HEALTH AND»EFFICIENCY Book y\ i z CoipgM? COHRIGHT DEPOSJt EFFICIENCY HEALTH AND EFFICIENCY BY JOHN DALY McCARTHY, M.A., Ph.D. /;/ Charge, of Hygiene, De Witt Clinton High School, New York City New York HENRY HOLT AND COMPANY 1922 Copyright, 1922 BV HENRY HOLT AND COMPANY PRINTED IN THE U. S. A. JAN 1 9 1922 ©CU6-54318 nA-l I " DEDICATED TO THE BEST AND WISEST OF ALL MY TEACHERS MY FATHER AND MOTHER PREFACE This book has been written for boys and girls in the Junior and Senior High Schools. It aims to pre- sent the fundamental principles of Hygiene and San- itation in such a way as to lead to better health and greater efficiency. Only sufficient Anatomy and Phys- iology has been included to form a suitable background for the study of the principles of good living. From an experience of over ten years with High School pupils the author is convinced that too much emphasis has been laid on a technical study of body structure and function and too little on the care of the body. The author believes furthermore that the study of the care of the body is of much more consequence to the High School girl and boy than is a detailed study of its composition. Many teachers attempt problems in Anatomy and Physiology with Secondary School pupils which College and University students find difficult. The author acknowledges with appreciation the as- sistance given by the New York City Department of Health; the Massachusetts State Board of Health; the American Posture League ; and the U. S. Hygienic Laboratory. To Dr. John L. Tildsley, Associate Su- perintendent in charge of High Schools and Training Schools, New York City, the author is indebted for a vi PREFACE large share of the interest which he has in educational problems generally and for constant guidance and help- fulness. The outline followed in writing the book is one which was used at the DeWitt Clinton High School, New York City, by the Department of Hy- giene. It was completed only by the cooperation of the teachers of Hygiene in that school and by the very friendly helpfulness of the Principal, Dr. Francis H. J. Paul. The Department of Hygiene in the DeWitt Clinton High School is an outgrowth of the Depart- ment of Biology of that school of which Dr. Geo. W. Hunter, now Professor of Biology in Knox College, was formerly Chairman. Dr. Hunter was one of the pioneers in the teaching of Biology and Hygiene in this country and the author is indebted to him for many valuable suggestions. In conclusion the author extends his warmest thanks to his wife who has provided constant encouragement and helpful direction to the enterprise. John Daly McCarthy. CONTENTS PART I— PERSONAL HYGIENE CHAPTER PAGE I General structure of the human body . 3 II Man and disease 16 III Posture and exercise 39 IV Air and breathing 57 V Food and diet 72 VI The care of the mouth, nose, throat and ORGANS OF SPEECH IO9 VII Digestion, absorption, circulation, and THE HYGIENE OF THE ALIMENTARY CANAL . 120 VIII The hygiene of the skin and the use of CLOTHING 135 IX The organs of sense 145 X Mental hygiene 155 XI First aid 168 PART II— SCHOOL AND HOME HYGIENE XII School hygiene 179 XIII Hygiene of the home ...,,,, 185 vii viii CONTENTS PART III— COMMUNITY HYGIENE CHAPTER PAGE XIV Food distribution 199 XV Disposition of wastes 222 XVI Some animal enemies of man .... 226 XVII Community control of disease . . . . 240 XVIII Industrial hygiene 247 Index 261 PART I PERSONAL HYGIENE CHAPTER I THE GENERAL STRUCTURE OF THE HUMAN BODY i. Introduction. Man's knowledge of his own body has always been less than his knowledge of vehicles of travel, of habitations, and of machinery. The struggle for existence, the desire for gold, for travel* and for luxury seem always to have been greater than the desire to know the secrets of the human body, the seat of intellect. In fact, at different times, such study of the human body by means of dissection has been forbidden even by some of our own state laws. In view of this prejudice, it is not surprising that men are so little acquainted with their own physical struc- ture, even though a knowledge of the structure of the human body is fundamental to a knowledge of medicine, of hygiene, of sanitation, and in general, to a knowledge of healthy living and human efficiency. The wave of feeling against the use of alcohol has been due, in large part, to a knowledge of what alco- hol does to the body after its absorption. Instead of the orgies, so common in the past, when men loaded their bodies with food and drink, we find to-day more and more persons restricting their consumption of beverages and food with a view to making themselves 3 4 HEALTH AND EFFICIENCY as efficient as the machines which their minds have devised. We owe the astounding advances in medicine to a study of the structure of the human body. In olden times it was sometimes even held that disease was due to evil spirits. Fortunately, however, here and there, inquiring and observing men, by applying them- selves to a practical study of the human structure gained an immense amount of information about it. We are especially indebted to the Italian scientists, who, many years ago, established centers of inquiry for the pursuit of this study. At the great and famous University of Bologna, very skillful dissec- tions were made as early as the thirteenth century and one of the records of these was a standard text for several hundred years. The traditions thus estab- lished finally bore fruit in the great discovery of Pas- teur that minute organisms are very frequently the cause of disease. While men vary in their racial origins, their envir- onment, customs, and tastes, the same fundamental physical structure is a heritage of all. Whether we regard the Scriptural account of the origin of man as indicating that he was formed in a very short per- iod of time, or whether, with Augustine, we regard the body as the product of ages of development from lower forms of life, we must all agree that it is a marvelous structure. So wonderfully perfect is it in its workings that the Psalmist was led to cry out, " I will praise Thee, O Lord ; for I am fearfully and won- derfully made." Fig. 1. — A front view of an adult human skeleton to illustrate the mode in which the bones are connected at the joints. a Ligaments of the Elbow Joint; b The Ligament which is con- nected with the ventral surfaces of the bodies of the Vertebrae; ■e Ligament connecting the Pelvis to the Spine; / Ligament con-, necting the Pelvis to the Sacrum; g The Ligaments of the Wrist Joint; h The Membrane which fills up the interval between the two bones of the Forearm; / A similar Membrane between the two bones of the Leg, and, lower down, /, ligaments of the Ankle Joint; n Ligaments of the Knee Joint; oo Ligaments of the Toes and Fingers; p Capsular Ligament of the Hip Joint; q Capsular Ligament of the Shoulder Joint. 6 HEALTH AND EFFICIENCY 2. The bony framework and the muscles. Much of our knowledge of the structure of the human body has been gained by first studying the lower animals, both living and dead. The body of a cat or of a fish, for instance, resembles in several ways the human body. Each contains a bony framework which gives it form and strength. This is not present in a worm or a jelly fish, and if it were not present in the human body locomotion would be difficult and many of the more delicate arts like painting, construction, and writ- ing would be impossible. There are about two hun- dred bones in the human body — varying in size from the tiny bones of the ear to the huge thigh bone of the leg. Reference to Fig. i shows that the skeleton is made up, in general, of the skull (the bony framework of the head), the spinal column (backbone), the bones of the shoulders, the bones of the hips, the ribs, and those of the appendages (arms and legs). The skull and spinal column surround and protect the central part of the nervous system — the brain and spinal cord. The backbone is made up of many small parts called vertebrae. The tips of these vertebrae can be felt by running the fingers along the backbone in the living human body. The spinal column, when seen from the side, forms a curve similar to that in an elon- gated S. This arrangement of the vertebrae is one of the most marvelous adaptations found in Nature. It adds grace to the body, affords protection to some of the organs of the abdomen, and hinders the transmis- sion of shocks from the feet to the head. It should be noted here that although the spine shows a curve when GENERAL STRUCTURE HUMAN BODY 7 examined from the side, it forms a straight line ill the normal body when seen from behind. The bones of the spinal column, as well as most other bones in the body, act as attachments for muscles. Thus one can feel on each side of the nape of the neck two thick, short muscles running from the base of the skull to the upper part of the spinal column. When these con- tract, the head is pulled backward. It is as if a thick rubber band were stretched from the rear of the skull to the top of the backbone and attached at these two points. One can easily see that the result would be to bend the head backward. Similarly, two other sets of muscles run along the front part of the backbone and pull the head forward. Consequently, when the pull of the two sets of muscles — front and back — is equal, the head is in such a position that the eyes look straight forward. A similar pairing of muscles is seen in the upper arm where the pull of the muscle on the front of the arm doubles the arm, while the pull of the muscle on the back of the arm straightens it out. Besides serving as attachments for muscles, the bones often protect delicate parts in the interior of the body, as for example the bones of the skull pro- tect the brain, and the rib bones protect the lungs and heart. Some of the bones, for instance those of the upper arm and of the leg, are hollow, thereby decreasing the weight of the body and adding to the ability of the skeleton to support it in an upright position. Engin- eers have borrowed this principle from Nature, and made supporting iron pillars for bridges, etc., hollow. HEALTH AND EFFICIENCY It has been discovered in recent years that the soft, red- dish substance often seen in soup bones and called Jiiver JiQryt intestine Jippendi% prnall intestine. Fig. 2. — The digestive system " marrow " is the source of a very important part of the blood. In fact several diseases of the blood seem to have their origin in disturbances of the bone marrow. GENERAL STRUCTURE HUMAN BODY 9 3. The digestive canal is a coiled tube, nearly thirty feet in length, which runs through the body. Refer- ence to Fig. 2 shows that it begins with the mouth and •runs through the neck to the stomach. After leaving this organ, it coils from side to side across the abdomen, finally expanding and ending as the large intestine. The part between the stomach and the large intestine is the small intestine and is about 22 feet in length. Near the stomach, connected with the small intestine by means of ducts or canals, is the large, three lobed, reddish brown liver and the small, yellow- ish pancreas, both of which secrete into the intestine very important fluids which digest our food. At the point where the small intestine passes into the large in- testine is a finger-like projection about two or three inches long. This is the appendix. Inflammation of this organ is frequently accompanied by pain in the lower right part of the abdomen. The intestine occu- pies a large part of the abdomen*. In cases of overeat- ing and as a result of certain diseases, huge masses of fat are deposited between the coils of the intestine, producing a protruding abdomen, one of the most hid- eous deformities of the body. Demonstrate to the class the general position of your own stomach, liver, small intestine, large intestine, and appendix. 4. The heart and blood channels. If you put the palm of the hand on the left side of the chest in the region of the fifth or sixth rib, you will feel a firm tap at least every second. This is produced by the heart, a large muscular organ about the size of the fist, which 10 HEALTH AND EFFICIENCY contracts and relaxes with pronounced regularity. The heart keeps up its work from birth until death — Arteries to head, arm and Deck Puhno'naru vem~TJ] Left auricle, Aoria Left ventricle. Artenes to lover part of Tj bockj 0tomach and intestine Capillaries Vein s from head arm and neck rnonaru arteru R19M auricle Riaht ventricle Vein from intestine to liver Wj (Ported vein) 7/ •jArterij to liver Tissue cells Fig. 3. — Diagram of the circulation the left ventricle pumping blood into the arteries which carry it to the most remote parts of the body, from where it flows back by way of the veins to the GENERAL STRUCTURE HUMAN BODY 11 right auricle to be pumped into the right ventricle. The right ventricle pumps the blood into the pulmonary artery which carries it to the lungs, from where it passes into the pulmonary vein to be carried to the left auricle and thence to the left ventricle. The left ventricle has the strongest walls of any of the four chambers because of the great amount of w r ork it has to do. The four chambers do not work independently but the two auricles contract first, followed a fraction of a second later by a contraction of the ventricles. From the fact that the beat of the heart is felt most distinctly on the left side of the body most persons give that as its location, but, as a matter of fact, it is lo- cated about in the middle of the chest, between the two lungs. The best way to study the heart is to get a beef heart at the butcher's and to cut it open. It will be found to contain four chambers, two upper, the auri- cles, and two lower, the ventricles. Connected with these are muscular tubes, which, when the heart is in its proper place, lead to, or from, various parts of the body. The tubes are the blood vessels and are classi- fied as veins and arteries. If they carry blood to the heart they are called veins and if they carry blood away from the heart they are called arteries. Through them and through the heart the blood circulates in life in a never ending stream, the heart with each contraction pumping blood to the head, to the organs of the abdo- men, and to the extremities, and then drawing it back again. The entire time taken for a drop of blood to make a complete circuit of the body is about thirty 12 HEALTH AND EFFICIENCY seconds. When one remembers that about one-thir- teenth of the weight of the body is blood and that the entire amount is kept in constant, rapid circulation, Vein bringing blood to the heart from the upper parts of the body- Right auricle Large artery carrying blood to all parts of the body except the lungs Artery which carrys blood to the lungs Wall of right auricle \k^. Valve Wall of right ventricle Valve Vein bringing blood to the heart from the lower parts of the body Left ventricle Fig. 4.— Showing the interior of the right side of the heart he gets a good idea of the amount of work placed on the heart. 5. The organs of breathing consist mainly of the GENERAL STRUCTURE HUMAN BODY 13 two lungs, which lie within the chest walls. The air comes through the mouth or nose and thence down the windpipe or trachea to the lungs. Just before the trachea reaches the lungs it subdivides into two short branches, the bronchi, one of which goes toward the right side of the chest, to connect with the right lung; the other toward the left to connect with the left lung. Fig. 5. — The breathing system Upon entering the lungs, the bronchi at once multiply into an immense number of smaller branches, the bronchial tubes, which in turn divide into smaller ones and thus penetrate to every part of the lungs. The bronchial tubes have very thin walls and each one leads to numerous rounded spaces called air sacs. Sur- rounding each air sac is a meshwork of tiny blood 14 HEALTH AND EFFICIENCY vessels. It is estimated that if this meshwork of blood vessels surrounding the air sacs in the two lungs could be patched together, it would cover an area of 800 square feet. Surrounding each lung is a sheet of thin membrane called the pleura. Sometimes the pleura becomes in- flamed and a disease called pleurisy is produced. 6. The brain and other parts of the nervous sys- tem. The brain, through which the mind acts, is so complex, both in its structure and function, that it is impossible to thoroughly comprehend the problems which it presents. The brain of a normal male adult Anglo-Saxon averages about three pounds, although tlie weight may vary from this figure by as much as a pound, and the person be perfectly normal. The hu- man brain is surrounded and protected by the bones of the skull. Although it is provided with few blood vessels in proportion to the work that it does, yet one- fifth of the entire blood supply of the body goes to it. It consists of three main parts called respectively the fore, mid, and hind brain. It is to be noted that the fore brain is the largest of these, and that it is divided into right and left halves, called hemispheres. The brain is not only the seat of thought but it contains centers connected with the organs of seeing, hearing, smelling, efc. So important is the function of these centers that it has been said, " A person does not have a musical ear, he has a musical brain. " A great economy of energy is shown by the brain. Thus the entire brain does not supervise hearing or seeing or thinking, but separate areas are set apart GENERAL STRUCTURE HUMAN BODY 15 for each of these functions. Consequently, if a tumor grows on one portion of the brain, the sense of sight is interfered with; if it grows on another portion of the brain, the sense of hearing is interfered with, and so on. The brain is in contact with the eye, the ear, the nose, etc., by means of lines of communication called nerves. From the hind brain, the spinal cord runs down through the spinal column, giving out branches through the spaces between the vertebrae, and finally completely branching in the region of the small of the back. The branches, or nerves, run to the lungs, heart, stomach, muscles, and other organs. The beating of the heart, the digestion of food, and the action of the muscles are all regulated by impulses sent from the brain, or cord, along the nerves. Vice versa, it is by impulses sent from the skin, eyes and ears along the nerves to the cord and brain that we feel, see, and hear. CHAPTER II MAN AND DISEASE 7. Early conceptions of disease. The ideas of prim- itive man in regard to disease were clothed in mystery. Disease was sometimes thought to be due to evil spirits taking possession of the body. It was then combated by prayer to the good spirits or to the gods of the tribe. In America, each Indian tribe had its Medicine Man, an individual chosen with care and surrounded with considerable dignity. In cases of epidemics, the Med- icine Man was called upon to cast out the evil spirits which brought disease. Among more advanced peo- ples, such as the early Greeks and Romans, disease was thought to be due to a disturbance in the relative amounts of " humors," or fluids, circulating about the body. The conceptions of the Hebrews seem to have been more definite, for Moses drew up for that people an excellent set of laws pertaining to diet, living condi- tions, and the disposition of wastes. 8. The discoveries of Pasteur. Only recently, how- ever, have we known very definitely the cause of dis- ease. The man who made this great discovery was Louis Pasteur, a French scientist, who died in 1895. Pasteur was a chemist whose attention was attracted to the subject of disease by an epidemic which spread among the silk worms in France during the year 1865. 16 MAN AND DISEASE 17 In the south of France, the manufacture of silk is a very important industry, thousands of persons depend- ing on it for a livelihood. Silk is made by a caterpillar which lives on the leaves of the mulberry and other Copyright, Underwood & Underwood Fig. 6. — Pasteur trees and which will, if undisturbed, weave about itself a cocoon of white silk in which it will remain for sev- eral weeks or months and then come forth as a beauti- ful moth. The cocoons of at least two species of silk worms can be found in this country, but the silk is not 18 HEALTH AND EFFICIENCY of a high enough grade to warrant the development of an industry. The silk made by the silk worms of France brings to that country a revenue running up into millions of dollars. In the year 1865 the silk worms were attacked by an unknown disease which killed them before they were able to build cocoons. The silk owners and the Government were aroused. Experts in the raising of silk worms were sent for. Scientists were summoned from their laboratories. But all in vain ! Not one of them could stop the epi- demic. Finally Pasteur was summoned. He protested that he had no knowledge of silk worms and could be of no service. But he was implored to study the silk worm sickness for even a short time. His work was rewarded by the discovery in the bodies of the sick worms, of tiny creatures which he later proved to be the cause of sickness. He was then able to show the silk growers a remedy for the disease. In this manner Pasteur became the founder of the very important science of Germ-life or Bacteriology. He extended his studies and made important discoveries in regard to cholera and pneumonia. Later still, be- coming interested in the terrible sufferings of children who had been bitten by dogs or cats and who had in consequence developed rabies or hydrophobia, Pasteur was able to prove that the disease was spread through the saliva of the dog or cat. Although he was not able to find the germ causing this disease, he discovered a way to save thousands of lives through a treatment of rabies. 9. What are germs? Most persons will reply to MAN AND DISEASE 19 this question, " Why, they are microbes. " And if they are asked, " What are microbes ? " they will either say that they are germs or that they do not know. Why is it we talk so much about germs and yet know so lit- tle about them? The reason is that we know them 1 -. '■ 18 ■ 11 ! , Fig. 7. — Tubes of nutrient material used for growing bacteria. The whitish deposits on the surface represent colonies of bacteria chiefly by their effects. They are so small that only the largest can be seen .with our best microscopes. Some are therefore so small that no one has ever seen them. Here again we know them only by their effects. What are their effects? Among other things they de- cay food ; they cause disease ; they sour milk ; they tan 20 HEALTH AND EFFICIENCY leather; they make possible the flax and hemp indus- tries ; and they give flavor to cheese and cream. Germs are, in consequence, the friends and foes of man. Some varieties are scrupulously avoided because they produce horrible epidemics of disease ; other varieties are carefully cultivated and eaten with food because they are said to improve digestion and assimilation. An example of the former variety is the germ which causes the influenza and which has been the cause of awful plagues and pestilences of the past; an ex- ample of the latter is the germ in sour milk, butter- milk, and their commercialized products, Fermillac, Zoolac, etc. Some germs are animals ; others are plants. Malaria is caused by a tiny one-celled animal which looks like an amoeba. Tuberculosis, on the other hand, is caused by a one-celled plant. Germs were first ob- served in 1650 by a Jesuit priest — Kircher. Plant germs belong to that division of the plant kingdom called bacteria. Ask your teacher to show you some Bulgarian bacteria under the microscope. They can be bought at the drug stores in compressed masses and then grown in milk. A drop of the milk can then be stained with a dye and the bacteria will stand out dis- tinctly. Men who tend horses or cattle sometimes con- tract a dreaded disease called anthrax, the germ get- ting into the system through a cut or a pimple. A case occurred in New York recently, where a man probably contracted it by getting a sliver into his hand from a hitching post. Can you trace the course that the germ took in this case? Other cases are on record of men MAN AND DISEASE 21 contracting it through the handling of hides, leather, furs, or even the use of a shaving brush. If you have examined the Bulgarian bacteria under the microscope you have found them to be about one- eighth of an inch long. But your microscope magnified Photograph from Underwood & Underwood Fig. 8. — Metchnikof, a noted Russian physiologist, suc- cessor to Pasteur as director of the Pasteur Institute, Paris them how much ? What was their actual length, there- fore? So you see that bacteria are extremely small. They are very different from most plants that you have seen because they are so very tiny and are not green. Bacteria have very curious shapes. In fact, they do not look like living things; but those who 22 HEALTH AND EFFICIENCY have been so unfortunate as to have harbored the bacteria of diphtheria or influenza know that they are very much alive. They are very simple in structure, being composed of only one cell. If you examine with a microscope a thin section of another plant with which you are familiar, for instance a portion of the Photograph from Underwood & Underwood Fig. 9- — Charles Darwin, the great English biologist ; founder of the " Darwinian " theory of evolution leaf of a lily, you notice that it is composed of many tiny structures called cells. These are held together by cell walls, which surround the cells and which are more or less continuous. The cell wall encloses a mass of slimy material somewhat like the white of a raw egg f called living matter or protoplasm. The protoplasm, in turn, usually contains, near its center, a rounded MAN AND DISEASE 23 mass of denser protoplasm, which is called a nucleus. Most of the plants with which we are familiar are very complicated in structure, but not so with bacteria. They are apparently as simple as they are tiny. Each bacterium consists mainly of a minute mass of proto- plasm enclosed by a cell wall of cellulose. Some have tiny whip-like projections from their bodies by means of which they swim about in liquids. They swarm al- most everywhere but are particularly abundant in filth, decaying flesh, and in stagnant water. They increase in number at an incredible rate; when a bacterium reaches a certain size it simply divides into two bac- teria. Since the bacteria grow very fast when they receive plenty of food and since they sometimes divide as often as once in twenty minutes, millions may be formed in a day. Take a pencil and paper and figure it out for yourself. 