of the rules are : 
 
 1. Overeating is to be avoided. A heavy meat and eggs diet is especially 
 to be avoided. 
 
 2. The bowels are to be kept regular. 
 
 3. The boy must do hard physical labor either in his daily work or else 
 in his play. It is the idler and not the athlete in active training who is 
 dissolute. 
 
 4. The boy must keep good company. Boys who tell lewd stories and 
 who indulge in salacious gossip are especially to be avoided. 
 
 5. He must cultivate his morals by thinking morally and living morally, 
 by associating with moral people. 
 
 6. He must cultivate decision and strength of character. 
 The above statements apply to girls as well. 
 
 NIGHT LOSSES AND WET DREAMS 
 
 The spermatozoa manufactured by the testicles are stored in sacs pro- 
 vided for the purpose and located in the pelvis at the base of the bladder. 
 These sacs are called the seminal vesicles or sacs. When these sacs become 
 over-distended with secretion they empty themselves. If they empty during 
 sleep the result is a seminal emission, night loss or wet dream. 
 
 For such emptying to take place is natural. When it occurs with mod- 
 erate frequency it means that the man is vigorous. It is a sign of health, not 
 of illness. Wet dreams do not lower vitality or cause a loss of manhood 
 or bring about insanity. 
 
 Then why all the fear on the subject? The people have not had any 
 opportunity to read the truth. The plain truth was supposed to be too indeli- 
 cate a subject for newspapers and books. But the quacks had no such scruples. 
 They have used newspaper space, billboards, pamphlets and books to frighten 
 the people about wet dreams. The only chance for education on these sub- 
 jects was the writings of the quack. " Everybody wanted to Inow— therefore, 
 they read what the quacks wrote. It was tffeir only source of education. In 
 consequence, education"" in erro* and in groundless fear is the rule. 
 
 It is only exceptionally that we find a man who knows that wet dreams 
 are a^good sign and not a bad one; that they are a sign of strength, not of 
 weakness; that in a young man they are natural and not unnatural. 
 
LOST MANHOOD 1305 
 
 There is nothing specially vital about the seminal fluid. When it is 
 discharged there is no special drain on the system. The sex glands do secrete 
 powerful chemicals very necessary for the grown person. Those secretions 
 are known as the ductless gland secretions of the gonads or sex glands. But 
 get this clearly in mind — this secretion passes directly from the sex glands 
 into the blood. It is never discharged as is the ordinary secretion. Therefore, 
 night losses have nothing to do with that secretion. That part of the secre- 
 tion which is discharged has to do with the formation of the child; it has 
 nothing to do with the health or strength of the man (or the woman, for 
 that matter). 
 
 But the great part of those who fear they are going insane because 
 of night losses are even more foolish still. They notice that when they strain 
 at stool a few drops of discharge flow from the urethra. They have read that 
 this is seminal fluid, that the loss of a drop of it at stool indicates that it is 
 oozing away all the time and that insanity and loss of manhood will be a 
 necessary result. This discharge is nothing but a few drops of mucous secre- 
 tion from the urethra itself. It is composed of about the same chemicals 
 as a nose discharge or phlegm from the throat. Such discharge is unimportant 
 from every standpoint. 
 
 SELF-ABUSE 
 
 I feel like saying no word for self-abuse. Nothing can be said for it. 
 It is not necessary for health or strength as some boys are told. It is filthy 
 and immoral. But at that it is not so bad as it is painted. Self -abuse does 
 not cause dementia precox or insanity or loss of memory. Here, again, we 
 have an effect of that education of misstatement by the advertising doctor. 
 He wanted business. The way to get it was to frighten. There is no better 
 way to frighten boys and men than to tell them with some show of authority 
 that self-abuse causes loss of memory, indecision and, finally, insanity. 
 
 This is the explanation of the present popular view of self-abuse. A 
 saner view is that it is somewhat harmful physically; that it leads to even 
 worse habits ; and that it lowers a person's self-respect and moral tone. 
 
 LOST MANHOOD 
 
 What these words mean nobody knows exactly. They are mighty good 
 words to scare a poor fellow with and, in consequence, the quacks have 
 worked them overtime. We have been told that lost manhood means that 
 the man's vitality is gone. It means nothing of the sort. It means that 
 the man is worried or afraid. The way to cure a man of lost manhood is to 
 get fear out of him. If the man who is afraid that he is suffering from lost 
 manhood will stop thinking about his sex organs, his sex life, sex matters 
 of every kind — will put the subject wholly out of his mind — he will find his 
 lost manhood. The best way to find your manhood is to lose all thought 
 of it. 
 
1306 VENEREAL DISEASES 
 
 VARICOCELE 
 
 It would be almost true were one to say there is no such disease as 
 varicocele. 
 
 Within the scrotum are the veins which return the blood from the testicles. 
 These veins being somewhat loose in the scrotum are without the lateral sup- 
 port which most veins have. The walls of all veins are thin and the tissues 
 lying next them in part support the thin walls. The veins which return the 
 blood from the testicles have no such support. In consequence, in a great 
 many men, the veins of the scrotum are somewhat enlarged. In describing 
 the feel of these enlarged veins it is frequently said that they feel like a "bag 
 of worms." That is the condition known as varicocele and that is all that 
 it is. 
 
 Have you ever noticed a crooked, swollen vein on your forehead or on 
 your hand? What does that amount to? Or the enlarged veins of piles? 
 Whoever claimed that these endangered life, or were liable to be followed 
 by dreadful consequences ? The only reason for the fright which some people 
 get about varicocele is the campaigns to frighten them which advertising men 
 have run for years. 
 
 Varicocele is of no consequence. It does not endanger life, or health, 
 or the sexual powers. It does not lead to loss of sexual powers. Let a man 
 with varicocele lead a pure life or let him marry and his varicocele disap- 
 pears nine times out of ten. 
 
 The only importance of varicocele is that it is a source of fear and 
 worry. Varicocele is a prolific source of sexual neurasthenia. In other words, 
 the condition varicocele is of trifling importance, is practically non-existent — 
 but the bogy varicocele has a lot of men scared to a frazzle. 
 
 What is the best treatment for varicocele? To forget it. 
 
 WHEN CAN A SYPHILITIC MAN MARRY? 
 
 Pusey says that the following rule is safe to follow. A patient may 
 marry five years after infection provided that, during the first three years, 
 he has been thoroughly treated and during the last two years he has shown no 
 manifestations of the disease. Marriage in accordance with this rule is safe 
 even though the person gives a positive Wassermann reaction. 
 
 The Wassermann reaction is not of value in settling the advisability of 
 marriage. Within the first years after infection marriage is not safe, though 
 a Wassermann is negative. Later on, marriage is safe even though a Wasser- 
 mann is positive. 
 
 Syphilis is actively contagious in its primary and secondary stages. It 
 is not contagious during the tertiary stage. A positive Wassermann is a 
 symptom of tertiary as well as of primary and secondary syphilis. Therefore, 
 it is not a dependable guide for marriage. 
 
 If syphilis is not contagious during the tertiary stages, what is the danger 
 from marrying once the secondaries have disappeared ? The danger is that 
 there will be a relapse and that secondaries will appear, during which the 
 
WHEN CAN A SYPHILITIC WOMAN MARRY? 1307 
 
 disease is contagious. The question then conies down to the danger of a 
 relapse. 
 
 Pusey quotes Gennerich as proving that, when the treatment is begun 
 very early and kept up very actively, only 5 per cent of the cases relapse. By 
 giving full doses of salvarsan, or its equivalent, as soon as the disease could 
 be diagnosed, the symptoms disappeared in a few days and all evidence of 
 infectiousness was gone in a few weeks. By persisting in active, thorough 
 treatment the percentage of relapses was very small. 
 
 Ninety-five out of each 100 cases treated by the Gennerich method 
 (salvarsan and mercury in full doses) could marry in three months with 
 safety. But nobody can tell which case is to fall in the 95 per cent group 
 and which in the 5 per cent group. Therefore, no person with a conscience 
 will recommend marriage after so brief an interval. 
 
 So few people make the taking of syphilitic treatment their business of 
 first importance or even a matter of great importance. Some stick well all 
 the time, some carry out directions for most of the time, some are less careful 
 still. It is for this reason that competent authorities are so conservative 
 in their recommendations, for there is a vast difference between the theoretic 
 safety after a three months' interval and the conservative rule requiring a 
 five years' interval. 
 
 Keyes found that the chance that a syphilitic husband, taking no special 
 precautions, would infect his wife during the first year of his disease was 
 12 to 1. If he did not expose her until the second year of the disease and 
 then took no special precautions to protect her, the chance that he would 
 infect her was 5 to 2. During the third year the chance was 1 to 4. After 
 the fourth year the chance of infection was very slight. 
 
 In former times we spoke of the danger that a man would infect his 
 progeny and that he would infect his wife as being separate subjects for 
 discussion, on the theory that a man could infect his unborn child without 
 infecting its mother. It has been proved that, unless a man infects his wife, 
 he cannot infect his children with congenital syphilis. Congenital syphilis 
 can only be conveyed to the child through the mother. 
 
 WHEN CAN A SYPHILITIC WOMAN MARRY? 
 
 The question is divided into two parts. First, what is the danger that 
 she will infect her husband and how long does that danger last? Second, 
 what is the danger that she will infect her children and how long does that 
 danger last ? 
 
 As to the first question. The rules are the same as in the case of the 
 man. Vigorous treatment may cause her lesions to disappear in a few days. 
 She may cease to be infectious in a few weeks. Should she have a relapse, 
 she would be infectious during the relapse. 
 
 As to the second question. The danger that a mother will infect her 
 child is greater than the danger that the father will. In well-treated cases 
 women bear healthy children, in some instances, within a year after infec- 
 tion. After four years in such cases there is practically no danger. Irregu- 
 larly and improperly treated women have been known to bear infected children 
 
1308 VENEEEAL DISEASES 
 
 ten years after they were infected. The rule given as a safe, conservative one 
 for a syphilitic man is also safe and conservative for a woman. 
 
 MARRIAGE AFTER INFECTION WITH GONOCOCCUS 
 
 A man who has been infected by gonococci can marry with safety when 
 all discharge has ceased and cannot be renewed by irritation of the urethra 
 by the passage of a sound, provided there is no sign of infection of the 
 prostate and testicles and a complement fixation test is negative. 
 
 To be certain no relapse will occur, the interval between the total ces- 
 sation of all symptoms as above indicated and marriage should be at least 
 three months. 
 
 A woman who has been infected with gonococci can marry with safety 
 when all discharges have ceased and cannot be renewed by irritating appli- 
 cations to the urethra, vagina or cervix, provided there is no sign of infection 
 of the fallopian tubes or endometrium and complement fixation is negative. 
 
 To be certain no relapse will occur, the interval between the total cessation 
 of all symptoms as above indicated and marriage should be at least three 
 months. 
 
 The gonococcus is prone to locate on the surface of membranes or in 
 the lining of glands. It does not infect the deeper tissues as does the 
 treponema of syphilis. In consequence, gonococcal infections are less apt 
 to relapse in after years than is the case with syphilis. If a person who has 
 been infected is free from all discharges and from all symptoms of inflam- 
 mation of the genital organs, it is reasonably certain that he or she is cured 
 of his or her disease and is therefore not subject to relapse. If there are 
 discharges, there should be no marriage. Whether in the man or woman, 
 there should be no marriage until microscopic tests and a complement fixation 
 test have shown that gonococci are not present. 
 
 Parents cannot transmit gonococcus inflammation to an unborn child, 
 except that the eyes of the child being born may be infected by the discharges 
 from an infected mother. 
 
 Inherited Syphilis. — Mrs. A. W. C. writes: "My father contracted 
 syphilis in youth and died from effects of same a number of years ago. 
 My mother has always been in perfect health. I am 32 years old, have 
 one boy 9 years old. I have never been sick with the exception of the 
 ordinary ailments of life. No eruptions on my shin or anything in fact. 
 Am apparently in perfect health. My boy also is in perfect health. 
 
 "What I should like to know is whether or not I run any chances of 
 inheriting any bad effects after this number of years and whether or not 
 it would be advisable to have a Wassermann test made. Please let me hear 
 from you soon, as I have seen two or three similar cases lately which have 
 been practically the same although the offspring had shown some symptoms 
 of rickets, etc., when babies." 
 
 Eeply. — I do not think you have anything to fear. Your father ap- 
 parently never infected your mother, which means that you are not in- 
 fected. Even if you were infected the chance is that your boy is not, 
 since the blood cleans itself in a generation or so. Then, too, the time 
 
VENEREAL DISEASES 1309 
 
 that has elapsed without symptoms is in your favor. You and your boy 
 are all right, I am sure. 
 
 Insufficiently Treated Syphilis. — Mrs. M. R. J. writes: "About 7 years 
 ago my fiance contracted syphilis through the use of a public towel. The 
 only symptoms present, beside the original ulcer which formed on the 
 neck, were ulcers of the mouth and throat. After a few months treatment 
 these ulcers disappeared. Before learning the nature of the ailment I con- 
 tracted it through a hiss. I experienced every possible symptom: slight 
 fever, falling hair, ulcers in mouth, copper-colored spots and lumps on 
 the neck and under arm. After four weeks' treatment every symptom dis- 
 appeared. The physician who treated us said that having contracted the 
 disease at second and third hand the attack woidd probably be light. We 
 were married a year later and have experienced no further symptoms. We 
 are rather above the average in health and good family histories and lead 
 very regular lives. 1. Is it not possible that the disease is cured? 2. If not, 
 what form would a recurrence take and are there no means one could apply 
 to minimize the chance of a return?" 
 
 Reply. — 1. It is not probable that you are cured though it is possible. 
 I do not know what you mean by catching it at second or third hand. Both 
 of you caught it from someone who had it as does everyone who has it. The 
 way you caught it does not warrant the prophecy that it will be mild. You 
 and your husband should have more treatment. 
 
 2. If you have gone for seven years without relapse you will probably 
 not have one now. What you should look out for now is locomotor ataxia, 
 paralysis or some disease of that kind. 
 
 Contagiousness of Syphilis. — C. A. G. writes: "I understand that 
 there are a great many people in this country afflicted with syphilis. 1. Is 
 this disease considered contagious? That is, is the germ carried from one 
 to another on articles used that have been used by the diseased person? 
 2. If so, what would be the symptoms in taking the disease in this way?" 
 
 Reply. — 1. Yes. The danger of infection through handling objects 
 that syphilitics have handled is not great. The danger from drinking 
 from a cup used by a syphilitic is greater. 
 
 2. A sore appears at the point of contact. This comes two to three 
 weeks after the infection. About two to three weeks after the appearance 
 of the sore a rash appears on the skin. 
 
 Safety of Salvarsan. — C. W. D. writes: "1. Is it dangerous for an ap- 
 parently well person to take salvarsan? 2. Is there any sure test by which 
 a person can detect syphilis? I have been informed by a physician that 
 there is a medicine that is injected under the skin and if the proper sore 
 develops this is a never failing sign that a person has syphilis." 
 
 Reply. — 1. There is some danger in taking a salvarsan whether one 
 is sick or well. 
 
 2. Clinical symptoms, the spirochete test, the Noguchi test and the 
 Wassermann test combined are reasonably sure. 
 
 Infection from an Unclean Toilet. — G. D. S. asks: "Will you please 
 name the diseases that may be contracted from an unclean toilet?" 
 
 Reply. — Syphilis, gonorrhea and chancroid are possible. Infestation 
 with body lice is also possible. 
 
1310 VENEREAL DISEASES 
 
 Cure of Syphilis. — J. J. J. writes: "A man contracts blood poisoning 
 and is given one injection of neosalvarsan when secondary symptoms ap- 
 pear. This is followed by 6 months of mercury injections in the muscle 
 and patient is taking by mouth at same time. At the end of the six months 
 three more injections of neosalvarsan are given followed by nearly one 
 year of mercury injected twice each week. During last six months patient 
 has been taking mercury by mouth. There have been no visible symptoms 
 of the disease at any time during the two years' treatment. 1. Do you think 
 enough treatment has been given? 2. Would you stop treatment for a 
 Wassermann test? 3. How long after stopping treatment should Wasser- 
 mann test be made? Jf. If test is negative how soon should another be 
 taken? 5. Does a cure insure a man against locomotor ataxia or paralysis 
 later in life?" 
 
 Eeply. — 1. Another year of treatment would be safer. 
 
 2. No. 
 
 3. Say two months. 
 
 4. Two months. 
 
 5. Yes. 
 
 Relapse in Syphilis. — P. writes: "1. How does a relapse in syphilis mani- 
 fest itself. 2. Are the symptoms the same as those when the disease first 
 made its appearance. 3. If a person has shown no symptoms of any kind 
 for several years can he have a relapse?" 
 
 Reply. — 1. By mucous patches, sores and a copper-colored to red, non- 
 itching eruption on the skin. 
 
 2. Yes, practically so. 
 
 3. Yes, if he has not been thoroughly treated. However, the danger 
 of a relapse lessens as each year passes. 
 
 Curability of Syphilis. — W. H. writes: "1. Is syphilis in the primary part 
 of the second stage curable? If so, how long a period does it take to effect 
 a complete cure providing the victim is sound otherwise? 2. Is the disease 
 so contagious as to compel person afflicted to remain away from family?" 
 
 Reply. — 1. Yes. Treatment under the direction of a physician for 
 three years is advised. If the treatment is very active at the start the 
 treatment during the last two and a half years of this time can be quite 
 mild. 
 
 2. Not if he takes proper precautions. 
 
 Neglected Gonorrhea.— E. L. H. writes: "Please tell me what effect a 
 case of gonorrhea will have on a man if allowed to run for say 6 or 8 weeks? 
 Does it affect the blood as syphilis does?" 
 
 Reply. — Gonorrhea does not affect the blood. A gonorrhea lasting over 
 six weeks may cause rheumatism, suppuration of the glands of the groin, 
 prostate trouble, infection of the testicle, sterility, or it may become 
 chronic. 
 
 Gonorrhea with Few Symptoms. — A. B. N. writes: "Will you kindly 
 tell me if it is possible for a man to contract an apparently gonorrheal in- 
 fection from a woman who has no symptoms of that disease and who is 
 especially neat in that respect?" 
 
 Reply. — Sometimes a case of gonorrhea is infectious even though there 
 are very few symptoms. 
 
VENEREAL DISEASES 1311 
 
 Gleet. — W. H. B. writes: "Is there a cure for gleet after it is about 18 
 months old? If so, what is it?' 
 
 Reply. — Gleet is mild chronic gonorrhea. It is infectious. It can be 
 cured by persistent, scientific, local treatment. 
 
 Gonorrhea Not Inheritable. — Reader writes: "If a man marries who 
 has been cured from a case of gonorrhea will his children be healthy and 
 strong?" 
 
 Reply. — Yes. 
 
 Contagiousness of Gonorrhea. — H. M. S. asks: "1. May gonorrhea be 
 transmitted by hissing, or otherwise than by sexual intercourse? 2. Is a 
 chronic case of gonorrhea curable?" 
 
 Reply. — 1. No to the first part of the question. Yes to the latter part. 
 2. Yes. 
 
 Gonorrheal Rheumatism. — W. S. writes : "Please inform me if there is 
 a cure for gonorrheal rheumatism. Have had it for seven weeks. Am 
 cured of the gonorrhea. How long will it take to cure it? I feel it in my 
 legs and ankles mostly." 
 
 Reply. — I doubt the accuracy of your statement that you are cured of 
 your gonorrhea. I think a very careful examination will show that you 
 still have a gonococcus infection of your prostate or some other locality. 
 When you cure up your local infection your rheumatism will get well. In 
 addition to treatment for gonorrhea take massage and baths. A vaccine 
 will help you. 
 
 Varicocele. — E. H. S. writes: "During the last two months I have 
 noticed the appearance of a knotty growth on my scrotum, as if the veins 
 were knotted together. A friend of mine tells me it is known as vari- 
 cocele and is cured only by operation. Is this true or is there some other 
 method? I am a healthy young man of 21 and a fair athlete. Until about 
 three months ago I had taken no interest in girls. Then for about a month 
 I 'made a fool of myself with the result that I am sadder but wiser. I 
 feel in perfect condition. Would go to a physician but am rather bashful 
 and would rather not go unless it was absolutely necessary. Have heard it 
 was quite a common complaint." 
 
 Reply. — It is a common complaint and one of no importance. Pay no 
 attention to it. Do not talk to people about it. 
 
 A Rupture or Hydrocele.— L. E. G. asks : "I am 50 years old. One of 
 my testicles did not come down till I was quite old. Now it gets as big or 
 bigger than a baseball. When I lie down it goes back but when I stand up 
 it comes down again. Doesn't pain me much but feels rather uncomfort- 
 able. What can be done? If operation, would it be dangerous? I am 
 very thin but comparatively strong." 
 
 Reply. — I think you should see a physician. It is possible you have a 
 rupture or perhaps a hydrocele. 
 
 Varicocele. — R. H. asks: "1. What are the effects of varicocele? 2. Are 
 the cases of varicocele few or are there many of them? 8. What danger to 
 the health and vitality in after years goes with it?" 
 
1312 VENEREAL DISEASES 
 
 Reply. — 1. None or nearly none. 
 
 2. Many. 
 
 3. None. 
 
 Undescended Testicles.— N. C. asks : "If the testes in a young man 20 
 years old have not yet descended to their natural position what would you 
 advise? Is this condition liable to hurt the young man in later years?" 
 
 Reply. — You had better have a physician examine you. The condition 
 probably will never harm you but the location of the organs may be of 
 some importance. 
 
 Spermatorrhea. — P. B. S. writes: "Is there a cure for a boy of eighteen 
 years suffering from spermatorrhea? Would it be advisable to see a doctor 
 about it?" 
 
 Reply. — The condition is of no consequence. Do not worry about it. 
 You need not see a doctor. 
 
 Circumcision. — L. A. J. writes: "1. Would be pleased to have you in- 
 form me the benefit of being circumcised. 2. How long would a person be 
 laid up if he were circumcised? I am 21 years old." 
 
 Reply. — 1. It is sometimes advantageous for reasons of cleanliness. 
 2. A week or less. 
 
 Night Losses. — M. S. writes: "Kindly inform me if spermatorrhea or 
 night losses can be cured. If so, how?" 
 
 Reply. — Probably there is no reason why it should be cured. It is a 
 natural condition. Stop worrying. 
 
 Mucus from Urethra. — W. L. A. writes: "1. I have wet dreams about 
 once a week. Will the wet dreams hurt me? 2. When I have bowel move- 
 ments and if I have to stay on the seat very long a drop or two of semen 
 will come out but I have no sensation when it does. I am 20 years old, If. 
 feet S 1 /} inches tall, and weigh Ilk pounds." 
 
 Reply. — 1. No. 
 
 2. This is mucus from certain small glands. It is of no consequence. 
 
 Erections in a Child of no Consequence. — L. D. writes: "Erections of 
 little boys seem to give many parents much alarm. My boy is nearly four 
 years old. He has some indigestion and only weighs SO pounds. Some 
 nights he gets several erections. A few nights he had as many as five or six 
 at intervals of 30 minutes. These were exceptionably bad nights and were 
 after the child had eaten a heavy supper. We are considered as educated 
 people and as knowing how to raise a child. We have studied Holt but fail 
 to "be able to obtain any advice on the subject of erections. Doctors seem 
 to give the matter little attention for I have consulted some of the best. I 
 wanted to get your help" 
 
 Reply. — This is a matter of no consequence. Give the boy a light sup- 
 per and have him void the urine just before retiring. 
 
 Self -Abuse. — A Friend in Need writes: "I have been a victim of a 
 vicious habit for four years but have now stopped. I am now ITV2 years 
 old. When a boy starts this habit and then stops the questions which come 
 
VENEREAL DISEASES 1313 
 
 to his mind are: 1. Will it affect the length of my life? 2. What are its 
 effects and can they he cured and how? 8. Will it affect my children if 
 I have any?" 
 
 Keply. — 1 and 3. No. 
 
 2. There are no effects that need be lasting. You must cultivate self- 
 control as you would cultivate the ability to keep from drinking whisky, 
 stealing or giving away to fits of anger. The person who yields shows that 
 he is weak-willed and the will becomes weaker from yielding. To help in 
 self-control you must not drink nor overeat nor listen to smutty stories. 
 Keep in good physical trim and associate with clean, strong-willed people. 
 
 Masturbation in a Child. — Mrs. J. C. C. writes: "1. Would masturba- 
 tion in a child necessarily tend to make him or her a degenerate man or 
 woman incompetent of being normal? 2. What is the treatment or cure? 
 3. Is this condition hereditary?" 
 
 Keply. — 1. No. 
 
 2. The habit is not difficult to break. Either the hands or the legs 
 should be fastened, according to the circumstances. Surgical supply 
 houses have hand covers and thigh fasteners for the purpose. 
 
 3. It is not hereditary. In most instances, the children are taught the 
 habit by their nurses or other attendants. 
 
 Stupidity and Self -Abuse. — Worried writes: "A boy nearly 17 years 
 old has supposedly from childhood been dissipating by handling his sexual 
 organs. He does not inherit such immoral traits. He is stupid in most of 
 his studies, takes no interest in his work and, consequently, is severely 
 scolded at all times by his father. His home surroundings are not specially 
 pleasant. What will be the result if the practice is continued? Does such 
 dissipating have any serious effect on the mind?" 
 
 Reply. — It is more likely that the boy's sex habits are the result of a 
 poor mind than that his poor mind is the result of his bad sex habits. My 
 advice is that you have the boy examined by someone who specializes in 
 children's minds. Perhaps he has dementia precox. Perhaps he is a mental 
 defective of another sort. 
 
 A Worrier. — X. Y. Z. writes: "A young man having had considerable 
 trouble over which he constantly brooded for the past eight months has 
 now reached the stage where he constantly worries over what appears to 
 have been an abnormal immoral act committed by himself. The act was 
 of no seriousness except that he has magnified it to large proportions and, 
 although fully conscious of that fact himself, cannot overcome it. If 
 not worrying over this particular act he will revert back to the original 
 trouble. He has made several attempts to work but cannot seem to pull 
 himself through, until he is now broken in spirit. Do you think it possible 
 for one having only small means to cure this condition without resorting 
 to a sanitarium, of which place I have a horror. Is this neurasthenia or 
 nervous prostration? Will it lead to insanity?" 
 
