HOW TO LIVE AUTHORIZED BY THE HYGIENE REFERENCE BOARD OF THE LIFE EXTENSION INSTITUTE, INC. FISHER AND FISK. CORNELL UNIVERSITY LIBRARY GIFT OF President E. E. Day Cornell University Library 3 1924 031 194 560 olln.anx The original of tliis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31 924031 1 94560 HOW TO LIVE " Hon, William Howard Taft Chairman, Board of Directors Life Extension Inslitule, Inc. HOW TO LIVE RULES FOR HEALTHFUL LIVING BASED ON MODERN SCIENCE AUTHORIZED BY AND PREPARED IN- COLLABO- RATION WITH THE HYGIENE REFERENCE BOARD OF THE LIFE EXTENSION INSTITUTE. INC. BY IRVING FISHER, Chairman, PKOFESSOR OF POLITICAL ECONOMY, YALE UNIVEBSITY AND EUGENE LYMAN FISK, M.D., oniBCTOR or hyqieme of the iNSTinrrE SECOND EDITION FUNK & WAGNALLS COMPANY NEW YORK AND LONDON 1915 COFTKIGHT, 1915, BY FUNK & WAGNALLS COMPANY (Printed in the United States of America) Puhliahed, October, 1915 FOREWORD To one who has been an eye-witness of the wonderful achievements of American medical science in the conquest of acute communicable and pestilential diseases in those regions of the earth where they were supposed to be im- pregnably entrenched, there is the strongest possible appeal in the present rapidly growing movement for the improvement of physical efficiency and the conquest of chronic diseases of the vital organs. Through the patient, intelligent and often heroic work of our army medical men, and the staff of the United States Public Health Service, death-rates supposedly fixed have been cut in half. "While it is true that to the public mind there is a more lurid and spectacular menace in such diseases as small-pox,, yellow fever and plague, medical men and public health workers are beginning to realize that, with the warfare against such maladies well or- [vii] FOREWORD ganized, it is now time to give attention to the heavy loss from lowered physical efficiency and chronic, preventable disease, a loss ex- ceeding in magnitude that sustained from the more widely feared communicable dis- eases. The insidious encroachment of the chronic diseases that sap the vitality of the individual and impair the efficiency of the race is a mat- ter of increasing importance. The mere ex- tension of human life is not only in itself an end to be desired, but the well digested scien- tific facts presented in this volume clearly show that the most direct and effective means of lengthening human life are at the same time those that make it more livable and add to its power and capacity for achievement. Many years ago, Disraeli, keenly alive to influences affecting national prosperity, stat- ed: "Public Health is the foundation on which reposes the happiness of the people and the power of a country. The care of the public health is the first duty of a states- man." It may well be claimed that the care of individual and family health is the first and most patriotic duty of a citizen. These are the considerations that have in- [ viii ] FOREWORD flueneed me to co-operate with the life ex- tension movement, and to commend this vol- ume to the earnest consideration of all who desire authoritative guidance in improving their own physical condition or in making effective the knowledge now available for bringing health and happiness to our people. WM. H. TAFT. New Haven, June 12, 1915. [ix] PREFACE The purpose of this book is to spread knowledge of Individual Hygiene and thus to promote the aims of the Life Extension In- stitute. These may be summarized briefly as : (1) to provide the individual and the physi- cian with the latest and best conclusions on individual hygiene; (2) to ascertain the exact and special needs of the individual through periodic health examinations; (3) to induce all persons who are found to be in need of medical attention to visit their physicians. A sad commentary on the low health-ideals which now exist is that to most people the expression "to keep well" means no more than to keep out of a sick-bed. Hitherto, the subject-matter of hygiene has been consid- ered in its relation to disease rather than to health. In this manual, on the other hand, it is treated in its relation to (1) the preser- vation of health; (2) the improvement in the physical condition of the individual, and (3) [xi] PREFACE the increase of his vitality. In short, the objects of the manual are positive rather than negative. It aims to include every practical procedure that, according to the present state of our knowledge, an athlete needs in order to make himself superbly "fit," or that a mental worker needs in order to keep his wits sharpened to a razor-edge. For this reason some suggestions, which might otherwise be regarded as of