10. How do we know that germs may produce disease? As was indicated in the first part of this chapter, it took man a long time to learn that disease may be caused by germs. Indeed there are some edu- cated people to-day who do not believe it. In view of this, it would be well to examine into the reasons for believing in one of the greatest discoveries of all time — the Germ Theory of Disease. In the first place, it is well to note that the leaders in the study of this field have all been hard-headed scientists — such men as Pas- teur, Koch, and Lister — men to whom only seeing is believing. Pasteur said, " In experimental science, it is always a mistake not to doubt when facts do not compel affirmation." So much of a doubter was Koch that 24 HEALTH AND EFFICIENCY he lay down four tests, or postulates, as he called them, which an investigator must satisfy if he wishes to con- vince others that he has discovered the germ causing a certain disease. First, Koch said, the investigator must show that the germ described is invariably found in the diseased part — in the case of ordinary tuberculosis it would be the lung : Secondly, he must grow the germ in pure culture ; that is, he must cause it to grow out- side the body on some culture substance like gelatin or Fig. 10. — A modern method of treating tuberculosis albumen and unmixed with any other form of germ: Thirdly, this germ, w T hen injected into the body of an animal like a rabbit or guinea pig, must produce the disease under consideration : Fourthly, the germ must be recovered from the diseased part of the sick animal. When medical science, therefore, assures us that the MAN AND DISEASE 25 cause of a certain disease has been found, we may un- derstand that the case has been subjected to a most searching and critical examination. ii. Action of germs in the body. It is almost in- comprehensible that such tiny and simple creatures as germs could produce horrible diseases and even death. Yet such is the case. How do they do it? Well, for instance, the germ causing tuberculosis produces dis- ease by slowly consuming the lungs or other parts of the body. This germ, therefore, which is so ^BHffff -''' * ! " — tT^^w^^- -^ \ " 1K5S ^^ 1 Copyright, Underwood & Underwood Fig. ii. — " Muffled faces " — to halt the influenza epidemic small that it is difficult to find it even with a high-pow- ered microscope, is capable of causing conditions which produce the sweats, fever, and shrunken bodies of tubercular people. Other diseases, as for instance diphtheria, are produced by germs which secrete poisons or toxins. These toxins are carried by the blood stream all over the body, affecting certain tissues or organs and thus producing the symptoms characteristic of the dis- ease. Since the body frequently offers a favorable 26 HEALTH AND EFFICIENCY condition for the growth and multiplication of bacteria, a few finding lodgment may cause untold harm in a short time. 12. How do germs spread from one person to an- other? — The influenza epidemic, which played such havoc throughout the world, started in Russia, swept through the Scandinavian countries, then went into England, Germany, France, Spain, and finally reached America. How was it carried? If we knew the germ that causes influenza it would be much easier to answer this question. But from its general nature and from its resemblance to other diseases, as for instance grippe, medical authorities believe that it was spread largely by means of the discharges from human bodies, principally by coughing, sneezing, or talking with effort close to another person, When a person sneezes or coughs into the air tiny droplets of moisture pass from his mouth in the form of a fine spray as you have prob- ably noticed. These droplets of moisture remain sus- pended in the air, perhaps for some time. They are very apt to contain germs gathered from the person's mouth, nose, and throat and may consequently spread such diseases as colds, grippe, and influenza. For this reason no intelligent person coughs or sneezes into the air. A handkerchief should always be put over the mouth and nose to catch their discharges. The influ- enza epidemic may have been spread also by hand- shaking, kissing, and by the use of common towels and drinking cups. Since communicable diseases, that is to say diseases which may be carried from one person to another, are caused by germs, any object coming in MAN AND DISEASE 27 contact with a diseased person may transmit the sick- ness. Thus lead-pencils, drinking and eating utensils, straps on trolley cars, door knobs, etc., may convey the germs causing disease. For this reason the face, hands, and neck should be washed as soon as a pupil reaches home. It should be remembered, however, that such objects as some of those first mentioned would furnish no food for the germs and that the latter would conse- quently die in a short time if left upon them. How- Fig. 12. — Properly cleaned utensils to be used in handling milk ever, common towels, door knobs, and car straps are in constant use and new deposits of germs are being made constantly. Some very severe diseases such as typhoid fever, tuberculosis, and scarlet fever may be transmitted by using food containing them. Before public health edu- cation was as well developed as it is now, typhoid epi- demics were altogether too frequently brought about 28 HEALTH AND EFFICIENCY by using water or milk infected by typhoid bacteria. While more care is taken with milk and water to-day, not enough attention is paid to flies. These insects feed on both filth and human food and not infrequently alight on our food with their feet covered with typhoid germs. It is easy to see how under such conditions bacteria may be taken in with our food. If conditions are favorable to growth and reproduction such bacteria produce toxins which are sometimes so powerful as to cause prostration and even death. Curiously enough, some persons may harbor disease germs and not have the disease. There are a few cases on record where the germs of diphtheria or typhoid have been growing and reproducing in the bodies of persons who have never had the disease. Such persons are called " carriers " and they may cause epidemics of disease. One of the best known " carriers " is a woman in New York who was employed as a cook for years. She is know T n as" Typhoid Mary " and the New York City Department of Health has traced to her over twenty cases of typhoid in families where she has been employed. The Department of Health was able to se- cure from her a promise that she would not seek em- ployment as a cook. In 1914 typhoid broke out in a maternity hospital in New York and several mothers and babies were infected. An examination of the milk and water failed to show the method by which the dis- ease had been transmitted, and it was only after a visit- ing physician had recognized a worker in the kitchen as M Typhoid Mary " that the epidemic was controlled. It MAN AND DISEASE 29 is supposed that she transmitted the disease to the pa- tients in the hospital by means of salads, the fresh veg- tables of which she prepared for the wards. 13. How does the body fight disease? One natu- rally wonders why it is that disease is not more pre- valent, when one considers how closely human beings associate to-day, through how many hands food passes, and how careless some persons are about sneezing and spitting. We should exercise the greatest vigilance to prevent the acquisition or transmission of disease. If we do we can cut down the death rate appreciably. This is clearly recognized by the health departments in all of our States. In New York, the State Department PfOtOpli A B C D E, Fig. 13. — A white blood cell eating a bacterium of Health has adopted a slogan, " Public Health is Pur- chaseable." Think about this statement and you will discover several ways in which public health is pur- chaseable. If we try to live up to the rules and laws laid down by Departments of Health, we will find that we have a good friend in Nature to whom disease is sinful. We have been endowed with very wonderful bodies, made up of parts which work together in a very delicate harmony, providing they are not abused by excesses or lack of exercise or by poisons from without. 30 HEALTH AND EFFICIENCY In order to keep out disease germs, Nature has clothed us in a tenacious tissue of skin. Sometimes this be- comes torn or cut and disease germs get into the blood stream. Does this mean that we get a disease? Not necessarily, for moving about in the blood are tiny cells which act as the policemen of the body. These cells are not exactly like the cells that we found in the leaf of the lily, for in the first place, they are not joined to- gether, but move about independently of one another; furthermore, they have no cell wall and each one is capable of changing its shape. There are millions of them in the blood stream, moving about through the tissues, seeking germs which they may destroy. Fig. 13 shows one of these cells attacking a bacterium. They are called white blood cells, or leucocytes. When a leucocyte approaches a germ, it spreads out its proto- plasm, gradually surrounds the germ, kills and digests it. Germs, then, are the food of leucocytes and we should do all that we can to insure vigor to our bodies in order that these policemen may always be active. It has been discovered also that the liquid part of the blood contains chemicals which have the power of rendering disease batceria harmless. From the fact that the blood has the power of killing germs it is said to be germicidal. The germicidal power is not constant, however, but varies with individuals and with condi- tions. 14. How can man help Nature fight disease? As was pointed out in the preceding paragraph, a cut or a torn skin may be the portal for the entrance of dis- ease germs, which may develop into a serious case of MAN AND DISEASE 31 blood poisoning or anthrax. Blood poisoning is a dis- ease in which certain kinds of germs are found circu- lating in the blood. Anthrax is a disease of cattle and sheep in which ulcers are formed and severe symptoms of collapse are seen. It is found from time to time among human beings and is said to be transmitted by shaving brushes, furs, and the hides of ani- mals. While the leucocytes may be successful in their Fig. 14. — The scarlet fever ward of a modern hospital fight against disease sometimes, often they are unsuc- cessful. We must not leave all to Nature, therefore, but must assist Nature at every turn. A pin prick, a bleeding gum, an inflamed tonsil, or a sliver in the hand may seem to be too trifling to need attention, but we know now that such is not the case. A bruise should first be cleaned of such foreign matter as dirt and then washed with an antiseptic of which there are many kinds. Can you give the names and methods of 32 HEALTH AND EFFICIENCY applying three? After the bruise has been cleaned and washed with an antiseptic, a clean bandage may be applied to keep out more germs. This treatment, if applied immediately, will usually suffice, as the antisep- tic should check the growth of the bacteria or in some cases kill them. 15. What happens when we are vaccinated. An- other, more complicated method of fighting disease was discovered by an English physician named Jenner. Jenner had been told by people in the country districts of England that milkmaids were not apt to be infected with smallpox, which w r as, at that time, a very horrible and common disease. He investigated the story and found it to be true. The reason was that the women in milking got on their hands some of the pus from the cowpox, which commonly affected the cattle and which is probably a mild form of small pox, and this pus gained entrance to the blood through cuts, etc., in the skin. In the blood the pus of the cowpox stimulated the tissues to form chemicals which had a germicidal property toward any smallpox germs which might later gain entrance into the body. Such a per- son was, therefore, immune to smallpox, and the im- munity had been acquired. While some persons are immune to smallpox from birth, and are consequently said to be naturally immune, most persons are easily susceptible to it. In view of this, and in view of the virulence of the disease, it is advisable to adopt the procedure advocated by Jenner, that of vaccination. This consists in scratching the skin with a pointed instrument and rubbing into the tissues under the skin MAN AND DISEASE 33 the virus taken from blisters or swellings found on cattle with cowpox. In a few days a small solid ele- vation appears at the site of inoculation, folowed in a few more days by a small sac, filled with liquid. After eight days the area around the sac becomes red and finally a scab forms. This later falls off, leaving a scar. The process of vaccination is therefore a sim- ple one and at the same time so efficacious that it has been called the greatest single benefit ever conferred Fig. 15. — A Red Cross boat taking little sufferers for a day's outing by one man upon the human race. The value of it was indicated sharply at the time of the Franco-Prussian War. An epidemic of smallpox was raging and the German soldiers had been vaccinated against it while the French had not. The German mortality from the disease was 450, while the French was 23,400. 16. Diphtheria and the use of antitoxin. It is said that a king of ancient Greece accustomed himself to poison by taking it in very small doses and gradually 34 HEALTH AND EFFICIENCY increasing the amount until the ordinarily fatal dose had no effect. It was discovered about 25 years ago that diphtheria germs grown in broth produced a poi- son, or toxin, which could be injected into an animal in gradually increasing doses, until a dose, large enough to kill a great many animals which had not been accus- tomed to it, could be given. Later, it was learned that the blood serum from such an animal, if injected into another animal, rendered the latter immune to the poison. The reason for this is that the blood of the first animal developes an antitoxin to neu- tralize the toxin from the diphtheria germs. This anti- toxin is known as diphtheria antitoxin and is now pre- pared from the blood of horses. In cases of suspected diphtheria the first treatment consists in the introduc- tion of diphtheria antitoxin into the blood of the pa- tient. It can not be too strongly emphasized that this must be done as early as possible. Do not neglect to consult a physician in case you have a sore throat in which a white patch can be seen ; or when the sore throat has developed after exposure to a known case of diphtheria ; or when you have a sore throat accom- panied by fever and general indisposition. 17. The treatment of disease by the use of serums and vaccines. The blood is made up of a solid and liquid portion. If it is allowed to clot, a solid por- tion may be strained off, leaving the liquid portion, or serum. We have seen in the case of diphtheria and smallpox, that the serum of an animal may, under cer- tain conditions, contain substances called antibodies which are able to counteract or neutralize the poisons MAN AND DISEASE 35 or toxins of disease germs. In some cases the anti- bodies of smallpox are present in the blood from birth and persons who are so fortunate do not contract small- pox and they are said to be naturally immune to the disease. On the other hand the antibodies, or else sub- Copyright by Underwood & Underwood Fig. 16. — Former Surgeon General Gorgas, especially noted for his work in freeing Havanna from yellow fever stances which will cause the tissues to produce them, may be injected into the blood and the person may thus acquire an immunity to the particular disease. Since each disease germ produces its own specific poi- son or toxin, the antitoxin or antibody used must be 36 HEALTH AND EFFICIENCY the specific one which will neutralize that particular toxin. Antibodies is the general term used to indi- cate the protective substances which are generated by the animal against the invading disease germ. Anti- toxin is one variety of antibody. Copyright . by Underwood & Underwood Fig. 17. — Dr. Wilfred T. Grenfell, Medical Missionary of the Frozen North Usually the most lasting form of immunity is that which is acquired by the tissue cells of the animal pro- ducing specific antibodies against the invading germ. A lasting degree of this form of immunity usually fol- lows recovery from smallpox, scarlatina, measles, and typhoid fever. As a result, the individual does not have MAN AND DISEASE 37 a repetition of the particular disease. In other diseases — pneumonia for instance — the immunity, if present at all, lasts for only a short time. In either case, the degree of immunity is not in proportion to the severity of the disease, since a lifelong immunity may follow a mild infection, or a severe infection may be followed by no immunity, or one of short duration. The foundations of the science of immunity were laid by Pasteur, who found that he was able to produce a form of chicken cholera germ which he could inject into fowls without producing a severe form of cholera. Pasteur accomplished this by cultivating the germ over a long period of time, so that the strain became weakened. Injection of this weakened germ caused the tissues of the fowl to pro- duce the specific antibodies and thereafter the fowl was immune to any form of the disease. Pasteur later found that germs could be weakened by exposing them to certain temperatures for varying lengths of time, and also, in the case of one disease, the virus (the ma- terial supposedly containing the germ) could be weak- ened by drying. Artificial immunity may be produced by (a) the use of a serum or (b) the use of a vaccine. By serum therapy we mean the process of immunization induced for the purpose of preventing or curing a disease, by means of the injection into the blood of the serum of another animal which has been actively immunized, against the particular disease. An example of this process is the injection of diphtheria antitoxin. Vac- cine therapy differs from serum therapy. It is the 38 HEALTH AND EFFICIENCY process of making the tissues immune by the injection of dead bacteria directly into the tissues. An instance of vaccination by the injection of disease germs is that of typhoid vaccination. The typhoid vaccine is pre- pared by putting a definite number of typhoid bacteria in salt water and heating them until they are dead. If this weakened germ is injected under the skin the pro- cess is not followed by any lasting ill effects and a high degree of immunity is produced. CHAPTER III POSTURE AND EXERCISE 18. Posture and military life. The importance of maintaining good posture in order to secure good health and also the prevalence of remedial defects of posture were brought forcefully to our attention in 1917, when it was found that a large percentage of the young men of the country subject to military service were unfit for such service because of physical defects. The examining physicians were amazed at the number of cases of flat feet, spinal curvature, hollow chests, and protruding abdomens. So general were these de- fects that the following letter was sent out from the Office of the Adjutant General at Washington : 44 Perhaps the most glaring faults noted in aspirants to the Officers' Reserve Corps and one that might be corrected by proper attention in our high schools, pre- paratory schools, and colleges, might be characterized by the general word ' Slouchiness ' I refer to what might be termed a mental and physical indifference. I have observed at my camp otherwise excellent men who have failed because in our school system sufficient em- phasis is not placed upon the avoidance of this mental and physical handicap. " At military camps throughout the country mental 39 40 HEALTH AND EFFICIENCY alertness, accuracy in thinking and acting, clearness in enunciation, sureness and ease of carriage and bearing must be insisted upon, for two reasons — that success may be assured as nearly as human effort can guarantee it with the material and means at hand, and that price- less human lives may not be criminally sacrificed. Only From plate loaned by the American Posture League. Fig. 18. — In the middle a girl in good posture. What are the defects of posture shown by the girls on each side ? by the possession of the qualities referred to does one become a natural leader. " A great number of men have failed at camp because of inability to articulate clearly. Many men disquali- fied by this handicap might have become officers under their country's flag, had they been properly trained in school and college. " It is hoped therefore that more emphasis will be POSTURE AND EXERCISE 41 placed upon the basic principles of elocution in the training of our youth . . . Great improvement could be wrought by instructors in our schools and colleges, regardless of the subject, insisting that all answers be given in a loud, clear, well rounded voice, which, of course, necessitates the opening of the mouth and free movement of the lips. u In addition to this physical disability and slouch- iness is what might be termed the slouchiness of mental attitude. Many men have not been trained to appre- ciate the importance of accuracy in thinking. Too many schools are satisfied with an approximate answer to questions. Little or no incentive is given increased mental effort to coordinate one's ideas and present them clearly and unequivocally . . . " I have further noted at camp that even some of our better military schools have turned out products that, while many of them have the bearing of a soldier in the ranks, yet their carriage is totally different as soon as they ' fall out.' Schools, military and non- military, should place more insistence upon the bearing of pupils all the time. It should become a second na- ture with them to walk and carry themselves with the bearing of an officer and a gentleman. " As a last important element that seems to me has been lacking in the moral and mental make-up of some of our students here, is the characteristic of grit. Not that they would have proven cowardly in battle, neces- sarily, but some have exhibited a tendency to throw up fhe sponge upon the administration of severe rebuke or criticism. Their * feelings have been hurt ' and they 42 HEALTH AND EFFICIENCY resign. They have never been taught the true spirit of subordination. They are not ready for the rough edges of life. The true training school should en- deavor to keep one's eyes fixed upon the goal rather than upon the roughness of the path, to realize that one unable to rise above the hard knocks of discipline cannot hope to face with equanimity the tremendous From plate loaned by the American Posture League Fig. 19. — In the middle a boy in good posture. What are the defects of posture shown by the boys on each side? responsibilities of the officer under modern conditions of warfare. This ideal of grit belongs in the school room as well as upon the campus. ,, POSTURE AND EXERCISE 43 In spite, however, of the general slouchiness re- ferred to here, and of other defects of posture, the mil- itary authorities, by patient and intelligent direction, were able to accomplish wonders with the material with which they had to work. Many young men will owe not only sound health but success in business and pro- fessional life to the careful training of their bodies, which they received during their period of service. 