 Reply. — The man is a worrier or a neurasthenic. Occasionally, such 
 a man can cure himself of his bad mental habit by studying daily from 
 some such book as "Worry and Nervousness" by Sadler or a Christian 
 Science textbook. 
 
1314 VENEREAL DISEASES 
 
 Fear and Worry. — J. R. T. writes: "Will you please prescribe a remedy 
 for partial impotencyf The desire is as great as ever and sterility does 
 not seem to be affected. There is so much quackery about this disease, I 
 hate to go to the advertising doctors." 
 
 Reply. — Your condition is the result of fear. Quit thinking about 
 your sex organs and your sex acts. That is all you need do. 
 
 A Sexual Neurasthenic. — C. 8. L. writes: "I am 23 years old and intend 
 to marry soon. This is why I am writing to you for some advice. First 
 of all, I have no bad habits. I am 5 feet 8 in. tall, weight, 11+2 pounds. 
 My condition is: nervousness (nervous debility), dizzy, continuous head- 
 ache, sometimes no ambition to work, cannot gain any flesh although I eat 
 everything suitable and retire about 10 p. m. 
 
 "1. For the past few months I get from one to four times a week 
 'nightly losses.' Will this, when continued, cause locomotor ataxia or 
 other disease? 2. Is chromium sulphate of any aid to stop the losses?" 
 
 Reply. — 1. No. Exercise in the open air, stop worrying, keep your 
 thoughts clean and marry. You are and will be all right. 
 
 2. No. 
 
 Doubting Daisy writes: "How is a young girl to know if it is right to 
 marry a man in a town who is supposed to have sowed oats once, the wild 
 variety, and was laid up sick, so gossip goes, and who is not strong, but 
 very nice, kind, generous, and anxious for a home and wife. No one will 
 say what he had or what he has and would he ask me to marry him if he 
 knew he was diseased? How can any clean girl know what she is getting 
 when no one will say and she cant ask him? All I know is learned from 
 the movies — 'Damaged Goods' and 'Ghosts' — and one of the older women 
 in town told me he was 'unfit for marriage,' and when I asked her why she 
 changed the subject. 
 
 "I have no mother and am only 18 and in perfect health. He seems to 
 be crazy over me but I don't love him enough to raise idiots and bury a 
 lot of innocent babes full of poison. On the other hand, I'd be the happiest 
 girl alive today to know for sure he is clean and healthy, for that suspicion 
 is the only toad under my rosebush. 
 
 "Please tell me, Dr. Evans, must I leap in the dark, as so many of my 
 earthly sisters have done? To me good health and the joy of living make 
 life. I can't bear to think of sickness and doctors' offices and undertakers 
 and wreaths. It's hateful. I reason out — if he is diseased and I ask him he 
 will act the offended stunt and where am I? Do they ever acknowledge 
 it? Would I acknowledge it if it meant the losing of wife, home and 
 happiness ? 
 
 "Dr. Evans, please tell me as if I was a little sister how I can tell. 
 What are the danger signals? And I'm writing in the 20th century, too! 
 What a thought! The dogs and live stock are far better off when it comes 
 to mating for human intelligence directs. We just blunder along and litter 
 up the earth with halfwits. Why don't you doctors help us? Why is it 
 charming men with real personalities are so often the ones rumor says are 
 poisonous? Oh, I'm so puzzled and so miserable." 
 
 Reply. — A number of questions but no answer. 
 
GENERAL INDEX 
 
 Abnormal children, grouping of, 1253 
 percentage of, 1253 
 reasons for, 1253 
 Acetanilid poisoning, antidote for, 885 
 Acetic acid poisoning, antidote for, 886 
 Acid burns, prevention of, in industries, 
 894 
 treatment of, 894, 895 
 Acromegaly, and giantism, 556 
 definition of, 556 
 symptoms of, 556 
 Actinomycosis. See Lumpy jaw. 
 Addison's disease, nature of, 580 
 symptoms of, 580 
 treatment of, 580 
 Adenoids, cause of swelling of, 20 
 enlarged, prevention of, 21 
 
 removal of, 21 
 general understanding of, 20 
 narrowing of nose space by, 13 
 position of, 15 
 removal of, 20 
 
 swelling of, due to absorption from 
 nose, 17 
 Adhesions, due to ptosis, 1081 
 
 symptoms of, 1081 
 Adrenal bodies, Addison's disease from 
 destruction of, 580 
 effect on, of fright, anxiety, worry, 577 
 function of, 576 
 location of, 576 
 neurasthenia caused by trouble with, 
 
 577 
 secretion of, distribution to nerve cells, 
 
 576 
 size and weight of, 576 
 tuberculosis of, 580 
 Adrenalin, proper use of, 580 
 Age, relation of, to tuberculosis, 74 
 Aging, gradual, and bathing, 953 
 and clothes, 952 
 and constipation, 954 
 and exercise, 952 
 care of skin, 953 
 diet, 953 
 habits of, 954 
 
 Aging, gradual, periodical examinations, 
 952 
 sleep, 952 
 Air route, organs of, 15 
 Albino, definition of, 704 
 Albuminuria, in pregnancy, 626 
 Alcohol, and heat, 340 
 
 food and fuel value of, 339 
 
 justified use of, 339 
 
 overindulgence in, predisposing to colds 
 
 and pneumonia, 61 
 place of, in medicine, 340 
 predisposing to pneumonia, 56, 60, 61 
 relation of, to tuberculosis, 73 
 rules for getting drunk, 341 
 Alcohol habits, and insanity, 368 
 appeal of, 339 
 cure of, 340 
 effect of, 339 
 Alcoholism, and eugenics, 1010 
 Alimentary canal, length of, 654 
 Alkalies (such as lye, washing powders, 
 etc.), antidote for poisoning 
 from, 886 
 Alkaloids, antidote for poisoning from, 886 
 Amenorrhea, definition and causes of, 1277 
 Anthrax, and furs, 289 
 bacillus of, 289 
 carbuncle of, and ordinary carbuncle, 
 
 288, 290 
 common in cows and horses, 288 
 enlargement of spleen in, 585 
 human, description of, 288 
 internal, 288 
 
 location of carbuncle of, 288 
 symptoms of, 288 
 in blood, 288, 289 
 of lungs, 288 
 Anaphylaxis, 49 
 Anemia, and dirty teeth, 747 
 Anesthesia, Crile's method of, 987, 988 
 Anger, effect of, on body, 366 
 
 "toxins" of, 366 
 Anopheles, or malaria-carrying mosquitoes, 
 
 265 
 Antifebrin poisoning, antidote for, 885 
 
 1315 
 
1316 
 
 GENERAL INDEX 
 
 Antipyrin poisoning, antidote for, 995 
 Antitoxins and toxins, 489 
 Antivaccinationists, 225 
 Antrum, 11 
 
 Apoplexy, as a cause of death and dis- 
 ablement, 612 
 
 cause of, 613 
 
 improvement of condition in, after fever 
 stage, 612 
 
 in families, 612 
 
 order of events in evolution of, 612 
 
 paralysis due to, 614 
 
 premonitory symptoms of, 612 
 
 preventive measures against, 612 
 
 pseudo, forms of, 614, 615 
 
 usual history of, 612 
 
 warnings of, 614 
 Arsenic poisoning, antidote for, 886, 901 
 
 prevention of, in industries, 901 
 
 symptoms of, acute and chronic, 901 
 Arthritis, rheumatoid, 141 
 Arthritis deformans, 141 
 Artificial respiration, 874 
 
 Sylvester method of, 875 
 Asthma, bronchitis associated with, 44 
 
 definition of, 43 
 
 element of spasm in, 421 
 
 paroxysms of, 44 
 
 relief for, 44 
 
 source of trouble in, 43 
 
 symptoms of, 44 
 Asylums, and eugenics, 1013 
 
 "Babies, and heat, 809 
 
 colic in, conditions mistaken for, 814 
 
 due to gas, 814 
 
 prevention of, 815 
 
 treatment of, 814 
 cry of, meaning of various kinds of, 
 805 
 
 reasons for, 804 
 danger sign with, 803 
 death rate among, from diarrhea, in cer- 
 tain months of year, 809 
 
 in country, 808 
 diarrhea in, 803 
 
 its treatment, 813 
 dyspepsia in, cause of, 815 
 
 symptoms of, 815 
 
 treatment of, 817 
 eyes of, condition of, at birth, 817 
 
 development of, 817 
 
 variations from normal in, 818 
 
 Babies, fat, 807 
 feeding of, 801 
 
 after nine months, 825 
 
 amount of food given, 824 
 
 amount of water to be added, 823 
 
 during second summer, 826 
 
 long interval plan for, 823 
 
 making energy by, 822 
 
 simple system and formula for, 821, 
 822 
 
 too much, in hot weather, 803 
 
 under three months, 826 
 
 when baby food must be resorted to, 
 799, 828 
 
 when sick, 827 
 fresh air for, 802 
 growth of, 800 
 
 hazards of early life of, 795 
 keeping well in hot weather, 809 
 lessened death rate among, 797 
 
 in New York City, 798 
 main elements in needed care of, 795 
 making milk safe for, 830 
 need of, for water, 798 
 nerves of, after feeding, 805 
 
 and play, 805 
 nervous, symptoms of, 806 
 
 treatment of, 806 
 nursing of, its importance, 797 
 
 periods of, 798 
 orange juice for, 798 
 policy of New Zealand on, 798, 799 
 sick, feeding of, 827 
 summer complaint among, 811 
 
 and flies, 813 
 weaning of, diet after, 820 
 
 gradual, 819 
 
 time for, 818 
 weight disturbance in, 820 
 
 treatment of, 821 
 weight of, at birth, and increase in, 800 
 Baby foods, selection of, 828 
 
 merit of, 829 
 Baldness, cause of, 755 
 
 location of, 755 
 Baths, and skin, 706 
 cleansing, 706 
 cold, 706 
 
 warm, without soap, 706 
 
 Bed bugs, local applications for, 919 
 
 method of destroying, 918, 919 
 
 transmission of disease by, 918 
 
 Bed-wetting, thyroid extract for, 559 
 
GENEEAL INDEX 
 
 1317 
 
 3, application for bite of, 920 
 Belching, a habit, 652 
 acquisition of, 653 
 cause of, 653 
 effect of, 653 
 Benzin, to prevent explosions with, 901, 
 
 902 
 Benzin poisoning, 902 
 
 Beriberi, and cooking, prolonged and at 
 high temperature, 174 
 and rice, 174, 178 
 cause of, 177, 178, 489 
 definition of, 177 
 diet for prevention of, 173, 174 
 distribution of, 172 
 existence of, in United States, 172, 177 
 general lessons from, 175 
 government plan to combat, and result 
 
 of, 172 
 preventability of, 177 
 reasons for interest in, 172 
 symptoms of, 176 
 treatment for, 178 
 varieties of, 176 
 Bichlorid of mercury, antidotes for, 887 
 Bites of insects, suggestions to mothers 
 
 for, 873 
 Black eyes, treatment for, 872 
 Black flies, application to bite of, 920 
 to destroy larvae of, in breeding places, 
 920 
 Blindness, and venereal diseases, 1290 
 cataract, 116 
 
 due to syphilitic iritis, 126 
 in Bright 's disease, 117 
 inevitable, preparation of patient for 
 
 oncoming of, 117 
 preventable, Crede's method for, 113 
 decrease in rate of, 111 
 due to accidents, 116 
 due to trachoma, 115, 118 
 mother's cooperation against, 113, 
 
 115 
 ophthalmia neonatorum, or infection 
 of eyes occurring during birth 
 or within first few days there- 
 after, 112 
 percentages of, 113, 114 
 public education and cooperation 
 against, 115 
 statistics on, 111, 112 
 Blood, Metchnikoff 's study of, 87 
 
 protection of, by lymphatic system, 606 
 
 Blood, sugar in, 159, 160 
 Blood cells, 87, 88 
 red, 552 
 white, 551 
 Blood flow, 606 
 
 and lymphatic system, 607 
 Blood glands, 583 
 
 Blood pressure, and life insurance, 605, 
 606 
 relation to, of adrenals, 581 
 Blood pressure records, 605, 606 
 Blood pressure test, 605 
 Blood purifiers, 154, 155 
 Body, influence of, on mind, 375, 376 
 Boils, cause of, 713 
 treatment of, 713 
 Bowel movements, normal number and 
 
 time of daily, 655 
 Bread, baking of, 453 
 constituents of, 451, 452 
 food value of, 454 
 relative food value of flours used in 
 
 making of, 454 
 sanitation in bakeries, 454, 455 
 Breads, hot, frequent use of, 454 
 Breast, caking of, 966 
 cysts of, 966 
 fibroma of, 966 
 tumors of, 966 
 Breathing, difficult, causes of, 12 
 
 object of, 43 
 Bright 's disease, acute, apoplectiform, 619 
 due to infection, 619 
 albumin in urine in, 617 
 and diabetes, 627 
 and life insurance, 619 
 and pregnancy, 625 
 chronic, mode of life in, 622 
 or gouty form of, 621, 622 
 with much albumin, associated condi- 
 tions of, 623 
 causes of, 623 
 symptoms of, 623 
 treatment of, 624 
 death rate from, 618 
 definition of, 617 
 due to other diseases, 618 
 indication of blindness in, 117 
 progressive form of, 621 
 testing of urine for, 627 
 treatment for, 618 
 
 J. E. Hardy's, 629, 630 
 Von Noorden on, 678 
 
1318 
 
 GENERAL INDEX 
 
 Bright 's Disease, very slow, 624 
 
 warning of, 618 
 Bronchi, description and function of, 46 
 
 location of, 46 
 Bronchitis, associated with asthma, 44 
 cause of, 46 
 cough remedies for, 47 
 definition of, 46 
 differentiated from laryngitis and tra- 
 
 chitis, 46 
 symptoms of, cough, 46 
 
 " soreness in the lungs,' 7 46 
 Brown-tailed moth, poisoning effect of, 
 923 
 rash of, 922 
 Brown-tailed rash, symptoms of, and 
 
 treatment for, 923 
 Bruises, first aid in, 873 
 Buildings, sites for, 1121 
 Bulgarian bacillus, as preventive of senil- 
 ity, 949, 950 
 Burns, first aid to, 866 
 Butter, made from pasteurized milk, 
 479 
 tuberculosis from, 478 
 typhoid fever due to, 478 
 Buttermilk, food value of, 480 
 
 Cabot, work of, in introducing broader 
 
 care for sick, 1026 
 Caffein, effect of, summary of conclusions 
 from Hollingsworth 's and Rivers' 
 tests, 353 
 effect of moderate doses of, 351 
 Hollingsworth 's tests on, 351 
 on general health, 353 
 on nerves, muscles and mind, 351, 352 
 on sleep, 352 
 Caisson disease, cause of, 902, 903 
 
 prevention of, 903 
 Caking of breast, 966 
 Camp, sensible, plan of, 1130 
 Cancer, and eugenics, 1004, 1010 
 and heredity, 958, 975, 985 
 and rats, 295 
 and sarcoma, 972 
 contagion of, 958 
 curability of, 959 
 
 diagnosis of, methods of, 963, 964 
 efforts to cure, 974, 975 
 arsenic and zinc paste, 960 
 injections into blood of colloidal cop- 
 per, 960 
 
 Cancer, efforts to cure, injections into 
 blood, of colloidal serenium, and 
 eosin, 960 
 radium, 965, 975 
 surgery, 964 
 vaccine, 960 
 x-ray, 960, 975 
 human and mouse, 961 
 importance of early recognition of, 964, 
 
 965 
 importance of knowledge of, 962- 
 
 966 
 kinds of, relative difference between, 
 
 961, 962 
 localized nature of, 965 
 of breast, first indications of, pain and 
 lump in breast, 966 
 indications for operation for, 967 
 operation for, 967 
 succeeding symptoms of, 966, 967 
 of face, and smoking, 967 
 course of, 968 
 cure of, 967 
 lower and upper, 967 
 suspicious signs of, 968 
 of mouth, and ulcers of mouth, 968 
 of tongue, danger of temporizing with, 
 969 
 location of, 968 
 symptoms of, 969 
 of skin, symptoms and diagnosis of, 
 
 971 
 of stomach, and liver, 969 
 diagnosis of, 970 
 early signs of, 969 
 examination for, 969 
 frequency of, 969 
 suspicious signs of, 970 
 of uterus, and general knowledge, 972 
 
 symptoms of, 972 
 operation for, 964 
 
 on suspicion or on positive diagnosis, 
 964, 965 
 percentage of deaths from, 959, 963 
 prevention of, 974, 975 
 serum from, in animals and men, 960 
 theories as to cause of, 957 
 theories as to contributing causes of, 
 
 958 
 warding off of, 973 
 Cancer cells, 962 
 Cancer houses and districts, 958 
 Cannabis indica-hashish, antidote for, 888 
 
GENEKAL INDEX 
 
 1319 
 
 Carbohydrates, 450, 675 
 
 Carbolic acid poisoning, antidote for, 888 
 
 Carbon monoxid poisoning, or being 
 
 " gassed,' ' 897 
 Carpet beating, danger from, to janitors 
 
 and carpet beaters, 1136 
 Cataract, aging of lens of eye, 122 
 
 and eugenics, 1010 
 
 causes and diitribution of, 116, 117 
 
 first symptoms of, 122 
 
 operation for, old way, 122 
 Smith way, 122, 123 
 
 prevalence of, in India, 123 
 Catarrh, and rheumatism, 150 
 
 beginning of, 11 
 
 definition of, 35 
 
 inflammation of, and discharge from 
 middle ear due to, 35 
 Caterpillars, harmless and poisonous, 922 
 Centipedes, treatment of bite of, 920 
 Cerebral hemorrhage. See Apoplexy. 
 Cerebrospinal fever, 258 
 
 cause of, 258, 259 
 
 epidemic of, 258 
 
 symptoms of, 259 
 
 transmission of, 259 
 Cerebrospinal meningitis, and infantile 
 paralysis, 257 
 
 atypical and typical cases of, 257 
 
 cause of, 257 
 
 epidemics of, 257 
 
 transmission of, 257 
 Cheese, constipation due to, 469 
 
 digestibility of, 469 
 
 flavor of, due to bacteria, 470 
 
 food value of, 469 
 
 made from milk first sterilized, and cul- 
 ture added, 470 
 
 stored, 469 
 
 tubercle bacilli in, 469, 470 
 Chest, narrow, 1064, 1065 
 
 tendency in man to deep, narrow, 1062 
 Chest development, relation of, to tuber- 
 culosis, 74 
 Chewing gum, after overeating, 493 
 
 between meals, effect of, 637 
 Chicken, frozen, 460, 461 
 
 purchase of, in city, 460, 461 
 
 rules for purchase of, 460, 461 
 Chicken pox, carriers of, 248 
 
 contagion of, 248 
 
 incubation period of, 248 
 
 medical treatment of, 249 
 
 Chicken pox, nature of, 248 
 
 prevention of scratching during, 248 
 spreading of, 192 
 symptoms and course of, 248 
 transmission of, 248 
 Childbirth, procedure in case of child ar- 
 riving before doctor, 775 
 supplies for, 780 
 Children, abnormal, 1252 
 
 backward, causes of, poor vision, 841 
 correction of, 844 
 effect of, on child, 841 
 percentage of faulty vision among, 842 
 crippled, from tuberculosis, 848 
 treatment for, 848 
 knowledge to be had by mothers of, 
 848 
 cross-eyed, discovery of, in first stages, 
 842 
 effect of, on child, 842 
 outgrowing of, 842 
 evidence of normality in, at different 
 
 age periods, 845 
 feeding of, 1254 
 
 incorrigible, due to physical defects, 843 
 neglected, 1256 
 
 poor vision among, causing backward- 
 ness, 841, 842 
 percentage having, 843 
 score cards for entry of, in baby shows, 
 
 846 
 training of, 846 
 
 unnecessary losing of, in infancy, 847 
 Chloral hydrate poisoning, antidote for, 
 
 888 
 Chloroform poisoning (internal), antidote 
 
 for, 888 
 Choking, suggestions to mothers for, 872 
 Cholera, disinfection after, 208 
 Chorea. See St. Vitus' dance, 
 acute rheumatic, 423 
 Huntington's. See Huntington's chorea. 
 Clams and oysters, and typhoid fever, 311 
 Coal oil poisoning, antidote for, 888 
 Cocain, no warrant for medical use of, 
 338 
 warning against careless use of, 338 
 Cocain habit, and spraying for hay fever, 
 338 
 cure for, 338 
 
 effect of drug, when deprived of, 334, 
 338 
 when under its influence, 338 
 
1320 
 
 GENEKAL INDEX 
 
 Cocain habit, Harrison law against, 329, 
 330, 331 
 inexcusability of, 337 
 in neurasthenics, 337. 
 Cocain poisoning, antidote for, 888 
 Cock eye. See Squint. 
 Coffee, a drug, 350 
 effect of, general, 355 
 on digestion, 354, 355 
 on general health, 353 
 on nerves, muscles and mind, as re- 
 sult of Hollingsworth tests, 351, 
 352 
 on sleep, 352 
 
 su mm ary of conclusions reached by 
 Hollingsworth and Eivers, 353. 
 habit of, 355, 357 
 Hollingsworth 's tests on effect of caf- 
 
 fein, 351 
 ingredients of, 354 
 methods of making, and their relative 
 
 values, 356 
 relative amount of caffein in tea and, 
 
 350 
 use of, 350 
 
 how and when, 355, 357 
 per capita, in United States, Europe 
 and Australia, 350 
 Cold storage, control of, 509 
 
 rules for, 508, 509 
 Colds, and grip, epidemics of, 55 
 beginning of, in nose, 29. 
 
 in throat, 29 
 causes of, 25 
 bacterial, 28, 35 
 contributing, 29 
 cost of, 29 
 dangers of, 28 
 discharge of, 11 
 drafts and, 30, 31 
 earaches due to, 134 
 fresh air and cold showers as preventives 
 
 of, 56 
 infectiousness of, 25, 28 
 inherited susceptibility to, 134 
 kinds of, 28 
 
 necessity for prompt care of, 28 
 nose infections, 28 
 not a necessity, 25 
 onset of, 27 
 outdoor life and, 25 
 pneumonia due to neglect of, 55 
 prevention of, 25, 29, 31 
 
 Colds, serious, 27, 28 
 
 symptoms of, 27, 28 
 
 with chronic cough, 28 
 Colic, first aid in, 869 
 
 in babies, 814 
 Colon, length of, 654 
 
 muscular fibers and motion of, 654 
 Color blindness, and eugenics, 1010 
 Constipation, and foods, 656 
 
 and senility, 487 
 
 cathartics and laxatives for, 656 
 
 chronic, with pain in certain nerve cen- 
 ters, meat in, 459 
 
 definition of, 655 
 
 due to too little fluid in colon, 654 
 
 long-standing, ultimate and permanent 
 relief of, 656 
 
 number of natural movements a day, 
 and time of, 655 
 
 occurrence of, 654 
 
 prevention of, in children, 655 
 Consumption. See Tuberculosis. 
 Contagion and infection, 192 
 
 control of, in cities, 195 
 
 in small towns and country, 195 
 rules for, 197, 198 
 
 percentage of infants and adults sus- 
 ceptible to, 201, 203 
 Contagious diseases, apparently sporadic 
 cases of, 197 
 
 carriers of, 214 
 
 control of, 201, 203 
 
 harm done by unreported cases of, 195 
 
 immunity to, 201, 203 
 
 incubation period of, 199 
 
 initial symptoms of, 199 
 
 manner of spreading of, 192, 193 
 
 penalty for not reporting, 195 
 
 period between exposure and illness in 
 average case, 199 
 
 preventability of, 193 
 
 prime importance of reporting, 195 
 
 to be reported, 193, 195 
 
 tracing of source of contagion of, 197 
 
 transmission of, from pets, 200 
 Continence, 1302 
 Convulsions, and epilepsy, 419 
 
 and rickets, 419 
 
 and worms, 419 
 
 course of action followed by doctor, in 
 case of, 418, 419 
 
 description of, 418 
 
 during course of disease, 419 
 
GENERAL IXDEX 
 
 1321 
 
 Convulsions, fear of, 418 
 
 first signs of oncoming, 418 
 importance of discovering cause of, 419 
 in adults, diseases associated with, 420 
 
 gravity of, 420 
 restlessness, fever, headache, prelimi- 
 nary to, 418 
 symptomatic nature of, 416 
 ushering in infectious diseases, 418, 419 
 Cottonseed food, and pellagra, 477 
 Cottonseed meal and flour, food value of, 
 478 
 recipe for corn cakes made with, 478 
 richness of, in protein, protection against 
 pellagra, 478 
 Cough, danger of ' ' taking something for, ' ' 
 41 
 doping for, 42 
 helpful and useless, 41, 42 
 meaning of, 40, 41 
 
 sources of irritations capable of caus- 
 ing, 40 
 treatment of, 42 
 useless, causes of, 41, 42 
 sedatives for, 47 
 suppression of, 42 
 Cough remedies, 42 
 containing opium, 42 
 expectorants, 47 
 for bronchial cough, 47 
 sedatives, 47 
 Cradle cap, 709 
 
 Cramps, due to difficult menstruation, 
 1278 
 first aid in, 869 
 Cretinism, 561 
 
 and eugenics, 1010 
 and heredity, 558 
 congenital and acquired, 562 
 definition of, 558 
 Criminality, due to physical defects, 
 