19. Bad posture may be the result of disease. The importance of bad posture as a symptom of disease has probably not received the attention that it deserves. Bad posture is too often considered merely a lack of at- tention to proper carriage. Of course, in many cases, it is this, but very often it is the definite result of a dis- eased condition. The effect of disease on posture is very marked in the case of tuberculosis. Every one has noticed the emaciation, the hollow chest, and the stoop — the consumptive stoop — so characteristic of this disease. One eminent physician has said that the first remedial measure which he undertakes with a tu- bercular patient is to recommend the daily perform- ance of physical exercises calculated to correct the de- fect of posture. The stoop caused by a rheumatic condition, partic- ularly in old people, is a matter of common observation. That defective posture may be the result of nervous exhaustion or of some organic debility, has not been so clearly noted. In the case of boys and girls of high school age, poor posture, especially when asso- ciated with paleness and a loss of appetite, may indicate 44 HEALTH AND EFFICIENCY illness. Pains in the abdomen are often relieved by pressure secured by bending forward. This act re- peated frequently may result in the permanent acquisi- tion of a stoop and the consequent disregard of the original trouble. Defects of posture among children are very frequently the result of diseases of the bones such as " rickets," which, in turn, has been brought on by an unbalanced diet. Among school children, poor posture is frequently induced by eye and ear defects. Failure to hear distinctly with one ear tends to a tilting of the body in the directions from which the sound comes. Poor eyesight usually results in an effort to bring the eyes toward a book rather than in an effort to bring the book toward the eyes. Close attention to the posture of the patient is a distinct aid to the physician in the diagnosis of disease. 20. Bad posture may be the cause of disease. Man, unlike most of the lower animals, walks upright. The normal position of the human body when standing is such that the neck and trunk form a straight vertical line. This position is well illustrated by a drawing pre- pared by the American Posture League. In this posi- tion the organs of the body are not unduly compressed and the nervous and circulatory systems in particular are allowed full play for their functions. In this po- sition, the spinal column, or backbone, supports the head in such a way that one not only looks alert, but feels alert. The head is well balanced and the eyes look straight forward. This point deserves more at- tention than it usually receives. William James, the celebrated psychologist, believed that posture has a POSTURE AND EXERCISE 45 great deal to do with the emotions ; that an attitude of courage, with the head up, chest out, and hand clenched, engenders courage ; and that a low, slouching, limp pos- ture engenders cowardice. Moreover, when the body is carried properly, the nerve branches from the brain and the spinal cord are not pinched off or stretched and their function thus interfered with. Mormal fool Hal-fool Fig. 20. — Imprint of a normal foot and of one with a fallen arch The arrangement of the bones of the skeleton is such that, with the body in correct posture, the heart beats freely and the stomach is afforded support so that it does not sag and allow food to stagnate. There is some reason to believe that a habitual stoop leads to tubercu- losis. In cases where one shoulder is lower than the Other the ribs are crowded together on that side leaving 46 HEALTH AND EFFICIENCY less space for lung movements and consequently de- creasing the amount of air taken into the body. On the side of the high shoulder fresh air does not get up into the top or apex of the lung, a stagnant condition results, and the germs causing consumption multiply rapidly. It is also the experience of physicians that a bending forward of the body crowds the organs of the abdomen downward, and, by pressing these organs against one another, causes a stagnation of food and waste in the bowel, and of blood in some neighboring structures. As a result of this condition, intestinal disturbance known as " constipation, diarrhea, flatulence, (collec- tion of gas), disturbances of circulation, headaches, ner- vous irritability and, most marked of all, fatigue out of proportion to effort expended, lessen the efficiency of the individual and often make life a burden/' 21. The elements of good posture. These, so far as they apply to posture while walking or standing, have been mentioned — the neck and trunk form a straight, vertical line. This posture is one requiring of the body the least energy to hold it upright. The Amer- ican Posture League has found by repeated investiga- tions that " it is also the posture in which the internal organs rest in their natural positions and relations, with adequate room to perform their functions. " This same society has also found that " the principles of correct seating require comfortable support of the feet, thighs, and usually of the back, for work or rest, as the case may be. The seat should be of a height to per- mit the feet to rest comfortably on the floor. The arms should be so modeled as to favor sitting with the pel- POSTURE AND EXERCISE 47 vis as close to the back of the chair as possible; this prevents sliding forward and distributes the pressure properly. The front of the seat should be rounded so as not to press against the legs. The back of the seat should have a slight backward slope and afford support In FLARED OUTFLARED Straight Fig. 21. — The American Posture League, after a very extensive study, has concluded that there are three main types of feet. They are now designing lasts from which shoes of these three types can be made to the small of the back. Seats modeled along the lines indicated were adopted by the Brooklyn Rapid Transit Company and are now in use in the Brooklyn Subway. The league has also designed a chair which em- bodies the desirable points enumerated above. This 48 HEALTH AND EFFICIENCY chair has been adopted by several communities for school room use and has given great satisfaction. The American Posture League (i Madison Ave., N. Y. City) issues a pin for good posture. The design, made especially for the League, shows an American Indian in profile on a small oval. Good Posture So- cieties should be organized in all schools and these pins can be used for insignia. 22. Other defects of posture. Besides the hollow chest, protruding abdomen, and the round shoulders there are defects of the lower extremities, notably flat feet. The service draft examination showed that one person out of every five examined had flat feet. In the normal human foot there is an arch under the instep. This arch is formed by the bones of the foot being drawn upward by muscles and ligaments. If the muscles weaken in any way, the pull on the extrem- ities of the arch decreases and the arch " falls " result- ing in a flat foot. The collapse of the bony arch com- presses the bloodvessels and nerves under it. In con- sequence, the circulation of blood is impeded and the pressure on the nerves produces pain which may extend up to the back and abdomen. Many pains thought to be due to diseased kidneys are produced by fallen arches. Fig. 20 shows imprints of a normal foot and one in which the arch has fallen. These imprints may be made by moistening the sole of the foot and then placing it on a dry surface like that of the floor. The arch may h.e prevented from falling, or fallen arches may be corrected even, by exercises which call for the use of the muscles of the feet; such exercises, for in- POSTURE AND EXERCISE 49 stance, as rising on the toes, with the toes turned in- ward, and turning on the ankles, both outward and in- ward. It has been ascertained by extensive inquiry that there are three main types of feet as shown in Fig. 21. It follows, therefore, that no one type of shoe will fit all feet. Shoes are being constructed over lasts of the three types, designed by the technical committee of the American Posture League. Men and women are learn- ing that more attention must be paid to fitting the shoe to the foot, rather than the fitting of the foot to the shoe. The wearing of improperly fitted shoes results in the formation of blisters, bunions, callouses, " corns," etc. These not only deform the foot and detract from the grace of the body but are often the source of con- siderable annoyance and pain. A person having defec- tive feet should first secure the services of a chiropodist and afterward wear the proper type of shoe. When the feet pain — for instance from standing and not from any physical defect — putting them in hot or cold water for five or ten minutes at night will often give relief. Persons who walk a great deal on pavements or cement floors should wear rubber heels to lighten the shock. The wearing of high heels is detrimental to the foot and to the body generally. It causes a pronounced shock to be sent to the spine and brain, resulting in pains in the region of the back and in headaches. The practice cannot be too strongly condemned. 23. Corrective exercises. The exercises listed be- low, prepared by the Physical Training Department of 50 HEALTH AND EFFICIENCY New York City have been found after extensive exper- ience to be useful in preventing or even correcting de- fects of posture. Either these exercises or others of a similar nature may well be performed on rising and before retiring and also as a setting up exercise at the beginning of a class room period. Before starting the Fig. 22. — These seats, designed by the American Posture League, are now in use on the Brooklyn Rapid Transit lines exercises loosen the clothing as much as possible and open the windows. i. Breathing. 4 times. In ! Six counts for inhalation. Out! Four counts for exhalation. Right (Left) : — Face! POSTURE AND EXERCISE 51 2. Stretching. 4 times. This exercise must be done to Response Commands, using the cues indicated. Bend ! Bend the trunk forward, touching hands to toes. Shoulders! Stand erect, touching hands at sides of shoulders in passing to the next po- sition. Stretch ! Stretch the arms upward, palms to- ward each other. Do not bend backward. Higher! Make an effort to stretch higher. Down ! Turn hands and bring arms sideways downward quickly, without noise. If the room is too crowded for the sideways down- ward movement, the arms may be brought down close to the body. 3. Knee Bending. (Thumbs locked behind with- out command). 8 times. This exercise should be taught, using the cues indi- cated; when it is thoroughly learned, it may be done to Rhythmic Commands. Down ! Bend the knees deeply. Up ! Stretch the knees quickly. Right (Left) : — Face! 4. Breathing. 4 times. In ! Six counts for inhalation. Out! Four counts for exhalation. Class : — Sit ! 24. Out of door and gymnastic exercise. Every boy and girl should take part in some out of door game and endeavor to become proficient in it. Swimming, 52 HEALTH AND EFFICIENCY skating, golf, tennis, walking, hunting, and fishing all provide moderate exercise and contact with Nature. In congested cities, opportunities along these lines are lim- ited and recourse should be had to the gymnasium. Gymnastic clubs can develop keen competition, strong bodies and well toned nerves. 25. Athletics. It has been pointed out repeatedly that the remarkable adaptability of the American youth to modern warfare was due largely to his training in athletics. The lessons of courage, resourcefulness, and even chivalry, learned on the ball field, were quickly transferred to the battle field. These qualities made the American fighting man the equal of any the world has ever seen. " We can kill them but we cannot stop them, ,, the Germans are said to have complained. Even in peace times, a sound, athletic body is a very great help to anyone. It makes possible more and better work and encourages a healthy optimistic outlook on life. " Grouches " and " dyspeptics " are not found very often among athletes. Mere muscular strength is not the goal to be aimed at but rather organic vigor together with whatever muscular development may be needed to adapt one to the game or activity in question. Boxing, baseball, basket ball, and football develop these qualities remarkably well. Participation in these games has demonstrated repeatedly that, to be in con- dition, one must avoid overeating, carousing, smoking, and drinking. A sound mind in a sound body, together with sound morals, make up the perfect American. There are certain precautions to be taken, however, if one is to take part in athletics. First, one should POSTURE AND EXERCISE 53 be examined by a physician. If a defect of any organ is found the physician should indicate the exercise that will correct it, and should give advice as to what forms Fig. 23. — Photograph of a chair designed by the American Posture League. What advantages does this chair have over the ones in common use ? of athletics are to be avoided. Secondly, it should be kept in mind, as pointed out before, that the develop- ment of huge muscles is not what is desired. Thirdly, 54 HEALTH AND EFFICIENCY one should not give up strenuous exercises suddenly. After a dash along the track, the runner should not come to a dead stop at the tape, but should gradually decrease the gait to a walk. This gives the heart a chance to adapt itself to the new condition. Finally, after any strenuous exercise, one should bathe in warm water to remove the perspiration and should follow the warm water with cold water in order to close the pores of the skin and send the blood to the interior of the body. Copyright by Underwood & Underwood Fig. 24. — East meets West at tennis 26. Health admonitions from Walter Camp's In- sruction Book for the Senior Service Corps. Warm feet and a cool head need no physician. A bath, cool if you please, hot if you must, with a good rub, starts the day right. Dress cool when you walk and warm when you ride. Wearing the same weight underclothing the year around will save you a lot of colds. Your nose, not your mouth, was given you to breathe through. POSTURE AND EXERCISE 55 Clean skin, clean socks, clean underwear every day. Don't sit still with wet feet. Walk until you have a chance to change. Never let a day pass without covering four miles on foot. See how high you can hold your head and how deeply you can breathe whenever you are out of doors. Hot water quick is the best thing for a sprain. Short shoes and shoes that don't fit cost a lot in the long run. Getting mad makes black marks on the health. Envy, jealousy, and wrath will ruin any digestion. When you rob the trolley company of a nickel by walking, you add a dime to your deposit of health. You'll never get the gout from walking. Sleep w r oos the physically tired man ; she flouts the mentally exhausted. The best record in golf is the record it has made of restored health to the middle-aged. Tennis up to the thirties, but golf after forty. Nature never punished a man for getting his legs tired. She has punished many for getting their nerves exhausted. Two hours of oudoor exercise by the master never yet made him over critical of the cook. Don't ask the heart to pump extra blood to the brain all day and then to an overloaded stomach all night. Tight shoes have sent many a man to bed with a cold. Leg weariness never yet produced brain fag. Loose clothes, loose gloves, easy shoes spell comfort and health. 56 HEALTH AND EFFICIENCY No wise athlete stands still after exercise without putting something over him. Open windows don't make half as many colds as closed ones do. Blood pressure does not come to the men who walk a lot out of doors ; instead it looks for those who sit and eat a lot indoors. Many a man finds too late that his motor car has cost him more in health and legs than it has in tires and gasoline. Copyright, Underwood & Underwood Fig. 25. — Championship game of baseball A four or five-mile walk daily makes your credit at the bank of health mount up steadily. Nature won't stand for overdrafts any more than your bank. The men who chase the golf ball don't have to pur- sue the doctor. CHAPTER IV AIR AND BREATHING 27. What contact with air does for the body. Many persons think that the only use for air is for breathing, and that the only use for water is for drinking. They have not learned what physicians have found, that mere contact with air and water have a very decided effect in keeping the body in a healthy condition and even in restoring it to health when it has been invaded by disease. So true is this that one of the most successful forms of treatment for con- sumption and nervous diseases in children consists in allowing the children to romp and play, attired only in as much clothing as decency requires. The healthy response which the body shows to this form of treat- ment is remarkable and its fulh explanation is not known. It is a matter of common observation that persons living out of doors have a healthier complexion and are more energetic than those living indoors. This is, of course, explained partly by the beneficial action of sunlight on the body and partly by the increased mus- cular action induced by the out of doors. A change of air temperature, either from the day to the night or from summer to winter, is probably best suited to the 57 58 HEALTH AND EFFICIENCY healthy functioning of the body. Every one should take full advantage of fresh, cool air, particularly those suffering from any wasting disease or from any disease of the nervous system which may be produced by overwork or worry. 28. Howi and why we breathe. Our bodies are in some respects like steam engines. For instance, they require fuel. A steam engine drawing a train of cars has to be kept constantly supplied with coal. If the fire box of the engine is not sufficiently supplied with Copyright, Underwood & Underwood Fig. 26. — East meets West at football (Harvard vs. Michigan) this fuel, it is unable to perform the work that is nec- essary to draw" such a heavy load. We need to w r ork just as much as an engine does. An engine that can- not perform work is useless, and so is a human body. To perform work our bodies must have fuel in the form which they can use ; for instance, bread, potatoes, meat, and milk. But every one has noticed that, in order to have fuel burn in a stove or fireplace, it is necessary to have the dampers open so that a draft or current of air may come in contact with the fuel. If for any reason sufficient air does not pass through the fuel, the fire AIR AND BREATHING 59 burns down. In like manner, our food will not be burned and we will not be provided with heat and power to work, unless our bodies are supplied with a constant stream of air. We are all conscious of breath- ing — we have noticed the nostrils dilate, the chest rise and fall, and we have felt the passage of air through the mouth or nose, the back part of the throat, and down into the chest. Most persons know that they have lungs but few could describe them. The best way to get an idea of what the lungs look Photograph from Underwood & Underwood Fig. 27 — What is the source of the energy used by this engine? like is to ask a butcher to show you the " pluck " of a calf. This consists of the windpipe, which conducts the air down from the throat, the two lungs, and be- tween the lungs, the heart. An examination of the lungs will -show them to be pinkish in color, due to the presence of blood, and very compressible. If one takes a pocket knife and slits open the windpipe and then follows it down into the lungs he will find that it di- vides into two main branches, one going to each lung. Each subdivides, and these subdivisions finally end in 60 HEALTH AND EFFICIENCY the spongy tissue of which the lung is composed. This spongy lung-tissue is easily compressed by the muscles Fig. 28. — Showing workmen cutting pearl shell unpro- tected from the excessive and dangerous dust and ribs in the chest wall ; but when the pressure is re- leased the lung returns to its normal expanded position AIR AND BREATHING 61 and sucks in air from the outside through the windpipe, mouth, and nose. When the air reaches the lung-tissue it almost comes in contact with the blood, giving to the blood a remarkable substance, oxygen, which has the faculty of enabling fuel to burn. The blood in re- turn for the oxygen, gives back to the air waste pro- ducts — carbon dioxide and water, which are likewise formed when coal or wood burns. When the chest " falls " during breathing the wall of the chest com- presses the lungs, and the air containing carbon dioxide is forced out along the same path taken by the incom- ing current of air. 29. What we breathe. We are all acquainted with the fact that we breathe air. But not every one knows what air is. Of course we know that it is a gaseous substance, colorless, and that it flows about readily from one place to another. It is constantly in motion as we are aware from our experiences with " drafts " and " winds." But yet what is air? Chemists have found that it is made up principally of gases, and biologists have found floating about in it other substances — some dead, some living, and still others which never had life. Two of the gaseous substances composing the air, we have already mentioned, oxygen and carbon dioxide, but these exist in relatively small amounts as is seen from the following table : Air that we breathe in Air that we breathe out Oxygen 20.96% Oxygen 16.4% Nitrogen _ . % 79.00% Nitrogen _ . 79-5% Carbon dioxide 0.04% Carbon dioxide 4.1% Among the dead substances floating about in the air are particles formed from the bodies of plants and ani- 62 HEALTH AND EFFICIENCY mals during decomposition. Among the substances which never had life are particles of steel and stone, which often get into our eyes. The living substances are bacteria, spores of molds, and pollen grains. The living bodies found in the air are particularly interest- ing because some of them cause disease. The mold spores are seeds of the mold which we see growing on stale bread, apple cores, etc. These spores are blown about by the currents of air and sometimes lodge in the ear or nose where they may grow and produce disease. Expose a piece of moist bread, a moist apple core or a moist banana peel to the air for an hour and then put them under a cup to see how many kinds of molds you can raise. Bacteria, together with certain kinds of one-celled animals, are commonly called " germs " They are so small that they can be seen only with the aid of a microscope, and yet they kill thousands of peo- ple each day, either by secreting poisons in them or by actually eating the tissues of their bodies. One form of bacteria, in particular, thrives in the soft spongy tissue of the lung, consuming it and producing a disease which we call consumption. As the germ caus- ing this disease eats away more and more of the lung- tissue, less and less oxygen can be taken up by the blood. At the same time that it is consuming the lung-tissue, it is secreting a poisonous substance which is taken up by the blood and distributed throughout the body, causing a loss of vitality and weight. We should be constantly the prey of the tuberculosis bacteria if it were not for certain safeguards which Nature has thrown about us. First, there are the hairs in the nos- AIR AND BREATHING 63 trils which act as a sieve, straining out particles of dirt and bacteria ; there is also the slimy mucous secre- tion of the nostrils, which catches many more invaders ; finally the tissues of the lungs are able to offer what is called " resistance " to the disease germs, if the body has plenty of nourishing food and is given the required Fig. 29. — Showing how workers in the process of casting brass are protected against zinc fumes amount of rest, sleep, and exercise. The importance of breathing through the nose rather than through the mouth lies in the fact that the nostrils not only pre- vent much of the dust from reaching the lungs but they also warm the air before it reaches the throat and lungs. For this reason it is necessary to have the nos- trils well cleared so that nose breathing will be as easy 64 HEALTH AND EFFICIENCY as mouth breathing and far more healthful. There are persons, to be sure, particularly in damp climates, who fall victims to consumption in spite of the best medical care. Some of these persons, at least, have inherited weak constitutions, or at least weak lungs, and thus start out in life at a disadvantage. 