 843 
 Crippled children, causes of physical dis- 
 ability of, 253 
 percentage of, due to infantile paralysis, 
 254 
 in United States, 253 
 11 Cross eyes," explanation of, 125 
 
 neglected, blindness resulting from, 
 
 125 
 See also Squint, convergent. 
 Croup, membranous, and diphtheria, 239 
 points for recognition of, 239 
 
 Croup, ordinary or spasmodic, treatment 
 
 for, 239 
 Crowds in hot places, 915 
 Cuts, first aid in, 873 
 Cyanid of potassium poisoning, antidote 
 
 for, 888 
 Cysts of breast, 966 
 
 Deaf child, knowledge that should be had 
 
 by mother of, 135, 136 
 Deaf mutism, and eugenics, 1009 
 
 inheritance of, 134 
 Deafness, developing in later life, inheri- 
 tance of, 134 
 due to middle ear infections, 134 
 generally due to nose, throat or ear in- 
 fection, in early life, 137 
 lip-reading for, 136, 137 
 over-sensitiveness in, 137 
 Volta bureau for increase and diffusion 
 of knowledge relating to the deaf, 
 134 
 See also Hearing, failing. 
 Deaths, in middle age, most important 
 contributor to, 951 
 percentage of, at different age periods, 
 951 
 Deformities, present-day decrease in num- 
 ber of, 186 
 Dementia precox, false diagnosis of, 416 
 importance of early recognition of, 416 
 nature of, 416 
 
 percentage of cases of, 416, 417 
 symptoms of. in early stages, 416 
 later, 416, 417 
 Dermatitis Shamberge. See Straw itch. 
 Dermoids, cause of, 714 
 
 congenital tumors, moles, birthmarks, 
 hairy patches, tabs and clefts con- 
 stituting, 714 
 Diabetes, and Bright 's disease, 158, 627 
 causative factor of, 677 
 cause of, theories on, 497 
 causes of, 158 
 definition of, 158 
 diet for, 160 
 due to deficient secretion of pancreas, 
 
 158 
 essential condition in, 677 
 liver kind of, 158 
 relation of, to tuberculosis, 72 
 rendering one subject to infections, 158 
 sign for diagnosis of, 159 
 
1322 
 
 GENEKAL INDEX 
 
 Diabetes, test for sugar in, 159 
 treatment for, diet, 677, 678 
 Diarrhea, due to lead poisoning, 897, 
 898 
 in babies, 803 
 
 treatment of, 813 
 transient, first aid in, 870 
 Diathesis, definition of, 154 
 Digestion, action of saliva on food, 637 
 and eczema, 708 
 
 importance of chewing food, 637 
 influence on, of mind, 373 
 of starch, 496, 497 
 process of, 638 
 Digestive troubles, 639, 640 
 Diphtheria, almanac talk on, 237 
 and croup, membranous, 239 
 axioms for, 238 
 cause of, 233 
 control of, 236, 238 
 definition and nature of, 237, 238 
 diagnosis of, by microscopic examina- 
 tion, 235 
 by throat cultures, 236 
 disinfection after, 208 
 effect of, on heart, 234 
 on nerves, 235 
 on kidneys, 235 
 initial symptoms of, 235 
 location of, 235 
 period of incubation of, 235 
 poison or toxin of, amount of, 235 
 its circulation through body, 234 
 rules for exclusion of children from 
 
 school because of, 1250 
 spreading of, 192 
 swelling of glands on outside of face 
 
 and neck in, 234 
 thirty years ago and now, 237 
 transmission of, 237 
 treatment of, antitoxin, 236, 237 
 vaccination against, 237 
 Diphtheria antitoxin, disadvantages of, 
 236 
 dosage of, 237 
 nature of, 236 
 
 promptness in administering, 238 
 Diphtheria bacillus, 233 
 action of, 234 
 entrance of, into body, 233 
 follicular tonsillitis due to, 235 
 presence of, in throat, without causing 
 symptoms, 236 
 
 Diphtheria bacillus, site of, 234 
 
 sore throat due to, 536 
 Diphtheria toxin, 234, 235 
 Discharge from ear, due to catarrh, 35 
 Disease, and insanity, 368, 369 
 
 lowered rates of, 172, 173, 184 
 Disinfection, by air and sunlight, 209 
 for all infectious diseases, 208 
 futility of, in room occupied by pa- 
 tient, 208 
 nature's agencies, sun, air and drying, 
 
 208 
 of excretions, in cholera and typhoid 
 
 fever, 208 
 of mouth secretions, in consumption, 
 pneumonia and diphtheria, 208 
 Dislocations, first aid in, 866 
 Dissaccharid, 496 
 Dog days, 300 
 Drafts, and colds, 30, 31 
 definition of, 30 
 morbid fear of, 31 
 regulation of, 30 
 Drug habit, and eugenics, 1010 
 and insanity, 368 
 cure for, Sceleth drug treatment, 333 
 
 Towns morphin cure method, 332 
 effect on, of Harrison law, 331 
 in one city, 328 
 
 legislation against, and its weaknesses, 
 329, 330 
 Harrison law, 329, 330, 331 
 starting points of, 327, 329 
 Drugs, habit-forming, percentage of, con- 
 sumed, 327 
 Drunkenness. See Alcohol habit, Alcohol- 
 ism. 
 Ductless glands, 555 
 adrenal bodies, 576 
 effects of changes in, 567, 568 
 extracts from, made from castrated ani- 
 mals, 579 
 growth due to secretions of, 556 
 pituitary body, acromegaly disease of, 
 
 556 
 thymus, 567 
 
 thyroid, maladies of, 556 
 Dumps, rubbish, 1215 
 Dust, in shoe factories, 905 
 
 kinds of, 903 
 Dusty trades, and tuberculosis, 904 
 effect of, 903, 904 
 shoe factories, 905 
 
GENERAL INDEX 
 
 1323 
 
 Dysentery, and armies, 358 
 Dysmenorrhea, definition and importance 
 of, 1279 
 
 thorough examination advised for, 1279 
 
 treatment for relief of, 1279 
 Dyspepsia, in babies, 815 
 
 Ear, middle, 9 
 
 Ear disturbances, due to nose diseases, 35 
 Earache, danger of neglect of, 134 
 due to catarrh, 35 
 due to colds, 134 
 failing hearing due to, 134 
 ordinary treatment for, 134 
 Ears, proper care of, 35 
 Eczema, and digestion, 708 
 cause of, 708 
 definition of, 707, 708 
 in babies, cradle cap, 709 
 on chest, 708 
 on face and head, 708 
 tetter or milk, 709 
 treatment of, 709 
 skin changes in, 708 
 Eggs, advantages of, as food, 464 
 basic principles for producer, 466 
 cold storage, 469 
 country held, 467 
 
 diagram of composition of food mate- 
 rials of, 465 
 fertile and infertile, 466 
 flavor of, 467 
 fresh, 464 
 
 difficulty of obtaining, 465 
 keeping of, 508 
 keeping and marketing of, 466 
 keeping qualities of, 466 
 market classification of, 466 
 refrigerated, 507 
 retailing of, 468 
 
 season of greatest scarcity of, 468 
 stale, for cooking, 468 
 storage, 467 
 Electric shock, first aid to, 867 
 Emergencies, minor, first aid to. See 
 First aid. 
 suggestions to mothers for, 872 
 Emotion, influence of, on body, 366 
 
 on heart, 375 
 Enlarged tonsils, narrowing of nose space 
 
 by, 13 
 Epidemics, in small towns and country, 
 control of, 198 
 
 Epilepsy, after effects of attacks of, 425 
 
 and consanguinity, 424 
 
 and heredity, 424 
 
 and occupation, 426 
 
 and sleep, 425 
 
 and society, 426 
 
 beginning in childhood, with convulsions, 
 419 
 
 causes of, 424, 427 
 
 colony plan for, 426, 427 
 
 famous people with, 427, 428 
 
 forms of, 423 
 
 little known of, 423 
 
 mental aura of, 425 
 
 night attacks of, 425 
 
 not inconsistent with life of utility, or 
 even with important career, 428 
 
 percentage of, 423 
 
 percentage of cures of, 425 
 
 signs of oncoming attack of, 425 
 Epileptic manifestations, 423 
 Ergcgraph, 1035 
 Ergot, 489 
 Erysipelas, and seasons, 262 
 
 blood examination in, 262 
 
 cause of, 259 
 
 course of poison of, in body, 262 
 
 distribution of, 260 
 
 dread formerly held in, 259, 260 
 
 effect of, on insanity, 413 
 
 hospitals foci for disease, 261 
 
 liability to, increased by former attack, 
 262 . 
 
 recovery from, 263 
 
 streptococcus of, 262 
 
 symptoms of, 259, 262 
 
 transmission of, by people, not things, 
 261 
 
 treatment for, 263 , 
 Ethnoid cells, 11 
 
 Eugenics, Adami on results of one's liv- 
 ing, 1007 
 
 age of science of, 1009 
 
 and alcoholism, 1010 
 
 and asylums, 1013 
 
 and becoming hard of hearing with age, 
 1009 
 
 and blue eyes, 1010 
 
 and cancer, 1010 
 
 and cataract, 1010 
 
 and color blindness, 1010 
 
 and cretins, 1010 
 
 and deaf mutes, 1009 
 
1324 
 
 GENERAL INDEX 
 
 Eugenics, and determination of heredity 
 of each human trait, 998 
 
 and drug addiction, 1010 
 
 and exophthalmic goiter, 1010 
 
 and genealogy, 993 
 
 and inheritance, clearing of in four gen- 
 erations, 999 
 
 and insanity, 1010 
 
 and multiple sclerosis of nervous sys- 
 tem, 1010 
 
 and neurotics, 1010 
 
 and small families, 1015 
 
 and St. Vitus' dance, 1010 
 
 and " Survival of the Fittest/ ' 1005, 
 1006 
 
 and the immigrant's child, 1014 
 
 and the only child, 1016 
 
 and tuberculosis, 1010 
 
 collecting data for, 987-1001 
 
 conclusions on, cancer, 1004 
 criminality, 1004 
 Ewart's, 1003 
 hemophilia, 1004 
 memory, 1004 
 mental defects, 1003 
 Mongolians, 1003 
 
 Salaman, on facial expression of Jews 
 and Gentiles, 1003 
 
 Dr. Goddard's study of a family, 990, 
 992 
 
 environment and inheritance, 1015 
 
 family studies in record office of, "The 
 Hill Folk," 1011 
 the Nam family, 1012 
 
 Galton, father of, 989 
 
 literature on, Galton, Sir Francis, 1008, 
 1009 
 Mendel, 1008 
 
 man made laws and nature's laws in, 
 1009 
 
 marriage of Jews and Gentiles, 1003 
 
 meaning of term, 989 
 
 medical examination and certification as 
 a basis of marriage, 1009 
 
 negative and positive, 990 
 
 optimism of, 1001 
 
 plan for keeping family histories, 
 999 
 
 practical problem of, 996 
 
 problem of the feebleminded, 1002 
 
 standard and normal line for, 996 
 
 tendency of bloods, 100*4, 1005 
 
 tendency to return to mediocrity, 993 
 
 Eugenics, "Unto the Third and Fourth 
 Generation," 1007 
 Weismann, on environment and heredity, 
 1007 
 Eugenics Eecord Office, Family History 
 Book issued by, 999 
 schedule of, for recording family traits, 
 987 
 Eustachian tube, 9 
 
 Exercise, and athletics, advantage of, 1046 
 and play abidingness of, 1046 
 importance of, 1044 
 Maria Montessori on, 1044, 1045 
 need of child for, 1046 
 archery, 1040 
 
 athletic games, baseball, 1037 
 golf, 1037, 1038 
 handball, 1036 
 tennis, 1036, 1037 
 avoidance in, of stiffness and soreness, 
 
 1035 
 billiards, 1038 
 for children, 1043 
 for convalescents, 1042 
 for old people, 952 
 for sedentary workers, 1034 
 horseback riding, 1047 
 important aims of, 1045 
 on all fours, argument against, 1033 
 
 Shock's theory of, 1032 
 overdose of, 1035 
 swimming, 1041 
 
 to straighten spinal curves, slide shoul- 
 ders back and eliminate hollows 
 about collar bone, 1033 
 walking, correct method of, 1036 
 Exophthalmic goiter, and eugenics, 1010 
 Expectorants, 47 
 
 Eye disturbances, due to nose diseases, 35 
 Eye fatigue, types of, due to trades, 120, 
 121 
 miners' nystagmus, 121 
 Eyes, affections of, pink eye, 126 
 apparatus of, 121 
 blindness, preventable, 115 
 color of, and eugenics, 1010 
 conditions of, tending to blindness, 117 
 dangers to, from industrial poisonings, 
 
 121, 122 
 inflammation of iris of, iritis, 125 
 lens of, 122 
 
 soreness of, trachoma due to, 118 
 iritis due to, 125 
 
GENERAL INDEX 
 
 1325 
 
 Fat, as sign of age, 681 
 
 Fats, 450 
 
 Fear, abnormal, foundation and effect of, 
 
 372 
 Feebleminded, problem of, 1002 
 Feet, and low heels, 764 
 
 care of, 761 
 
 effect on, of tight shoes, 1060 
 
 flat, 763 
 
 metal arches for, 762 
 
 pigeontoed, 762 
 
 slew-footed, 762 
 
 use of, 766 
 Fermentation, intestinal, dieting for, 641, 
 
 642 
 Fever, meat in, 459 
 Fibroma of breast, 966 
 First aid, artificial respiration, 874 
 
 in black eye, 872 
 
 in bruises, 873 
 
 in burns, 866 
 
 in colic and cramps, conditions causing, 
 and treatment of, 869 
 
 in cuts, 873 
 
 in diarrheas, transient, 870 
 
 in dislocations, 866 
 
 in electric shock, 867 
 
 in fracture, 861, 862 
 
 in hiccough, 871 
 
 in insect bites, 873 
 
 in internal hemorrhage, 865 
 
 in nausea and vomiting, 870 
 
 in neuralgia, 871 
 
 in nose bleed, 865 
 
 in poisoning, 883 
 
 in rescues from fires, 866 
 
 in rusty nail wound, 873 
 
 in sunstroke, 876 
 
 in wounds, 864 
 
 application of tourniquet, 865 
 hemorrhage from, 864, 865 
 
 keeping away from patient of unneces- 
 sary people, 860 
 
 list for household emergency box, 868 
 
 materials for, 860 
 
 moving of patient, with fractures, 861, 
 862 
 
 position for patient, 860 
 
 teaching of, 859 
 
 treatment in profound shock, 861 
 
 water and stimulants, 860 
 First aid outfits, 880 
 First aid requirements, 877 
 
 Fish, diagram of composition of food 
 materials of, 462 
 
 fresh, 461 
 
 frozen, 463 
 
 keeping of, 461 
 
 purchase of, 463 
 
 refrozen, 462 
 
 thawed, 461 
 Flat feet, cause of, 763 
 
 effect of, 761 
 
 prevention and cure of, 764 
 Fleas, disease transmitted by, 919 
 
 lotions and fumigation against, 919 
 Flies, and food, 926 
 
 and removal of screens, 940 
 
 and typhoid fever, 924 
 
 averting menace of, 936 
 
 breeding of, prevention of, 931 
 
 campaign against, Flyless Havana, 93b 
 
 danger from, in fall of year, 934, 
 936 
 
 defense against, 933 
 
 door fans for, 938 
 
 household trap for, 937 
 
 keeping down of, on garbage dump, by 
 covering with sand, 924 
 
 new trap for, 938 
 
 open season for, 928 
 
 stable, 940 
 
 stables and, 934 
 
 "swat the fly" and "starve the fly," 
 941 
 Fly catechism, 927 
 Fly family, description of, 927, 928 
 Fly trap, household, 937 
 
 new, 938 
 Food, and flies, 926 
 
 chewing of, and taste nerves, 637 
 
 cooking of, prolonged, and at high tem- 
 perature, 174 
 
 over-refining and over-repairing of, 
 175 
 
 proper adjustment between work and, 5 
 Food economics, 485 
 Food preservation, benzoate for, 506 
 
 methods of, 507 
 
 spices for, 507 
 Food route, organs of, 15 
 Food values, 493, 494, 495 
 
 of economical dishes, 494, 495 
 Foods, and constipation, 656 
 
 animal and vegetable, as sources of 
 protein, 450 
 
1326 
 
 GENEKAL INDEX 
 
 Foods, animal foods and dairy products 
 most important sources of fats, 
 450 
 bread, baking of, 453 
 constituents of, 451, 452 
 food value of, 454 
 hot, frequent use of, 454 
 relative food value of flours used in 
 
 making of, 454 
 sanitation in bakeries, 454, 455 
 butter, pasteurized, 478 
 cheese, 469 
 classes of, 450 
 cold storage of, 508, 509 
 cottonseed, 477 
 
 diagram of composition of food mate- 
 rials, in apple, dried fig, straw- 
 berry and banana, 475 
 in breads, oat breakfast food and 
 
 macaroni, 452 
 in eggs, cream cheese and cottage 
 
 cheese, 465 
 in fish, 462 
 in grapes, raisins, grape juice, canned 
 
 fruit, and fruit jelly, 472 
 in meats, 456 
 in nuts, 473 
 in olive oil, bacon, beef suet, butter 
 
 and lard, 477 
 in parsnip, onion, potato and celery, 
 
 474 
 in shelled bean, fresh, navy bean, 
 dry, string bean, dry, corn, green, 
 476 
 in sugar, molasses, stick candy, maple 
 
 sugar and honey, 488 
 in various flours, 453 
 in whole milk, skim milk, buttermilk 
 and cream, 481 
 diagram of dietary standards, 490 
 diagram of functions, uses and constitu- 
 ents of, 451 
 digestibility of, 486 
 economical dishes, 494 
 
 food values of, 494, 495 
 effect of cold storage on dietary habit, 
 
 450 
 egg, 464 
 fish, 461 
 fruit, 471 
 
 greater consumption of, by Americans 
 than by Europeans or Asiatics, 
 450 
 
 Foods, inorganic, 450 
 
 insects infesting, 921 
 
 methods of control of, 922 
 
 meat, 455 
 
 meats and poultry as chief sources of 
 protein, 450 
 
 milk, 480 
 
 mushrooms, 470 
 
 organic, carbohydrates, 450 
 fats, 450 
 proteids, 450 
 
 overeating at dinner, 491 
 
 oysters, 463 
 
 quantity of, 490, 491 
 
 refrigeration of, 507 
 
 relative values of, 490, 491 
 
 rules for Thanksgiving dinner, 492 
 
 salt in, 498 
 
 starch, digestion of, 496, 497 
 
 toxins in, 489 
 
 typical dinner, food values in, 491 
 Foot, structure of, 761 
 Foot and mouth disease, cause of, 322 
 
 danger of, to children, 323 
 
 easily avoided, 323 
 
 geographical distribution of, 322 
 
 incubation period of, 322 
 
 procedure for prevention of spreading 
 of, 323 
 
 symptoms of, 322 
 
 transmission of, 322 
 Foreign bodies in nose, suggestions to 
 
 mothers for, 872 
 Formaldehyd poisoning, antidote for, 
 
 889 
 Fracture, 001168', 1028 
 
 of long bone, and massage, 1028 
 Fractures, healing of, 1027 
 
 massage and exercise for, 1027 
 
 use of X-ray in, 1027 
 Frost, keeping off windows by electric 
 
 fans, 1188 
 Fruit, digestibility of, 486 
 
 food value of, 471, 472 
 
 "grape cure" for obesity, 475 
 
 making a meal of, 471 
 
 nutritive value of, 471 
 
 preserved, for winter use, advantages 
 of, 487 
 
 proper use of, 476 
 
 rules for eating of, 474, 475 
 
 time of eating, as a laxative, 
 473 
 
GENERAL INDEX 
 
 1327 
 
 Fruit, time of eating, for appetizing value, 
 472 
 for nutritive value, 473 
 Fumigation, agitation against, 207 
 
 formaldehyd (formalin) method for de- 
 stroying bacteria, and description 
 of, 206, 207 
 losing ground, as a means of destroying 
 
 bacteria, 206 
 seldom required, 209 
 sulphur fumes, method for killing in- 
 sects, 207 
 
 Garbage, and stable manure, 1221 
 burning of, 1218 
 disposal of, by burning, 1218 
 by destructors, 1219 
 by dumps, 1214 
 by feeding to hogs, 1219 
 by plowing into ground, 1219 
 by reduction method, 1216 
 commissions on, 1220 
 St. Joseph's report on, 1220 
 Garbage dumps, harm resulting from, 1214, 
 
 1215 
 Garbage reduction, 1216 
 Gas, illuminating, antidote for poisoning 
 
 from, 889 
 Genealogy, heredity of feeble-mindedness, 
 
 993, 996 
 Genius, 365 
 
 Giantism, and acromegaly, 556 
 Girth, to decrease, 682 
 Goiter, and constipation, 567 
 and cretinism, 563, 564 
 and digestion, 566, 567 
 and inheritance, 563 
 and rats, 566 
 battling with, 566, 567 
 cause of, 563 
 
 cough or suffocation due to, 560 
 definition of, 558, 565 
 due to water, 563, 566 
 endemic or epidemic, 565, 566 
 enlargement of, due to disturbance 
 
 elsewhere in body, 560 
 importance of medical supervision in, 
 
 566 
 meat in, 459 
 occurrence of, 562 
 percentage of cases of, 564, 565 
 size of, 562, 563 
 toxic, 561 
 
 Goiter, treatment of, 560, 561 
 by surgery, 563 
 in inoperable cases, 563, 564 
 without symptoms, 560 
 Gonococcal infections, cure of, 1286 
 diagnosis of, 1286 
 education against, 1289 
 evil effects of, 1289, 1302 
 importance of, in inheritance relations, 
 
 1302 
 in children, 1299 
 marriage after, 1307 
 percentage of, among men, women and 
 
 children, 1289 
 public education against, 1286 
 stopping symptoms of, without curing 
 
 disorder, 1290 
 symptoms and course of, 1289 
 tendency in young boys to regard as of 
 
 no importance, 1289 
 tendency of, to remain close to focus of 
 infection, 1291 
 Gonorrhea, diagnosis of, 1297 
 
 method in use in U. S. Army, 1297 
 germ of, 1288, 1291 
 method of treatment of, in army, 1297 
 symptoms and course of, 1289 
 Gout, and meat, 458 
 
 atypical cases of, in evidence in spring, 
 
 142 
 diseases resulting from, 142 
 inflammatory joint type of (rich man's), 
 
 142 
 living to avoid, 142 
 treatment for, 143 
 Gouty aches, 142 
 
 Gouty diathesis, and consumption, 154 
 disposition accompanying, 154 
 mode of life determined by, 154 
 prevention of, 155 
 11 Grape cure," for obesity, 475 
 Grip, and colds, epidemics of, 55 
 epidemics of, 55 
 
 personal protection against, 55 
 Growing pains, custom of giving medicine 
 for, its danger, and proper treat- 
 ment, 144, 145 
 Growth, and thymus gland, 568 
 
 due to secretions in ductless glands, 
 556 
 
 Hair, need of caring for, 701 
 purpose of, 700 
 
1328 
 
 GENERAL INDEX 
 
 Hay fever, absence of cure for or preven- 
 tion of, 47, 51 
 
 as an anaphylaxis, 49 
 
 attributed to pollen of different kinds of 
 grasses, hays and sedges, 48, 51 
 
 due to condition of nose and cavities 
 leading from it, 50, 53 
 
 effect of, 49 
 
 not imaginary disease, 47, 53 
 
 prophylaxis for, 51 
 
 "running away," 51 
 time for, 52 
 where, 52 
 
 sufferers from, poisoned by substances 
 not poisonous to most people, 48 
 
 symptoms of, 49 
 
 treatment of, condition of nose and cavi- 
 ties leading from it, 50, 53 
 temperamental makeup of patient, 49 
 washes, snuffs and cures, 51 
 
 vaccination against, 52 
 
 warning against cocain, morphin and 
 adrenalin and preparations not 
 known to be free from them, 51 
 Head noises, causes for, and some sugges- 
 tions for cure of, 442 
 
 training one's self to forget, in incur- 
 able cases of, 442 
 Headache prevention method, 445 
 Headaches, causes of, 443 
 
 danger of coal tar products for, 443, 
 444 
 
 danger of headache powders for, 443 
 
 danger of medicines for, 446 
 
 due to biliousness-overeating-constipa- 
 tion, 443 
 
 due to eye strain, 443 
 
 due to infections, 443 
 
 due to neurasthenia, 444 
 
 due to oncoming of Bright 's disease or 
 arteriosclerosis, 443 
 
 due to rheumatism, 444 
 
 due to sinus trouble, 444 
 
 importance of diagnosing cause of, 443, 
 444 
 
 migraine, 444 
 
 prime necessity of treatment for, 444 
 Health, and carpet beating, 1136 
 
 buying of, 3 
 
 definition and nature of, 2 
 
 general rules for, 369 
 
 necessary contributing factors to, 4, 7 
 
 public, and dumps, 1215 
 
 Hearing, failing, due to earache, 134 
 incapacity resulting from, 135 
 lip-reading for, 136, 137 
 test of, for extremely early stages, 133 
 simple, 133 
 with age, and eugenics, 1009 
 ordinary method of, 133 
 re-education of, 135 
 Heart, and circulation, influence on, of 
 mind, 374, 375 
 and exercise, 592, 593 
 beating of, 591 • 
 throbbing of, 591 
 Heart £ic3ase, and failing compensation, 
 590, 591 
 and rheumatism, 590 
 cause of, 590 
 
 relation of, to tuberculosis, 71 
 Heart leakage. See also Heart disease. 
 Heat, and alcohol, 340 
 
 using of, 1185 
 Heating, and temperature of incoming air, 
 1157 
 and thermometer habit, 1185 
 and ventilation, 1147 
 factors, varying principles involved, 1173 
 need of human body for changes in 
 
 temperature, 1185 
 normal temperature of rooms without 
 
 fans, 1185 
 of house, by direct-indirect heating, 1175 
 by hot water, 1174 
 by steam, 1175 
 healthful, 1173 
 of incoming air, before it reaches occu- 
 pants of room, 1148 
 of living room, 1161 
 problems of, 1175 
 raising or maintaining of, 1176 
 temperature of air in different parts of 
 
 room, 1148 
 types of, central plant, 1184 
 
 direct-indirect heating and ventilation, 
 
 1183 
 gas heaters, 1176 
 gas logs, 1177 
 hot air, 1182 
 hot water, 1179 
 open fireplaces, 1177 
 steam, 1179 
 stoves, 1178 
 Height, and correct standing, 1068 
 and good feeding in childhood, 1068 
 