30. Diseases of the breathing organs. Physicians who have had years of experience iri conducting u au- topsies," or examinations of dead bodies, say that al- most every one has consumption at some time or other during his life. They know this from " scars " left by the disease in the lungs. If a person keeps himself in good condition his body is able to resist the disease successfully. So great is the danger from this disease that each one should know just what to do to avoid it and what to do to combat it. Mention was made in the preceding paragraphs of the tendency to tuberculosis in damp climates. This same tendency is found in damp communities and in damp houses. The tendency is found among those who live indoors a great deal, particularly among those who inhale large quantities of -dust, as men do who work in close, ill-ventilated rooms, or in rooms where marble or wood is being pol- ished. It is found among those who overwork or un- der-exercise ; among those who worry or grieve ; in a word among those who do not live out under the blue dome of Heaven, as God intended that they should. It is, of course, impossible in our present " civilization " for every one to do this — we need office workers as well as field workers. But those who work inside, either through choice or necessity, must guard well AIR AND BREATHING 65 their health. They should ventilate their work-rooms as well as the construction will allow. If the room it- self is not adapted for good ventilation, complaint should be made to the employer or to the Board of Health. Workers have tolerated bad working condi- tions too long, and one of the greatest services that can i^iiii ^ B Ai «W ■ I „.d> 91 iH HI III ■Lk * s lag lit * t 1 '. £mk So 5 *|kV\ * ill m ' ^W MPP*" ' v;.4'g^^^B ■B Fig. 30. — Women at work on small cores in a well lighted, well ventilated and well kept foundry be done for a community is for students in hygiene classes to call attention to these facts through the press or by personal interviews with the Health authorities. The question now arises, if tuberculosis or consump- tion is so general, how is one to recognize it? At one time it was very difficult to recognize the disease in its early stages but now, with more refined methods of 66 HEALTH AND EFFICIENCY diagnosis, particularly by the use of the X-ray, physi- cians are able to distinguish the disease at a very early date. It usually causes a loss of energy, loss of weight, a cough, and sometimes night sweating. If a person is aware of any combination of these symptoms, it would be well to consult a physician immediately. The disease is not hopeless as many think ; as a matter of fact, one of the greatest monuments erected to the mem- ory of the hundreds of self-sacrificing physicians who have studied this disease is the successful treatment which they have devised for it. A hundred years ago the disease was called the '* Great White Plague," and its victims considered themselves doomed to a speedy death. Now, however, if the consumptive begins in time, he can defeat the disease and restore himself to normal health by a well-regulated diet and hygienic conditions of living. Out-of-door living plays a great part in the treatment. In the first paragraph of this chapter there was de- scribed a new form of treatment for tuberculosis in children by means of air baths. The knowledge of this form of treatment should be more general, and re- course should be had to it whenever circumstances per- mit. Fresh air, both by day and night, and plenty of nourishing food furnish the key to the cure. The question of foods and dietaries form the subject of a subsequent chapter, but one should note here that certain foods like eggs, milk, cooked and uncooked cer- eals, and coarse bread should form the basis of the diet. Fats and oils are particularly nourishing to those suf- fering from respiratory diseases. It seems impossible AIR AND BREATHING 67 for one to overeat during the course of the disease, though one may overwork. Rest, or at the most, light out-of-door work is essential, in order that no new strain may be put on the body. And the best rest is that which is taken in contact with fresh, cool air. For- tunately the prejudice against night air is disappearing. Fig. 31. — A disciple of Dr. Trudeau The coolness of the night air makes it especially use- ful in the treatment of consumption. Of course, if the air is cold, the body should be guarded against chills by proper street and bed clothing. People thought that Dr. Trudeau was crazy when he took his tubercular pa- tients to winter in the Adirondacks, where snow lies on the ground six months in the year and the temperature 68 HEALTH AND EFFICIENCY often goes as low as 30 degrees below zero. But the. patients got well, and now Dr. Trudeau is known as the " Beloved Physician/' and a town is named in his honor. Boards of Health are always ready to cooperate in an endeavor to check this disease and will give the best medical advice, and often complete treatment, free of charge, to those who need and desire it. In the larger cities well equipped clinics for diagnosis, and complete sanataria for treatment are provided. Another disease of the lungs which causes thousands of deaths is pneumonia. People make themselves sus- ceptible to the disease by over-eating, overworking, over-exposure to cold winds, by going about with wet feet, and by neglecting colds. Pneumonia shows itself by symptoms of fatigue, chills, fever, and a loss of ap- petite. The disease develops so rapidly that it is always best, when these symptoms are present, to call a physi- cian. Certain first aid measures should be taken while awaiting the physician's call. First, one should take a physic and put the feet in hot mustard water (one table- spoonful of mustard to a gallon of water). Immed- iately afterward, one should go to bed and, while keep- ing well covered, drink a bowl of lemonade as hot as it can be taken. If pains in the chest are present, the physician will probably recommend a mustard or flax seed poultice ; the use of these, therefore, may be antic- ipated. Directions for making the poultices are given in Chapter XIII. The directions given above apply equally well to ordinary colds, grippe, or influenza. 31. Problems of ventilation. So much of what has been said about air and the diseases of the breathing AIR AND BREATHING 69 organs is involved in methods of ventilating that it seems well to summarize here. Ventilation means providing the body with currents of air. It used to be supposed that ventilation was necessary because of the collection of waste products in the air which came from the lungs, and because of the exhaustion of the oxy- :! "^pt ; ;^ ; -,,^: ^ ^>;IStg:'' 1 -' ' ' '■"■■'"'■ 'W^-"x '■:■.:■:■ :. . Fig. 32. — A well lighted workroom having whitened walls, prismatic glass kept clean and shades for windows gen from the air of the room. It is known now, how- ever, that it is not possible to reduce the oxygen supply in a room to the danger point by breathing and that the ill effect of carbon dioxide is negligible. What the body needs most of all is a current of fresh, cool air, containing a small amount of moisture. It is be- 70 HEALTH AND EFFICIENCY cause of this fact that we should keep out in the air as much as possible during the day and that we should ventilate our living rooms day and night by having the windows open top and bottom. Rooms ventilated by keeping the windows in this condition will enable one to work better and sleep better, since there will be a constant stream of fresh air into the room, by way of the lower part of the window, and a constant stream of Fig. 33- — A well ventilated schoolrooom heated and vitiated air out, by way of the top of the window. If the draft produced by opening the win- dow in this way is too severe, a wooden frame, covered with cheese cloth and fitted into the bottom of the win- dow, will moderate the air current.' As an example of the disastrous effects of a failure to ventilate, the experience of the British soldiers locked in the Black Hole of Calcutta may be cited. About AIR AND BREATHING 71 150 soldiers were confined, during a hot tropical night, in a room about 20 feet square, provided with only two windows, both on the same side of the room. In the morning twenty-three were found alive ! This inci- dent has given rise to many theories as to the cause of death. There may have been a shortage of oxygen and an accumulation of carbon dioxide and other poisonous waste products. That these do not constitute the im- mediate cause of the loss of 127 lives in one night is the prevailing opinion of specialists on ventilation. The real cause of the disaster was probably the rise in the temperature, due to the presence of so many human beings closely confined in a small room. As the tem- perature rose, the living conditions became more un- bearable and the movements of the agonized prisoners rendered the situation increasingly acute. CHAPTER V FOOD AND DIET 32. The body considered as an engine. It will help us to understand how the human body performs its work if we consider first a steam, engine. It may seem at first thought that there is little resemblance between the two, but yet they bear to one another a very pro- found likeness. In the first place, both move and both do work. A steam engine, if hitched to a car, can pull it, and a man, if hitched to a smaller car, can pull that also. Where do they get this ability to do work? Since the engine is much the simpler structure of the two, we will consider that first. If you watch a steam engine as it comes into a railroad station, you notice that there are two men in it — an engineer, to start and direct it, and a fireman, to supply it with coal. What happens to the coal? If you watch the fireman, you notice that he shovels the coal into a fire box, where it burns. But how does this run the engine? If you ask the fireman, he will show you that the fire box is under a great tank of water. You know what happens to a kettle of water when it is put on a hot stove. When the water boils, the cover of the kettle moves up and down, due to the pressure of steam within. A similar change takes place in the engine. The heat of the burn- ing coal changes the water into steam, and the steam 72 FOOD AND DIET 73 moves the piston rod up and down, and the piston rod moving up and down moves the wheels around, and so the engine is able to do work. In other words, from the burning coal comes heat energy and motion energy. So in our own bodies, food is burned from which we obtain heat and motion energy. A starving person has little vitality and does not move about much as only a small portion of fuel is being burned in his body. On the other hand, during some diseases such as influenza, ■Ji..JL*— La 1 1 s iiiS^llll§81 EBBB ***** ' •■■■' .■■:■; Copyright, Underwood & Underwood Fig. 34. — Potato farming — potatoes are a valuable food fuel is burned too fast, and the person's temperature rises, causing what is called a " fever." At other times in the same disease, too little fuel may be burned, so that the person suffers from a lowered temperature or " chill." The temperature of the human body is nor- mally about 98.6 F. This is maintained in several dif- ferent ways among which are sweating, shivering, and drinking hot or cold liquids. If there is a tendency 74 HEALTH AND EFFICIENCY for the temperature to rise, the body gives off sweat, which evaporates on the skin, thus cooling the body. If there is a tendency for the temperature to fall the body resorts to shivering, which is a very effective means of generating heat. In disease, it is frequently necessary to produce sweating by hot drinks, such as hot lemon- ade, or to give hot baths. On the other hand in chills, Copyright, Underwood & Underwood Fig. 35- — Rice farming — Transplanting rice shoots, near Kyoto, Japan it may be necessary to wrap the patient up warm and to apply hot flannels or hot water bottles in addition to giving hot drinks frequently. 33. Food as fuel. Not all things that burn are suit- able for fuel either for the steam engine or for the hu- man body. For instance, the ordinary steam engine is not constructed so that it can utilize kerosene or gaso- line, and yet both burn. So with the human body. FOOD AND DIET 75 Substances which can be utilized by the human body as fuel or for repair or regulation are known as foods. We will first consider those foods which serve as fuel. In general, they are the starchy, sugary, and oily foods. Under this head would come bread, potatoes, honey, and bacon. The Life Extension Institute of New York City, of which Ex-President Taft is Chairman of the Board of Directors, has compiled in its booklet called -v" \ : W- Copyright by Underwood & Underwood Fig. 36. — Threshing wheat " Food — Fuel for the Human Machine/' a list of fuel foods divided into three classes and arranged in such an order that those coming first are the ones giv- ing the most energy for the money. . Starchy Foods 2. Sugars 3. Fats Cornmeal Hominy Broken rice Sugar Corn Syrup Dates Drippings Lard Salt pork 76 HEALTH AND EFFICIENCY :. Starchy Foods 2. Sugars 3. Fats Oatmeal Candy Oleomargarine Flour Molasses Nut margarine Rice Most fruits Peanut butter Macaroni Milk Spaghetti Bacon Cornstarch Butter Dried lima beans Cream Split peas, yellow Dried navy beans Bread Potatoes Bananas These foods, when used in moderation, are burned in the body and release heat and work energy. Where does the burning take place ? W£ learned in an earlier chapter that the leaf of the lily is composed of tiny structures called cells. The same is true of a human body. Every organ and tissue of the body is made up of cells. It is in these cells that the food is burned, being carried there by the blood stream. Each cell is like the fire box of the engine since it is the place where the chemical energy of the food is changed, by burning, into heat and work energy. A word of caution should be given here in regard to the danger of taking into the body too much starchy and sugary food. Starch is digested into sugar, which, together with the sugar contained in puddings, candies, ice cream etc., is stored in the liver, from which it is gradually given to the blood to be fed to the cells. The amount of sugar normally present in the blood at any one time is very small — less than one per cent. But under the constant bombardment of sugar-contain- ing foods, the sugar content of the blood may rise FOOD AND DIET 77 much higher than that, and sugar in large quantities is a poison. Mr. Alfred McCann, Food Expert for the New York Globe, says that " America has become a nation of refined sugar hogs." He says that " the aver- 6 -s. Yrs. 7 Yrs. 8 Yrs. 9 Yrs. 10 Yrs. 11 Yrs. 12 Yrs. 13 Yrs. 14 Yrs. 15 Yrs. 16 Yrs. 17 Yrs. 18 Yrs. 39 c 40 ■ 41 I 42 t 43 t 44 / 45 i 46 t 47 . 48 . 49 . 50 . 51 . 52 . 53 . 54 35 56 37 58 39 10 41 12 42 14 45 16 47 18 48 . 49 . 51 . 53 36 38 40 42 43 45 47 49 50 52 54 56 59 62 43 44 46 48 50 51 53 55 57 60 63 66 49 51 52 54 56 58 61 64 67 53 55 56 57 58 59 62 65 68 60 63 66 68 61 64 67 69 TO 70 no r- A HEIGHT and WEIGHT TABLE for BOYS ABOUT WHAT A BOY SHOULD GAIN EACH MONTH Age 5 to 8 . . . . 6 oz. 8 to 12 . . . . 8oz. 12 to 14 . . . . 12 oz. 14 to 16 . . . . 16 oz. 16 to 18 . . . .8 oz. ABOUT WHAT A GIRL SHOULD GAIN EACH MONTH Age 5 to 8 # . . . 6 oz. 8 to 11 . . . 8oz. 11 to 14 . . . . 12 oz. 14 to 16 . . . . 8oz. 16 to 18 . . . . 4oz. Try and do as much better than the average as you can DEPARTMENT OF THE INTERIOR BUREAU OF EDUCATION HEIGHT and WEIGHT TABLE for GIRLS Hgt: Ins: 5 frs. 6 frs. 7 Yrs. 8 Yrs. Yrs. 10 Yrs. 11 Yrs. 12 Yrs. 13 Yrs. 14 Yrs. 15 Yrs. 16 Yrs. 17 Yrs. 18 Yrs. Hgt 5 Yrs 6 Yrs 7 Yrs 8 Yrs 9 Yrs 10 Yrs 11 Yrs 12 Yrs 13 Yrs 14 Yrs. 15 Yr 16 . Yrs 17 18 Yrs. Yrs. 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 35 37 39 41 43 45 47 48 36 38 40 42 44 46 47 49 51 53 55 37 39 41 43 45 46 48 50 52 54 56 58 60 62 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 34 3( 38 40 42 44 46 48 3E 3 r 3£ 41 42 4£ 47 48 49 51 53 3( 3* 4C 42 4C 4£ 47 4£ 5C 52 54 56 59 62 44 46 47 48 50 52 55 57 59 61 63 66 69 43 44 4( 48 5( 51 53 55 57 60 63 66 68 49 51 53 55 58 60 62 64 67 70 73 77 4i 51 52 54 56 58 61 64 67 69 72 76 54 56 58 60 63 65 68 71 74 78 81 84 87 91 53 55 57 59 61 64 67 69 72 75 79 82 85 88 92 95 100 105 Sh 57 58 62 65 68 70 73 76 80 83 86 89 93 97 102 107 113 59 62 65 68 70 73 77 81 85 89 60 63 66 68 71 74 78 82 86 90 94 99 104 109 61 64 67 69 72 75 79 83 87 91 95 101 106 111 115 117 119 71 74 77 81 84 87 90 94 99 104 109 115 120 125 130 134 138 70 73 76 80 84 88 93 97 102 107 112 117 119 121 124 126 29 78 82 85 88 92 97 102 106 111 117 122 126 131 135 139 142 147 152 157 162 77 81 85 89 94 99 104 109 113 118 120 L22 L26 L28 L31 34 38 90 94 99 104 109 114 118 123 127 132 136 140 144 149 154 159 164 169 174 86 90 95 100 L06 111 115 119 122 124 127 L30 33 36 40 45 91 96 101 106 111 115 119 124 128 133 137 141 145 150 155 160 165 170 175 91 96 102 108 113 117 120 123 126 128 132 135 98.'.'.' 104106 109111 114115 118119 121122 124125 127128 129130 133134 36 137 102 108 117 120 125 129 134 138 142 146 151 156 161 166 171 176 no 116 119 122 126 130 135 139 143 147 152 157 162 167 172 177 38139140 42143144 47148149 ■ Prepared by Dr. Thomas D. Wood Prepared by Dr. Thomas D. Wood Height and weight to be taken in house clothes without shoes. Weigh on the same day each month. Age the nearest ■birthday. Each child to enter his own weight. FOOD AND DIET 91 that foods are composed of various substances called nutrients, which may be classified as (a) carbohydrates (starches and sugars), (b) fats and oils, (c) proteins, (d) mineral substances, and (e) water. To the nu- trients should be added fibrous material and vitamines. Not all foods are composed of these substances in the same proportion. A glance at the figures prepared by the United States Department of Agriculture will make this clear. From the foods given in the chart shown on pages 92 to 97 inclusive select two that are especially rich in carbohydrates ; two that are espe- cially rich in fats; two that are especially rich in pro- tein, and two that are especially rich in mineral matter or ash. 38. Overweight and under weight. The question of overweight for men and women of thirty-five years and over is an important one. The Life Extension In- stitute of New York says, " after the age of 35, over- weight is associated with an increasingly high death rate, and at middle life, it becomes a real menace to health, either by reason of its mere presence as a physi- cal handicap or because of the faulty living habits that are often responsible for its development. If there is a family tendency to overweight, one should begin early to form habits that will check this tendency. If con- siderable overweight is already present, caution is nec- essary in bringing about a reduction. Barring actual disease, this can usually be done without drugs if the person will be persevering and faithful to a certain regime." 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J Fig- 53- — Mucous membrane of small intestine to depict it accurately would occupy too much space. It is about twenty-two feet long and lies coiled in the abdomen. In this tube digestion is completed. Into it are poured bile from the liver, pancreatic juice from the pancreas, and other digestive fluids from glands in its wall. Bile, secreted by the liver, collects in the gall bladder or bile sac, and is, on occasion, poured into the intes- tine. It is partly a waste product, being made up of worn out blood corpuscles and other wastes, and partly a digestive fluid, facilitating the passage of fats into DIGESTION AND ABSORPTION 123 the blood. Conditions described as sluggishness of the liver and biliousness are common. They are charac- terized by a feeling of irritability, grouchiness, indis- position, constipation, and lack of the usual relish for food. They can usually be corrected by exercise and diet. Any general exercise like walking and swimming is valuable but should be supplemented by special cor- rective exercises that call for action on the part of the abdominal muscles. Special exercise of this sort is obtained by standing erect, hands on hips, and bending first to one side, then to the other ; this should be fol- lowed by bending forward and backward and by twist- ing the abdomen on the hips while keeping the legs rigid. This exercise should be varied by lying on the back and raising the body and the legs alternately from the floor. A corrective diet for the symptoms indicated above should include fruit, marmalade, and fibrous vegetables like turnip, spinach, dandelions, and cabbage (fresh or as sauerkraut). This diet should be supplemented by drinking large quantities of water. In some acute cases a cathartic is needed and, if so, it had better be epsom salts, cascara, or castor oil, rather than a patented preparation whose composition is obscure. The pancreatic juice, secreted by the pancreas, con- tains enzymes which digest proteins, oils, and starch. In cases of an unbalanced diet, or of overeating, or of hasty eating, some food will pass on undigested even after the combined action of saliva, gastric juice, bile, and pancreatic juice. Of course, there is always the fibrous content of the food that cannot be digested by any of these fluids. Besides this, there is the residuum 124 HEALTH AND EFFICIENCY of foods which is capable of being digested but which has gone on undigested. This latter is frequently the source of much disease. If it is not quickly expelled, it is apt to be attacked, in the large intestine, by bac- teria producing poisonous substances which are ab- Spilheli Intestinal gland lacteal Fig. 54. — Diagram showing how the blood circulates through the villi sorbed by the blood and distributed over the body. Many headaches and so-called " bilious attacks " are due to this cause. This condition of seli-poisoning is common and is responsible for many serious diseases ; it emphasizes again the need for careful attention to diet, with the inclusion of liberal quantities of fruit and DIGESTION AND ABSORPTION 125 vegetables, the need for exercise, and for plenty of water. Water helps to prevent constipation. 55. How is food absorbed from the small intes- tine? On the interior surface of the small intestine are so many tiny projections that it looks somewhat like velvet. Each of these is a food absorbing structure, known as a villus. Fig. 54 shows that each villus is covered with a sheet of cuboidal cells. These have the power of absorbing needed food materials, which, in case they are mineral matters or digested proteins or starches, are passed on to the blood vessels ; or, in case they are digested fats, they are passed on to the lacteals. Food materials going into the lacteals are later emptied into the blood stream. 56. What is blood? Most persons know that blood is a red, thickish liquid, but few persons know that it is continually being made and discarded by the body. Much of it is water and much is digested food. Some of it is solid, some liquid, and some gaseous. The gaseous part is oxygen, breathed in from the air, and carbon dioxide, formed by burning food substances in the tissues ; the solid part is made up of red cells, carry- ing their loads of oxygen or carbon dioxide, and white cells, seeking disease bacteria to devour ; the liquid part is largely dissolved food substances. The red cells, which are so necessary to the life of the tissues, are made in the marrow of the bone, and the white cells are probably made in the spleen, bone marrow, and in such glands as the tonsil and adenoid. Red blood can be acquired by eating nutritious foods — cereals, vege- tables, fruit, milk, eggs and whole wheat bread ; by ex- 126 HEALTH AND EFFICIENCY ercising out of doors ; and by securing mental poise by means of recreation and sleep. All of these are es- sential and the omission of any one interferes with the process of blood making. Advertisements for so-called ik blood making " medi- cines emphasize the fact that iron is an essential part of the blood. So it is, but unless prescribed by a phy- sician, patent medicines advertised to contain iron should not be used, but rather such iron-rich foods as spinach, string beans, dandelions, carrots, raisins, and cabbages. All of these contain iron in abundance and in a form easily assimilated by the tissues. 