GENERAL INDEX 
 
 1329 
 
 Height, and inheritance, 1068 
 
 and regulation of sway in back, 1068 
 increase or decrease in, of our popula- 
 tion, 1069 
 increasing, 1069 
 
 internal glandular secretions for, 1068 
 long-bodied people, 1070 
 Hemorrhage, from uterus, not due to men- 
 struation, 1278 
 internal, first aid in, 865 
 Hernia, acquired, 665 
 cause of, 665 
 congenital, 665 
 due to accident, 667 
 explanation of, 667, 668 
 history of, 668 
 importance of, 666 
 in families, 665 
 kinds of, 665 
 
 percentage of each, 666 
 strangulation or rupture of, 666 
 symptoms of, 668 
 treatment of, 667 
 in infant, 666, 667 
 Heroin habit, effect on user of withdrawal 
 
 of drug, 334 
 Hiccough, first aid in, 871 
 Hives, nature of, 717 
 " poison of, 717 
 treatment of, 717 
 Hodgkin's disease, cause of, 551 
 nature of, 551 
 origin of name of, 551 
 vaccine for, 551 
 Hogs, inspection of, in stockyards, 547 
 Hornets, application for bite of, 920 
 Hospitals, advantage of, for consumption 
 cases, 1229 
 confinement cases, 1228 
 for contagious cases, 1230 
 for ordinary illnesses, 1229 
 for typhoid fever, 1229 
 in cases of emergency, 1227 
 and broader care of sick, introduced by 
 
 Cabot, 1026 
 as contributing to mental well-being of 
 
 patient, 1228 
 care of teething babies in, 1229 
 certainty of efficient care in, 1228 
 contagion in, 1230 
 
 headquarters for latest and most im- 
 proved methods for caring for 
 sick and injured, 1226 
 
 Hospitals, lessons of sanitation and hy- 
 giene from, 1226, 1227 
 operations in, as opposed to ill-prepared 
 
 surroundings, 1228 
 prejudice against, 1226 
 role of, in education of medical profes- 
 sion and public in general, 1226 
 system and regularity of, 1227 
 value of, 1226 
 Hot places, crowds in, 915 
 Hot weather, » advice for, 911 
 disease in, 913 
 liver in, 914 
 sleeping in, 916 
 work in, 912 
 House fly, female, journal of, 927 
 Houses, and cold walls, 1127 
 and curtains and carpets, 1129 
 and damp walls, 1128 
 and heating, 1173 
 and humidity, 1193 
 and ice boxes, 1127 
 
 and improperly ventilated rooms, 1128 
 and kitchens, 1127 
 and living rooms, temperature and 
 
 humidity of, 1161 
 and pantries and closets, 1127 
 and porches, 1131 
 and sanitary bathrooms, 1125 
 and spring cleaning, 1135 
 and sunlight, 1125 
 arrangement of, questions and answers 
 
 in regard to, 1131-1135 
 bedroom, ventilation of, 1163 
 choice of building site for, and high 
 ground, 1121 
 and land, 1122 
 
 and other considerations, 1122 
 and soils, 1121 
 disease history of, 1107- 
 keeping of, 1126 
 
 selection of, and basements, 1124 
 and bath room, 1125 
 and bedroom, 1122 
 and height of ceilings, 1124 
 and ice box, 1123 
 and insulation of walls and floors, 
 
 1124 
 and kitchen, 1123 
 and pantries and closets, 1123 
 and sitting-room, 1123 
 and window leakage, 1124 
 large rooms or small, 1123 
 
1330 
 
 GENEKAL INDEX 
 
 Housing, and congestion of population, 
 1109, 1110 
 and fatalism among poor, 1101 
 and general dirtiness, 1100, 1101 
 and price of land, 1110 
 
 preventing land sweating, 1111, 1112 
 and rehousing financial plan, 1104 
 and rehousing, in Liverpool, 1105 
 and town planning, 1113 
 and use of rooms, 1092 
 and ventilation, 1144 
 bad, and congestion, 1099, 1100 
 
 and effect of, on standards of occu- 
 pants, 1103 
 direct causes of ill effects from, 1097- 
 
 1099 
 ill effects of, 1092 
 punishment for, 1106 
 bad conditions of, formerly prevailing 
 
 in New York City, 1095 
 better, need for, 1085 
 
 plans proposed for, 1085 
 Charles Dickens on, 1084 
 consideration of health in choice of, 
 
 1084 
 flat and cottage, 1116 
 good, effect of, 1103 
 houses and, 1084 
 ill effects of overcrowding, 1100 
 improving sanitation of, 1107 
 influence of, 1099 
 neighborhood standards, 1101 
 new building code for Chicago and dis- 
 agreements of commission for, 
 1094, 1095 
 of poor people, 1095 
 problems of, in America, 1086 
 
 and suggested ordinance against, 
 1090" 
 evils of city life, 1087, 1088 
 factory location, 1090 
 financing of small home, 1090, 1091 
 in large and small cities, towns, vil- 
 lages, etc., 1088 
 overcrowding, 1089 
 
 due to need or greed, 1089, 1090 
 relay bed system, 1089 
 setting of house, in city, 1093 
 
 in country with regard to points of 
 compass and sunlight, 1092, 1093 
 sunlight and shade, 1093 
 tenement house commission and law of 
 New York City, 1095 
 
 Housing, too much of, 1092 
 Housing plans, 1096, 1097 
 Humidifying, method of, 1194 
 
 suggestion for, in steam heated room, 
 1196 
 Humidity, and frosted windows, 1193 
 and hygrometer, 1195 
 and plants as gauge of fitness of rooms 
 
 for human occupancy, 1195 
 measuring of, 1195, 1196 
 of living room, 1162 
 raising of, 1199 
 
 relative, of hot out-door air in summer 
 and hot indoor air in winter, 1197, 
 1198 
 Huntington's chorea, absence of cure for, 
 432 
 and marriage, 434 
 first symptoms of trouble, 432 
 hereditary nature of, 432 
 history of, 432 
 origin of, 432 
 origin of name of, 432 
 Hydrocarbons, 675 
 Hydrophobia, a disease of dogs, 301 
 absence of laboratory test and of treat- 
 ment for, 301 
 due to infection excreted by saliva, 301 
 incubation period of, 301 
 standard plan for prevention of, 301, 
 302 
 Hygrometer, 1195 
 Hyperthyroidism, 558 
 Hypnotism, function and use of, 379 
 Hypochlorite (bleaching powder), antidote 
 
 for poisoning from, 889 
 Hypothyroidism, 558 
 
 giving of thyroid extract for conditions 
 supposed to be due to, 558, 559 
 Hysteria, and neurasthenia, causes of, bad 
 inheritance and home training, 
 404 
 faulty education, 403 
 definition of, Bridger's, 404 
 influences predisposing to, 406 
 mind caused and mind cured, 379 
 symptoms of, 406 
 
 and organic changes, 377, 379 
 treatment of, 406, 407 
 Bridger 's, 407 
 
 Ice box odors, 510 
 cure for, 511 
 
GENERAL INDEX 
 
 1331 
 
 Ice cream, regulation of manufacture of, 
 536, 537 
 
 Idiosyncrasies, 49 
 Industrial poisonings, to eyes, 121 
 Infantile paralysis, and cerebrospinal 
 fever, 258 
 and cerebrospinal meningitis, 257 
 and flies, 249, 250 
 
 contagion of, from nose secretions, 250 
 control of, 250, 251 
 distribution of, 250 
 
 importance of play in open air in, 254 
 incubation period of, 250 
 initial symptom of, fever, 254 
 suggestions for prevention of, 250, 251 
 transmission of, by flies, 249, 250 
 by nose secretions, 250 
 by well persons, 250 
 treatment of, by exercise, 252 
 virus of, its nature and location in body 
 
 of sick person, 249 
 wasting of muscles in, no restoration for, 
 254 
 prevention of, 254 
 Infantile scurvy, and diet, 176 
 
 symptoms of cases not definitely sick, 
 176 
 Infection, and contagion, 192 
 cause of, 158 
 
 conditions increasing sensitiveness to, 
 159 
 Inheritance, clearing of, in four genera- 
 tions, 999 
 qualities that cannot be bred out, 999 
 Insanity, and alcohol habit, 368 
 and drug habit, 368 
 and diseases contributing to, 368, 369 
 and eugenics, 1010 
 and venereal diseases, 1301 
 effect on, of erysipelas, 413 
 of sudden shock, 414 
 of typhoid fever, 414 
 mind in, 377 
 percentage of, 413 
 prevention of, knowledge necessary for, 
 
 413 
 symptoms and organic changes, 377 
 Insects infesting food, 921 
 
 method of control of, 922 
 Insomnia, causes of, 408 
 occurrence of, 408 
 remedy for, 408, 409 
 Instinct, following of, 1059 
 
 Insurance, health, effect of, 1223 
 industrial, 1225 
 social, 1224 
 Intestinal fermentation, dieting for, 641, 
 
 642 
 Intestinal stasis, effect of, 1079 
 
 Metchnikoff 's and Lane's work on, 1079, 
 
 1080 
 Intestines, effect on system of retention of 
 
 waste in, 1080 
 Iodin poisoning, antidote for, 889 
 Iritis, 125 
 Iron workers, accidents and diseases of, 
 
 896 
 Itch, transmission of, 716 
 Itch parasites, treatment of, 917, 918 
 
 Joints, inflammation of, treatment of, 
 147 
 stiff, due to lack of movement, 147 
 due to neglect of inflammation, 147 
 
 Kidney, of pregnancy, 625 
 Kidney cures, 628 
 Kidneys, and diabetes, 158 
 
 best stimulant for, 628 
 
 drinking water for, 621 
 
 infections of, 620, 621 
 
 transmission of infection to, 620 
 1 ' Klondyke bed, ' ' making of, 1163 
 
 Lead colic, first aid treatment of, 889 
 Lead poisoning, different trades subject to, 
 900 
 preventive method for, 898 
 recognition of, 899, 900 
 sources of, in children, 897, 898 
 symptoms of, 897, 899, 900 
 Lead salts poisoning, antidote for, 889 
 Leprosy, a disappearing disease, 300 
 and rats, 295 
 cause of, 587 
 
 contagiousness of, 715, 716 
 degree of danger from, 299, 300 
 enlargement of lymph glands in, 551 
 enlargement of lymph glands and of 
 
 spleen in, 552 
 enlargement of spleen in, 583, 587 
 increase in number of white cells in, 552 
 number of cases in United States, 300 
 use of term in biblical times, 299 
 Leukocytes, 87 
 
1332 
 
 GENEKAL INDEX 
 
 Lice, typhus fever and Brill's disease 
 transmitted by, 918 
 varieties of, and treatment for, 918 
 Life, duration of, 5, 7 
 ending well, 5 
 eternal, Metchnikoff on, 5 
 living of, 2 
 
 starting and stopping points of, 1 
 Life insurance, and blood pressure, 605, 
 606 
 and Bright 's disease, 619 
 Lip-reading, 136, 137 
 
 for deafness, methods of, 137 
 Liver, in hot weather, 914 
 Liver spots, due to ptosis of abdominal 
 
 organs, 1082 
 Lockjaw, action of poison of, on body, 303 
 bacillus of, 303 
 incubation period of, 303 
 percentage of cures of, 303 
 symptoms of, at onset, and course of, 
 
 303 
 treatment for, 304 
 
 wounds most liable to infection of, 
 303 
 Longevity, and Bulgarian bacillus, 949, 950 
 and heredity, 951 
 percentage of deaths at different age 
 
 periods, 951 
 plans for, 955, 956 
 procedure to attain, 951 
 Lost manhood, 1305 
 Lumbar curve, purpose of, 1062 
 Lumpy jaw, a disease of man as well as 
 cattle, 547 
 cause of, 547 
 organs attacked by, 547 
 Lupus, contagiousness of, 716 
 Lymph flow, 552 
 Lymph nodes, 12 
 
 Lymphatic glands, and lumpy jaw, 547 
 chronic suppurative condition of, due to 
 
 rickets, 550 
 diseased conditions of, Osier on, 548, 
 
 549 
 enlargement of, due to infectious dis- 
 ease, 549 
 in and about neck and jaw, 549 
 in leukemia, 551 
 under arm, 549 
 
 under tongue just back of chin, 549 
 gateway of all lines of disease invasion, 
 550 
 
 Lymphatic glands, general inflammation 
 of, in infectious disease, 550 
 history of, 548 
 normal size of, 607 
 
 protection of, by discovering and re- 
 moving cause of enlargement of, 
 552 
 structure and distribution of, 550 
 swelling of, due to Hodgkin's disease, 
 
 551 
 tenderness or pain in, 607 
 Lymphatic system, function of, 607 
 Lymphocytes, 88 
 
 Malaria, as a bar to prosperity, 276 
 cost of, on a plantation, 276, 277 
 
 cause of, 265 
 
 control of, 265, 266, 267 
 
 danger of autumn for those infected 
 with, 275 
 
 enlargement of spleen in, 583, 587 
 
 eradication of, by control of mosquitos, 
 274 
 
 half-cured, its danger, 276 
 
 importance of curing, before winter, 275 
 
 malignant, 275 
 
 manner of spreading of, 271 
 
 meaning of term, 265 
 
 method of controlling, by preventing 
 breeding of mosquitoes, 273 
 by preventing infection of mosquitoes 
 
 by people, 273 
 by preventing infection of people by 
 mosquitoes, 273 
 
 mosquito policy in prevention and con- 
 trol of, 272 
 
 mosquitoes causing, day and night bit- 
 ing, 266 
 
 obstacle to eradication of, 271 
 
 prevention of, by oiling, 282 
 
 for following spring, by curing pres- 
 ent cases, 275 
 
 prophylactic administration of quinin 
 for, 278 
 
 quinin policy in cure and control of, 272 
 
 rapid decrease in, 275 
 
 transmission of, 265, 271, 277 
 
 treatment for complete eradication of, 
 272 
 
 treatment of, 271 
 
 use of quinin for prevention of, 277, 
 278 
 Manhood, lost, 1305 
 
GENERAL INDEX 
 
 1333 
 
 Marriage, after gonococcus infection, 1307 
 and Huntington's chorea, 434 
 and mental and physical fitness, 367 
 and syphilis, 1306 
 for syphilitic woman, 1307 
 of feeble-minded, imbecile or epileptic, 
 
 367 
 of intemperates, 367 
 of the closely related, 366, 367 
 Marriage requirements, and venereal dis- 
 eases, 1299 
 Massage and exercise, for fractures, 1027, 
 1028 
 for rheumatism, 1030 
 Matches, poisoning from. See Phosphorus. 
 Measles, contagion of, 240, 716 
 control of, 240 
 death rate due to, 240 
 epidemics of, daily examination of school 
 
 children during, 240 
 initial symptoms of, 199, 200 
 mortality from, in nursing babies, 
 
 240 
 rules for exclusion of children from 
 
 school because of, 1251 
 spreading of, 193 
 
 symptoms of, and their course, 240 
 Meat, amount of, consumed in America, 
 455 
 amount of lean, fat, and waste per pound 
 
 in every cut of, 457 
 and gout, 458 
 and milk, 460 
 chicken, frozen, 460, 461 
 
 rules for purchase of, 460, 461 
 containing purin bodies, 458, 459 
 cost per pound of the nutritious elements 
 
 in every cut of, 457 
 diagram of composition of food mate- 
 rials in, 456 
 in chronic constipation, 459 
 in fever, 459 
 in goiter, 459 
 " tastier " portions of, 456 
 Medical profession, fifty years ago and 
 
 to-day, 362 
 Medicine, preventive, advent of, 1, 2 
 Melancholia, effect on, of erysipelas, 413 
 
 no physical basis for, 414 
 Meningitis, and pneumonia, 258 
 
 burning or boiling of nose and throat 
 secretions for years after recov- 
 ery from, 258 
 
 Meningitis, cerebrospinal. See Cerebro- 
 spinal meningitis, 
 epidemic, 257 
 Menorrhagia, 1278 
 causes of, 1278 
 checking of, 1278 
 cure of, 1278 
 Menstruation, absence of, or amenorrhea, 
 1277 
 causes of, 1277 
 amount of flow during, 1274, 1275 
 and ovulation, 1275 
 bathing during, 1276 
 difficult, or dysmenorrhea, 1278 
 discharge of blood between periods, of 
 
 metrorrhagia, 1278 
 duration of flow during, 1274, 1275 
 excessive flow during, or menorrhagia, 
 
 1278 
 exercise during, 1276 
 exposure to cold or wet during, 1276 
 hygiene of 1276 
 local douche after, 1276 
 medicines to increase or decrease amount 
 
 of flow, 1275 
 normal period of, 1274 
 
 exceptions to, 1275 
 scanty, as symptom, 1277 
 conditions producing, 1277 
 menstrual habit of, 1277 
 symptoms accompanying, 1274 
 symptoms preceding, 1275 
 termination of period of, with discharge 
 
 of mucus, 1275 
 variation in amount, time and symptoms 
 of, 1276 
 Mental disorders, mind. in, 377-380 
 Mental equilibrium, and present-day high 
 
 pressure, 369 
 Mental healing, and medicine, of old-time 
 family physician, 362 
 basis for credence in, 364 
 of various new cults, 362 
 Mental hygiene, advantage of, 380 
 and habits, 368 
 and marriage, 367 
 and training of children, 367 
 circular of Massachusetts Society for, 
 
 367-369 
 general advice, 369 
 Mercury poisoning, acute and chronic, 900 
 prevention of, 901 
 symptoms of, 901 
 
1334 
 
 GENERAL INDEX 
 
 Metchnikoff, and Bulgarian bacilli, 949 
 
 and longevity, 949 
 
 belief of, 949, 950 
 Metrorrhagia, 1278 
 
 causes of, 1278 
 Middle ear, 9 
 
 infection of, 10 
 
 inflammation of and discharge from, due 
 to catarrh, 35 
 Middle ear infections, deafness due to, 134 
 Migraine, 444 
 Milk, action on, by stomach, 481 
 
 age of, 514 
 
 an infant diet, 515 
 
 and meat, 460 
 
 as food, 513 
 
 at summer resorts, 527 
 
 buttermilk, food value of, 480 
 
 canned or concentrated, advantages and 
 disadvantages of, 484 
 
 certified, 521 
 
 city delivery of, 517 
 
 clean and dirty, 522, 523 
 
 condensed, 484 
 
 constituents of, 480 
 
 cooling of, and keeping cold, 529 
 
 desiccated, 484 
 
 deterioration of, with exposure to air, 
 514 
 
 diagram of composition of food mate- 
 rials in whole milk, skim milk, 
 buttermilk and cream, 481 
 
 epidemic of streptococcus sore throat 
 from, 531, 532 
 
 evaporated, 482 
 
 flyless, odorless dairy for, 523, 525 
 
 government's position on, 531 
 
 harm done by, bad, 520 
 
 when sold under unsanitary condi- 
 tions, 523 
 
 harm done, when not fresh, 521 
 
 infections in, increasing with age of, 513 
 
 La Salle, 525 
 
 ordinances for, 525, 526 
 
 pasteurization of, time and temperature 
 for, diagram of, 535 
 
 plain talk to producers of, 533 
 
 products of, 513 
 
 Eichmond, Va., 526, 527 
 
 rules for infants', 528 
 
 skim, food value of, 480 
 
 sold in bulk, 519 
 
 sold in small cities, 532 
 
 Milk, sold under proper conditions, 526, 527 
 sour, 480, 481, 482 
 standards for, 518, 519 
 sweet, 480 
 
 tainted, treating of, 534 
 warm and dirty, 530 
 Milk production, 515 
 Milk report, indorsed, 518 
 Milk store score card, 519 
 Milk transportation, 515 
 
 city delivery, 517 
 Mind, and emotions, 366 
 and genius, 365 
 and heredity, 363 
 and level-headedness, 365 
 and prenatal influence, 363 
 care of, between ages of seven and sev- 
 enteen, 1233 
 feminine type of, 404 
 groups of, 404 
 normal average, 405 
 in mental disorders, 377, 379, 380 
 influence of, on body, anger, 366 
 emotions, 366 
 equanimity, 366 
 on body generally, 365 
 on digestion, 373 
 on disease, 363 
 
 conclusions on, 365 
 
 and mental healing, 364 
 contagious, 364 
 element of fear, 363 
 its course and symptoms, 365 
 symptoms, 364 
 on heart and circulation, 374, 375 
 on life and death, 363 
 on nutrition, 374 
 on offspring, 363 
 influence on, of body, 375, 376 
 isolation of, leading to neurasthenia, 405 
 masculine type of, normal, 405 
 "The Human Machine," 365 
 untrained, waste due to, 365 
 Mineral acids, antidotes for poisoning 
 
 from, 890 
 Miners' nystagmus, 121 
 Monosaccharid, 496 
 Morphin, amount of, consumed by addicts, 
 
 327 
 Morphin habit, acquisition of, 327 
 cure for, Sceleth drug treatment, 333 
 Towns' morphin cure method, 332 
 curing of, 328 
 
GENERAL INDEX 
 
 1335 
 
 Morphin poisoning. See Opium poisoning 
 Mosquito campaign, Herms' "Malaria," 
 as guide in, 271 
 in New Jersey, 280, 281 
 outline for, 278, 279 
 Mosquito repellants, efficacy of, 269 
 Mosquitoes, breeding places for, 285 
 control of, 267, 268 
 directions for easing hurt of bite of, 
 
 269 
 directions for preventing the bite of, 
 
 269 
 malaria due to, 265 
 
 method of catching those in room, 269 
 methods for prevention of, 267, 268 
 mixture for killing young of, in breed- 
 ing places, 268 
 non- traveling nature of, 269 
 prevention of breeding of, 273 
 prevention of breeding places, 287 
 prevention of infection of, by malarial 
 
 people, 273 
 prevention of infection of people by, 273 
 to keep pools free from, 269 
 yellow fever due to, 264 
 Mouth, cleaning of, 21 
 Mouth breathing, dangers of, 20 
 effect of, 738 
 predisposing to colds, 60 
 Moving pictures, need of, 1257 
 Multiple sclerosis of nervous systems, and 
 
 eugenics, .1010 
 Mumps, contagion of, 247 
 epidemics of, 247 
 incubation period of, 247 
 injection for prevention of, after ex- 
 posure to, 247 
 Muscle sagging, 1079 
 
 Muscles, abdominal, plan of exercises for 
 development of, 1082 
 ptosis of, liver spots due to, 1082 
 arrangement of, 1079 
 as reason for dyspepsia and indigestion, 
 
 1073 
 building and training of, 1075 
 exercise of, open-air, 1076 
 formation of fatigue toxins and anti- 
 toxins by exercise of, 1077 
 need of, for air, 1073 
 for exercise, 1073 
 for food, 1073 
 for play, 1076, 1077 
 of abdomen, 1079 
 
 Muscles, of leg and arm, and six exercises 
 for building up of, 1077 
 plan for development of, 1074 
 ptosis of, 1079 
 
 and effects of, 1079 
 
 intestinal stasis due to, and its effects 
 
 on system, 1079, 1080 
 kinks and adhesions due to, and effect 
 of, on system, 1081, 1082 
 Mushroom poisoning, antidote for, 890 
 Mushrooms, canned, 471 
 cultivation of, 470 
 food value of, 470 
 how to tell edible varieties of, 470 
 Myxedema, partial, French's six groups 
 of people suffering from, 558 
 
 Nails, purpose of, 700 
 Nasopharynx, 9 
 
 Nausea and vomiting, first aid in, 870 
 Nerves, purpose of, 65 
 
 visceral, 370 
 Nervous disorders, convulsive, 418 
 
 functional, symptoms and organic 
 changes, 377 
 Nervous habits, wisdom of overcoming, 422 
 Nervous system, sympathetic, and persist- 
 ing neuralgias, 381-383 
 disturbance areas of, 371 
 outline of, 370 
 referred pains of, 371 
 Nervousness, prevention of, in child, 371 
 Neuralgia, definition of, 383 
 
 distinguished from neuritis, 384 
 
 first aid in, 871 
 
 nature of pain of, 384 
 
 painful or tender points in, 384 
 
 persisting, location and removal of cause 
 
 of, 381-383 
 relief for, 384 
 
 treatment of underlying cause of, 384 
 Neurasthenia, among poor as well as rich, 
 395 
 and capacity, 579 
 
 and hysteria, causes of, bad inheritance 
 and home training, 404 
 faulty education, 403 
 and indecision, 372 
 and inheritance, 578 
 basis of, 379 
 causes of, 395, 396 
 
 change in attitude of physician to and 
 of sufferer from, 577, 578 
 
1336 
 
 GENEKAL INDEX 
 
 Neurasthenia, cure for, 404 
 definition of, 394 
 Bridger's, 404 
 due to trouble with adrenal bodies, 577 
 
 typical cases of, 577, 578 
 foundation in type for, 394 
 headaches due to, 444 
 letter of typical sufferer from, 395 
 mind caused and mind cured, 379, 380 
 need of spiritual help in, 393 
 symptoms of, 394 
 treatment of, 396-398 
 Bridger's, 407 
 Neurasthenics, and the physician, 393 
 Neuritis, distinguished from neuralgia, 384 
 Neurotics, and eugenics, 1010 
 Newborn infant, care of, 780 
 Night losses and wet dreams, 1304 
 Nose, baby's, 12 
 
 causes of narrowed space in, 13 
 causes of obstruction in, 12, 13 
 cleaning of, 17 
 ear, eye and other disturbances due to 
 
 diseases of, 35 
 function of, 12 
 infection of, frequency of, 9 
 
 through eustachian tube to middle ear 
 cavity, 10 
 lymphatics of, 12 
 midbone of, 13 
 mucous membrane of, 12 
 ' openings into, eustachian tube, 9 
 from antrum, 11 
 
 from cavity in bones of forehead, 11 
 from ethnoid cells, 11 
 from sphenoidal sinus, 11 
 number and purpose of, 9 
 tear ducts, 9 
 preparation of air for lungs by, 11, 12 
 size of, 12 
 
 turbinated bones of, 12 
 Nosebleed, first aid in, 865 
 Nursing mother, foods for, 798 
 Nutrition, influence on, of mind, 374 
 Nystagmus, miners', 121 
 
 Obesity, and thinness, 672 
 
 treatment of, and factors in, 673, 674 
 causes of, 672, 673, 680 
 disadvantages of, 680 
 due to senility of thyroid gland, 568 
 11 grape cure" for, 475 
 predisposing to pneumonia, 61 
 