57. Other parts of the body influencing nutrition and growth. The condition of the nervous system has a very important effect on the nutrition of the body. Consequently, it is well to surround a meal with con- siderable ceremony. Moreover, there are several glands in the body, called ductless glands, because they have no ducts to carry off their secretions. These empty di- rectly into the blood and are represented by the pituitary body at the base of the brain, regulating growth, and the thyroid gland situated at the front and sides of the neck, which has something to do with the nutrition of the body. The thyroid sometimes becomes enlarged, resulting in a condition called " goitre." At one time, these and other glands were thought to be useless struc- tures inherited from our animal ancestors, but now it is known that they are necessary to the life of the organ- ism. This should indicate to us that each part of the body is set aside for a certain function and that neglect DIGESTION AND ABSORPTION 127 or abuse of any part may have a very serious effect on the rest of the body. 58. The action of drugs on the heart and blood. The heart is a large muscle which contracts, on an aver- age, about seventy-two times a minute, forcing the blood throughout the body so that the tissues may be nourished and the w r aste products removed. One can get an idea of the work that the heart does in twenty- four hours, if he closes and opens his fist at one second intervals until the muscles of the hand are too tired to work more. The hand begins to tire in a few minutes, but the muscle of the heart keeps up its work, not only for minutes, or hours, or days, but for years. To do its work, it needs a well-toned nervous system, nutritious food, bodily exercise, and fresh, out-of- door air. The muscle of the heart needs care, but it frequently receives, instead, a bombardment of drugs, stimulating it to greater exertion or depressing its energies so that it is unable fully to do its work. Sometimes it is caffeine, at other times nicotine, and at other times alcohol. And yet some persons wonder why they suffer from palpitation of the heart, or from irregular beating, or from high blood pressure. Alcohol does not give greater strength to the body or mind but it simply stimulates the imagination so that a person thinks that he is gaining strength. Ex- periments with typesetters, typists, and with students have demonstrated beyond doubt that alcohol produces an increase in the number of errors and increases the time of production. Contrary to common opinion, al- 128 HEALTH AND EFFICIENCY cohol is, in the long run, not a stimulant but a narcotic. After absorption into the blood, it readily unites with Photograph from Underwood & Underwood Fig- 55- — Benjamin Franklin — an advocate of simple living oxygen, thereby depriving the tissues of this vitally needed element. Unless prescribed by a physician of experience, it should never be used. DIGESTION AND ABSORPTION 129 Trainers of athletes know that tobacco lessens physi- cal efficiency. Cigarette smoking, in particular, is apt to produce anemia and to interfere with the nutrition of the body. Records such as those kept by Prof. Charles F. Emerson, Dean of Dartmouth College and a member of the class of 1868, indicate why many educators and physicians oppose the use of alcohol and tobacco. Dean Emerson was secretary of his class and, at the close of senior year, each member was asked to state whether he had used tobacco or liquor while in college. The replies were recorded at the time in a book kept by the secretary. About half of those who reported " yes " as to the use of liquor, qualified the statement by say- ing, " only light wine, ale, or beer," but they were classed with the users. In the following statistics, no account is taken of any qualification made by members of the class, nor of the personal habits of members since graduation. The secretary has kept an accurate record of the dates of death during the fifty years since gradu- ation, and the statistics are compiled from these data. The average age at death for those who passed away during the past 50 years is 44 years and 1 1 months for those who used liquor while in college, and is 63 years and 6 months for those who did not use liquor ; a differ- ence of 18 years and seven months in favor of non- users. During the first 25 years after graduation, 29.4% of the users of liquor had died, while only 6.7% of the non-users had passed away. The average age at death for those who used tobacco in college is 49 years and nine months, while for those who did not use 130 HEALTH AND EFFICIENCY tobacco, it is 59 years and 4 months, or nearly 10 years in favor of the non-user. Similar records as those cited above obtained from six other class secretaries indi- cated similar results, although varying from 3 to 15 years. The total records included observations on 500 young men. The caffeine of tea and coffee, like alcohol and nico- tine, acts on the heart and, if used continually, may pro- duce severe derangement. All may lead to nervous- ness, digestive disturbances, and anemia. 59. Patent medicines. When a house is out of order, a carpenter is called, and when the body is out of order, a physician should be called. The body de- serves the most skillful treatment that it can receive. Many communities now provide physicians to give needed medical treatment free of all charge to those who cannot afford to pay. These officials are men or women who have received a complete medical training and who have been licensed to practise medicine only after a thorough examination. The larger cities sup- port highly organized clinics and hospitals, where ex- pert medical and surgical treatment is given. In spite of this knowledge many persons use patent medicines. The New York State Department of Health, in a booklet entitled " Patent Medicines/' says: " What you get when you take a dose of a patent medicine. It is very much as though you took a teaspoonfull of the con- tents of a drug store slop pail. much as though you took a fc tents of a drug store slop pail. DIGESTION AND ABSORPTION 131 Because all patent medicines contain only such drugs as may be got in any drug store, and any par- ticular patent medicine contains just so much of a few of these drugs in a combination no more suitable to your illness than any haphazard mixtures. Remember the label on a patent medicine bottle is intended to make as many readers of it as possible think it will do them good — to boost the sales. No one drug or combination of drugs is good for all diseases. Without medical advice you cannot tell what is the matter when you are sick. An example: Suppose you have a troublesome headache and take a guess as to the cause, see how easily you might miss the mark, as headache is very noticeable in all of the following conditions : Typhoid fever Pneumonia Also most infectious diseases of severe type, such as smallpox, at onset All forms of meningitis Malaria Anemia Heart disease Kidney disease etc., etc." Patent medicines are used because they contain stimu- lants, which may produce a feeling of well being for a time; or they contain purgatives, which often bring temporary relief ; or they contain " dope " which may 132 HEALTH AND EFFICIENCY dull pain; or they contain an alkali, like baking soda, which neutralizes the acids formed by fermenting foods, and thus temporarily relieves stomach ache; or they contain a drug such as opium which may stop diarrhoea for a while." A fuller discussion of this subject can be found in " The Great American Fraud," by Samuel Hopkins Adams, which is issued by the American Medical Asso- ciation, 535 North Dearborn Street, Chicago. This association, which has been organized by the leading physicians of the United States and Canada, also pub- lishes a pamphlet, u Making the Right Start," which classifies and rates the medical schools of this country and shows their laboratory and clinical facilities. No prospective student of medicine should select a medical school without first consulting it. 60. A study of the pulse. Turn the palm of the left hand upward and press the tips of the index and forefingers of the right hand gently on the thumb side of the wrist in a depression between a group of tendons which go to the fingers and the long bone which makes up the outer border of the forearm. A distinct throb occurs at regular intervals. This is the pulse. Count the number of throbs per minute while you are sitting quietly. Count them after running up and down stairs. What is the effect of exercise upon the pulse rate? The pulse is produced by the rhythmic dis- charge of blood from the heart into the arteries. It therefore shows the rhythm and rate at which the heart is beating, the pressure of blood within the arteries, and the elasticity of the walls of the arteries. DIGESTION AND ABSORPTION 133 61. Treatment of cuts and bruises. Even the slightest puncture of the skin should be washed with an antiseptic such as iodine. It is unsafe to rely on hydrogen peroxide as it is a weak antiseptic. Iodine is very reliable for general purposes. If the wound does not heal, but is inflamed and painful, the probability is that bacteria are present in the wound and a physician should be consulted. Fig. 56. — First Aid room in an automobile factory If the wound is deep so that the blood spurts out, pressure must be applied to prevent the person from bleeding to death. The pressure must be applied be- tween the wound and the heart as the spurting blood indicates that an artery has been cut. If the wound is in the arm or leg, a bandage put loosely about the part but tied with a strong knot and later twisted with a stick, will stop the flow of blood. Such a bandage is 134 HEALTH AND EFFICIENCY called a tourniquet. Practise- making a tourniquet out of your handkerchief by tying it about the arm of an- other person. Remember that the circulation should not be shut off for over a half hour, unless necessary, otherwise, permanent injury may result. Remember, also, that the tourniquet should not be applied any tighter than is necessary. 62. Irritations of the mouth. The lips frequently become chapped during the winter, causing considerable annoyance. In extreme cases, the lips crack and bleed freely. A simple and effective form of treatment con- sists in rubbing vaseline gently on the lips at night. Sore spots on the tongue or inside of the cheeks, called cankers, may be treated by rubbing a little powdered alum on them or by dissolving alum in warm water and washing the mouth with the liquid. If the spots do not heal consult a physician. The application of rouge to the lips is deceptive and harmful. It is deceptive because the redness of the lips should come from circulation of good blood and the person who paints pale lips removes a warning signal of ill health. It is harmful because of its irritating action on the tissues. It should be recalled here that the mouth is one part of the body where cancer is particularly apt to occur and that this disease seems to be frequently associated with such irritations as may be produced by hot liquids or the sharp edges of teeth. CHAPTER VIII THE HYGIENE OF THE SKIN AND THE USE OF CLOTHING 63. What is perspiration? The skin is constantly giving off to the air or clothing a watery liquid with a salty taste. Sometimes this collects on the skin in drops but usually it evaporates into the air. One can assure himself that this liquid is being given off to the air by putting the hand into a cold, quart, fruit jar and then packing the mouth of the jar with cotton. A film of moisture soon collects on the sides of the jar. This is perspiration. It has been given off through the tiny pores of the skin, having been carried there by the blood which has collected it from the tissues. It is a part of the liquid waste formed by the burning of foods in the cells. In addition to salts and water, it contains car- bon dioxide and urea. It has much the same chemical composition as the liquid which is collected from the blood by the kidneys. One perspires most freely during or after exercise, since more foods are being burned to supply the muscles with energy. Free perspiration lightens the work of the kidneys, since it removes from the body poisonous wastes which would otherwise have to be removed by the kidneys. Failure to perspire freely can usually be corrected by drinking large quan- tities of water, by exercise, bathing, and diet. Bathing i35 136 HEALTH AND EFFICIENCY and a change of clothing are made necessary by the col- lection of perspiration on the skin. 64. Hygiene of bathing, etc. The perspiration, oil, and dirt which collect on the skin can usually be re- moved by bathing in warm water containing soap. Any castile or toilet soap will do. Failure to bathe once or twice a week causes the body to have a disagreeable Fig. 57-- Photograph by Underwood & Underzcood ■ A popular bathing resort — Coney Island, N. Y. odor. Warm baths, without the use of soap, draw the blood to the skin and thereby rest the nervous system and induce sleep. Warm baths are valuable when one is nervous or tired and produce a restful feeling much more completely than tea, coffee, or other stimu- HYGIENE OF THE SKIN 137 lants. Cold baths drive the blood inward, producing exhilaration. They should be taken in the early part of the day and should leave one with a feeling of warmth. Cold baths should be followed by brisk rub- bing with a coarse towel. If they do not produce a feeling of warmth they should be avoided and in any case one should leave a cold bath before he begins to feel chilly. Hot towels should not be used in cold weather if one is going out of doors. On leaving a barber shop in cold weather it is well to turn up the coat collar if the hair has been trimmed, as the skin, under these circumstances, is quite sensitive. If the skin tends to chafe, talcum powder, cornstarch, or oxide of zinc can be applied after bathing. If the flesh is very tender, vaseline will tend to heal it. In the application of perfumes to the body or clothing, discrimination should be shown both in the quality and quantity. Oily skins can usually be improved by the reduction in the amount of sugary and oily foods and by an increase in the amount of fruits and fibrous vegetables. 65. Eruptions of the skin. It is usual for boys and girls of fourteen or fifteen years to find that the skin becomes rough and even pimply. Attention to diet, the drinking of large quantities of water, use of fruits and vegetables, exercise and warm baths, will help to correct the condition. If the eruption is on the face, an examination should be made to find out whether the condition is caused by " blackheads " — conical masses of oil and dirt which form in the pores and irritate the surrounding tissues. They are frequently pres- 138 HEALTH AND EFFICIENCY ent and may be removed by a " blackhead remover," which can be purchased at a drug store. After using the instrument, the skin should be bathed in listerine. Under no circumstances should the fingers be used to remove blackheads, because the fingernails easily tear the skin and a new infection may be started. Lemon juice taken as lemonade is said to have a very beneficial effect on the skin. In the case of boils it is best to apply a hot poultice first. If it breaks, the pus can be removed by gentle pressure from the sides, taking care to cover the fingers with a clean handkerchief or towel. An anti- septic such as iodine should then be applied. If the boil does not break it should be lanced by a physician. 66. Care of the hair. Hair is an outgrowth of the skin and requires cleansing. It may be shampooed as often as once or twice a month, especially if dan- druff or excess oil is present. It is well to massage the scalp with the fingertips daily. If the hair is dry and brittle, olive oil will benefit it. Nothing is to be gained by the use of eggs as a shampoo. If dandruff is present it can be relieved by regulating the diet, rest, and by frequent shampoos. For this latter pur- pose castile soap will do. Wet the hair thoroughly with warm water and then rub the soap into it until a thick lather forms ; after this has been worked into the scalp, wash thoroughly with warm water and fin- ally with cold water. Twenty-five per cent, alco- hol, rubbed into the scalps once or twice a month, or a ten per cent, ointment of sulphur, used as fre- HYGIENE OF THE SKIN 139 quently but not at the same time, may prove helpful. The hair of school children occasionally becomes infested with vermin. Under such circumstances kerosene should be rubbed into the hair immediately. It is a good practice for each child to arrange to have his hair examined frequently by an older member of the family. If vermin are present in the hair of other children, the teacher should be informed. 67. Care of the nails. The nails should be care- fully trimmed with scissors to prevent them from breaking. They should be neatly rounded and should not project a great deal beyond the end of the fingers. Boys will find an inexpensive " nail clip " a con- venient instrument. These cost from ten to twenty- five cents and can be bought in drug stores. The nails should not be cleaned with a knife blade as it roughens the under surface, permitting dirt to collect there more easily. Biting the nails is usually due to ner- vousness. More out of door exercise should be taken and, if the case is pronounced, a physician should be consulted. One who wishes to overcome the habit can get aid by smearing laundry soap, red pepper, wormwood, or bitter aloes over the tips of the fingers. 68. Callouses, bunions, warts, etc. It is always best to consult a specialist in regard to these matters. The science of Chiropody has developed greatly during the past few years and much help may be obtained from it. Blisters on the feet or aching feet are some- times relieved by holding the feet under cold, running water at night. Frequently, however, the trouble is due to misshapen shoes or fallen arches of the foot. 140 HEALTH AND EFFICIENCY Much of the inconvenience caused by corns, nails, etc. can be prevented if constant attention is paid to the feet. If they are subject to irritation they should be washed in warm water daily, although soap need not always be used. The nails should be trimmed at fre- quent intervals, each time cutting straight across and not snipping off the corners. Corns may be made less annoying if rubbed with fine sandpaper. One of the most common causes of foot trouble is that of wear- ing shoes too short for the foot. Such shoes bind the feet and act as a constant irritant to the skin. Per- sons with tender or sore feet will find it helpful to change the shoes frequently and not attempt to break in a new shoe at once. House slippers rest not only the feet but the whole body. 69. The hygiene of the clothing. The hygienic value of clothing lies, first, in its power of conducting heat, and secondly, in the power of absorbing moisture. Wool (made from the hair of sheep), cotton and linen (made from the fibers of plants), together with silk (made from the cocoons spun by the silk worm cater- pillar), make up a large part of our clothing. Loosely woven material (woolen cloth) is a poor conductor of heat, because its meshes are filled with air, which does not conduct heat well. Tightly woven cloth (cotton) is a good conductor of heat. Clothing therefore does not make heat, but on the other hand it either permits the heat of the body to pass into the air and therefore has a cooling effect, or it prevents the passage of heat and thus keeps the body warm. Several layers of thin HYGIENE OF THE SKIN 141 clothing are warmer than a single layer of thick cloth- ing, because the layers of air between the layers of cloth prevent the passage of heat from the body. It is for this reason that layers of newspapers are some- times put under the clothing. Woolen clothing takes up perspiration rapidly and does not leave the body damp and chilled as other cloth- ing does. Clothing should be adjusted to the occupation and to the season. A person doing much muscular work does not need as much clothing as one doing little. Again, one should dress differently in school from what he does on the way to school. In winter, over- coats should be w r orn to school but they should be re- moved on entering the building. The same is true of rubbers and overshoes ; these are a necessity in stormy weather, but they are a source of ill health when worn indoors. Even shoes should be subject to seasonal changes — low shoes for summer, but not for winter. The dye in stockings frequently poisons the feet through blisters. If blisters form they should be thor- oughly washed and dried and then covered with a thin film of vaseline and a clean, soft white cloth wrapped over the injured part to protect it from the dye. Rubber clothing, such as a mackintosh, does not al- low the heat of the body to pass off readily, conse- quently such a garment, as well as rubbers, rubber boots, and overshoes should be removed as soon as pos- sible. Mackintoshes and rain coats should be pro- 142 HEALTH AND EFFICIENCY vided with large pores in the arm pit to allow ventila- tion. Socks should be changed frequently, since they ab- sorb the perspiration of the feet. Some persons find Photograph by Underwood & Underwood Fig. 58. — Examining immigrants near Ellis Island, N. Y. Clothing often harbors vermin it necessary to change the socks daily. The odor of the body should be a clean, pleasant one, but this cannot be unless bathing is frequent, the clothing changed often, the teeth kept clean and entire, and the toilet habits are regular. Tight garments compress the tissues, especially the blood vessels, and therefore interfere with the normal functioning of the body. Tight garters interfere with the supply of blood to the leg, and tight corsets not HYGIENE OF THE SKIN 143 only interfere with the blood supply to the organs of the chest and abdomen but compress and distort the intestines, stomach, and liver. It is, of course, a mistake to wear light clothing in winter and furs in summer. Dressing in this fashion lowers the vitality of the body and consequently the resistance to disease. Tight hats are frequently a source of headaches. A cap should rest lightly on the head but should not set down so far as to distort the ears. Woolen clothing is warmer than cotton clothing, and is better adapted for winter wear. Woolen bath- ing suits are to be preferred to cotton. There is danger of dressing too warmly, as there is of dressing too coolly. If too much bed clothing is used, sleep will be interfered with, and too much clothing during the day may interfere with perspiration. On a cold night two thin bed covers are warmer than one thick one. Why? Dressing too warmly in the house dur- ing the winter time may lead to chills when one goes out of doors. Wet clothing is a source of danger as it may lead to colds, rheumatism, or pneumonia. Un- derwear should be changed frequently as it is con- stantly absorbing perspiration. It is well to hang up the undergarments at night so that they will be well aired. Of course, undergarments are intended for day wear and a different set of clothing should be worn at night. Xight clothes should be adapted to the season, should be washed frequently, and should be aired thoroughly during the day. 144 HEALTH AND EFFICIENCY As soon as one rises in the morning the bed covers should be pulled down over the foot of the bed and the pillows put on chairs. If sunlight does not strike the bed, the bed clothing should be put near open windows. CHAPTER IX THE ORGANS OF SENSE 70. The five senses. Bunyan has described the human head as the City of Man's Soul and has spoken of Satan attacking through the four gates of the city — Eargate, Eyegate, Nosegate, and Mouthgate. Bunyan of course meant by this that evil knowledge comes to our minds through these channels. It is equally true, however, that wisdom comes to us by the same paths. Through the eye comes the wisdom of the ages, pre- served in manuscript and print ; through the ear music and the solace of other voices; through the mouth and nose food and air, to sustain the mind in all its mani- festations. To the senses mentioned by Bunyan, feel- ing is commonly added, making five in all. As a mat- ter of fact, there are other senses which put us in touch with our environment, but the five mentioned are the ones commonly given. 71. Structure of the human eye. The human eye is a very delicate and complicated organ which frequently becomes defective. Among high school pupils, as many as twenty per cent, have been found to have de- fective vision. Since the condition of the eye depends a great deal upon its care, and since that in turn de- pends a great deal on a knowledge of its structure and function, every student should be familiar with the i45 146 HEALTH AND EFFICIENCY 59. — A man pointing awls has his eyes protected by a glass plate in the hood fully general structure of the eye. If you will examine the eye of another person, you notice that it is spherical in shape and has a black circular area in front. This THE ORGANS OF SENSE 147 Fig. 60. — A man chipping iron castings is exposed to eye injury small black area is surrounded by a colored area (brown, grey, blue, etc.), and this, in turn, by a white area. The black central area is the pupil, the sur- 148 HEALTH AND EFFICIENCY rounding, colored area is the iris, and the white area is a stout cloak which covers the rest of the eye. If you ask the person to shut his eyes for a minute and then to open them, you notice changes in the size of the pupil, especially if he looks first at objects near at hand and then at objects at a distance. You will also see that this change in the size of the pupil is due to the iris, which seems at times to pucker, making the pupil Fig. 61. — Shows spectacles worn by an employee in a steel foundry. A chip of steel from a casting destroyed one lense, as shown above, without injur- ing the eye of the wearer. smaller. The pupil is the window of the eye and the iris the curtain. If the iris is drawn back, much light goes into the eye, where it spreads out on the dark in- terior surface. It is this dark background that makes the pupil look black. The dark background, or retina, corresponds to the plate of a camera, and the rays of light falling on it leave an impression. As each im- pression is made on the retina, the eye nerve leading from the eye to the brain is stimulated and we see. THE ORGANS OF SENSE 149 72. The care of the eye. The eye is easily irritated and quickly fatigued. It is, morover, subject to bac- terial infections. Because of this, care should be taken in the use of towels. Bacteria which have produced a disease in the eyes of one person are often trans- mitted to the eyes of another person through towels. Since we frequently rub our eyes during the day, it is necessary to keep the hands clean. The author knows of the case of a high school girl who lost the sight of one eye because of a disease transmitted from a sub- way strap to her hand and thence to the eye. The hands should always be washed before eating and should be washed frequently if one has come in con- tact with door knobs, car straps, etc., in public places. Soap is one of the best antiseptics known and should be used liberally. For general toilet purposes, castile soap is the best. If a foreign body, like a piece of dirt, gets into the eye, the eye should not be rubbed. The first thing to do is to take hold of the eye lashes of the upper lid and to pull the lid down and out. This will cause tears to run over the eyeball and over the inner surface of the upper lid. Frequently in this way, a foreign body can be washed ofif. Blowing the nose at the same time may accelerate the tear current. It is not advisable, under ordinary circumstances, to use any " wash " on the eye. Tears are Nature's eye wash, being composed of salt and water, and having a tonic action on the eye. If the eye is inflamed or if a mucilaginous substance accumulates at the edge of the lids, warm water, to which boric acid has been added, will reinforce the action of the tears. If the 150 HEALTH AND EFFICIENCY condition is not corrected by this treatment, a physi- cian should be consulted. There are some persons who make a practice of washing out the eyes with water, thinking that the eyes need to be washed. This is ordinarily not true, as the tear glands are constantly secreting a wash which cleans the eye as much as is necessary. The work of the eye is interfered with by reading while one is lying down, or in a moving vehicle, or through a veil, or in a dim or flickering light. A per- son should not face the light while reading, but the light should come from behind and preferably over the left shoulder. The book should be held in such a way that it receives the most favorable degree of light. The proper reading distance is fourteen inches for or- dinary type and school chairs and desks should be ad- justed accordingly. Motion pictures are a strain to the eye and if watched more than occasionally not only fatigue the eye but produce headaches and nausea. 73. Artificial light. When one has a choice of arti- ficial light, it is well to use some discrimination. The naked gas flame and the candle flame are so uneven that they flicker and. throw fine shadows across the page, easily fatiguing the eye. A gas flame of any kind is objectionable because of the gas which escapes and because of the poisonous products formed during burning. Some plants are so sensitive to these poisons that they die in a few hours if left in a room where gas is burning. For a student's lamp, the acetylene kind does very well. If an electric light is used, care should be taken that it is not too bright and that it THE ORGANS OF SENSE 151 209 B C E T P R - F Z B D E OFLCTG - AEORPTDZ « UPRTVZBDFH ■ • YVCEZLNP to Fig. 62. Snelling Chart 152 HEALTH AND EFFICIENCY does not shine directly into the eyes. All light should come from above, preferably from the left, and should be of sufficient intensity to enable one to read com- fortably. It is a good plan to close the eyes for a few minutes each day, in order to rest them. 74. Defects of vision. Headaches, sick stomach, aching eyes, blurred vision, a scowling forehead, and squinting eyes are frequently symptoms of defective eye sight. The lens in the front of the eye should be able to adjust itself to near and far objects. When it is not able to do so, objects appear blurred. Again, if the front of the eyeball is not perfectly round, ob- jects appear blurred and a person is said to have " as- tigmatism. " The vision can be easily examined by means of the Snelling Chart, a reduced copy of which is shown on page 151. In a comfortably lighted room, one should be able to read line 30 of the full sized chart from the left to right and from the right to left, at a distance of thirty feet ; line 20, at a distance of twenty feet; and line 15, at a distance of fifteen feet. If one is unable to do this, it would be well to consult a spe- cialist on the eye. 75. The structure and care of the ear. What we usually speak of as the ear is only the outer ear, which exists for the purpose of catching sounds. Leading in- ward from this is a canal, which has a thin sheet of membrane, called the drum, stretched across it at its inner end. Connected with the drum at its inner sur- face are some delicate bones to which the sound vibra- tions are transmitted. The waves are finally carried to a sensitive chamber, called the inner ear, whence impulses are sent, through the ear nerves, to the brain. THE ORGANS OF SENSE 153 A thick, brownish substance, called wax, is normally present in the canal and rolls out onto a handkerchief or towel when the external ear is agitated. Sometimes people try to remove the wax from the ear by using a hairpin, match, or corner of a towel. There is much danger in doing this, as it is easy to rupture the ear drum. An old rule says that nothing smaller than the elbow should be put in the ear. If the wax does not roll out of the ear, but collects in a ball, it interferes with the hearing and produces a throbbing or ring- ing. Many persons who think that they are deaf, might have their hearing restored by the removal of the wax. This, however, should be done by a physi- cian. It is a very simple procedure and involves no pain. Pain in the ear, or a liquid discharge, usually means trouble. A physician should be consulted if there is a discharge or if the pain persists. Sometimes a sim- ple case of ear ache can be relieved by a few drops of warm olive oil, dropped into the ear while one lies on his side. In doing this, it is best to pull the external ear upward and outward so as to make the canal straight. After the oil has been dropped in, it is well to fill a small bottle with hot water and apply it to the ear. If the bottle is too hot at first, a towel can be wrapped about it. If an insect gets into the ear, one should not get ex- cited, for a little warm water put in the ear will cause the creature to float out. If children put beans or buttons in the ear, it is always best to have a physician remove them. 154 HEALTH AND EFFICIENCY Pulling children by the ears, or boxing the ears, is a very dangerous practice, as it may result in tearing the ear drums. Diving is also attended with consider- able danger, as the sudden change of pressure may rupture the drum. While deafness may be caused by wax or foreign bodies in the canal and by rupturing the drum, tempo- rary deafness is frequently associated with colds. The reason for this is that the tubes leading from the middle ear to the throat may become clogged with mucous. The condition usually disappears when the cold gets better. CHAPTER X MENTAL HYGIENE 76. The human brain is located in the head and is almost completely enclosed by the bones of the skull. Running to it from the eyes, nose, and ears are nerves which tell us what is around us, and running from it are nerves which control the heart, lungs, and certain muscles of the throat, jaws, and tongue. The sub- stance of the brain continues down through the verte- bral column as the spinal cord, which has branches running to the abdomen and appendages. The brain varies in shape and size. Attempts have been made to show that intelligence depends upon the size or shape or chemical composition of the brain. All such attempts have failed. The average Anglo Saxon brain weights about three pounds. Men of un- usual intelligence have had brains which have weighed both more and less than this. Thus the brain of Cuvier, the great scientist, weighed about four pounds, while that of Gambetta, the French statesman, weigh- ed only two and a half pounds. Occasionally one reads that intelligence is dependent upon the amount of phosphorus present in the brain, but there are at least two animals whose brains contain more phosphor- us than the human brain — the sheep and the goose. No attention need be paid therefore to the arguments i55 156 HEALTH AND EFFICIENCY of phrenologists, who say that they are able to describe one's abilities after an examination of the skull, or to patent medicine fakers, who claim to have discovered a medicine containing elements which will produce new brain tissue. Certain medicinal remedies, to be sure, Photograph from Western Newspaper Union Fig. 63. — Leon Gambetta — a distinguished French statesman stimulate the brain but they supply no new tissue and should be used only under a physician's direction. If brain tissue is needed, the body can build it if supplied with such foods as vegetables, milk, eggs, and cereals, MENTAL HYGIENE 157 and the mind, in turn, can be trained by an application of the "will power. 77. Why we should study mental hygiene. Ner- vous breakdowns, paralytic strokes, insanity, and ner- vousness in general are increasing at an alarming rate. Nerve racking travel, hurried meals, the din produced by whistles, bells, wagons, cars, and trains, the high pitched quest for money, the anxiety incident to keep- ing a certain social standard, the tremendous responsi- bilities assumed by business men and women, together with an atmosphere of fault finding, are slowly but surely undermining our nervous fiber. The death rate for middle aged people is much higher in America than in Europe, and insanity is much more common in the city than in the country. It is probably true that many chronic diseases such as indigestion, dia- betes, ulcers of the stomach, etc., are fundamentally due to a weakened nervous system. So alarming has the condition become that thousands of city people are looking forward to the time when they will be able to return to the soil from which their parents came. 78. Headache. It w r as pointed out in a previous chapter that headache may be a symptom of over twenty different ailments. Headache is, therefore, a warning that something is wrong with the machinery of the body and serves the same purpose as a red light on a railroad track. So does all pain. To suppress a headache with aspirin or a headache powder, is to destroy Nature's warnings. It is as rash as would be the engineer who would destroy a red lantern ahead 158 HEALTH AND EFFICIENCY of his train. If you suffer from headaches, find out whether you need glasses or whether a cathartic is needed or just what is the cause. This can best be done by consulting a physician. If it does not seem advisable to do this, consult your Hygiene teacher or the School Nurse. Remember that you can be of in- dispensable assistance to the physician by taking a great deal of exercise in the open air, by frequent baths (cold baths have a stimulating action, while hot ones have a soothing effect), by sleeping nine hours at night, by a well selected diet, by avoiding eye strain, and by having needed dental work done. 79. Nervousness. This condition may be indi- cated by restlessness, lack of will power, twitching, ten- dency to worry or to be easily startled, biting finger- nails, etc., or there may be a decided lack of energy and a general indifference. Nervousness is said to be much more common among clerks, students, and teach- ers than among farmers, laborers, and fishermen. This gives us a suggestion as to its treatment. It responds readily to exercise out of doors, to a well regulated diet, containing plenty of fresh vegetables, dark bread, milk, and eggs. 80. Epilepsy. This trouble is characterized by con- vulsions or fits, and should be treated by a physician. Not all convulsions are caused by epilepsy, however, as they are not infrequently due to auto intoxication, eye strain, decayed teeth, intestinal parasites, and nasal growths. It is always advisable to consult a physician whenever this symptom occurs. 81. Fears and suppressed emotions. Fears may MENTAL HYGIENE 159 be reasonable or unreasonable; examples of unreason- able fears are fear of the dark, fear of a catastrophe, fear of being unable to sleep, etc. The best way to conquer a fear of this sort is by a close study of the facts involved — do they warrant such a fear ; and by attempting to get accustomed to the feared situation. If the fear persists in spite of all that you can do, con- sult a person who you think will understand your case. 82. Friends of our nerves. Boys and girls who are lacking in energy, or who are pale, or fretty, or " fidgety," who bite their fingernails, or sleep poorly, or lack the ability to apply themselves, can receive help from Nature. Do not use patent medicines. You may not know what is in them but even if you do the medicine may do you more harm than good. Follow the general rules of Hygiene and if more is needed consult a physician. Get nine hours of sleep or rest. It is a good plan to retire not later than ten o'clock and to arise by seven. Sleep with the windows open, out of doors if possible, and use just as little bed clothing as is nec- essary. On arising, perform the exercises outlined in Chapter III. These may be followed by a neutral bath (water neither hot nor cold). Before eating breakfast drink a glass of water. Eat your meals slowly and eat freely of whole wheat and bran bread, cereals like oatmeal and cornmeal, beef and mutton soups and stews, as well as fruits and vegetables that you like and can afford. Chew the food thoroughly; remember that the wastes of the body will produce 160 HEALTH AND EFFICIENCY poisoning, if not excreted regularly.. Keep in the cool, open air as much as possible, doing what you most enjoy — ■ walking, fishing, playing ball, etc. Nature study is a better remedy for tired nerves than motion pictures. Get interested in something — a story, or stamps, a game, a vocation, or w r ork, such as that of the Big Brothers, Big Sisters, or Scouts. Be very careful of your habits ! Avoid tea, coffee, and to- bacco. Avoid morbid and distressing stories. Mold your habits and character so that some other person will have faith in you and develop to the utmost your reliance on God. 83. Reflex actions. When a particle of dust gets into the eye, the lids of the eyes immediately close and tears flow over the eyeball ; when the hand touches a hot object, the muscles of the arm and hand contract and the hand is quickly withdrawn ; and again when a fishbone gets in the throat, the muscles of the thorax contract and coughing is produced in an effort to ex- pell the object. All of these incidents are examples of reflex actions. They happen in the twinkle of an eye. They take place so quickly that we are not immediately conscious of them. Yet notice the purpose that they serve. In the first instance, the closure of the eye prevents more dust gaining entrance and the flow of tears aids the eye in removing the particle already there; in the second instance, the contraction of the arm muscles draws the hand away from the hot object ; in the third instance, the coughing is the body's effort to expel the fishbone. Reflex actions are character- ized, therefore, (1) by the rapidity with which they MENTAL HYGIENE 161 take place, (2) by the absence of volition, and (3) by the fact that they aid in protecting the body. What are the events of a reflex act? These can be best studied in the reflex produced by a hot object, since the action is familiar and involves only parts well known. The first event in this reflex was the feeling ^-Skin Spinal cord Sweat gland Sensory nerve affected by warmth Motor (secretory; nerve to Motor nerve cells Intermediate nerve cells Motor (vasodilator) nerves to blood vessels of skin Fig. 64. — Diagram showing a part of the reflex mechan- ism of the blood-vessels in the skin and in the secretion of perspiration. (From Fitz.) of heat by the sensitive parts of the skin. Moreover, the heat was so intense that it produced an impulse passing along the nerves leading from the burned area of the skin, to the spinal cord. From the cord, an im- pulse was sent outward along nerves supplying the muscles which bend the arm. The impulse, on reach- ing the terminations of the nerves in the arm, caused 162 HEALTH AND EFFICIENCY the muscle to contract and the arm to be drawn away from the heat. The reflex act involved, therefore, ( i ) the surface receiving the stimulation (the skin) ; (2) a nerve along which an impulse passed to the central nervous system; (3) the spinal cord (a part of the central nervous system) ; (4) a nerve along which an impulse passed from the cord to the (5) muscle. Any reflex act is said, therefore, to involve: (1) Receptor; (2) Afferent nerve; (3) Central nervous system; (4) Efferent nerve; (5) Effector. The nerve impulse which produces the reflex act passes from one part of the nervous system to another by way of nerve cells or neurons. These are very ir- regular, branched cells, with long, thin processes — one of these being longer than the others and being called an axon. Nerves are bundles of axons belonging to cells of the central nervous system. Although one nerve cell is probably not actually continuous with other nerve cells, yet the end of one is placed very close to the beginning of another. There are, however, gaps between the neurons which have to be passed over by the nerve impulse. It is here that fatigue takes place and it is probably on these parts that such drugs as caffeine and chloroform act. 84. Habits. Such reflex actions as we have just discussed do not have to be learned — they are inborn in the individual. A baby draws his hand away from MENTAL HYGIENE 163 the hot stove and attempts to expel an irritating ob- ject in his throat almost as quickly as an adult. How- ever, some reflex actions are learned — writing, walk- ing, dressing, etc. Each of these actions was performed in the beginning only with considerable labor, and close attention. As the action was per- formed over and over again, it not only became easier and required less attention but it was done better and at a great saving to the nervous system, sparing the higher centers (cerebrum) for other thought processes, and delegating to the lower centers (spinal cord and medulla) the task of carrying out a multitude of simple reflexes. How tired your mind would be at the end of a day if you had to think out each motion in dress- ing, washing, brushing the hair, eating, preparing for school, choosing the route, carrying books, etc., etc. You would have little mental energy left for your studies. For these reasons Professor William James says that the " practical effects of a habit are (i) Habit simplifies our movements, makes them accurate, and diminishes fatigue. (2) Habit diminishes the conscious attention with which our acts are performed. " If the acquisition of habits has such a great value to the individual, conserving his nervous energy and giv- ing an opportunity to take up additional educational tasks, it is of the greatest importance to have a few rules in mind to serve as a guide in the acquisition of good habits and in the breaking of bad ones. Pro- fessor James gives these as follows : 164 HEALTH AND EFFICIENCY (i) In the acquisition of a new habit, or the leaving off of an old one, we must take care to launch ourselves with as strong and decided an in- itiative as possible. To take for instance the case of a man who is constantly late to work or the pupil con- stantly late to school, the application of this rule would involve such acts as buying an alarm clock, announcing to friends the new resolve and the making of appointments which necessitate one's presence in office or school before the opening hour. (2) Never suffer an exception to occur till the new habit is securely rooted in your life. Pro- fessor James says that one lapse is like the letting fall of a ball of string which one is carefully winding up ; a single slip undoes more than a great many turns will wind again. (3) Seize the very first possible opportunity to act on every resolution you make, and on every emotional prompting you may experience in the direction of the habits you aspire to gain. In this connection Professor James says : " No matter how full a reservoir of maxims one may possess, and no matter how good one's sentiments may be, if one has not taken ad- vantage of every concrete opportunity to act, one's character may remain entirely unaf- fected for the better." Before you leave this subject think of one bad habit which you would like to be rid of, and of an opposite MENTAL HYGIENE 165 virtue which you know that you should cultivate. Begin now, strike while the iron is hot, and keep per- sistently at it each day until you have conquered. 