 Obesity, prevention of, 681 
 
 reducing in, Van Noorden on, 675, 676 
 
 tendency to, and factors in, 680 
 
 treatment of, 681 
 
 weight, according to age and height con- 
 stituting scale of, 679, 680 
 Obesity cures, 683 
 
 Occupational diseases, accidents and dis- 
 eases of ironworkers, 896 
 
 acid burns, 894 
 
 arsenic and benzin poisoning, 901 
 
 caisson disease, 902 
 
 carbon monoxid poisoning, 897 
 
 due to working in wet air, 906 
 
 from dusty trades, 903 
 
 lead poisoning, 897 
 
 mercury poisoning, 900 
 
 phosphorus poisoning, 895 
 
 poisoning from wood alcohol, 896 
 
 preventive movement against, 893 
 Old age, reasons for disease and death in, 
 
 951 
 Ophthalmia neonatorum, 112 
 
 percentage of blindness due to, 113, 114 
 Opium habit, addiction to, by neuras- 
 thenics, 328 
 
 Harrison law against, 329, 330, 331 
 Opium poisoning, antidote for, 890 
 Ovaries, 1274 
 Overeating, at dinner, 491 
 
 at Thanksgiving dinner, 492 
 
 relief for, 492, 493 
 Ovulation, 1274 
 
 and menstruation, 1275 
 Ovum, 1274 
 Oysters, and seasons for, 464 
 
 and typhoid fever, 463 
 
 safety of eating, 463, 464 
 
 and clams, and typhoid fever, 311 
 Oxalic acid (salt of lemon, ink eradicator), 
 
 antidote for poisoning from. 890 
 Ozone, and germs killed by, 1161 
 
 definition of, 1160 
 
 Pancreas, definition and function of, 158 
 Pantry pests, 921 
 Paralysis, due to apoplexy, 614 
 Paralysis agitans, cause of, 431 
 
 common test for, 430 
 
 muscular rigidity of, 431 
 
 treatment of, by extract of parathyroid, 
 431 
 
GENERAL INDEX 
 
 1337 
 
 Paralysis agitans, tremor of, 430 
 Parasitical pests, bed bugs, 918 
 fleas, 919 
 
 itch parasites, 917 
 lice, 918 
 red bugs, 917 
 straw itch, 917 
 ticks, 919 
 Patent medicines, and drug habit, 327 
 
 worthlessness of, 329 
 Pellagra, ability of change of diet to cure 
 individual case of, 165 
 amount and spread of, 167, 168 
 and diet, 165 
 cause of, 165 
 diagnosis of, common mistakes in, 168 
 
 necessity of, 168 
 diet list, to avoid disease, 165 
 
 to cure disease, 166 
 eventual eradication of, from South, 165 
 noncommunicability of, 165 
 prevention of, and cottonseed food, 477, 
 
 478 
 symptoms of, 168 
 
 treatment of, climate and altitude, 169 
 diet, 166, 168 
 drugs, 169 
 
 general hygienic, 168 
 Pets, dangers from, anthrax, 201 
 consumption, 201 
 glanders, 291 
 hydrophobia, 201 
 
 in spreading contagious disease, 200 
 itch, 200 
 plague, 201 
 tapeworms, 200 
 Pharynx, lining of, 15 
 
 location and purpose of, 15 
 Phosphorus poisoning (matches, some rat 
 pastes), antidote for, 890 
 deformities of, 895 
 legislation for, 895 
 Phrenology, 441 
 
 Pimples, cause and prevention of, 707 
 Pink eye, causes of, 126 
 
 danger from, in formation of ulcers, 
 
 126 
 infectious nature of, 126 
 symptoms of, 126 
 Plague, and ground squirrels, 292 
 and Panama Canal, 295, 296 
 and rats, 292 
 
 primarily disease of rodents, 294, 295 
 
 Plague, forms of, and their respective 
 symptoms, 297 
 harboring of, among rats and small ani- 
 mals of field, 292 
 history of, in California, 291, 292 
 importation of. into civilized countries, 
 
 290 
 sources of epidemics of, 290 
 spread of, 297 
 
 its prevention, 297 
 transmission of, from rats, by means of 
 fleas, 294 
 Play cure, 1044-1047 
 Pleura, description of, 64 
 functions of, 65 
 location and nature of, 64 
 nerves of, 65 
 Pleurisy, associated with tuberculosis, 67 
 conditions mistaken for, 65 
 dry, symptoms of, 67 
 following pneumonia, 68 
 forms of, mild, 65, 66 
 
 serious, 66 
 how to differentiate from hard cold, 67 
 mistakes in diagnosis of, 66 
 porous plaster for, 65 
 prognosis of, 68 
 suppurative, 68 
 with effusion, 67 
 
 how to suspect presence of, 66 
 symptoms of, 66, 67 
 Pneumococci, causing heart disease, 62 
 causing meningitis, 62 
 causing pleurisy, 62 
 elsewhere than in lungs, 62 
 Pneumonia, after-treatment of, 61, 62 
 and meningitis, 258 
 
 burning or boiling of nose and throat 
 secretions for years after recov- 
 ery from, 258 
 causes of, bacterial, 58 
 
 meteorological influences, 59 
 predisposing and contributing, 59 
 contagious nature of, 57, 58 
 disinfection after, 208 
 due to neglected colds, 55 
 enlargement of spleen in, 585 
 epidemics of, 58 
 fresh air and cold showers as preventives 
 
 of, 56 
 geographical distribution of, 56 
 number of deaths due to, 56 
 open-air treatment of, 61 
 
1338 
 
 GENERAL INDEX 
 
 Pneumonia, other diseases due to germ of, 
 62, 63 
 pleurisy following, 68 
 possible cure for, Dr. Roseuow's, 63 
 predisposing effect to, of food gorging, 
 
 56 
 predisposition to, in obesity, 61 
 
 of overindulgence in alcohol, 56, 60, 
 61 
 prevention of, 57, 58 
 susceptibility to, in age, 56 
 in sex and race, 56 
 in town or country, 56 
 of rich, 56 
 symptoms of, 58 
 wide prevalence of, 56 
 Poisoning, first aid in, 883 
 Poisons, antidotes for, 883 
 Pollantin, 52 
 Polynuclears, 87 
 Polysaccharid, 496 
 Porous plasters, for pleurisy, 65 
 Posture, as expression of character and 
 intelligence, 1060 
 correct, vertical line test for, 1066 
 incorrect, inefficiency of, 1066 
 
 sciatica and leg pains due to, 1062 
 influence on, of disease, 1060 
 
 of occupations, 1060 
 upright, advantages and disadvantages 
 of, 1063 
 not natural for man, 1063 
 origin of, 1059 
 Pregnancy, albuminuria in, 626 
 and Bright 's disease, 625 
 and confinement, treatise on, " Prenatal 
 
 Care," 781 
 and sore breasts, 1016, 1017 
 kidney of, 625 
 
 relation of, to tuberculosis, 72 
 Prenatal influence, 363 
 Preventive medicine, advent of, 1, 2 
 Prickly heat, treatment of, 714 
 Prophylaxis, 49 
 
 Prostitution, and venereal diseases, 1298 
 Proteids, 450, 675 
 
 Prussic acid, poisoning, antidote for, 890 
 Psoriasis, due to too much protein, 712 
 
 treatment of, by diet, 712 
 Pus cocci, 1288 
 
 Pyemia, enlargement of spleen in, 585 
 Pyorrhea, and constitutional diseases, 746 
 cause and treatment of, 741 
 
 Pyorrhea, cure of, 746, 747 
 stages of, 746 
 
 Race, relation of, to tuberculosis, 74 
 
 Rat-bite disease, 295 
 
 Rat fleas, as agent transmitting plague 
 
 bacillus, 294 
 Rats, abundance of, 293 
 and goiter, 566 
 black, 293 
 breeding of, 293 
 common or brown, 293 
 cost of, 298 
 
 diseases of, fleas, lice and mites, 295 
 leprosy, 295 
 parasites, 295 
 plague, 294, 295 
 rat-bite disease, 295 
 trichinosis, 295 
 tumors, including cancer, 295 
 ferocity of, 293 
 importance of, 292 
 migration of, its significance, 293 
 prevention and eradication of, 298 
 Raynaud's disease, forms of, 581 
 
 symptoms and course of, 581 
 Red bugs, prevention and treatment of, 
 
 917 
 Refrigerators, odors in, 510 
 
 cure for, 511 
 Rescues from fires, first aid to, 866 
 Rheumatic and gouty pains, 142 
 Rheumatism, acute, advice for, 142, 143 
 definition and causes of, 142 
 infectious nature of, 149 
 and catarrh, 150 
 and climate, 147 
 and heart disease, 590 
 and hygiene, 150, 151 
 and massage and exercise, 1030 
 and teeth, 740 
 cause of, 740 
 chronic, causes of, 143 
 
 diseases commonly known as, 143 
 treatment of, 143 
 conditions commonly known as, 143 
 condition known as "full of rheuma- 
 tism," 143 
 effect of, on heart, 141 
 examination of mouth, throat and nose 
 
 in, for focus of trouble, 141 
 false popular ideas upon, 149 
 gout mistaken for, 143 
 
GENERAL INDEX 
 
 1339 
 
 Bheumatism, headaches due to, 444 
 in children, custom of giving medicine 
 for, its danger, and proper treat- 
 ment, 144, 145 
 inflammatory, causes of, 141 
 
 definition of, 141 
 joint affections akin to, 141 
 prevention of, 150 
 pus cocci found in tonsillar crypts in 
 
 cases of, 15 
 rheumatoid arthritis distinguished from, 
 
 148 
 so-called, bad consequences of, if allowed 
 
 to run, 143 
 treatment of, 143 
 
 by prevention or correction of stiff- 
 ness of joints, by massage and 
 exercise, 1030 
 for control of gateway of infection, 
 
 1029 
 for relief of pain, 1029 
 mineral springs, 1031 
 ridding body of poisons, and increas- 
 ing resistance, 149 
 surgical, 150 
 vaccines, 150 
 use of term, 141 
 Eheumatoid arthritis, 141 
 causes of, 145 
 
 distinguished from rheumatism, 148 
 focus of trouble in teeth and gums, 141 
 pus cocci found in tonsillar crypts in 
 
 cases of, 15 
 symptoms of, 149 
 
 treatment of, by treatment of cause, 145, 
 146 
 by vaccines, 146 
 trouble in bone, 148 
 Eice, and beriberi, 174, 178 
 Eickets, and fat babies, 187 
 bone changes in, 186 
 convulsions with, 419 
 due to fattening foods, 187 
 early diagnosis of, 185 
 early signs of, head formation, 187 
 peevishness, not otherwise explainable, 
 
 187 
 "potbelly," 187 
 slowness in walking, 187 
 sweating of head, 186 
 teeth, 186 
 medical direction for, 188 
 treatment for, 188 
 
 Eingworm, transmission of, 716 
 Eocky Mountain spotted fever, distribution 
 of, 325, 326 
 
 epidemic standpoint of, 325 
 
 eradication of, 325 
 
 transmission of, by wood ticks, 325 
 Eusty nail wound, first aid in, 873 
 
 Salt, in foods, 498 
 
 Sanitation, in bakeries, 454, 455 
 
 in cloak industry, 906 
 Sarcoma, and cancer, 972 
 Sarcomas, nature of, 973 
 
 recognition of, 973 
 Scarlet fever, and atmospheric tempera- 
 ture, 230 
 and hot houses, 229, 230 
 and the throat, 229 
 cause of, not known, 230 
 contagiousness of, 716 
 development of, 229 
 exclusion of children from school because 
 
 of, rules for, 1250 
 higher death rate from, in north than 
 
 in south, 230 
 initial symptoms of, 199, 200 
 spreading of, 193 
 symptoms of, 229 
 transmission of, 228 
 School children, care of mind of, between 
 ages of seven and seventeen, 1*233 
 working at low efficiency, 1232 
 School efficiency report, 1231 
 School hygiene, 1235 
 School laboratories, 1257 
 School nurse, 1252 
 
 Schools, and feeding of growing genera- 
 tion, 1254 
 and neglected children, 1256 
 and teaching in cold air, 1242 
 care in, of child, mental and physical, 
 
 1234 
 cold room and open air, 1243 
 compulsory education and compulsory 
 
 attendance laws, 1236 
 country, safeguarding health of teach- 
 ers of, 1261 
 ventilation standards of, 1242 
 efficiency for, 1232 
 
 exclusion of children from, because of 
 diphtheria, 1250 
 because of measles, 1251 
 because of scarlet fever, 1250 
 
1340 
 
 GENEKAL INDEX 
 
 Schools, exclusion of children from, be- 
 cause of whooping cough, 1252 
 health observation of, 1261 
 larger use of, 1256 
 medical inspection of, 1244 
 abnormal children, 1252 
 benefits of, 1245 
 cooperation of parents in, 1256 
 for contagion, 1248, 1249 
 for physical defects, 1249 
 in Chicago, 1246 
 justified demands of parents from, 
 
 1249, 1250 
 work of inspectors, 1248 
 one room, heating and ventilation of, 
 
 1241 
 proposed lines for heating and ventila- 
 tion of, 1240 
 regulations of health department for ex- 
 clusion of children from, 1250 
 tendency to unload all burdens in con- 
 nection with, on teacher, 1231 
 value of medical and lay cooperation 
 in advancement of school health, 
 1231 
 various improvements in hygiene of, 
 
 1232 
 ventilation of, and blowing out during 
 play periods, 1240 
 and constantly moving air, 1239 
 and humidity, 1238 
 and temperature, 1238 
 deflection of hot air, 1240 
 faulty mechanical systems of, 1237 
 improvements in, 1238 
 location of radiation, 1239 
 village plan for, 1259 
 yearly sum spent by people of United 
 States for, and its application, 
 1231, 1232 
 and its misapplication, 1233 
 Sciatica, classification of cases of, into 
 groups, 385 
 definition of, 385 
 due to incorrect posture, 1062 
 location and removal of underlying 
 cause, 385 
 Scorpions, bite of, and treatment for, 920 
 Scrofula, 740 
 
 and operation, 185 
 and tuberculosis, 184, 185 
 cause of, 185 
 meaning of, 184 
 
 Scrofula, mode of infection by, 185 
 
 symptoms of, 185 
 Scurvy, a disease of winter and spring, 179 
 and diet, 180, 181 
 for babies, 183 
 cause of, 179, 180 
 diet for prevention of, 183 
 former prevalence of, and its decrease, 
 
 180, 181 
 infantile, age for development of, 182 
 symptoms of, 183 
 treatment of, 183 
 prevention of, by diet, 181 
 susceptibility to, of babies, and their 
 
 symptoms of, 179 
 symptoms of, 183 
 "a touch of," 179 
 old-fashioned, 179 
 treatment of, 183 
 Seasickness, prevention of, 664 
 physical and somatic, 663 
 treatment of, 664 
 Sedatives, 47 
 Self abuse, 1304 
 
 Senility, and Bulgarian bacilli, 949 
 and rheumatism and gout, 155 
 constipation and, 487 
 Septicemia, enlargement of spleen in, 585 
 Septum, 13 
 
 Sex organs, female, 1274 
 Sexual indulgence, in boys, 1303 
 Sexual manifestations, self abuse, 1304 
 lost manhood, 1305 
 night losses and wet dreams, 1304 
 rules to be followed for, 1303 
 Shoulders, broad, cultivation of, 1062 
 sagging, pressure of, on other structures, 
 
 1061 
 stooping, 1063, 1064 
 
 cure of by breathing, 1065 
 Silver solution, Grede's method of use 
 of, for prevention of blindness, 
 113 
 Sinus, sphenoidal, 11 
 Sinus trouble, headaches due to, 444 
 Skin, 700 
 
 and bathing, 706 
 and digestion, 707 
 and goose-flesh, 703 
 and pimples, 707 
 and boils, 710 
 and sunshine, 704 
 and sweat, 702 
 
GENEKAL INDEX 
 
 1341 
 
 Skin, and wind, 704 
 bronzing of, 709 
 carbuncles, 710 
 care of, in tropics, 701 
 diseases contagious through, itch and 
 ringworm, 716 
 leprosy, 715, 716 
 lupus, or tuberculosis of skin, 716 
 smallpox, 716 
 diseases which show themselves in, 709, 
 
 710 
 effect on, of climate, 701, 702 
 
 of tropics, 701 
 faint lemon hue in, 710 
 glands of, 702 
 grease glands of, 703 
 layers of, 706 
 marked yellow in, 710 
 pale, white, 710 
 pigment of, 701 
 protection of, 705 
 purpose of, 700 
 structure of, 700 
 sunburn of, without exposure to sun, 
 
 709 
 sweat glands of, 702, 703 
 tanning of, 704 
 
 the process and effect, 705 
 typhoid patches on, in typhoid fever, 716 
 Skin diseases, boils, 713 
 causes and origins of, 703 
 dermoids, 714 
 Skin diseases, eczema, 708 
 pimples, 707 
 prickly heat, 714 
 Skin eruptions, in spring, treatment for, 
 
 155 
 Sleep, for old people, 952 
 Sleeping, in hot weather, 916 
 Sleeping porches, 1131 
 Slew-footedness, 762 
 Smallpox, and cleanliness, 216 
 
 and reliability of city health authorities, 
 
 216, 217 
 and vaccination, 213 
 
 statistics on, 219, 220 
 cases developing in town or city a sure 
 indication that measures for con- 
 trol are being neglected, 218 
 contagion of, 216, 716 
 control of, 214 
 
 its difficulty, in mild cases, 215 
 cost of protection against, 220 
 
 Smallpox, epidemics of, 216, 217 
 incubation period of, 216 
 initial symptoms of, 200 
 mild cases of, contagion of, 216 
 
 symptoms of, 215 
 spreading of, 192 
 
 symptoms of, and their development, 
 216 
 in mild cases, 215 
 transmission of, 214 
 treatment of, 216 
 Sneezing, and colds, 30 
 
 causes of, 30 
 Snoring, causes of, 22, 23 
 
 curing of, 23 
 Soils, in selection of building sites, 1121 
 
 unhealthy for building sites, 1122 
 Sore throat, causes of, 37 
 dangers of, 37 
 
 particularly in children, 37 
 importance of calling in physician for, 
 
 37, 38 
 prevention of, 37 
 symptoms accompanying, indicating 
 
 need of immediate attention, 37 
 uselessness of certain home remedies for, 
 37 
 Spasmodic tics, 421 
 
 Spasms, general, or convulsions. See 
 Convulsions, 
 local, associated with many disorders, 
 420 
 remedy for, 420, 421 
 Sphenoidal sinus, 11 
 Spiders, application to bite of, 920 
 bite of, 919 
 
 varieties of, dangerous to life, 919 
 Spine, curves of, 1062 
 
 lumbar curve of, 1062 
 Spleen, a blood gland, 583 
 and surgery, 589 
 blood flow in, 585 
 blood vessels to, 585 
 enlargement of, in anthrax, 585 
 in consumption, 587 
 in leukemia, 583, 587 
 in malaria, 583, 587 
 in pneumonia, 585 
 in septicemia and pyemia, 585 
 in syphilis, 585 
 in typhoid fever, 585 
 function of, 585, 587 
 location of, 583 
 
1342 
 
 GENEKAL INDEX 
 
 Spraying of nose, Setter 's or Dobell 's solu- 
 tion for, 35 
 Spring cleaning, 1135 
 
 and carpet beating, 1136 
 
 and pests, 1138 
 
 and outhouses, 1138 
 
 considerations in, 1139 
 
 custom and instinct of, 1136 
 
 method of, 1137 
 
 necessity for, 1138 
 
 object of, 1137 
 Squint, acquired, causes of, 124 
 
 congenital, 124 
 
 convergent, 124 
 
 development of, in early childhood, 124 
 
 explanation of, 124 
 
 non-paralytic, 124 
 
 paralytic, 124 
 
 treatment of, by wearing of glasses, 125 
 
 with eye turning out, 125 
 St. Vitus' dance, and eugenics, 1010 
 
 causes of, 420 
 
 course in treatment of, 420, 421 
 
 premonitory signs of, 422 
 
 treatment for, 423 
 Stable manure, as breeding place for flies, 
 1221 
 
 disposition of, 1221 
 Stammering, cause of, in mental processes, 
 437> 
 
 facts associated with, 436, 437 
 
 physical additions present with, 437 
 
 schools for, 439 
 
 study and analysis of, by Bluemel, 438, 
 439 
 
 treatment of, 436 
 
 See also Stuttering. 
 Starch, digestion of, 496, 497 
 Sterility, diagnosing of, 1279 
 
 disposition to, of fat women, 1277 
 
 percentage of cases of, in marriage, 1279 
 Stiff legs, 146 
 
 Stinging pests, bees, hornets, wasps and 
 yellow jackets, 920 
 
 black flies, 920 
 
 centipedes, 920 
 
 scorpions, 920 
 
 spiders, 919 
 Stomach, and exercise, 640, 641 
 
 chief function of, 638 
 Stomach trouble, influence on, of mind 
 
 and proper food, 373, 374 
 Strabismus. See Squint. 
 
 Straw itch, cause of, 711 
 origin of, 710 
 prevention of, 711, 917 
 treatment of, 711, 917 
 Stuttering, causes of, 435 
 remedy for, 435 
 See also Stammering. 
 Sugar, in blood, excessive, 160 
 
 normal, 159 
 Sugar eating, 642, 643 
 Sunstroke, first treatment for, 876 
 Sweat, composition and purpose of, 702 
 Sweating out poisons, common idea of, 
 
 1035 
 Sylvester method of artificial respiration, 
 
 875 
 Syphilis, actively at work, when no symp- 
 toms exist, 1292 
 and marriage, 1306 
 and spleen, 585 
 banishment of, 1285 
 confusing cure of symptoms with cure 
 
 of disease in, 1292 
 cure of, complete and permanent, 1286 
 curing of, 1292 
 diagnosis of, 1295 
 effects of, 369 
 
 first symptom of, and time of appear- 
 ance of, after infection, 1295 
 germ of, 1285, 1291 
 
 greatest harm of, due to half -cures, 1286 
 in unborn babe, 1292 
 inherited, 1301 
 
 harboring of germ in, 1302 
 mild nature of, 1292 
 not blood disease, 1292 
 iritis due to, 125 
 preventability of, 1285 
 public education against, 1286 
 secretions from ulcer of and other secret- 
 ing patches, 1296 
 symptoms of, in second stage, 1292 
 tests for, laboratory, Wassermann and 
 Noguchi, 1296 
 spirochetes, 1296 
 therapeutic, 1296 
 ulcer of, 1295, 1296 
 Syphilitic infection, tendency of, to travel 
 to other parts of body from focus 
 of infection, 1291 
 
 Tanning, effect of, on skin, 705 
 process of, 705 
 
GENERAL INDEX 
 
 1343 
 
 Tarantulas. See Spiders. 
 Tea, and war, 358 
 beneficial effects of, 357, 358 
 habit of drinking, 357 
 rate of consumption of, 350, 351 
 relative amount of caffein in coffee and, 
 
 350 
 use of, how and when, 357 
 Teachers, safeguarding health of, consti- 
 pation, 1262 
 contagion, 1262, 1263 
 fruit and water, 1262 
 muscular exercise, 1265 
 nerves, 1261 
 recesses, 1264 
 sleep, 1265 
 temperature and humidity of room, 
 
 1263 
 ventilation, 1263 
 water supply, 1264 
 Tear ducts, 9 
 
 Tears, cleansing nature of, 9 
 Teeth, and importance in digestion, 742 
 and irregular jaws, 744 
 and rheumatism, 740 
 and tooth brushes, 747, 748 
 as field of pollution, 17 
 as harborers and transmitters of infec- 
 tion, 742 
 cause of decay of, 740 
 cavities in, causes and prevention of, 
 
 743, 744 
 cleaning of, 17, 21 
 dirty, and anemia, 747 
 erosions of, 745, 746 
 functions of, 742 
 horses', 738, 739 
 importance of, 738, 741, 742 
 infections due to, 739, 740 
 meeting of, 744 
 need for care of, 743 
 pyorrhea, 741, 746 
 Tetanus. See Lockjaw. 
 Thermometer habit, 1198 
 Thermometers, advantage of, 1185 
 Thinness, and fattening, method of, 695, 
 696 
 Von Noorden on, 676, 677 
 and obesity, 672 
 
 treatment of, and factors in, 673, 674 
 Throat cultures, in suspected diphtheria, 
 
 236 
 Throbbing pains, 592 
 
 Thumb-sucking, effeet of, 738 
 Thymus gland, growth impulse in, 568 
 Thyroid deficiency, 564 
 Thyroid extract, for bed- wetting, 559 
 for obesity due to senility of thyroid 
 
 gland, 568 
 giving of, for conditions supposed to be 
 due to hypothyroidism, 558, 559 
 for partial myxedema, 559 
 in case of woman with symptoms sug- 
 gestive of Bright 's disease, in- 
 toxication and dropsy, 559 
 Thyroid gland, conditions of, 561, 562 
 diseased, definite intoxication from, 568 
 enlargement of, conditions causing, 565 
 in ancient Egyptian worship and Greek 
 
 art, 562 
 influence of secretion of, on rest of body, 
 
 561, 562 
 location of, 561 
 
 number of cases in Switzerland of thy- 
 roid out of balance, 565 
 obesity due to senility of, 568 
 relation between, and conditions of 
 
 adenoids and tonsils, 565 
 secretion of, 561 
 
 undersecretion of, complicating many 
 diseases, 560 
 Thyroid poisoning, 561 
 Ticks, 919 
 
 as cause of Rocky Mountain spotted 
 
 fever, 325 
 to rid a region of, 325 
 Tissues, 1073 
 
 Tobacco, and mental stimulation, 343 
 cigarettes, main objections to, 343 . 
 excretion of, from pores, by heavy users 
 
 of, 343 
 for young people, 344 
 juice of, in mouth, not antiseptic, 343 
 relative harm in cigarettes, cigars and 
 
 pipe tobacco, 343 
 use of, by women, 343 
 uselessness of, 343 
 Tobacco blindness, 343 
 Tobacco heart, 343 
 Tongue, cleaning of, 17, 21 
 Tonsil, lingual, 20 
 
 pharyngeal, 20 
 Tonsillar crypts, cleaning of, 21 
 description of, 15 
 
 pus cocci in, in cases of rheumatism 
 and rheumatic arthritis, 15 
 
1344 
 
 GENERAL INDEX 
 
 Tonsillar crypts, theories as to purpose 
 
 of, 15 
 Tonsillitis, follicular, due to diphtheria 
 
 bacillus, 235 
 Tonsils, cause of frequent inflammation of, 
 16, 17 
 cleaning of, 17 
 
 crypts of. See Tonsillar crypts, 
 effect of removal of, 16 
 enlarged, due to uncleanliness, 21 
 outgrowing of, 16 
 prevention of, 21 
 removal of, 16, 21 
 eustachian, 20 
 faucial, 20 
 
 indications for removal of, 16, 21 
 lymph gland portion of, 16 
 number of, 20 
 position of, 15, 20 
 purpose of, 16, 17 
 Tooth, arrangement of, 745 
 Tourniquet, application of, for wounds in 
 
 limb, 865 
 Town planning, and housing, 1114 
 and width of street, 1115 
 diagonal and rectangular streets, 1116 
 division into zones with respective regu- 
 lations, 1114 
 health department, 1113 
 law of excess condemnation, 1114 
 Toxins, in food, 489 
 Trachoma, and cleanliness, 116 
 
 as cause of preventable blindness, 115 
 definition of, 119 
 difficulty of cure of, 116 
 distribution of, 118 
 infection of, 118, 119 
 nature of, 118, 119 
 origin of, 115 
 prevention of, 116 
 results of, 119 
 surveys for, 118 
 symptoms of, 119 
 Trades, danger to eyes resulting from, 
 121 
 eye fatigue resulting from, 120 
 Training of child, advice on, 367, 368 
 and food, 372 
 and habit of blaming, 373 
 and influence of fear, 372 
 and mental hardening, 372 
 and play, 372 
 and tantrums, 372 
 
 Training of child, effect of association 
 with neurasthenic parents, 371 
 overprotection of its nervous system, 373 
 study and attention given any unnatural 
 differences from other children, 
 417 
 Trichinosis, and rats, 295 
 Tuberculosis, absence of actual cure for, 
 79 
 and altitude, 88 
 and blood cells, 87, 88 
 and climate, 86, 87 
 choice of, 90, 91 
 
 consideration of individual needs, 90 
 for advanced cases, 91 
 and dusty trades, 904 
 and eugenics, 1010 
 and gouty diathesis, 154 
 and scrofula, 184, 185 
 and weight, 71 
 care of, at home or in other climate, 89 
 
 at home or in sanitariums, 86 
 conservation of energy in, 82 
 cure for, if taken in time, 70 
 custodial care of patients with, 92 
 death rate from, and insurance legisla- 
 tion, 75 
 in city and country, 74, 75 
 disinfection after, 208 
 due to butter, 478 
 earliest signs of, cough, 77 
 temperature, 76 
 unwarranted tire, 76 
 elements of cure for, 88, 89 
 enlargement of spleen in, 587 
 folly of leaving home without sufficient 
 
 resources, 89 
 frame of mind in, 81 
 heading off of, when suspected, 79, 80 
 history of having been thrown in close 
 
 contact with, 77 
 indications of presence of, 82, 83 
 indications of progress, of disease in, 84 
 infant's nurse with, 95 
 mode of life in, 85 
 diet, 85 
 
 medical direction, 85 
 sleep, 85 
 work, 85 
 necessity of early diagnosis, 76, 82 
 night camps for patients with, 92 
 of skin (lupus), contagiousness of, 716 
 percentage of people interested in, 86 
 
GENERAL INDEX 
 
 1345 
 
 Tuberculosis, prevention of, 71 
 progress in control of, 70, 93 
 to protect one's fellow men from, 77 
 to protect uninfected parts of one's own 
 
 body from, 77 
 relation to, of age, 74 
 of alcohol, 73 
 of chest development, 74 
 of diabetes, 72 
 of heart disease, 71 
 of inheritance, 70, 92 
 of occupation, 74 
 of pregnancy, 72 
 of race, 74 
 resistance to, 71 
 test for, 80 
 treatment of, 79 
 tuberculin for, 79 
 war against, 75, 94 
 
 Captain Baoul's example, 94 
 Tuberculosis day, 93 
 Tuberculosis surveys, 94 
 Tumors, and cancers, comparison of, 983 
 benign and malignant, 982 
 importance of prompt diagnosis of, 984 
 nature of, 982 
 no limit to growth of, 983 
 of breast, 966 
 studies being made of, 984 
 Thyroid gland, description of, 557 
 
 effect of secretion of, on rest of body, 
 
 557 
 enlargement of, conditions causing, 557 
 
 or goiter, 558 
 history of, 557 
 location of, 556 
 
 oversecretion of, or hyperthyroidism, 558 
 temporary or persistent slight under- 
 
 secretion of, or myxedema, 558 
 undersecretion of, or hypothyroidism, 
 
 558 
 undersize and undersecretion of, or cre- 
 tinism, 558 
 Typhoid bacillus, 304 
 Typhoid carriers, 304, 308 
 Typhoid fever, activity of, 315 
 and flies, 924 
 and milk, 313, 314 
 and water, 315, 316 
 blood culture in, 305 
 cause of, 304 
 complications in, 306 
 contact infection of, 313 
 
 Typhoid fever, contact of finger, 311, 313 
 
 contagion of, 311, 313 
 
 course of action, for prevention of, 
 308 
 on contraction of, 308 
 
 decrease of, 308 
 
 diagnosis of, 305, 310 
 
 diarrhea in, 305 
 
 disinfection after, 208 
 
 due to butter, 478 
 
 due to oysters, 463 
 
 effect of, on insanity, 414 
 
 enlargement of spleen in, 585 
 
 epidemics of, 313 
 
 foods causing, 311 
 
 how to get, and how to prevent, 309 
 
 immunity to, 307 
 
 importance in, of good nursing and good 
 medical care, 307, 308 
 
 in city and country, 315 
 
 incubation period of, 305 
 
 number of days allowed in figuring out 
 source of contagion, 305 
 
 old-fashioned type of, 306 
 
 onset and course of symptoms of, 305 
 
 peculiar to man, 304 
 
 preventability of, 304 
 
 rate of, winter and summer, 315, 316 
 
 spreading of, 193 
 
 transmission of, 313 
 
 by excretions from bowels and kid- 
 neys, 307, 308 , 
 
 vaccination against, 304, 308, 310 
 
 walking, 310 
 
 Widal test in, 305, 307 
 
 winter, 315, 316 
 Typhoid patches, 716 
 
 Typhus, as a disease of war and bad sani- 
 tary conditions, 326 
 
 campaign against, 326 
 
 transmission of, by lice, 326 
 Twilight sleep, danger to child in, 779 
 
 demand for, 779 
 
 method of, 778 
 
 objections to, 778 
 
 opinions on, 776-778 
 
 Ulcers of mouth, aphthous stomatitis, 968 
 cancerous, 968 
 dental, 968 
 dyspeptic, 968 
 forms of, 968 
 syphilitic, 968 
 
1346 
 
 GENERAL INDEX 
 
 Urine, routine examination of, in all con- 
 ditions throwing strain on kid- 
 neys, 620 
 testing of, forBright's disease, 627 
 
 Urticaria. See Hives. 
 
 Vaccination, against diphtheria, 237 
 
 against smallpox, 213 
 compulsory, 213 
 
 and Sir Alfred Wallace, 213, 214 
 
 and varioloid, 220 
 
 anti-vaceinationists, 225 
 
 discovery of, 222 
 
 method of, 225 
 
 result of, 224 
 
 when to vaccinate, 224 
 
 where to vaccinate, 224 
 Vaccination creed, 221, 222 
 Vaccination scar, 224 
 Vaccine, for hay fever, 52 
 
 smallpox, production of, 222 
 Varicocele, 1305 
 Varioloid, and vaccination, 220 
 
 definition of, 220 
 Vegetables, digestibility of, 486 
 Venereal diseases, 1285 
 
 and advertising doctors for men's dis- 
 eases, 1294 
 
 and blindness, 1290 
 
 and insanity, 1301 
 
 and marriage requirements, 1299 
 
 and prostitution, 1298 
 
 classification of, with contagious dis- 
 eases, 1287 
 
 epidemics of, in children's institutions 
 and hospital wards, 1288 
 
 evil effects of, 1287 
 
 figures as to prevalence of, 1293 
 
 gonococcal infections, 1286 
 in children, 1299 
 
 gonorrhea, 1288 
 
 hospital and dispensary system for, 
 1300 
 
 in New York City, 1302 
 
 innocently acquired, 1288 
 
 inherited, 1301 
 
 measures for control of, in army, 1295 
 
 peril of, 1293 
 
 prevention of, by education, 1287 
 by greater morality, 1287 
 
 public and general education on, 1287 
 
 reporting, registering and controlling 
 of, from health departments, 1287 
 
 Venereal diseases, so-called, 1286 
 
 syphilis, 1285, 1291 
 Venereal infections, gonococcal vaginitis 
 in young girls, 1288 
 pus tubes, innocently acquired, 1288 
 Ventilation, and air movement, 1151 
 and efficiency, 1145 
 and ozone, 1160 
 
 and philosophy of fanning, 1159 
 and temperature, problem of, 1147 
 and temperature of incoming air, 1157 
 by windows, 1159 
 country school, standards for, 1242 
 • diseases due to lack of, 1152 
 effect of wind on, 1158 
 effects of lack of, 1144 
 errors in, 1149 
 for fresh air duet, 1162 
 gravity, definition of, 1157, 1158 
 
 limitations of, 1158 
 importance of, in trades and industries, 
 
 1144 
 of bedroom, 1163 
 of living room, 1161 
 of offices, schools and stores, 1154 
 
 requirements for, 1156 
 poor, remedies for, 1156 
 principles now accepted as sanitary, 
 
 1151 
 reasons for failure of, 1152 
 
 in architects, 1154 
 
 in people, 1153 
 
 in sanitarians, 1154 
 
 in ventilating engineer, 1154 
 schoolroom, 1237 
 
 improvements in, 1238 
 
 Waldeyer's ring, 20 
 
 Walking typhoid, 310 
 
 Wasps, application for bite of, 920 
 
 Water supply, goiter due to, 566 
 
 Weight, reducing, 683, 684 
 
 reducing, strain of, 684, 685 
 
 scale of, according to age and height 
 for normal and obese, 679, 680 
 
 to increase, 695, 696 
 Wet air, conditions resulting from work- 
 ing in, 906 
 Wet dreams and night losses, 1304 
 Whisky, and heat, 340 
 Whooping cough, prevention of transmis- 
 sion of, 244 
 
 quarantine for, 244 
 
GENERAL INDEX 
 
 1347 
 
 Whooping cough, rules for exclusion of 
 
 children from school because of, 
 
 1252 
 Wood alcohol poisoning, preventive of, 
 
 897 
 remedy for, 897 
 symptoms of, 897 
 Work, proper adjustment between food 
 
 and, 5 
 Workday, too long, 910 
 Working under unsanitary conditions, 910 
 Workingman, duty of, in trade, 907, 
 
 908 
 
 Wounds, lessons on, from European war, 
 304 
 
 Yellow fever, army surgeons who demon- 
 strated mosquito to be carrier of, 
 264 
 
 cause of, 264 
 
 control of, 264 
 
 diagnosis of, 264 
 
 last region of, 263 
 
 onset of, 264 
 
 symptoms of, 264 
 Yellow jackets, application to bite of, 920 
 
INDEX TO QUESTIONS AND ANSWERS 
 
 Abdomen, reducing, 691 
 
 Abdominal pain, possible causes of, 38 
 
 Abortion, legal and moral right in, 786 
 
 Acetone, 162 
 
 Acidity of stomach, due to apples, 648 
 
 Acne, serum treatment for, 735 
 
 treatment of, 734 
 Acne vaccine, 734 
 Adenoids, cause of, 21 
 
 due to dryness of air, 22 
 
 prevention of, 21 
 
 removal of, 22 
 
 treatment of, 21 
 Agar, 501 
 
 definition of, 663 
 
 procuring of, and dosage, 611 
 Air, bad, effects of, 1201 
 
 dry and moist, 1203 
 
 dry, bad effects of, 1201 
 
 of high altitudes and of heated rooms, 
 
 1201, 1203 
 winter itch due to, in school children, 
 1271 
 
 humidifying of, 1203, 1206 
 Albumin in urine, as sign of Bright 's dis- 
 ease, 632 
 
 cause of, 632 
 Alcohol and rheumatism, 152 
 
 and whisky, 342 
 Alcohol habit, cures for, 343 
 
 nature and cure of, 342 
 
 periodic, 342 
 Amenorrhea, case of, 1281 
 
 definition of, 784 
 Agina pectoris, probable case of, 599 
 Ankles, weak, aid for, 850 
 Antikamnia and codein tablets, danger of 
 
 use of, 334 
 Ants, to get rid of, 944 
 Aorta, leaky, avoiding "remedy" for, 599 
 Apoplexy, accompanying high blood pres- 
 sure and chronic Bright 's disease, 
 632 
 
 and meat, 615 
 
 Apoplexy, cause of, 615 
 
 in families, 615 
 
 prevention of, 615 
 Appendicitis, chronic, and diet, 649 
 Arteriosclerosis, and interstitial nephritis, 
 631, 632 
 
 cause and treatment of, 603 
 Arthritis, definition of, 152 
 
 rheumatoid. See Rheumatoid arthritis 
 Aspirin, habit of, 337 
 Aspirin tablets, for headache, 449 
 Asthma, and air, 44 
 
 as symptom of heart or kidney disease, 
 44 
 
 associated with goiter, 44 
 
 bronchial, climate for, 45 
 curability of, 45 
 
 curability of, 45 
 
 dependent on cause, 45 
 
 incipient, to prevent becoming chronic, 
 44 
 
 not form of tuberculosis, 44 
 
 resulting from hay fever, 54 
 
 shortness of breath and, 45 
 Astigmatism, glasses for, 130 
 
 Babies, avoidance of drugs for, 835 
 bowlegs in, causes of, and remedy for, 
 
 839 
 broken tooth, 833 
 carriages for, 839 
 climate of southern California for, 
 
 833 
 colic in, treatment of, 835 
 constipation in, fruit for, 837 
 cross-eyed, correction of, 834 
 dandruff on head of, 836 
 feeding of, advice on, 836 
 
 amount of certified milk to be given 
 in twenty-four hours to 6-month- 
 old infant, 839 
 boiled milk, 837 
 fruit, 837 
 improper, 837 
 
 1349 
 
1350 
 
 INDEX TO QUESTIONS AND ANSWERS 
 
 Babies, feeding of, measures to enable 
 nursing of, 833, 838 
 potatoes, 857 
 when breast fails, 837 
 
 giving of saccharine to, 834 
 
 gritting of teeth by, 840 
 
 left-handedness in, 835 
 
 measurements for, at 32 months, 833 
 
 overfeeding of, 838 
 
 passing of undigested food in, 834 
 
 second summer of, 836 
 
 shape of heads of, 832 
 
 sleeping out of doors all year round, 
 835 
 
 sleeping with older people, 835 
 
 soft spot on head of, 832 
 
 sty in, cause, prevention and treatment 
 of, 840 
 
 thumb-sucking in, 840 
 
 uninterrupted sleep for, 833 
 
 weaning of, and "the sign of the 
 moon," 838 
 on becoming pregnant, 838 
 time for, 838, 839 
 Bacillus Bulgaricus, in diabetes, 161 
 Backache, causes of, 162 
 "Bad habits," disease of, 652 
 Baked beans, as a food, 503 
 Baldness, covering head in cold weather, 
 757 
 
 in men and women, 756 
 
 in spots, causes of, 758 
 Bananas, food value of, 347 
 Barber's itch, treatment for, 724 
 Bathrooms, keeping clean, 1142 
 Bedbugs, ridding community of, 944 
 Bedrooms, sunlight in, 1141, 1142 
 Belching, and nervousness, mental hygiene 
 for, 654 
 
 cause of, 653 
 
 excessive, 654 
 Bicarbonate of soda, use of, 652 
 Birth, best time of year for, 189 
 Birth marks, 1020, 1024 
 
 See also "Marking," prenatal. 
 Blackheads, alcohol for, 735 
 
 treatment of, 733 
 Bleeding gums, causes of, 752 
 
 conditions indicated by, 750 
 Blindness, and heredity, 1021, 1022 
 
 infant, cause of, 128, 129 
 
 oncoming. See Sight, failing. 
 
 prevention of, at time of birth, 129 
 
 Blood, spitting of, from nose, 14 
 Blood builders, 499 
 Blood pressure, and anemia, 610 
 and paralysis, 608 
 high, 600, 601 
 
 and interstitial nephritis, 631, 632 
 at forty, 610 
 cause and effect of, 609 
 conditions caused by, 608 
 symptoms of, 610 
 treatment for, 609, 610 
 normal, 608, 610 
 Bloodshot eyes, 129, 130 
 Bloody discharge, from mouth, while sleep- 
 ing, 753 
 "Blue" baby, 793 
 Boils, cause of, 732 
 treatment of, 733 
 Boric acid solution, directions for use of, 
 
 in infant's eyes, 129 
 Bowel obstruction, 660 
 Bran, for constipation, 661 
 
 for human food, 501 
 Bran gems, for constipation, 503 
 
 recipe for, 661 
 Brass chills, 908 
 Breast nodules, 977, 978 
 Breath, of dyspeptic, 645 
 
 shortness of, due to asthma, 45 
 Breathing, deep, exercises for, and benefit 
 of, 1083 
 mouth. See Mouth breathing. 
 Bright 's disease, and diabetes, 636 
 and salt, 635 
 and water, 631 
 diet for, 631, 632 
 incurable case of, 633, 634 
 symptoms of, 632 
 treatment for, 632, 633 
 Broken arch, relief for, 772 
 
 remedy for, 768 
 Bronchitis, chronic, change of climate for, 
 43 
 curability of, 45 
 
 due to underlying cause, 45 
 coughing up of gray pus with, 43 
 treatment of, 47 
 Buckwheat cakes, nutritive value of, 
 
 650 
 Burning leaves, 1222 
 Bunions, and corns, relief for, 772 
 cure for, 769 
 easy shoes for, 770 
 
INDEX TO QUESTIONS AND ANSWERS 
 
 1351 
 
 Butter, annatto coloring in, 503 
 
 and olive oil, relative food values of, 
 
 338 
 daily ration of, 339 
 Butterine, and butter, 500 
 
 to distinguish, 500 
 Buttermilk, 502 
 
 and arteriosclerosis, 608 
 and sweet milk, as articles of diet, 
 544 
 relative nutritive value of, 545 
 and weight, 692 
 disagreeing with one, 546 
 fattening effect of, 697 
 for intestinal putrefaction, 546, 608 
 formula for, 546 
 length of time remaining fit to drink, 
 
 545 
 not an infant's food, 545 
 relative value of freshly churned or ar- 
 tificially soured, 545, 546 
 value of, 546 
 Buttermilk tablets, 501, 502 
 
 Caffein, danger of, as stomach and nerve 
 
 bracer, 336 
 Cancer, and contagion, 979 
 and fish, 980 
 and heredity, 979 
 and pork, 981 
 
 and senseless worry about, 978 
 and x-ray, 979 
 cause of, 978 
 
 injury as contributing cause of, 978 
 length of time for development of in- 
 ternal, 979 
 need of knowledge of, 980 
 of bladder, 980 
 
 of breast, and operation, 976, 977 
 causes of, 978 
 when to judge of, 981 
 of stomach, salts of potash for, 979 
 symptoms of, 977, 979 
 Cancerous growth on face, 976 
 Candy, concentrated food, and when to 
 avoid, 504 
 giving of, to children, 849 
 Canker sores, and diet, 752 
 Carbuncles, cause of, and treatment for, 
 
 733 
 Cataract, dissolving treatment for, 126, 
 131 
 operation for, 130 
 
 Catarrh, advertised remedies for, 36 
 
 as a symptom, 36 
 
 bad breath due to, 36 
 
 chronic, meaning of, 35 
 
 nasal, and weak eyes, 36 
 vaccine for, 36 
 
 of head, meaning of, 36 
 
 of stomach, 647 
 
 spraying of nose for, 35 
 
 treatment of, 36 
 Catarrh snuffs, danger of, 350 
 Catarrhal jaundice, cause of, 727 
 Cerebrospinal meningitis and infantile 
 
 paralysis, 256 
 Cerebral hemorrhage. See Apoplexy. 
 Change of life, artificial, 789 
 
 hot flashes and mental condition of, 794 
 
 symptoms of, 1280 
 
 thirty-eight too young for, 1281 
 Chapped hands, 728 
 
 cure for, 728 
 Chest, pain in, 14 
 Chest expansion, exercise for, 1049 
 Chickenpox and smallpox, 221 
 Chicken-breastedness, exercise for, 1055 
 Chiggers and butter, 948 
 Chilblains, treatment for, 768, 770 
 Childbearing, and build, 782 
 
 and diseased ovaries, 1284 
 
 and gonorrheal infection, 782 
 
 and nervousness, 784 
 
 at forty-eight, 787, 794 
 
 at forty-three, 786, 791 
 
 at thirty-eight, 790 
 
 at thirty-nine, 793 
 
 no age limit for, 782 
 
 menstruation six weeks after, 791 
 Children, and contagious diseases, 852 
 
 bilious attacks in, 854 
 
 candy for, 849 
 
 celluloid toys for, danger of, 856 
 
 chafing and irritation in, 855 
 
 cleft palate in, 857 
 
 daily bath for, 850 
 
 earache in, 855 
 
 eating of mud, cause and treatment of, 
 856 
 
 eating of starch, 856 
 
 feeding of, after measles and mumps, 
 850 
 and economy, 853 
 at one year of age, 857 
 at four years of age, 855 
 
1352 
 
 INDEX TO QUESTIONS AND ANSWERS 
 
 Children, feeding of, bananas, 855 
 potatoes, 857 
 promiscuously, by other people, 855 
 
 fitful sleeping in, 851 
 
 giving of calomel to, 854 
 
 growing pains of, 854 
 
 harelip in, cure for, 858 
 
 needlessness of contagious diseases in, 
 852, 853 
 
 night sweats in, 850 
 
 nodding spasm in, 857 
 
 sleep for, 856 
 
 sniffling habit in, 854 
 
 sugar for, 849 
 
 worms in, cause of, 834 
 Chin truss for mouth breathing, 19 
 Cholera, and flies, 942 
 
 winter, and typhoid fever, 319, 320 
 Circumcision, advisability of, 670 
 
 and length of time disabled by, 1311 
 Cleft palate in children, 857 
 Climate, change of, beneficial for bron- 
 chitis, 43 
 Coca Cola habit, 361 
 
 danger from person addicted to, 338 
 Cocain habit, cure for, 338 
 
 danger of hay fever sprays, 339 
 Codein, and morphin, 336, 337 
 
 danger of, 336 
 Codein tablets, danger of use of, 334 
 Coffee, and caffein, 360 
 
 and fatigue, 359 
 
 and nervousness, 361 
 
 and sleep, 359 
 
 and tobacco, 360 
 
 effect of, 361 
 
 harm from, 360 
 
 over-stimulation of, 359 
 
 with cream and sugar, 360, 361 
 Colds, and ventilation, 1170 
 
 care of, 34 
 
 cause and cure of, 33, 34 
 
 contagious nature of, 33 
 
 frequency of, due to habits, 33 
 
 in children, treatment of, 852 
 
 in head, treatment of, 32 
 chronic, 32 
 
 prevention of, 33, 34 
 
 to cure, 32 
 
 treatment of, 33, 34 
 
 vaccination for, 608 
 Cold feet, exercise for, 1053 
 Cold hands and feet, 392 
 
 Cold sores. See Ulcers of mouth. 
 Colitis, diet for, 543 
 
 due to appendicitis, cured by operation 
 for, 608 
 Complexion, bad, cause of, 727 
 Conception, between menstrual periods, 
 1285 
 occurrence of, before menstruation, 782 
 Constipation, and drinking of water, 659 
 and pregnancy, 659 
 bran gems for, 503 
 calomel and castor oil for, 659 
 chronic, and diet, 649 
 
 treatment of, 658, 659 
 food in, 662 
 
 from bowel obstruction, 660 
 grapes for, 500 
 in young children, 659 
 internal bath for, 657 
 laxatives for, 660 
 not caused by liver, 658 
 patent medicines in, 663 
 treatment of, 645, 660 
 bran, and agar, 661 
 
 uncooked, 662 
 bran bread, 661 
 bran gems, recipe for, 661 
 enemas, 662 
 flaxseed, 662 
 oatmeal, 660 
 paraffin oil, 663 
 pumpernickel, 661 
 senna, 660 
 suggestion for, 662 
 wheat, 660 
 wheat bran, 661 
 when to seek medical advice, 662 
 Contagion, danger of, from clothes of party 
 coming from sick room, 206 
 from passing money or touching ob- 
 jects touched by persons with, 
 206 
 in regard to scarlet fever, diphtheria 
 and similar diseases, 206 
 vigilance against, price of safety, 206 
 Contagious diseases, and children, 852 
 barring child from school, 205 
 laws preventing traveling of persons 
 
 with, 246 
 needlessness of, for children, 852, 853 
 whooping cough, 243 
 Corns, and bunions, relief for, 772 
 and electricity, 769 
 
INDEX TO QUESTIONS AND ANSWEES 
 
 1353 
 
 Corns, and nitric acid, 768, 769 
 
 easy shoes for, 770 
 Cottonseed meal, nutritional value of, 504 
 Cottonseed oil and olive oil, 504 
 Cough, chronic, 43 
 
 due to chronic bronchitis, and change 
 of climate for, 47 
 coming on when exposed to drafts or 
 
 air, 633 
 due to bronchitis, 43 
 due to goiter, 43 
 raising of gray pus with, 43 
 Coughing in theaters, reason for, 1171 
 Cramps, exercise to prevent, 1054 
 
 in swimming, remedy for, 1083 
 Cretinism, definition of, 1017 
 distinguished from idiocy, 1017 
 length of life in, 575 
 treatment for, 575 
 Croup, and diphtheria, 239 
 nature and symptoms of, 238 
 possible causes of, 238, 239 
 Crying, continued, cause and effect of, 
 