85. The power of concentration. It is said that Charles Darwin, the great English scientist, was per- mitted by his physician to work, during the latter part of his life, only four hours a day. Yet so great was his ability to concentrate on the work at hand that he was able to accomplish several investigations, any one of which would have been considered a life work by most men. The ability to keep the mind to the im- mediate task is one of the most fruitful of mental accomplishments. It enables one to do more work of a better quality than would otherwise be the case. Most pupils fritter away their time. They think that they study, whereas from one-half to two-thirds of the time is spent in day dreaming. As an experimental study of your powers of concen- tration note the time when you begin the study of one of your lessons and make a check on a slip of paper every time you find your mind is not on the w T ork. Note the time necessary to accomplish this lesson. Keep a record of these figures and note how much your ability to apply yourself increases. If you find it particularly difficult to concentrate, ask yourself what the possible causes may be. Do you take plenty of exercise? You should be out of doors as much as possible. Does your diet include the foods indicated as essential in Chapter V? Do you get nine hours of sleep each night? Do you drink tea or cof- fee or use other drugs — if so, stop it. Do you have 166 HEALTH AND EFFICIENCY a quiet room for study? If not, can't you arrange to use a public library or another suitable place ? Are you interested in your studies? If not, talk over the difficulties with the teacher or principal. Finally, have you selected the right companions — those of your own age and those who are seriously interested in school work? 86. Steps to success. Just as some of the deepest sinners have become some of the greatest saints, so also have boys and girls, who at first showed little talent or promise of success, become leading thinkers and workers. In some cases, this can be explained by a lack of appreciation or sympathy on the part of par- ents or teachers. In other cases, however, it has been due to self discipline — the individual recognizing his shortcomings and striving to correct his weakness. It is well for a pupil to form a close friendship with a teacher and to invite the latter to point out his weak points. Study the biography, or better the auto- biography, of someone you greatly admire, to find out what some great man or woman has done to achieve success. Strengthen your memory and your powers of discrimination by keeping a diary and by taking notes on lectures and speeches. Keep a small note book where you can enter the names of books or maga- zine articles that have proved of value to you. It is usually too much of a task to carry these things in the mind but if they are carefully entered in a note book they will serve as pegs upon which to hang other facts. If a certain opinion regarding the cause of a period of rainy weather is current in your neighborhood, inves- MENTAL HYGIENE 167 tigate it to see if the facts support the theory. Many persons believe that flies develop out of rotten fish. Is it true? Others believe that a horse hair kept in water for nine days will develop into an eel. Will it? Before you express an opinion run over in your mind the facts bearing on the case. A person of sound judgment is one of the most valuable members of a community. If you are interested in insects or flow- ers or machinery or houses, learn to make simple, ac- curate, labeled drawings of the objects. In the midst of confusion, keep your wits. 87. The discipline of studies. Contact with Nature is the best school for training the senses. The fine lines, delicate coloring, the estimation of distances train the eye, while the perception of slight sounds, such as those made by the movements of small animals or the interpretation of bird and insect notes, train the ear. Books and contact with other minds discipline and en- rich the mind. The educated American who is unfa- miliar with the history of democratic movements is as lame as the cripple who hobbles down the street with the aid of a cane, and the man who lacks confidence in his ability to " tackle " a problem or the man who con- tinually makes snap judgments is as much handicapped in a struggle to get somewhere as he would be if his legs were tied together. CHAPTER XI FIRST AID 88. Fires and panics. Young men and women can be of very great service in time of panics if they keep their wits and station themselves at favorable places to direct and calm others. In case of accidents, try to be of service instead of standing by and idly looking en. In cases of fire, find the nearest alarm and, following directions carefully, put in a call for help. Do you know the location of the Fire Alarm Boxes nearest to your home and to the school? Do you know pre- cisely how to ring in an alarm? If you do not, get the information before you go home to-night. If you are in a burning building, remember that the air within six inches of the floor is free from smoke. If it is necessary to carry an insensible person from a smoke filled room, tie his hands together with a handkerchief and put them over your head, and you can crawl along the floor, dragging the person with you. If your clothing should catch fire, roll over on the floor to smother the flames. If a mat or heavy blanket is at hand, roll up in that as tightly as you can. If the clothes of another person catch fire, roll him up :n a coat, mat, or blanket. 89. Burns and scalds. The painfulness of a burn 168 FIRST AID 169 or scald can be relieved by applying a paste made by adding a little water to soda, flour, cornstarch, or by gently rubbing on a little vaseline, cream, or oil. Prob- ably the handiest and simplest application is soap. It can be softened a little by putting it in hot water. Do not try to remove clothing that sticks to a burn. Such a burn is serious and needs the attention of a phy- sician. Photograph from Underwood & Underwood Fig. 65. — Los Angeles firemen learning how to rescue those overcome by smoke 90. Ice rescue and drowning. If it becomes neces- sary for you to attempt the rescue of a person who has broken through the ice, you should first tie a rope around your body and have the other end tied or held on shore. To approach the person, lie on your stom- ach and push ahead of you a pole or board or ladder, until the person can reach it. If you break through 170 HEALTH AND EFFICIENCY the ice, and rescuers are near, support yourself on the edge of the ice until help arrives. In case of apparent drowning, lay the person on his stomach, face a little to one side, so as to allow the water to run out of his lungs. Then getting astride the person press the hands into the region of the short ribs to force water out of the lungs. Relax the pressure now to draw air into the lungs. Repeat this process at intervals of four seconds. It may be neces- sary to keep it up for an hour or two before signs of life appear. 91. Fractures. In case a leg is broken, make the in- jured person as comfortable as possible, supporting the leg so that it will lie flat. If it becomes necessary to move the person and a stretcher is not available, perhaps a door can be unhinged and used as a stretcher. If the skin has been broken and antiseptics are avail- able, wash the wound gently and then cover it with a piece of clean cloth. In order to prevent movement of the limb, a board, running from the sole of the foot to the arm pit, should be bound to the leg and to the body. A short splint on the inside of the leg, cov- ering the fracture, will help to further hold the leg in position until a physician can be obtained. In general a patient with a broken bone should be made as com- fortable as possible until medical aid can be obtained. Great care should be taken, in the case of fractured arms or legs, not to bend the part, as the bones will be displaced and the skin may be ruptured, which may produce an infection. 92. Bruises, sprains, and dislocation. If a joint FIRST AID 171 of the arm or leg is sprained, put that part in an el- evated position and wrap cloths wrung out in hot or cold water around it. The joint must be given perfect rest and the cloths should be kept tight about the limb and changed frequently. A bruise should be painted with iodine or washed with some other antiseptic and then bathed in hot or cold w T ater. Do not try to get a dislocated joint back in place. Cover the joint with hot or cold applications and take the person to a doctor. 93. Slight wounds (pin pricks, cuts, or tears). Suck some of the blood from the wound and then wash it with iodine. 94. Wounds with severe bleeding. Bleeding from a cut artery is more dangerous than bleeding from a cut vein, as the blood is coming direct from the heart. If the artery is cut, the blood is bright red in color and spurts out of the wound. In such a case, tie a tourni- quet around the limb, between the wound and heart. The tourniquet can be made by tying a handkerchief loosely but making the knot tight, and then slipping a stick under the handkerchief and twisting it so that the handkerchief binds the limb tightly. If the wound is not in a limb, press the finger into the flesh between the wound and heart, to see if you can feel the pul- sating artery. When you do, press a small block of wood or a stone on this point, so as to prevent further bleeding. If a vein has been cut, a pad or cloth fixed firmly on the wound will usually prevent further bleed- ing. If a vein in the neck is cut, blood is lost so rapidly that the person is in danger of immediate death and the finger should be applied immediately. 172 HEALTH AND EFFICIENCY Tourniquets should not be left on longer than half an hour. 95. Fainting. If the face is pale, lay the patient on his back in a horizontal position. If the face is red, raise the head on a pillow or coat. Loosen the cloth- ing about the neck and chest. Put a cloth wrung out in cold water over the forehead and sprinkle cold water Fig. 66. — A fresh air class on the face. Rub the limbs toward the body. Do not allow the patient to get up until he has fully recovered. 96. Frostbite. Rub the frozen part gently and gradually with snow or cold water until the flesh be- comes warm and begins to sting or burn. The patient should endeavor to exercise the part when this occurs. 97. Poisoning. First send for a physician at once, then do as follows: If a poisonous substance has been taken, prompt effort should be made to produce vomit- FIRST AID 173 ing. The first thing to do is to give a cup or bowl of lukewarm water to which salt or mustard may be added. This will hasten vomiting but it is well to put the finger back in the throat as soon as the liquid has been taken. Repeat the dose several times, using large quantities of water. If a strong acid has been taken, baking powder, plaster from the walls, or soap should be added to the water. If an alkali has been taken, dilute vinegar or lemon juice should be used. If the tissues have been badly irritated, olive oil or milk to which a beaten egg has been added, should be given. 98. Ivy Poisoning. Poison ivy grows as a trailing vine or as a shrub and can usually be recognized by its clusters of three leaves. The leaves are long and nar- row, dark green above and lighter below. It is com- monly found along stone walls, fences, rocks, or twisted around the trunks of trees. The juice of the leaves, roots, flowers, and green fruit causes an irritation of the skin which is not fatal but very annoying. Poison- ing may be caused by contact with the plant or by handling clothing or utensils which have been in contact with it. It is possible that its pollen, which is carried long distances by the winds, is capable of causing the poisoning. Some persons are more resistant to the disease than others, but it is not probable that any are entirely im- mune. The parts of the body most frequently attacked are the hands, face, and forearms. Burning and itch- ing are the first symptoms of the trouble, followed by inflammation of the skin and a fine rash. There is a strong desire to scratch which gives but slight relief 174 HEALTH AND EFFICIENCY and often tends to aggravate the irritation and is liable to spread the poison to other parts of the body. If one is known to have been in contact with the plant, prompt and thorough washing with soap and hot water will almost surely prevent the irritation. The washing must be very thorough and may be followed by washing with lime water, alcohol, or household am- monia, diluted with an equal amount of water. If these remedies do not prove successful it is best to con- sult a competent physician. 99. Nosebleed. Loosen the collar. Do not blow the nose. Apply a piece of ice or a handkerchief wrung out in cold water to the back of the neck. A wad of paper inserted between the upper lip and gum will help. If bleeding continues, plug the nostrils with cotton and consult a physician. 100. Convulsions (fits). Convulsions are often a symptom of a disease called epilepsy, in which the per- son gnashes the teeth, froths at the mouth, and then falls unconscious. No attempt should be made to pre- vent the movements, but the patient should be placed on the ground or floor and protected from harm as gently as possibly. If there is danger of biting the tongue, it is well to insert a piece of wood or a wad of paper between the teeth and then hold it in place. No effort should be made to rouse the person but he should be al- lowed to sleep until he awakens naturally. 10 1. Sunstroke. By this is meant a sudden attack of illness from over exposure to heat. If the body is very warm the treatment consists in reducing the temperature of the body as rapidly as FIRST AID 175 possible by bathing with cold water and by the appli- cation of ice. If the body feels cool, the treatment consists in rub- bing the surface of the body and the extremities, and the application of hot water bottles to the feet. The body should be covered with blankets, and kept warm. If the head becomes hot, apply cold water to it. PART II SCHOOL AND HOME HYGIENE CHAPTER XII SCHOOL HYGIENE 102. Introduction. The school is your home for at least six hours a day and you should do all that you can to make it a healthy and beautiful place to live in. If the building is new and well constructed, preserve it for others. Wipe your feet on mats when you enter; refrain from throwing papers or waste on the floors — ■ use the waste basket ; don't leave fingermarks on the walls ; don't mark up desks and walls ; don't pol- lute the air by sneezing or spitting; pick up papers from the floor ; and finally, keep your desk so clean that you will be proud of it. Present a tidy appearance yourself. Use soap and water on your hands and face before coming to school ; have your hair neatly brushed, and your finger nails cleaned. If the building is not what you would like it to be, show the city fathers that you appreciate even what has been given to you and then present to them a dignified, well thought out appeal for improvements. The pupils of the Julia Richman High School of New York were housed in five buildings, one of which was built in 1847. The rooms in this building were poorly ventilated and classes were separated from one another only by cur- tains. The working conditions were almost unbear- able. The pupils took an inventory of their school 179 180 HEALTH AND EFFICIENCY home, drew up a brief, and presented an argument to the school and municipal authorities for a new build- ing. Their efforts were rewarded by the allotment of $325,000 for the purchase of a new site upon which a new building will be erected to house the entire school. 103. A study in school hygiene. Put a numbered label on each of ten test tubes containing sterile agar. Do not open No. 1 ; leave No. 2 open for thirty min- Copyright by Underwood & Underwood Fig. 67. — Small girls make good housekeepers later utes in the class room during a recitation period ; leave No. 3 open for thirty minutes in the hall or corridor, while classes are passing; put two or three drops of water from a school faucet or drinking fountain in No. 4; put a few drops of thoroughly boiled w T ater in No. 5 ; open No. 6 quickly and have a pupil who has just washed his hands touch the agar in two or three SCHOOL HYGIENE 181 places with his fingers ; have a pupil who has not washed his hands for two or three hours touch the agar in No. 7 ; open No. 8 in the room for five minutes and then leave it in the sunlight ; do the same with No. 9 but put it in a dark place ; touch the feet of a fly to the agar in No. io. Keep the tubes at room temper- ature for a week. (a) Compare numbers I, 2, and 3. Which one has Fig. 68. — A school dental clinic the greatest number of bacteria or mold colonies? Which the least? Explain. (b) Why is it advisable to boil water if one is camp- ing? (c) Name a good antiseptic for the hands. (d) Why should a house be supplied with an abund- ance of sunlight? (e) Why are flies objectionable? 182 HEALTH AND EFFICIENCY 104. Care of drinking fountains, cups, and toilets. Only a few years ago, it was a common practice for many persons in homes, schools, and shops to use the same drinking cups and towels. These have now been replaced in most cases by water fountains and indi- vidual paper towels, and they will be replaced in all cases if the public will agitate actively against them. Such common utensils are a source of very great dan- ger, because they frequently act as distributing agents for eye and skin diseases and certain internal diseases Fig. 69. — A school garden like typhoid. Pupils should note here, however, a pos- sible source of danger in drinking fountains. The jet of water should rise at least two inches above the top of the fountain so that it is not necessary for the lips of the drinker to come in contact with the fountain itself. If the lips do come in contact with the foun- tain, the latter may become a source of infection, as disease germs may be caught in the currents which re- volve about the mouth of the fountain. Each pupil should be a Hygiene Inspector and, if he sees another SCHOOL HYGIENE 183 pupil misusing a fountain, should report the fact to the proper school authority. 105. Lunch rooms. It is an act of self-protection for pupils to insist that food at the lunch counter be covered as much as circumstances will permit. Glass cases should be provided to prevent handling of food and also to keep dust from settling on it. Paper cups should be used tor drinking purpose^. Milk should be covered and school authorities should be provided with a lactometer to test the composition of the milk. The woodwork should be washed with soap and water and the floors cleaned frequently. Waiters at the counters should be required to wash their hands with soap and water before beginning work and to present a tidy ap- pearance. 106. Inspection of janitorial service. Pupils can be of great service to their school if they will report to the principal, or to some one designated by him, in- stances where janitorial service is unsatisfactory. There may be cases w T here sweeping has not been done, or where rooms have not been heated or ventilated, or where dry cleaning has been resorted to. Except where expressly permitted, rooms should not be swept during school hours. Special cases may be allowed in the discretion of the principal. Halls should be cleaned by means of oiled brushes or by first sprinkling the floor with oiled sawdust and then sweeping it up. Toilets should be w r ell ventilated and kept in an effi- cient, sanitary condition. 107. Hygiene and Sanitary Squads. Pupils who are particularly interested in the upkeep of the school 184 HEALTH AND EFFICIENCY can be of service by organizing squads for the purpose of supervising the lunch room, the general sanitation of the building, or the personal hygiene of the pupils. Much good can be accomplished in this way as, both by suggestion and example, other pupils will come to understand that cleanliness comes next to godliness. CHAPTER XIII HYGIENE OF THE HOME 1 08. Ideals in home building. Inasmuch as Amer- ica is relatively a thinly populated country, most per- sons have some freedom of choice in the selection of a home. There are great areas in the east, west, north, and south that would afford opportunities to many per- sons for earning a livelihood and for healthy living. Furthermore, adjoining the large cities, are the subur- ban districts, where each man may have his own land and home. Aside from the matter of convenience, ex- pense, etc., the sanitary aspects of home building, which may be called the ideals in home building, should al- ways be taken into consideration. These are : ( 1 ) the home should be built on high, dry land; (2) it should be well lighted but should have a few shade trees near ; (3) it should be provided with a sanitary water system — either well or reservoir; (4) it should be connected with a well conducted sewage system; (5) it should have a large, dry cellar; (6) it should be well sheltered from prevailing winter storms; (7) it should have an efficient heating and lighting system. 109. Keeping a home clean. Benjamin Franklin urged cleanliness in all things — body cleanliness, clean- liness of clothing, and cleanliness of habitation. A lack of cleanliness means slovenly habits, both mental and 185 186 HEALTH AND EFFICIENCY physical. The successful business and professional men are those who keep their offices well ordered and who themselves present a tidy, neat appearance. Boys and girls should keep this in mind, as they will be judged largely by these points when they come in con- tact with teachers and employers. It is difficult for the individual to be clean if the home is not clean. Soiled clothes should not be left in corners or closets but Copyright by Underwood & Underwood Fig. 70. — A well lighted and notably kept room should be put in baskets or bags made for the purpose. Food should not be left on the table and dishes should be washed with soap and hot water after each meal. The floors should be swept and the woodwork washed frequently. Dry dusting should be avoided, as it sim- ply sweeps the dust into the air to be inhaled or to fall to the floor again. Rugs are preferred to carpets HYGIENE OF THE HOME 187 as they can be more easily taken up and cleaned out- side of the house. Carpets can best be swept if pieces of damp papers or damp tea leaves are first spread over them. This will prevent the dust from rising into the air. Carpet sweepers and vacuum cleaners are valu- Fig. 71. — Ineffective protection against- excessive steam and humidity able helpers to the housekeeper. The woodwork in sit- ting rooms, parlors, and bed rooms should be wiped with a cloth that has been slightly oiled. Bed linen should be changed every week, except in cases of sick- ness where it should be changed every day. If beds become infected with vermin, as they do sometimes even with unusual care, it is necessary to expose the 188 HEALTH AND EFFICIENCY mattress and bedding to the sunlight and to spray them, together with the framework of the bed and the wood- work of the room, with a preparation made for that purpose. This can be obtained in any drug store. no. The laundry. The washing of clothing is nec- essary for purposes of appearance and for purposes of Fig. 72. — Effective protection against excessive steam and humidity health. The underclothing is in contact with the skin and collects oils, dirt, and particles of skin. If not removed frequently it may become the breeding place for bacteria or vermin. Outer clothing, such as coats and skirts, continually gathers dirt and filth and should be frequently brushed in the open and hung in the sun- HYGIENE OF THE HOME 189 light. Underclothing should be washed in soap and hot water to remove the dirt and to destroy bacteria. in. Bathrooms and toilets. Toilets are frequently the source of discomfort. They should be continu- ously ventilated and should be shut off from the re- mainder of the house. Each toilet is provided with a mechanism for releasing a current of water and this mechanism should be used frequently. Every toilet is apt to generate a foul odor, even with the greatest care, but this can usually be counteracted by adding a few drops of lysol or some other disinfectant to the water in the bowl. The floor of the toilet, as well as the wood and metal work in it, should be frequently washed with soap and water. Each family should have its own bath tub and this should be frequently cleaned with soap, water, and a disinfectant. If it becomes necessary for one to use a bath in a boarding house or hotel, it is w r ell to rinse it out thoroughly before using. Shower baths are pre- ferred to tubs because it is very difficult to keep the interior of the latter clean. 112. Plumbing. The pipes running from sinks, toi- lets, and baths, if not cleaned, will attract roaches and water bugs, which may in turn distribute disease. It is a good plan to rinse such pipes with washing powder and to be particularly careful to see that no crumbs of food are left around. In spite of the greatest care, vermin sometimes creep in, in which case it is necessary to sprinkle roach powder freely about the infested parts. Open plumbing is preferred to that enclosed in wood- work, as it is more accessible to light and air and can 190 HEALTH AND EFFICIENCY be more easily cleaned. Sinks and plumbing can most easily be kept clean if the drain pipes are covered by a moderately fine filter which will prevent other than the smallest particles of waste from passing through. The waste which collects in the sink should be removed and put in a covered pail, which should preferably be kept outside of the house but, at any rate, away from the From Bulletin No. 56 — U. S. Hygienic Laboratory Fig. 73- — Following the letter but not the spirit of a law which did not allow milk to be kept in stables after milking, but failed to mention the hoghouse kitchen. If the drain pipe does become clogged it can usually be cleaned out by fastening the nozzle of a short hose to the faucet and passing the other end deep down in the pipe. HYGIENE OF THE HOME 191 113. Garbage. Waste from the table should be put in a covered metal can after each meal, and the con- tents of the can should be removed from the premises frequently. A metal can is better than a wooden one, as oils and other liquids are apt to seep through the lat- ter, making it filthy. If it is necessary to keep the gar- From Bulletin No. 56 — U. S. Hygienic Laboratory Fig. 74. — Stable yards of this tvpe are all too common. The cows are compelled to wade knee deep in manure in order to get into this stable. Much of the filth on legs and tail from this source gets into the milk bage can on the premises, it is well to sprinkle washing powder about it and to keep it enclo:ed as much as pos- sible. The can should be kept covered and as little liquid as possible put into it. If this is done and if it is lined with a sheet of newspaper, the contents will not sour in summer or freeze in winter as quickly as other- 192 HEALTH AND EFFICIENCY wise. The garbage should be removed from such a pail at least once in twenty- four hours. 