 849 
 Cuban itch, 221, 724 
 Curvature, of legs, due to rickets, 189 
 of spine, 97 
 
 and child bearing, 98, 190, 191 
 and marriage, 97, 98 
 causes of, 97 
 due to rickets, 190 
 Cystic tumor, 986 
 
 Dandruff, causes of, 128 
 
 definition and treatment for, 757 
 
 removal of, 757 
 
 treatment of, 128 
 Deafmutism, and heredity, 1025 
 
 and intermarriage, 1025 
 Deafness, and catarrh, 139 
 
 and coffee, 139 
 
 approaching, warding off of, 138 
 
 due to running of ears, 139 
 
 in one ear, due to perforated ear drum, 
 137 
 
 partial, heredity of, 138 
 Death rate, diminishing, and improved 
 
 hygiene and sanitation, 499 
 Debility, general, advice for, 359, 360 
 
 hyponuclane tablets for, 388 
 Dementia precox, definition and relief for, 
 
 417 
 Dental tools, unclean, 751 
 
 Diabetes, and age, 163 
 
 and " Bacillus Bulgaricus, ' ' 161 
 
 and bread, 163, 164 
 
 and Bright 's disease, 636 
 
 and diet, 162, 163 
 buttermilk, 163 
 
 and heredity, 162, 163 
 
 and liver, 162 
 
 and medicine, 161 
 
 and saccharin, 163, 164 
 
 and tuberculosis, 98 
 
 cause and amount of sugar in urine, 162 
 
 cause and treatment of, by diet, 160, 161 
 
 cause of, most general, 162 
 
 curability of, 161, 162, 163, 164 
 
 diet for, 160, 161 
 
 first symptoms of, 609 
 
 length of life with, 161 
 
 loss of flesh in, 161 
 
 nature of, 163 
 
 progress of, 162 
 
 stage of acetone, 162 
 
 symptoms of, 162 
 final, 162 
 first stages, 163 
 
 teeth in, 164 
 
 use of term, 162 
 Diabetic bread, 164 
 Diarrhea, winter, and typhoid fever, 319, 
 
 320 
 Diet, mixed, 500 
 
 vegetable and milk, 500, 501 
 Diphtheria, and croup, 239 
 
 carriers of, 238 
 
 epidemic of, in school, 1271 
 
 transmission of, 238 
 by animals, 238 
 Diphtheria bacillus, to "get rid of," 239 
 Dirt bands on ceiling, cause of, 1212 
 Discharge from ovary, due to leukorrhea, 
 
 1281 
 Discharging ear, meaning of, 242 
 Disease, transmission of, through cigar 
 
 ends, 349 
 Disinfection, after scarlet fever, 232, 233 
 
 of pantries, by formalin, method of, 203 
 Dizziness, after eating, 449 
 Dog bites, 302 
 Dreaming in children, 851 
 Dreams, cause of, 410, 411 
 
 effect of, 386 
 
 mental training for, 411 
 
 nightmares, cause and treatment of, 412 
 
1354 
 
 INDEX TO QUESTIONS AND ANSWEES 
 
 Drink habit. See Alcohol habit. 
 Dropsy, and heredity, 636 
 cause of, 636 
 cure of, 636 
 Drug habit, formation of, by codein tablets 
 or antikamnia and codein tablets 
 for headache, 334 
 moral degeneration from, 337 
 Drunkenness, periodic, 342 
 Dry air, winter itch due to, in school 
 
 children, 1271 
 Dust, danger from, 908 
 Dysentery, raw milk prohibited in, 540 
 
 Earache, due to tonsillitis, remedy for, 138 
 in children, 855 
 
 suppuration of middle ear, caused by 
 infection from tonsils or adenoids, 
 138 
 treatment of, by hot salt bag to ear, 
 138 
 Ear drum, perforated, apparatus for, 137 
 due to infection in early childhood, 
 137 
 Ears, custom of putting cotton in, on re- 
 tiring, 138 
 ringing in, 162, 163 
 
 cause and treatment of, 139, 140 
 running of, cause and danger of neglect 
 of, 138, 139 
 deafness due to, 139 
 throbbing in, due to Meniere's disease 
 and other causes, 139 
 Eczema, and cleanliness, 717 
 and muriatic acid, 718 
 cause of, theories on, 718 
 definition of, 720 
 flour, 721 
 noncontagious, 718 
 of head, in babies, treatment of, 717, 
 
 718 
 of scalp, treatment of, 719, 721 
 recurrence of, 718 
 seborrheic, treatment of, 719, 721 
 transmission of, 718 
 treatment for, 718, 720 
 Eggs and cream, acting as physic, 501 
 Electric, treatments and massage, for weak 
 
 muscles, 1054 
 Empyema, definition and nature of, 68, 69 
 English disease. See Eiekets. 
 Enlargement, of glands, Bobo's cure for 
 goiter, 570 
 
 Enlargement, of glands, of neck, causes 
 and treatment of, 101, 102 
 
 of liver, and diet, 156 
 Epidemics of scarlet fever, control of, 
 
 203, 204 
 Epilepsy, and "worm spasms," 429 
 
 curability of, 428, 429, 430 
 
 institutions for care of, 430 
 
 states containing colonies for, 429 
 
 treatment of, 428, 430 
 by rattlesnake venom, 429 
 Erections in children, 1312 
 Ergot, and miscarriage, 1285 
 
 effect of, 1024 
 
 nature of, 1285 
 Eugenics, advice on, 1023 
 
 and blindness, 1021, 1022 
 
 and deafmutism, 1025 
 
 and difference in age, nationality and 
 physique, 1020, 1021 
 
 and marriage of cousins, 1018, 1019, 
 1021, 1022 
 doubly related, 1022 
 
 and marriage of niece and uncle, 1022 
 
 and size of family, 1017, 1018, 1019 
 
 and twins, 1024 
 
 definition of, 1020 
 
 literature on, 1023, 1025 
 
 Mendel theory of, 1023 
 
 seriousness of, 1025 
 Eugenics Laboratory, service of, 1023 
 Evaporated milk, 500 
 Exercise, after operation, 1052 
 
 and fatigue, 1049 
 
 bathing, and minimum temperature for 
 lake bathing, 1055, 1056 
 and reaction, 1056 
 
 before breakfast, 1054 
 
 bicycle riding, 1052 
 
 effect of, on figures of women, 1052 
 
 for blind spells and dizziness, 1058 
 
 for chest expansion, 1049 
 
 for chicken-breastedness and prominent 
 right shoulder blade, 1055 
 
 for cold feet, 1053 
 
 for keeping in prime condition, 1053 
 
 for muscle, 1049 
 
 for students, 1050 
 
 for tired feeling, 1049, 1052 
 
 for too frequent yawning, 1057 
 
 gymnastic dancing, 1051 
 
 horseback riding, 1050 
 
 horseback riding astride, 1051 
 
INDEX TO QUESTIONS AND ANSWEBS 
 
 1355 
 
 Exercise, in middle age, 1057 
 
 in open air, and nervousness, 1050 
 
 motorcycling, 1049 
 
 out of doors, 1055, 1057 
 
 overdose of, 1050, 1055 
 
 roller skating, 1056 
 
 rowing, 1055 
 
 running, 1054 
 
 skating, 1051 
 
 swimming, 1054, 1055 
 
 tennis, 1051 
 
 to develop arms, 1051, 1052 
 
 to increase weight, 1052 
 
 to prevent cramps, 1054 
 
 to strengthen ankle, 1057 
 
 walking, 1056 
 Expectoration of clear mucus, 163 
 Eye drops for baby, directions for, 129 
 Eyelids, granulated, 128 
 Eyes, astigmatism of, 130 
 
 bloodshot, 129, 130 
 
 closed ducts of, 130 
 
 floating spots before, 128 
 
 infants', directions for using eye drops 
 in, 129 
 
 rings before, 128 
 
 senile changes in, 131, 132 
 
 styes, 131 
 
 watery, 130 
 Eye-strain, 132 
 Eyewashes, 131 
 
 Faintness and weakness, causes of, 162 
 Falling womb, operation for, 788 
 Families, size of, and eugenics, 1017, 1019 
 Fasting, to reduce weight, 501 
 
 until noon, 501 
 "Fattening up," 19 
 Fears, sudden, advice for, 390 
 Feet, aching, 767 
 
 and hands, cold, 772 
 
 and high heels, 769 
 
 burning, 767 
 
 cold, causes of, 771 
 treatment of, 772 
 
 itching, 771 
 
 perspiring, 769 
 
 and mattering between toes, 771 
 
 sore, cure for, 773 
 
 swollen, 774 
 
 tender, 769 
 Fever blisters, cause of, 721 
 Fibroid lungs, 106 
 
 Fibroid tumors, and radium, 788 
 
 exterior to uterus, 986 
 
 nature of, 787 
 
 operation for, 788 
 
 treatment for, 787 
 Finger ends turning white, 582 
 Finsen method of nonactinic light as cure 
 
 for smallpox, 220 
 Fish and cancer, 980 
 Fistula and tuberculosis, 98 
 Flat-dwellers, beating of rugs on back 
 
 porches, 1129 
 Flat feet, aid for, 770 
 
 reason for, 770 
 
 shoes for, 773 
 Fleas, to get rid of, 944 
 Fletcherizing and pyorrhea, 751, 754 
 Flies, and cholera, 942 
 
 and electric mixers, 946 
 
 and fly traps, duty of city, 946 
 
 barring of, from manure, 943 
 
 formula for iron sulphate prepara- 
 tion for, 943 
 
 fungus on, 944 
 
 in screened porches, 943 
 
 removing of screens, 945, 946 
 
 ridding basement of, 943 
 
 ridding community of, 942 
 
 small, plague of, 942 
 
 smudge plan to kill, 943 
 Floating kidney, facts about, 635 
 Floating spots before eyes, 128 
 Flour bugs, elimination of, 840 
 Flyless Havana, 945 
 Food, bulk of, 501 
 
 kept in refrigerators, 347 
 Foods, eating organs of animals to 
 strengthen corresponding organs 
 in people, 499 
 Foodstuffs, feeding of certain organs by 
 
 certain foods, 505 
 Foot and mouth disease, prevalence of, 
 324, 325 
 
 procedure on recovering from, 324 
 Fruit, dried, 503 
 Fumigation, after tuberculosis, 212 
 
 by sulphur fumes, for insect life, 211 
 
 directions for, 209, 210, 211 
 
 hydrocyanic gas for, 211 
 
 of book, 211 
 
 of cars, 211, 212 
 
 of filthy houses recently occupied, 209, 
 210 
 
1356 
 
 INDEX TO QUESTIONS AND ANSWERS 
 
 Fumigation, unnecessary, 211 
 
 with permanganate of potash and for- 
 maldehyd, directions for, 210 
 Furnace heat, treatment of, 1187 
 Furnace troubles, 1188, 1192 
 
 Garbage, as compost, 1222 
 
 disposal of, 1222 
 Garbage cans, burning out of, 1222 
 Gas heaters, chronic headaches due to, 1187 
 Gas ranges and fresh air, 1191 
 German measles, and common measles, 243 
 
 contagion of, 243 
 
 isolation for, 243 
 
 period of incubation of, 243 
 Girth, reducing, 691 
 
 Glands, of neck, enlargement of, causes 
 and treatment of, 101, 102 
 
 tubercular, 105 
 Glauber salts, 36 
 Gleet, cure of, 1310 
 
 Glycerin, composition and effect of, 633 
 Goiter, and children, 572 
 
 and contagion, 574 
 
 and marriage, 572 
 
 and operation, 575 . 
 
 and thyroid extract, 574 
 
 and water, 573 
 
 Bobo's cure for, 570 
 
 causes of, 573, 574 
 
 cough due to, 43 
 
 diminished, 573 
 
 indication for operation for, 573 
 
 treatment of, 572, 574 
 by medicine, 575 
 by operation, 571, 573 
 by sheep serum of antithyroidin, 571 
 Goiter heart, 574 
 Gonorrhea, and childbearing, 782 
 
 contagiousness of, 1310 
 
 neglected, 1310 
 
 not inheritable, 1310 
 
 with few symptoms, 1310 
 Gonorrheal rheumatism, 1310 
 Gout, and diet, 156 
 
 and rheumatism, 156 
 
 lumpy fingers due to, 156 
 Graham flour and whole wheat flour, 650 
 Granulated lids, meaning of, 128 
 Grapefruit, before breakfast, 506 
 
 with milk, 539 
 Grapes, eating of seeds, skin and pulp, 500 
 
 food value of, 500 
 
 Grapes, for constipation, 500 
 Graves' disease, 573 
 Grip, transmission of contagion, 210 
 Growing pains of children, 854 
 Growth in breast, 981, 986 
 
 with pain at intervals, 985 
 
 without pain, 985 
 Growths, operation for, and its effects, 
 
 788 
 Gum-chewing, effects of, 651 
 Gums, and lime water, 754 
 
 sore, 753 
 
 soreness and bleeding of, and falling 
 away from teeth, 184 
 
 tumor of, 753 
 Gymnastic dancing, 1051 
 
 Hair, care of, 757 
 
 dyes for, 759 
 
 falling, growing in light, 756 
 
 gray, 758, 759 
 
 premature graying of, 759 
 
 promoting growth of, by salt on scalp, 
 756 
 
 superfluous, 757 
 
 thin, 758 
 Hair tonic, cantharides in, 760 
 
 sage tea and sulphur for, 731 
 Hardening of arteries, blood pressure in, 
 601 
 
 cause and treatment of, 602 
 
 nitroglycerin for, 608 
 
 premature, 603 
 
 prevention of, 601 
 
 symptoms of, 604 
 
 tissue change in, 602 
 
 treatment of, 604 
 
 water in, 602 
 Harelip in children, cure for, 858 
 Hay fever, antitoxins for, 53 
 
 asthma resulting from, 54 
 
 causes of, 53 
 
 cures for, climate and serum, 54 
 
 no physical danger from, 53 
 
 sprays for, containing cocain, and dan- 
 ger of, 339 
 
 vaccines for, 53 
 Head noises, 138 
 Headaches, and aspirin tablets for, 449 
 
 and paraffin oil, 449 
 
 causes of, 447 
 
 chronic, due to gas heaters, 1187 
 
 coal tar products for relief of, 448 
 
INDEX TO QUESTIONS AND ANSWERS 
 
 1357 
 
 Headaches, danger of codein tablets or anti- 
 kamnia and codein tablets for, 334 
 from stomach, suggestions for, 447 
 kinds of, and medical advice for, 139 
 lemon and salt not preventive of, 448 
 medicines for, free distribution of, for- 
 bidden by law, 448, 449 
 sick (migraine), 446, 447 
 causes of, 447 
 relief for, 448 
 with tired feeling and temperature, sig- 
 nificance of, in small boy, 1273 
 Heart, and altitude, 595, 609 
 
 leaking, definition and symptoms of, 593, 
 
 594 
 nervous. See Nervous heart, 
 palpitation of, 596 
 weak action of, in small boy, 853 
 Heart beats, irregular, 598 
 
 rapid, 391 
 Heart disease and rheumatism, 609 
 Heart leakage, and tobacco, 348 
 
 heart specialist recommended for, 594 
 Heart murmur, 594, 600, 601 
 Heart sounds, 597 
 Heart symptoms, 601 
 Heart trouble, 595 
 and marriage, 599 
 in sixteen-year-old boy, 600 
 Heartburn, cause and cure of, 649 
 Heat, furnace, treatment of, 1187 
 Heating, and furnaces lacking capacity, 
 1188 
 and steam heat itch, due to low humid- 
 ity, 1192 
 for flats, 1191 
 by gas stove, 1192 
 hot water or steam as means of, 1166 
 outside air necessary in, 1189 
 recirculating system, 1191 
 ventilation and humidifying indoor air, 
 idea for, 1189 
 Heels, high, 769 
 
 Height, increasing of, 1071, 1072 
 and thyroid, 1071 
 in children, 858 
 rules for, 1072 
 Hemophilia and heredity, 611 
 Henoch's spasm of head, 857 
 Heredity and deaf-mutism, 1025 
 Hernia, and life insurance, 668 
 and marriage, 669 
 and pregnancy, 791 
 
 Hernia, cause of, 668 
 
 condition after operation for, 668 
 double, treatment of, 669 
 in infant, 670 
 operation for, 670, 671 
 second operation for, 669 
 treatment of, operative, 669 
 band or truss, 669, 670 
 by lymphol, 670 
 truss or operation, 670 
 Heroin, danger of, 336 
 
 derived from opium, 336 
 Hives, cause of, 736 
 
 and treatment of, 737 
 cure of, 736 
 prevention of, 736, 737 
 treatment of, 736 
 Hoarseness, cause and treatment of, 38 
 Hodgkin's disease, incurability of, 553 
 
 symptoms of, 553 
 Horseback riding, 1050 
 astride, 1051 
 
 during menstruation, 1282 
 Housing, bad conditions of, 1120 
 House, unsanitary conditions in, 1140 
 Humidifier, 1203, 1206 
 
 Humidity, and hot water radiators, 1210 
 and radiators, 1204 
 approximating, by hygrometers, 1208 
 arrangement for, 1200 
 electric spray device for attaining 
 
 proper degree of, 1203 
 good compromise in, 1204 
 humidifier for attaining proper degree 
 
 of, 1203 
 ideal, 1200 
 
 increasing of, 1203, 1206, 1207, 1210 
 by pans, 1208 
 
 in hot water heated room, 1207 
 in steam heated room, 1203, 1206 
 minimum register for, 1208 
 need of, 1208 
 
 relative, of high altitudes and of heated 
 rooms, 1201 
 Humidometer, 1208 
 Hydrocele or rupture, 1311 
 Hydrophobia, and dog bites, 302 
 
 and milk, 302 
 Hygrometer, 1208 
 
 to make, 1208, 1209 
 Hyponuclane tablets, for enriching blood, 
 
 388 
 Hysteria in young boy, advice on, 390 
 
1358 
 
 INDEX TO QUESTIONS AND ANSWERS 
 
 Ice, danger from, when taken from body 
 
 of water receiving sewage, 221 
 Ice box, stationary porcelain tub used for, 
 
 1141 
 Ice cream, poisoning from, 543 
 Ichthyosis, questions on, 732 
 Idiocy, distinguished from cretinism, 1017 
 Impotency, partial, remedy for, 1313 
 Indigestion, cure for, 647 
 
 irregular pulse due to, 643 
 Infantile paralysis, a germ disease, 255 
 
 and cerebrospinal meningitis, 256 
 
 and clothing, 255 
 
 and meningitis, 255 
 
 care of, 256 
 
 cause of increasing frequency of, 256 
 
 control of, 256 
 
 duration of infectious period of, 255 
 
 infectious nature of, 255 
 
 nose secretion main factor in spread of, 
 255 
 
 preventive measures, 255 
 
 quarantine for, 256 
 Infantile uterus, cause and effect of, 787 
 
 remedy for, 787 
 Ingrowing nail, treatment for, 725 
 Injuries, massage and exercise for, 1056 
 Insanity and marriage, 414 
 Insects in flour, 945 
 Insomnia, and coffee, 359 
 
 and mind, 387 
 
 and nervous prostration, cure for, 387, 
 388 
 
 cause and remedy for, 410 
 
 danger of taking sleeping powders for, 
 336 
 
 danger of taking veronal for, 336 
 
 danger of using drugs for, 409 
 
 distinguished from disease, 411 
 
 due to nervousness, advice for, 391, 392 
 
 training of mind as remedy for, 409, 410 
 
 warning against taking of drugs for, 334 
 Intermarriage, 1018, 1019, 1021, 1022 
 
 and deafmutism, 1025 
 Internal bath for constipation, 657 
 Intestinal indigestion, 647, 650 
 
 or intestinal fermentation, 645, 646 
 Intestinal putrefaction, diet for, 649 
 Itch, barber's, treatment for, 724 
 
 bath, and relief for, 724 
 cure for, 725 
 
 Cuban, 724 
 
 definition and manifestations of, 723 
 
 Itch, due to steam heat and insufficient 
 moisture in air, 1210 
 
 winter, 723 
 Itching, after bathing, 719 
 
 and festering, between toes, 719 
 
 cause of, 723 
 
 palliative for, 723 
 
 Jiggers, and butter, 948 
 
 application for pain and irritation due 
 to, 948 
 
 Kernels in neck of children, 849 
 Kidney disease and meat, 499 
 Kidney medicines, 636 
 Kidney trouble and diet, 162 
 Kidneys, and continued sitting, 162 
 
 and fruit and sugar, 162 
 
 loss of one, and its effect, 633 
 
 stone in, 634 
 
 use of, 634 
 Kitchen sinks, keeping clean, 1142 
 
 Laceration due to childbirth, 790 
 Lead poisoning, case of, in painter, 909, 
 910 
 cause of, 910 
 Leprosy, prevention of, 300 
 
 study and probable solution of, 300 
 Leukorrhea, 1281 
 cause of, 791 
 
 and care of, 100 
 cure for, 1282 
 results of, 1282 
 Lice, head, to get rid of, 947 
 Lighting, poor, in hotels and rooming 
 
 houses, 1142 
 Lip reading, advantages of, for persons 
 with approaching deafness, 139 
 information regarding, from Volta Bu- 
 reau, 139 
 Liquor habit. See Alcohol habit. 
 Listlessness, examination for cause of, 389, 
 
 390 
 Liver, sluggish, 648 
 Liver spot, 727 
 Lump on neck, 730 
 Lumpy fingers, due to gout, 156 
 Lungs, development of, in child with tu- 
 bercular history, 19 
 effect on, of removal of tonsils, 19 
 fibroid, 106 
 Lupus of nose, cure for, 102 
 
INDEX TO QUESTIONS AND ANSWEES 
 
 1359 
 
 Lymphatic glands, enlargement of, due to 
 tonsils or tuberculosis, 553 
 under chin, 554 
 under jawbone, 554 
 of neck, enlargement of, 554 
 swollen, on neck, near ear, 554 
 
 .Malaria, and stable odors, 284 
 
 and substitute for sewers, 284 
 
 and typhoid fever, 284 
 
 and weeds, 283 
 
 as a bar to progress, 283 
 
 blood examination for germs of, 284, 
 286 
 
 control of, 284 
 
 curability of, 284 
 
 quinin for, daily allowance of, 286 
 effects of, 286 
 
 severe headache about same time each 
 week, 284, 286 
 
 symptoms of, in absence of chill, 284, 
 286 
 Marking, prenatal, 783, 832, 1016, 1017 
 Marriage, and childbearing, at forty- 
 eight, 787 
 at forty-three, 786 
 
 and disparity in ages, 789, 1283 
 
 and goiter, 572 
 
 and heart trouble, 599 
 
 and insanity, 414 
 
 and neurasthenia, 399, 400 
 
 and paralysis agitans, 431 
 
 and self -abuse, 1284 
 
 for woman of forty-two, 1284 
 
 of cousins, 1018, 1019, 1021, 1022 
 
 of cousins doubly related, 1022 
 
 of niece and uncle, 1022 
 
 of second cousins, 1021 
 Massage, and electric treatments, for weak 
 muscles, 1054 
 
 and exercise, for injuries, 1056 
 Masturbation, in children, 1312 
 
 See also Self-abuse 
 Meals, liquids with, 501, 505 
 
 number of, a day, 650, 651 
 
 water with, 505 
 Measles, and open windows, 242 
 
 contagion of, from nurse, 242 
 
 from room occupied by patient, 242 
 time of, 242 
 
 control of, 240, 241 
 
 conveyance of, by third person, 241, 242 
 
 duration of isolation for, 24a 
 
 Measles, fumigation after, 242 
 
 immunity and susceptibility to, 242 
 
 not a universal disease, 240 
 
 period of incubation of, 242 
 
 quarantine rule for workers in same 
 house with, 205 
 Meat, and apoplexy, 615 
 
 and kidney irritation, 499 
 
 salt, 648 
 Melancholia and operation, 414 
 Memory, training of, 387 
 Meniere's disease, curability of, 139 
 
 explanation and symptoms of, 139 
 Meningitis and infantile paralysis, 255 
 Menorrhagia, case of, 1280 
 Menstruation, absence of, or amenorrhea, 
 1281, 1282 
 
 and horseback riding, 1282 
 
 after curettement for miscarriage, 791 
 
 bathing during, 1280 
 
 during pregnancy, 791, 792 
 
 excessive, or menorrhagia, advice for, 
 1280, 1281 
 
 normal, 1281 
 
 scanty, 1281 
 
 and pregnancy, 1282 
 
 six weeks after childbirth, 791 
 Mental disorders, treatment for, 390, 
 
 391 
 Mentality, poor, and self-abuse, 1312 
 Migraine, nature of, and cure for, 447, 448 
 Milk, and flesh, 537 
 
 and pimples, 537 
 
 as food, 538 
 
 boiled, 540, 542 
 
 care of, in infant feeding, 538 
 ' eentrifuged, 539 
 
 condensed, 543 
 
 evaporated, 500, 543 
 
 fresh, requirements for, 537 
 
 grapefruit with, 539 
 
 idiosyncrasy against, 538 
 
 pasteurized, 543, 544 
 
 proposal for safeguarding, 540 
 
 raw, prohibited for dysentery, 540 
 
 safe, 540 
 
 sour, 544 
 
 sterilized, 540 
 
 sweet, and buttermilk, as articles of 
 diet, 544 
 relative nutritive value of, 545 
 
 thermos-kept, 539 
 
 to gain in weight, 542, 543 
 
1360 
 
 INDEX TO QUESTIONS AND ANSWERS 
 
 Milk bottles, washing of, including its 
 
 cover, before opening, 203 
 Milk diet, 538 
 
 diseases recommended for, 537 
 
 effects of, 538 
 Milk leg, 794 
 Mind, and insomnia, 387 
 
 and nervous indigestion, 387 
 
 influence of, on disease, 387 
 
 relaxation of, 391 
 Mitral lesion, length of life with, 598 
 Mold germs, method of destroying, 203 
 Mole on nose, removal of, 720 
 Moles, cutting or burning of, 720 
 
 removal of, 719, 720, 731 
 
 sarcoma, or cancer, developing from, 720 
 Moral degeneration, due to drug habit, 
 
 337 
 Morphin, warning against, for insomnia, 
 
 334 
 Morphin habit, advisability of going to in- 
 stitution for cure of, 335 
 
 cure of, in one seriously addicted, 335 
 in one slightly addicted, 335 
 
 legislation against, barring drug users, 
 335 
 Mosquitoes, and weeds, 283 
 
 from cisterns, 286 
 
 in Arctic regions, 286 
 
 to get rid of, 944 
 Moth millers, prevention of, 946 
 Motorcycling, 1049 
 Mouth, keeping clean, 752 
 Mouth breathing, 852 
 
 cause of, 14, 19 
 
 dangers of, 14, 19 
 
 overcoming of, 14, 19 
 Mucus, clear, expectoration of, 163 
 
 from urethra, 1311 
 
 slimy, raising of, 43 
 
 thick, dark, from nose, 13 
 Muscles, exercise of, without moving 
 joints, 1082 
 
 of arm, exercises for, 1083 
 Myocarditis, chronic, symptoms and treat- 
 ment of, 597 
 Mysophobia, definition and remedy for, 
 414, 415 
 
 Nails, brittle, causes and treatment of, 
 725, 726 
 diseases of, 725 
 ingrowing, treatment for, 725 
 
 Nails, splitting of, 726 
 
 turning black, 582 
 Nasal catarrh. See Catarrh, nasal. 
 Nephritis, interstitial, and arteriosclerosis 
 and high blood pressure, 631, 632 
 definition of, 631, 632 
 development of, 631, 632 
 last stages of, 632 
 Nerves, books on, 399 
 
 of taste, 644 
 Nervous, distinguished from neurotic, 403 
 Nervous diseases, publication on, 339 
 Nervous habits, biting of finger nails, 415 
 
 drumming with hands, 415 
 Nervous heart, 600 
 
 causes of, 594, 595 
 
 definition of, 594 
 
 symptoms of, 594 
 
 treatment for, and consequences of 
 neglect, 594, 595 
 Nervous indigestion, influence on, of mind, 
 
 387 
 Nervous prostration, and cure for, 387, 388 
 Nervousness, 978 
 
 advice for, 391, 392, 400 
 
 and coffee, tea and tobacco, 361 
 
 and exercise, 392 
 
 and exercise in open air, 1050 
 
 and milk and cream, 392 
 
 and sleep, 410 
 
 during sleep, in children, 857 
 
 effect of, on one's child, 410, 411 
 
 sign of, 415 
 Neuralgia, cure of, by location and removal 
 of cause, 386 
 
 distinguished from neuritis, 385, 386 
 
 due principally to self-neglect, 790 
 
 possible causes of, 386 
 Neurasthenia, advice for, 399 
 
 and marriage, 399, 400 
 
 and medicine, 399 
 
 books on nerves valuable in, 399 
 
 books recommended to sufferers from, 
 400, 401, 403, 408 
 
 excessive, sanitarium treatment for, 388, 
 389 
 
 mild, 400 
 
 psychotherapy for, 402 
 
 self -cure of, 401 
 
 sexual, 1313 
 
 signs of, in children, 1272 
 
 treatment for, 400, 402, 407, 408 
 Neurasthenics, advice for, 1313 
 
INDEX TO QUESTIONS AND ANSWERS 
 
 1361 
 
 Neuritis, and teeth, 386 
 
 cure of, by location and removal of cause, 
 386 
 
 distinguished from neuralgia, 385, 386 
 
 possible causes of, 386 
 Neurotic, distinguished from nervous, 403 
 Night losses, 1311 
 
 Night sweats and loss of weight, 103 
 Night terror in children, treatment for, 851 
 Nightmare, and marriage, 1024 
 
 cause and treatment of, 412 
 Nitroglycerin for high blood pressure and 
 
 hardening of arteries, 608 
 "Nits," removal of, 947 
 Nodding spasm, 857 
 Nose, dull feeling on one side of, 13 
 
 infection of, chronic, 13 
 
 keeping clean, 752 
 
 mu^as from, thick dark, 13 
 
 Seller's or Dobell's solution for spray- 
 ing of, 35 
 
 spitting of blood from, 14 
 
 stoppage of, 14 
 
 toilet of, as cure for ozena, 32 
 Nosebleed, due to overeating, 501 
 
 treatment of, 611 
 Nostrils, obstructed, 14 
 Nux vomica, as stomach and nerve bracer, 
 danger of, 336 
 
 Obesity, overcoming, 690 
 tendency to, 686 
 to check, 689 
 
 treatment of, Oertel diet, 685 
 Obesity cures, short cut, 688 
 Ointment of yellow oxid of mercury, for 
 
 affections of eyelids, 128 
 Olive oil, and flesh, 537 
 
 and butter, relative food values of, 338 
 and pimples, 537 
 Onions, food value of, 648 
 Operation, complete readjustment after to 
 
 be expected with time, 1282 
 Opium, codein and heroin derivatives of, 
 336 
 warning against, for insomnia, 334 
 Oranges and smoking, 506 
 Ovaries, removal of one, and childbirth, 
 784 
 and marriage, 784 
 Overeating, danger of, 634 
 Oxid of mercury, yellow, ointment of, for 
 affections of eyelids, 128 
 
 Oysters, fuel value of, 503 
 
 temperature in cooking, required to kill 
 germs in, 503 
 
 taste and succulence of, 503 
 Ozena, cause of, 32 
 
 Palsy, telegrapher's, 909 
 Paralysis, and blood pressure, 608 
 
 due to apoplexy, cause of, 615 
 
 survival of strokes of, 615 
 Paralysis agitans, and heredity, 431 
 
 and marriage, 431 
 
 cause of, 431 
 
 symptoms of, 431 
 Patches, bright red, on scalp, 730 
 
 on face and neck, brown, 728 
 Peanut butter, food value of, 699 
 Pellagra, cause of, 170 
 
 diagnosed cases of, 171 
 
 diet for prevention of, 170 
 
 distribution of, 169 
 
 ' ' doctoring ' ' for, 170 
 
 duration of life after first symptom, 170 
 
 in cold climates, 170 
 
 symptoms pointing toward, 170, 171 
 Pests in flour, elimination of, 840 
 Phantom tumors, 1283 
 Phosphorus poisoning from matches, af- 
 fecting worker in, not consumer, 
 908 
 Pickles, food value of, 650 
 Pimples, and blackheads, treatment of, 734 
 
 cause of, and treatment for, 733 
 
 explanation of, 735 
 
 prevention of, 734 
 
 treatment of, 734, 735 
 Pityriasis, nature and treatment of, 729 
 Plague, bubonic, symptoms of, 299 
 Play, systematic, need of, for growing 
 children, 1270 
 
 in open air, 1049 
 Pneumonia, and air, 64 
 
 mortality from, in high altitudes, 721, 
 722 
 
 tuberculosis following, 98 
 Poison oak treatment, 891 
 Poisoning from tyrotoxicon in ice cream, 
 
 543 
 Pork, necessity for cooking, 650 
 Pregnancy, and age hazard, 784 
 
 and dancing, 782 
 
 and despondency, 784 
 
 and determining sex of child, 785 
 
1362 
 
 INDEX TO QUESTIONS AND ANSWEES 
 
 Pregnancy, and exercise, 789 
 
 and falls, 787 
 
 and hernia, 791 
 
 and hospital confinement for, 789 
 
 and maternity corsets, 785 
 
 and medicine called ' ' Mother 's Friend, ' ' 
 789 
 
 and menstruation, 782 
 
 and seasickness, 664 
 
 and sewing on machine, 1284 
 
 and teeth, 752 
 
 and traveling, 783 
 
 books on, 781 
 
 oare during, 785, 1284 
 
 care of nipples during, 784 
 
 corsets during, 1284 
 
 diagnosis of, 784 
 
 Abderhalden test for, 791 
 
 dropsical conditions and convulsions with, 
 recurrence of, 794 
 
 earliest diagnosis of, 1283 
 
 first signs of, 782 
 
 first symptoms of, 791 
 
 flowing during, 791, 792 
 
 influencing of child's mind during, 781 
 
 literature on, 789, 792 
 
 " marking' ' of child during, 783 
 
 missing of one period insufficient for 
 diagnosis of, 1281 
 
 morning sickness of, 793 
 
 reading books on, during, 1284 
 
 sick stomach of, treatment for, 792 
 
 test for, 790 
 
 time to consult physician in, 1285 
 
 with urine showing trace of albumin and 
 a few hyalin casts, 1282 
 Privy vault, danger from one long time 
 
 covered, 1222 
 Proteid, meaning of, 647 
 Psoriasis, and heredity, 729 
 
 and marriage, 729 
 
 and peroxid, 729 
 
 care of patches in, 729 
 
 definition, cause and symptoms of, 728 
 
 treatment of, 728, 729 
 Ptomain poisoning, protection from, 648 
 
 treatment for, 649 
 Pulse, irregular, due to indigestion, 643 
 Pulse rate, lowered, 598 
 Purging, as a habit, 34 
 Pyorrhea, and fletcherizing, 751, 754 
 
 and rheumatoid arthritis, 750 
 
 curability of, 748 
 
 Pyorrhea, cures for, 750 
 early treatment of, 753 
 manner of progression of, 
 not contagious, 750 
 treatment for, 754 
 
 750 
 
 Quacks, method of determining, 127 
 Quinin, nature and effects of, 286 
 
 Eadiators and dirt bands on ceiling, 1212 
 
 Eaisins, California, 651 
 
 Eash, due to dry air, 724 
 
 Eaynaud 's disease, cause and cure of, 582 
 
 nails turning black in, 582 
 
 symptoms of, 582 
 
 white finger ends from, 582 
 Eefrigerator, cleansing of, 512 
 
 insulation of, 512 
 
 lining for, 512 
 
 metal and wood, 512 
 
 temperature of, 512 
 Eelaxation of mind and body, 391 
 Eetarded walking, due to rickets, 189 
 Eetinal hemorrhage, explanation of, 129 
 Eheumatism, and alcoholic beverages, 152 
 
 and climate, 151, 152, 156, 157 
 
 and diet, 152 
 acid fruits, 152 
 meat, 152, 153 
 
 and gout, 156 
 
 and medicated woolen underwear, 151, 
 152, 153 
 
 and mineral baths, 152 
 
 and removal of tonsils, 151, 152 
 
 and tuberculosis, 722 
 
 causes and treatment of, 151 
 
 gonorrheal, 1310 
 Eheumatoid arthritis, and alcohol, 152 
 
 and pyorrhea, 750 
 
 and removal of tonsils, 750 
 
 definition and symptoms of, 151 
 
 symptoms and treatment of, 152 
 Eickets, and childbearing, 190, 191 
 
 causes of, 188, 189 
 
 congenital, 190 
 
 disposition to, 190 
 
 prevention of, 188, 189 
 
 sweating of head with, 190 
 
 treatment of, 190 
 Eings before eyes, 128 
 Eingworm, cure of, 729, 730 
 
 definition of, 729 
 Eochelle salts, 33, 34 
 
INDEX TO QUESTION'S AND ANSWERS 
 
 1363 
 
 Bun-around, treatment for, 726 
 Kupture or hydrocele, 1311 
 
 Saccharin, 163, 164 
 
 giving of, to babies, 834 
 Salt, and Bright 's disease, 635 
 Salt meat diet, 648 
 Salts, Glauber, 36 
 
 Eochelle, 33, 34 
 Salvarsan, safety of, 1309 
 Scalp, itching of, under sun, 759 
 Scalp disease, 756 
 Scarlatina and scarlet fever, 231 
 Scarlet fever, aftermath of, 233 
 
 animals as carriers of, 231 
 
 contagion of, during first stages, 231 
 from books, 211 
 from scales, 233 
 
 control of epidemic of, 203, 204, 232 
 
 disinfection after, 232, 233 
 
 length of quarantine for, 231 
 
 no immunization against, 232 
 
 period of incubation for, 231 
 
 reporting of, 231 
 
 resumption of exercise after, 233 
 
 transmission of, 232 
 
 not by houses, but by partly cured 
 
 patients, 233 
 peeling and throat condition, 231 
 time of, 232 
 
 treatment of, by hot baths, 232 
 Scars, cause of, after operation, and sec- 
 ond operation to remove, 720 
 
 removal of, 731 
 School inspection, barring of, from certain 
 schools, 1273 
 
 purpose of, 1270 
 School rooms, bad ventilation in, 1202 
 
 need of hygrometers in, 1203 
 Schools, heating of, and changing air, 
 1265 
 
 length of sessions of, 1271 
 Scurvy, cause and symptoms of, 189 
 
 symptoms pointing to, 184 
 Seasickness, and pregnancy, 664 
 
 prevention of, 664 
 Self-abuse, advice for, 1312 
 
 and marriage, 1284 
 
 and stupidity, 1312 
 
 See also Masturbation 
 " Sewer bug," 947 
 Sexual neurasthenia, 1313 
 Shingles, nature and cure of, 732 
 
 Shoulders, round, correction of, 1067 
 in children, correction of, 850 
 stooping, braces for, 1067, 1068 
 correction of, 1067, 1068 
 danger of, 1068 
 Sight, failing, causes of, 130 
 Silver nitrate solution, directions for use 
 
 of, in infant's eyes, 129 
 Skating, exercise of, 1051 
 Skin, bleaching of, 727 
 
 discoloration of, by ammonia and per- 
 oxid to remove superfluous hair, 
 727 
 dry, cause of, 718 
 
 itching, cracking and festering between 
 
 toes, cause and treatment of, 719 
 
 sensitiveness of, after bathing, treatment 
 
 of, 719 
 
 Skin irritation, of bright red and itching 
 
 spots, 722 
 Sleep, a mental condition, 410 
 adjustment of mind for, 386 
 and bromid or sleeping potions for, 386 
 and dreams, 386 
 and frame of mind, 410, 411 
 and nervousness, 410 
 disturbed, and treatment for, 410 
 for children, 856 
 
 nervousness during, treatment for, 851 
 Sleeping, and keeping warm, 1189, 1191 
 cold quarters for, 1190 
 fitful, in small boy, 851 
 in draft, 1167 
 out of doors, 1168 
 Sleeping porch, 1166 
 Sleeping room regulation, 1165 
 Smallpox, and chickenpox, 221 
 
 and Finsen method of nonactinic light, 
 
 220 
 contagion from, 221 
 control of, by vaccination, 221 
 danger from ice taken from body of 
 water receiving sewage from city 
 having a number of cases of 
 smallpox, 221 
 germ of, killed by sunshine and fresh 
 
 air, 228 
 immunity to, from vaccination, 227, 228 
 transmission of, 228 
 Snake bite, stimulant for, 891 
 Snoring, causes of, 23 
 
 effects of, 23 
 Snuff, use of, 349, 350 
 
1364 
 
 INDEX TO QUESTIONS AND ANSWERS 
 
 Soda, for stomach distress, its danger, 337 
 Sore throat, due to bacteria in crypts of 
 
 tonsils, 38, 39 
 Sour stomach, possible cause for, 652 
 Spermatorrhea, 1311 
 Spices, food value of, 650 
 Spine, curvature of, 97 
 
 tuberculosis of, 97 
 Spots, on body, 727 
 
 on face, 726, 727 
 Sputum, black, 100 
 
 Stammering, a nervous condition, and cure 
 for, 440 
 
 cure of, 439, 440 
 
 a matter of training, 440 
 
 Scripture's book on, recommended in 
 overcoming of, 441 
 
 self-cure of, 441 
 
 suggestion for treatment of, 441 
 
 See Stuttering 
 Stature, increasing, 858 
 Steam heat itch, due to low humidity, 1192, 
 
 1210 
 Sterility, advice for overcoming, 1285 
 
 time to judge of, 1283 
 Stomach, weak, diet for, 156 
 Storm window problem, 1189, 1190 
 Strychnin, danger of, as stomach and nerve 
 
 bracer, 336 
 Stuttering, and surgical operations, 440 
 
 prevention of, in young child, 440 
 
 See also Stammering 
 Styes, cause and treatment of, 131 
 Sugar, giving of, to children, 849 
 
 use of, 646 
 Sunlight, in bedrooms, 1141, 1142 
 Sweating arm pits, 728 
 Sweating of head in rickets, 190 
 Swelling of legs, accompanied by ache and 
 
 pain, 792 
 Swelling on right side of throat, probable 
 
 cause of, 553, 554 
 Swimming, cramps in, 1083 
 Swollen throat, possible cause of, 38 
 Sycosis, definition and nature of, 719 
 Syphilis, and safety of salvarsan for, 
 1309 
 
 contagiousness of, 1308 
 
 curability of, 1309 
 
 cure of, 1309 
 
 inherited, 1308 
 
 insufficiently treated, 1308 
 
 relapse in, 1309 
 
 Talking to one's self, 392 
 Taste, nerves of, 644 
 Tattooing, removal of, 726 
 Tea, and nervousness, 361 
 
 excessive use of, 361 
 
 making of, 361 
 
 over- stimulation of, 359 
 
 with cream and sugar, 360, 361 
 Teachers, help for nerves of, 1268 
 Tear ducts, closure of, 130 
 Teeth, and neuritis, 386 
 
 and pregnancy, 752 
 
 decaying, 751 
 
 in diabetes, 164 
 
 loose, 753 
 
 soft and decaying, hardening of, 752 
 
 wisdom, pulling of, 751 
 Telegrapher's palsy, 909 
 Temper in the morning, advice for, 402 
 Tenements, space in, 1141 
 Tennis, exercise of, 1051 
 Testicles, undescended, 1311 
 Tetter, 721 
 Thermometers, care of, 1187 
 
 inaccurate, 1186 
 Throat, constant clearing of, 13 
 
 daily washing of, 38 
 
 swollen, possible cause of, 38 
 Throat huskiness, 1271 
 Thymus gland, definition and location of, 
 
 575 
 Thymus gland tablets, 575 
 Thyroid gland, derangements of, 571 
 
 enlargement of, causes and treatment of, 
 569, 570 
 
 functions of, 571 
 
 location of, 571 
 Thyroid intoxication, 571, 572 
 Tick, spotted, bite of, 127 
 
 wood, bite of, 127 
 Tired feeling, exercise for, 1049, 1052 
 Tobacco, action of, on nerves, 347 
 
 and capacity, 344 
 
 and coffee, 360 
 
 and hearing, 348 
 
 and inhaling, 347 
 
 and nervousness, 361 
 
 and neurasthenia, 346 
 
 and sight, 347 
 
 and stunted growth, 346 
 
 and weak heart, 348 
 
 cigarette cure, Dr. Kress 's, 349 
 
 giving up of, 345, 347 
 
INDEX TO QUESTIONS AND ANSWERS 
 
 1365 
 
 Tobacco, persistence of craving for, 
 349 
 quitting use of, and effect on system, 
 
 347 
 transmission of disease through cigar 
 
 ends, 349 
 use of, by women, 345, 346 
 
 by young boys, 346 
 when to stop use of, 345, 346 
 Tobacco blindness, 347 
 Tobacco heart, 348 
 Toilets, unclean, diseases contracted from, 
 
 1309 
 Tomatoes, as food, 506 
 Tonsillar crypts, cleaning of, 18 
 formation of particles in, 18 
 sore throat due to bacteria in, 38, 39 
 Tonsillitis, relation of frequent attacks of, 
 
 to condition of tonsils, 19 
 Tonsils, cleaning of, 18 
 
 effect of removal of, on lungs, 19 
 indication for removal of, 18 
 infected, effect of, 18 
 Toxemia, 892 
 Trachoma, cause of, 127 
 
 definition and nature of, 127 
 infectiousness of, 127 
 prevention of, 127 
 symptoms of, 127 
 Tubercular glands, 105 
 
 of neck, consumption due to, 553 
 Tubercular kidneys, and "dope," 633 
 
 cause of, 633 
 Tuberculin, for tuberculosis, 104, 105 
 
 proper method of treatment with, 108 
 Tuberculosis, and climate, 102 
 advice on, 108 
 Amarillo, Texas, 108 
 Arizona, 110 
 
 choice of, dependent on personal con- 
 siderations, 109 
 circumstances warranting change of, 
 
 108 
 Florida, 110 
 
 reasons for going west, 106, 108 
 Rocky Mountains, 109, 110 
 sanitaria about Denver, 109 
 and diabetes, 98 
 and fistula, 98 
 and night sweats, 103 
 and pain, 100 
 and rheumatism, 722 
 and typhoid fever, 96 
 
 Tuberculosis, coughs not due to, 100 
 cures for, 100, 103, 104 
 
 "Deoraden," 108 
 danger from rooms vacated by person 
 
 with, 204 
 disinfection of articles used by patient 
 
 with, 105 
 disinfection of room occupied by person 
 
 with, 205 
 explanation of cough with, 99 
 fibroid lungs due to, 106 
 following pneumonia, 98 
 in animals, cause of, 99 
 in city and country, 96 
 need of medical advice for, 101 
 of knee, 102 
 of skin, 102 
 of spine, cause, symptoms and treatment 
 
 of, 97 
 curvature, 97 
 preventive measures, 100 
 relation of, to age, 96 
 symptoms of, very early, early, and later, 
 
 99 
 symptoms suggestive of, 100 
 
 in early stage, 108 
 treatment of, 105 
 when a menace to one's family and 
 
 neighbors, 103 
 Tumor, cystic, 986 
 in cul-de-sac, 986 
 of gums, 753 
 Tumors, fibroid, nature of, 787 
 
 phantom, 1283 
 Twins, mentality of, 1024 
 Typhoid fever, and cesspools, 317 
 and malaria, 284 
 and milk, 317 
 and tuberculosis, 96 
 and water filters, 319 
 and winter cholera or winter diarrhea, 
 
 319, 320 
 developing, 319 
 due to typhoid bacillus, 321 
 prevention of, by vaccination, 319 
 
 in epidemics, 317 
 vaccination against, 317, 319 
 
 Ulcers, of mouth, camphor for, 722 
 
 cause of, 722 
 
 treatment of, 722 
 of uterus, local treatment for, 790 
 Undescended testicles, 1311 
 
1366 
 
 INDEX TO QUESTIONS AND ANSWERS 
 
 Uremia, foods to be avoided in tendency 
 
 to, 632 
 Urethra, mucus from, 1311 
 Urinating, smarting and aching after, not 
 
 indicative of diabetes, 162 
 Urine, excessive passing of, 161 
 fetid odor in, 980 
 gravel in, 634 
 testing of, for sugar, 159, 163 
 
 Vaccination, advisability of lay person vac- 
 cinating self and family, in ab- 
 sence of doctors, 226 
 
 and amputation, 228 
 
 blood test after, 226 
 
 for colds, 608 
 
 immunity to smallpox from, duration of, 
 227 
 
 method of, 226 
 
 objections to, 228 
 
 unreliability of any but present-day sta- 
 tistics on, 226 
 Vaccine, for acne, 734, 735 
 
 for hay fever, 53 
 
 for nasal catarrh, 36 
 Varicocele, 1310, 1311 
 Varnish, counteracting smell of, 1171 
 Vasomotor disturbance, definition of, 608 
 Ventilation, and colds, 1170 
 
 and deflectors for open windows, 1164, 
 1167 
 
 and drafts and colds, 1168 
 
 and kitchen air, 1169 
 
 and open windows in winter, 1168 
 
 and recirculation of air, 1171 
 
 and sleeping in draft, 1167 
 
 bad, overcoming effects of, 1171 
 
 choice of closed windows or noises, 
 1164 
 
 fan system of, 1202 
 
 of cars, 1169, 1171 
 
 of churches, 1172 
 
 of furnace-heated sleeping room, 1165 
 
 of house, method of, 1170 
 
 of office, by window, 1166 
 
 of picture operators' booths, 1202 
 
 of school rooms, 1202 
 
 open windows in sleeping room of in- 
 fant, 1166 
 
 suggestion on, 1165 
 
 unhealthy air not necessarily transporter 
 of disease, 1168 
 
 without current of air, 1167 
 
 Veronal, for insomnia, 336 
 nature of, 336 
 
 Warts, removal of, 719, 730, 731 
 Water, at meals, 505 
 
 boiling of, 542 
 Weight, and buttermilk, 692 
 and worry, 699 
 keeping down, 695 
 reducing, 687, 692, 694 
 
 and water, 690 
 
 at fifty, 692 
 
 by Epsom salts, 694 
 
 by medicines, 687 
 
 by reducing food, 691, 694 
 
 diet for, 688 
 
 drugs for, 690 
 
 given result of treatment for, 692, 693 
 
 intelligently, 689 
 
 method of, 686 
 
 peril in, 689 
 
 too fast, 690 
 to increase, 697, 698, 699 
 
 bread, 699 
 
 by exercise, 1052 
 
 eggs for, 697 
 
 exercise and food for, 697 
 
 food and sleep, 698 
 
 foods for, 696 
 
 haphazardness in, 694 
 
 milk for, 697 
 Wen on head, removal of, 729 
 
 olive oil for, 696, 698 
 Whisky and alcohol, 342 
 Whiteheads, removal of, 734 
 Whole wheat flour and graham flour, 650 
 
 and quarantine, 246 
 Whooping cough, attendance of moving 
 picture shows by children with, 
 205 
 contagion of, 244, 245 
 
 its duration, 245, 246 
 
 on trains, 245, 246 
 control of, 243 
 
 danger of, to infants, 243, 244 
 duration of, 245, 246 
 fumigation after, by city, 247 
 germ of, 243 
 
 its location, 244 
 incubation period of, 245 
 initial symptoms and course of, 244 
 mortality from, 244 
 prevention and treatment of, 247 
 
INDEX TO QUESTIONS AND ANSWERS 
 
 1367 
 
 (VTiooping cough, relief of whoop in, 246 
 
 thick yellow mucus with, 245 
 Winter cholera or diarrhea and typhoid 
 
 fever, 319, 320 
 Winter itch, 1210, 1212 
 
 treatment of, 1213 
 Workers, protecting of, from heat, 909 
 Worms and epilepsy, 429 
 Worriers, advice for, 1313 
 
 Worry, ill-effects of, 391, 392 
 Wounds, treatment of, 892 
 Wrinkles, lotions for, 732 
 
 reducing, 731 
 Writer's cramp, 908 
 
 X-ray and cancer, 979 
 
 Yawning, frequent, more exercise for, 1057 
 Yellow fever, transmission of, 264 
 
/ Vrf.