114. Other parts of the house. The cellar is too frequently a dumping place for rubbish and a reser- voir for water. Under such conditions it becomes a Fig. 75. — A sanitary workroom for washing and steril- izing milk cans breeding place for germs, flies, and mosquitoes and con- sequently a menace to health. A cellar should be thoroughly drained, since the accumulation of moisture favors germ life. Decomposing material should not be allowed to remain in a cellar but should be immedi- ately removed from the premises or buried. Cellars should be well aired and well lighted, and the contents HYGIENE OF THE HOME 193 arranged in some regular order. Dark, damp cellars produce a. musty odor, which is apt to pervade the en- tire house. In addition they may easily become the source of disease. Dumbwaiters should not be littered with rubbish or garbage. They should be used for the transportation of such materials only at stated times of the day and the contents should be removed immediately. Tubs used for laundry purposes should be kept dry, otherwise they may attract vermin and cause the air of the room to be saturated with moisture. In this way colds or rheumatism may be aggravated. Wet wash should not for these reasons remain in the house for a longer time than is necessary. Furthermore, wet wash, if kept in a tub or basket, will acquire a growth of mold in two or three days, if the room is warm. A wet wash should be rinsed in clean w r ater as soon as re- ceived from the laundry. Laundrying should serve two purposes, first, that of cleansing, and secondly, that of sterilization. For these purposes soap and hot water serve the purpose best, except, of course, in the case of colored materials, where bleaching must be prevented. In general, there- fore, clothes should be thoroughly boiled in soap and water in order to render the garments sterile. 115. The sick room. It is very important to know how to properly care for the sick room. Each house- hold should have a medicine chest, or something corre- sponding to it, containing such remedies of common use as peroxide, iodine, epsom salts, castor oil, mustard, flaxseed, powdered ginger, and peppermint, each one 194 HEALTH AND EFFICIENCY in a receptacle, properly labeled. Antiseptics, disin- fectants, and poisons of all kinds should be in dark colored bottles and it is a good plan to have each attached to the wall of the medicine chest by a string which can be removed when the contents are needed. The medicine chest should be high enough from the floor to be out of the way of children. Fig. 76. — Model workroom in a machine shop The linen on the sick bed should be changed each day, both to insure cleanliness and to provide comfort to the patient. A clean bed is very refreshing. The room should be well ventilated and should be free from nauseous odors. In very warm weather, an elec- tric fan will add greatly to the comfort of the patient. HYGIENE OF THE HOME 195 Persons confined to bed frequently develop bed sores. These can be prevented if the general rules of cleanliness are observed. The body should be bathed with warm water. In some cases it may be necessary to do this daily. If the body tends to develop sores in spite of this treatment cotton batting, or warm rubber bags slightly inflated with air, should be placed under the tender parts. In preparing a bath for a sick person, attention should be given to the temperature of the water. For this purpose a bath thermometer should be at hand. For general purposes, water of about the temperature of the body (98 F.) should be used. In case a hot bath is called for, the water should have a temperature of over ioo° F. A cold bath can be given with water having a temperature under 85 F., depending on the kind of bath the patient has been used to and his pres- ent condition. In cases of colds, grippe, influenza, pneumonia, as well as in cases having no more definite symptoms than pains, it is frequently advisable to use poultices or other forms of applications. A good one is the turpentine stupe, made by sprinkling ordinary turpentine on a piece of old but clean flannel. The stupe is laid di- rectly over the painful area. When a hot water bottle is called for, a very good one can be improvised by filling an ordinary glass bottle, of any convenient size, with hot water, putting a stopper into it and then wrapping a towel or other cloth around it. This bottle may be of great service in cases of bowel pains, cramps, stomach ache, or ear ache. A good poultice can be 196 HEALTH AND EFFICIENCY made by mixing equal parts of flour and mustard and then by adding enough hot water to form a paste. This should be enclosed in muslin or cotton cloth and gently placed on the body. Great care should be taken to cleanse and disinfect the sick room. This can be done, in part, by providing proper ventilation and, in part, by frequently changing the bed linen, which should later be thoroughly washed in soap and hot water. In case of infectious disease, like typhoid, some disinfectant — lysol, for instance — should be added to all wastes from the person's body before they are emptied into the sewer. After the pa- tient has recovered, the woodwork of the room should be thoroughly washed with soap and water and the air and walls may be disinfected by burning formaldehyde candles. PART III COMMUNITY HYGIENE CHAPTER XIV FOOD DISTRIBUTION 116. Sources of milk supply. Milk is one of the most valuable of foods since it contains all the con- stituents necessary to sustain life, namely, fuel foods (sugar and fat) and building or repair foods (pro- teins), mineral substances, water, and vitamines. In cases of tuberculosis and in the case of those who have a tendency toward the disease or who grow quickly, or are thin, pale, and languid, milk is indis- pensable. The milk supplies fat to the tissues, render- ing them more resistant to disease. It is essential, however, that the milk be pure and undiluted. It is the practice among, some farmers to add water to the milk in order to increase the quantity. When one buys a quart of such milk he gets less of the real milk ingredients than he would if it had not been tampered with. Among other farmers it is the practice to re- move some of the cream, the fat of the milk, and to sell the milk in that condition or to add a thickening substance to replace the cream. Great care should be taken, therefore, in the se 1 :ection of a milk dealer. In case one is suspicious of the composition of the milk, a sample should be taken to the Board of Health for examination, or the matter quietly reported to them for investigation. 199 SCIENTIFICALLY CALLED Total ^ Solids Waters ORDINARILY CALLED > Cream Skim Milk (From Smith, The World's Food Resources.) Fig. yy. — The contents of a bottle of milk 200 From Bulletin No. 56 — U. S. Hygienic Laboratory Fig. 78. — Filthy walls, floors and ceilings. A condition frequently met with in old barns. Ceilings full of cobwebs and dust. Walls and floors show little evidence of cleaning. Clean milk can not be pro- duced is such a place 201 202 HEALTH AND EFFICIENCY Milk is easily contaminated by disease bacteria, espe- cially those varieties producing typhoid, tuberculosis, and scarlet fever. Cattle are frequently infected with tuberculosis and the bacteria of this disease may be transmitted to human beings by means of meat or milk. While it is not believed that tuberculosis among adults From Bulletin No. 56 — U. S. Hygienic Laboratory Fig. 79- — Dirty flanks. A common condition in winter. Flanks become caked with manure, which there is often no thought of removing. This is the source of most of the dirt found in milk in winter time is transmitted in this way, it is definitely known that tuberculosis among children is. What, then, can be done to give children this indispensable food and yet safeguard them from danger? The remedy lies in a careful supervision of the supply. Fortunately, there is a method, devised by the celebrated German physician FOOD DISTRIBUTION 203 Koch, called the tuberculin test, which, when applied to a cow, will tell whether she has tuberculosis bacteria growing in her body. This test is used very generally by Boards of Health to determine whether it is safe to allow r the use of milk from cattle under their super- vision. This method should be extended and only milk From Bulletin No. 56 — U. S. Hygienic Laboratory Fig. 80. — A clean, well lighted stable and healthy cows are important elements in the production of good milk coming from tuberculin tested cows should be used as food. Great care should be taken with the quarters where cattle are confined. The barn should be warm and, whether it is an old barn or a new one, it should be 204 HEALTH AND EFFICIENCY kept clean, The author recently visited a barn over fifty years old. There were four cows in it and he has seldom seen cattle kept in such comfort. The stalls were bedded with hay that could not be used as food and the manure was removed regularly. The stalls were well lighted and the room was well ventilated by means of adjustable windows. The owner of this barn From Bulletin No. 56 — U. S. Hygienic Laboratory Fig. 81. — Shows a clean barn-yard and well lighted barn was recently given a First Prize by the Massachusetts State Board of Health for the sanitary way in which he kept his cattle. The body of a cow giving milk should be clean, espe- cially about the udders. The pails into which the milk is drawn should have been thoroughly washed and aired and the milker should have washed his hands before FOOD DISTRIBUTION 205 milking. Only by taking precautions such as these can the milk supply be guaranteed. On some farms where there are a large number of cows to be milked, this work is done by means of electrically run appliances. This method, of course, decreases the danger of infec- tion. After the milk is drawn, it should be strained and put in a cool place. If it is to be cooled by placing the cans in wells, the well water should first be exam- ined to make sure that it contains no typhoid bacteria. The wastes of persons having this disease, as well as the wastes of typhoid " carriers," contain typhoid bac- teria and if such wastes are allowed to get into the water supply, serious damage may result. This some- times happens, for instance, where a toilet is located so near to a well that it drains into the well or where the w r ell is loosely covered with boards and typhoid- infected waste is washed in by rain water or carried there on dirt clinging to the soles of the feet. 117. Guarding the distribution of milk. As milk stands, the bacteria in it multiply very rapidly under fa- vorable conditions. To inhibit this growth, the milk must be kept at a low- temperature. It may be neces- sary to pasteurize the milk, also. This is done by sub- jecting the milk to a temperature of 142-145 F. for at least thirty minutes. In this way, the milk can be kept longer without souring and the possibility of dis- ease transmission is very much diminished. Even if milk has been pasteurized, it should be put on ice as soon as possible and kept there until ready to use. It is safer to use bottled milk than " loose " milk, since there is less danger of bacteria getting in from the out- 206 HEALTH AND EFFICIENCY side. " Loose " milk .can be used for cooking, as the heat will usually kill the bacteria. Babies, in .particular, need fresh, clean milk and parents will do well to leave no stone unturned to get it. It will frequently be found that persons, both young and old, with whom milk does not seem to agree, will be able to use it if the milk comes from one cow, or if a cereal like barley water or oatmeal is mixed with it. From Bulletin No. 56 — U. S. Hygienic Laboratory Fig. 82. — Types of milk pails. Narrow-top pails are the best It is impossible, with ordinary methods of handling, to get milk free from bacteria. The Department of Health of New York City, which has the highest sani- tary standards of any department in the world, accepts as of the highest grade, milk containing up to 60,000 bacteria in each cubic centimeter (half thimble full), Since bacteria multiply very rapidly at room tempera- ture, it is necessary to take many precautions in order to keep the number as low as possible. Milk may be FOOD DISTRIBUTION 207 From Bulletin No. 56 — t/. S. Hygienic Laboratory Fi g< g 3 — Good type of milking suit and pail made nearly sterile by boiling for five to ten minutes. The objections to this are that the protein material is 208 HEALTH AND EFFICIENCY hardened and some of the mineral substances are pre- cipitated, making the milk less digestible. This method has been superseded by pasteurization. When done on a large scale, the milk to be pasteurized is run in a thin stream over a heated metal surface. If the method is carefully followed out, all disease bacteria, such as From Bulletin No. 56 — U. S. Hygienic Laboratory Fig. 84.— Children wrongly intrusted with the important work of washing milk bottles those causing ' typhoid and tuberculosis, together with many of those which cause souring, are killed by the process. Milk may be pasteurized in the home by means of an apparatus consisting of a tin pail with a perforated cover, and containing a wire basket into which may be put a number of open bottles containing FOOD DISTRIBUTION 209 the milk. The water in the pail is heated to boiling, the wire basket then lowered so that the bottoms of the bottles nearly touch the water, where they are allowed to steam for ten minutes. At the end of this time, the bottles are covered and the steaming continued for fif- teen minutes longer. The bottles are then removed, immediately cooled, and put on ice. ■' llllfe: 1 11 llli t- $* ~ ' , |;#v : ;, : ■ fljJMSK&flMf* 1 , ; rr-'r 5 ,v- ^^v^^^^^^m 11 \ ■• -< x-^Ji '^^s i i tllllf iWl |r ^ «***; % «- ^^%^^^^-^^^^f'— . - „ . J? 1 ;iiittifi •;/•>• ,^,-v*. ^m&* " C ... ■ IBB . >*> From Bulletin No. 56 — [7. S". Hygienic Laboratory Fig. 85. — Dairy room in cellar, under stairs. No light, no ventilation. In order to prevent decomposition, all milk, even though pasteurized, must be kept cool by a temperature at least as low as 50 F. It is necessary to keep flies from milk as these insects readily introduce bacteria through the filth on 210 HEALTH AND EFFICIENCY their legs. Consequently, it is necessary to have doors and windows properly fitted with screens and to kill all flies that do get into the house. It is necessary also, to wash the top and sides of the bottles before using them, as cats and dogs frequently lick drops of milk from the tops of the full bottles, and the eggs of tape- worms may be thus introduced. g ;; W^KFe'*?- ^..ssfesi - - *%j^£$ ■.. Wn r 'f. BHllgi ■ From Bulletin No. 56 — U. S. Hygienic Laboratory Fig. 86. — A good type of inexpensive milk house The Department of Health of New York City sends inspectors to all farms where milk is produced to be sold in that city. Dealers in milk are compelled to comply with the Department of Health regulations, otherwise their licenses are taken away from them. The sanitary stabling of cows is required, together with cleanliness on the part of the milkers. Milk must FOOD DISTRIBUTION 211 be received in pails with small openings and immedi- ately strained and kept at a temperature not higher than 50 F. until used. All employees of concerns handling the milk must be free from transmissible dis- eases and all wholesale and retail establishments are Fig. 87. — A model milk and storage room, where certified milk is produced, showing enameled walls and cement floors. Note machine for putting caps on bottles under the constant supervision of the Health Depart- ment. In addition to a staff of inspectors, the Depart- ment has special laboratories for the bacteriological and chemical examination of milk samples sent in by in- spectors. 118. Sale and distribution of meat, vegetables, and £J2 3 <: boo cu~ (J T3 c bn T) u V 73 CJ >Xi w pq u < u Q o 2* >* < iS So ,2 ow £ ss E^ .3 cu 3 VM > o o en ft o < p o w 5 I rt £ c "SS 21 J3 ** H2 rt -c V o Cd £ >> n n cu < £ u > r3 o CJ E '"diw.flo O CU C •- u kiS c .C.O y JU y ~ w w „. ^ 2 rt ca £ ■Si" 5 •ca s §£ M 6 -fi a •« CU 3 g (L) - bE^~ -■Si! 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"'""- P ^ «| 'WIBi: j Fig. 106. — Effective dust removal system in Boot and Shoe Industry last) or care to select the individual best fitted to per- form the task, or attempt at readjustment if an individ- ual fails at one task, or attempt to ascertain why this worker cannot get along with oth.er workers, or why that one is " out " so much, or why another is given to intoxication. In a pamphlet prepared by the Bureau 254 HEALTH AND EFFICIENCY of Public Health Education, N. Y. City, and called " First Aid to the Industrial Worker," the author lays down the following suggestions which, if practised would, he believes, greatly improve human industrial efficiency : " i. Applicants for employment must be studied, ex- amined, tested, and taught. Fig. 107. — Bad bakery conditions. (On a main street in one of our large cities.) " 2. Applicants must be sorted to the task which physical construction and mental alertness sug- gests is most fitting. " 3. Workers must be supervised, not only to detect loafing or vicious habits, but also to see that INDUSTRIAL HYGIENE 255 they are efficient and that the labor is not in any manner causing wear or maladjustment of the human machine's parts. The same effort that is made to prevent waste of energy, in a machine, must be given to the laborer. When lost motion, friction, waste of Fig. 108. — Model bakery conditions. energy, or wear is indicated by evidences of physical defect or approaching disease, an im- mediate overhauling of the worker is demanded. This is done in the case of the expensive, com- plex, and delicate machine; why not with the workman who is an incomparable adjunct to the shop?" 256 HEALTH AND EFFICIENCY The photographs illustrating good and bad sanitary conditions in various industries were kindly loaned by the Mass. State Board of Health Fig. 109. — One protective hood out of position, being wrongly used by the workman for holding wax The author goes on to say: " If such were done, even only partly so, then there would not only be much less INDUSTRIAL HYGIENE 257 labor turn over, less loss of valuable raw products, less loss of time, but an appreciable reduction in human sickness and misery, a great increase in production, with a consequent helpfulness to all." 139. Health examinations and insurance. The worker in the factory goes over his machine regularly, cleaning it and noting any loosening or straining but he rarely thinks of his own machine which cannot be du- plicated and which can be built up only with difficulty when it breaks down. Modern medicine can do a great deal in the way of prevention of disease and in the sparing of weakened organs if sufficient notice is had. The only way to find out if the heart is pumping the blood as it should or the kidney excreting waste is by a thorough examination by a competent licensed phy- sician. The best experience shows that such an exam- ination should be made at least once a year. In spite of the best of care, however, accidents and epidemics occur and the hand or brain of the worker may be stilled in an instant. It is therefore only prudent that some measure be taken to care for one's family in such an event. This can best be done by Accident or Life Insurance. Before taking out a policy consult persons who have had experience with the different companies and read the prospectuses, etc. 140. Child labor. In a democratic commonwealth, education sufficient to enable each member to be an in- telligent participator in the affairs of the government is a fundamental necessity. It is now regarded as es- sential that the minimum requirement in this respect should be the completion of the grammar school course. 258 HEALTH AND EFFICIENCY In addition, it is essential that the worker be in sound physical health and that he should not be below a cer- tain age. If it becomes necessary for a boy or girl to leave school when he is old enough to obtain a workings certificate an opportunity for continuation of schooling; Fig. Copyright by Underwood & Underwood II0 . — Dr. Noguchi of the Rockefeller Institute for Medical Research. Dr. Noguchi has made several important discoveries in the field of infectious diseases should be offered by means of Continuation Schools. In one city the administration of the laws relating to the employment of children between the ages of 14 and 16 is in the hands of four agencies. This pro- INDUSTRIAL HYGIENE 259 tects children from being exploited at the expense of their bodies and souls. These agencies are: i. The State Department of Education. 2.. The City Department of Education. 3. The State Industrial Commission (the Depart- ment of Labor). 4. The local Board of Health. To obtain an employment certificate it is necessary for the pupil to present: (1) The School Record. (2) The Physical Examination Record. (3) The Employment Certificate Blank. The forms in all three of these cases must first be ap- proved by the Department of Labor. INDEX Adenoids, 116, 118 Air, 57 Air sacs, 13 Alcohol, 129 Amoeba, 20 Anthrax, 20 Antiseptic, 31 Antitoxin, 33 f 35 Appendix, 9 Athletics, 52 Augustine, 4 Auricle, 11 Barber shops, 245 Bathing, 136 Bathrooms, 189 Bedbug, 236 Beri-beri, 89 Bile, 122 Biliousness, 123 Blood, 125, 127 Boils, 138 Bologna, 4 Bones, 7 Brain, 14, 155 Breathing, 58 Bronchi, 13 Bruises, 133, 170 Bunions, 139 Burns, 168 Calcutta, 70 Callous, 139 Camp, Walter, 54 Canker, 134 Carriers, 28 Cells, 22 Cigarette smoking, 129 Circulation, 12 Clothing, 140 Concentration, 165 Convulsions, 174 Corrective exercises, 49 Cowpox, 32 Cuts, treatment, 133 Dental charts, 113 Dental examinations, 113 Digestion, 120 Digestive canal, 9 Diphtheria, 34 Disease, 16 Dislocations, 170 Drinking fountains, 182 Drowning, 169 Ductless glands, 126 Ear, 152 Economic aspect, 105 Engine, 72 Epidemic, 20 Epilepsy, 158 Eruptions of skin, 137 Eye, 145 Fainting, 172 Fat, S3 Fears, 158 Fires, 168 Flat feet, 48 Flea, 227 Fly, 230 Fractures, 170 Frostbite, 172 Garbage, 191 Germs, 18, 30, 31 Germ garden, 109 260 INDEX 261 Germicide, 30, 32 Goitre, 126 Habits, 162 Hair, 138 Headache, 157 Heart, 9, 59, 127 Hemispheres, 14 Hemoglobin, 86 Homebuilding, 185 Hookworm, 228 Hydrophobia, 18 Idiosyncracy, 94 Immunity, 36, 27 Immunization, 241 Industrial hygiene, 247 Infectious diseases, 240 Influenza, 26 Intestines, 9 Iron, 86 Isolation hospitals, 244 Ivy poisoning, 173 James, William, 44 Janitor service, 183 Jenner, 32 Koch, 22 Laundry, 193 Leucocytes, 30 Lice, 227 Life Extension Institute, 75 Lister, 23 Liver, 9 Lunch rooms, 183 Lungs, 13, 59 Mental hygiene, 155, 157 Microbes, 19 Milk supply, 199 Minerals, 81 Mosquito, 238 Nails, finger, 139 Nerves, 15, 158 Nervousness, 158 Neurous, 162 Nose, 116 Nosebleed, 174 Nucleus, 23 Nutrient, 80 Occupational diseases, 248 Overweight, 91 Pancreas, 9 Panics, 168 Pasteur, 4, 16, 27 Pasteurization, 205 Pellagra, 89 Personal dietaries, 97 Perspiration, 135 Plumbing, 189 Pneumonia, 68 Poisoning, 172 Posture, 39 Protein, 80 Protoplasm, 22, 80 Pulse, 133 Reflex action, 160 Regulating substances, 84 Regularity of meals, 94 Sanitaria, 244 Scalds, 168 Senses, five, 145 Scurvy, 89 School hygiene, 179 Serum, 34 Sewage, 222 Sickroom, 193 Skeleton, 6 Small intestine, 122 Smallpox, 23 Snelling chart, 152 Sour milk, 20 Speech defects, 119 262 INDEX Spinal cord, 15, 155 Sprains, 170 Stomach, 9, 120 Sugar, 78 Sunstroke, 174 Teeth, in Temperance, 92 Tonsils, 118 Tourniquet, 172 Toxins, 28 Trachea, 13, 119 Trichina, 226 Trudeau, 67 Tuberculin, 203 Tuberculosis, 20, 25, 64 Underweight, 91 Utilization of scraps, 107 Vaccine, 34, 37 Vaccination, 32 Vegetables, 87 Ventilation, 68 Ventricle, n Vertebra, 6 Villus, 125 Virus, 33 Vitamines, 89 Vocal cords, 119 Warts, 139 Wastes, 222 Worms, 226