minor importance, have been included and emphasized. While it is true that a moderate infraction of some of the minor rules of health is not inconsistent with maintaining good health in the sense of keep- ing out of a sick-bed, such infraction, be it ever so moderate, is utterly inconsistent with good health in the sense of attaining the highest physical and mental efficiency and power. Future advances of knowledge will doubt- less occasion additions to, or modifications of, the conclusions stated herein, and these will form the subject of subsequent publications by the Institute. In order that the Institute may have at its disposal the latest and most authoritative re- sults of scientific investigations, its Hygiene [xii] PREFACE Reference Board was created. The present book is the first general statement of the conclusions of this Board after a year of care- ful consideration. These conclusions are the joint product of the members of the Board, with the active co-operation of the Director of Hygiene of the Institute. They may fairly be said to constitute the most authoritative epitome thus far available in the great, but hitherto neglected, realm of individual hy- giene. The Chairman of the Board has exercised the function of editor, and is responsible for the order and arrangement of the material. Friends of the Institute may help its work by spreading the ideas given in the following pages and by increasing the number of its readers. Such profits as may be received by the Institute from the sale of this book will be devoted to further philanthropic effort by the Institute. Ibving Fishee, Eugene L. Fisk. New York, Sept., 1915. [ xi" ] CONTENTS TkOSt Introduction 1 CHAPTER I AIR SXCTION 1. Housing 7 2. Clothing 14 3. Outdoor Living 18 4. Outdoor Sleeping 20 5. Deep Breathing 24 CHAPTER II FOOD 1. Quantity of Food 28 2. Protein Poods 35 3. Hard, Bulky, and Uncooked Poods . . 40 4. Thorough Mastication 44 CHAPTER III POISONS 1. Constipation 51 2. Posture 57 [XV] CONTENTS SECTION PAGE 3. Poisons feom Without . . . . 64 4. Teeth and Gums CHAPTER IV ACTIVITY . 78 1. Work, Plat, Rest and Sleep . . . 89 2. Serenity and Poise .... CHAPTER V HYGIENE IN GENERAL . 105 1. The Fifteen Rules op Hygiene . . 119 2. The Unity op Hygiene . . . . 121 3. The Obstacles to Hygiene . . . 126 4. The Possibilities op Hygiene . 135 5. Hygiene and Civilization . . . 143 6. The Ftkt.ds op Hygiene . . . . 157 SUPPLEMENTARY NOTES ON SPECIAL SUBJECTS 1. Notes on Pood 171 2. Notes on Overweight and Underweight 212 3. Notes on Posture 221 4. Notes on Alcohol 227 [xvi] CONTENTS SECTION PAGE 5. Notes on Tobacco 250 6. Avoiding Colds 272 7. Signs of Increase of the Degenerative Diseases 281 8. Comparison of Degenerative Tenden- cies Among Nations 286 9. Eugenics 293 Index 325 [ xvii ] HYGIENE REFERENCE BOARD OF THE LIFE EXTENSION INSTITUTE. Inc. IRVING FISHEB, Chairman Professor of Political Economy Tale University Statistic!) WILLIAM J. HARRIS, Federal Trade Commission, United States Government. CRBSST L. WILBUR, M.D., Director, Division of Vital Statistics, Dept. of Health, State of New York. WALTER F. WILLCOX, Professor of Economics and Statistics, Cornell University. Pnbllc Health AdmlnlstTatlon HERMANN M. BIGGS, M.D., Commissioner of Health, State of New York. RUPERT BLUE, M.D., Surgeon General, U. S. Public Health Service. H. M. BRACKEN, M.D., Secretary Board of Health, State of Minnesota. J. B. GREGG CUSTIS, President Board of Medical Super- visors, District of Columbia. SAMUEL 6. DIXON, M.D., Commissioner of Health, State of Pennsylvania. OSCAR DOWLING, M.D., President Board of Health, State of Louisiana. JOHN S. FULTON, M.D., Secretary Dept. of Health, State of Maryland. S. S. GOLDWATBR, M.D., Supt., Mt. Sinai Hospital, New York WILLIAM C. GORGAS, Major General U. S. Army. CALVIN W. HENDRICK, Chief Engineer, Sewerage Com- mission of Baltimore. J. N. HURTY, M.D., Secretary Board of Health, State of Indiana. ^ „ „ ^ ^ W S RANKIN, M.D., Secretary and Treasurer, Board of Health, State of North Carolina. [ xix ] HYGIENE REFERENCE BOARD THEO. B. SACHS, M.D., President The Chicago Tubercu- losis Institute. JOSEPH W. SCHBBBSCHEWSKT, M.D., U. S. Public Health Service. GUILFOKD H. SUMNER, M.D., Secretary — Executive Offi- cer, Dept. of Health and Medical Examiners, State of Iowa. GEORGE C. WHIPPLE, Professor Sanitary Engineering, Harvard University. C. E. A. WINSLOW, Professor of Public Health, Tale Medical School. Medldne and Snrgery LEWELLTS F. BARKER, M.D., Professor of Medicine, Johns Hopkins University. GEORGE BL.UMER, M.D., Dean Tale Medical School. GEORGE W. CRILE, M.D., Professor Clinical Surgery, Western Reserve University. DAVID L,. EDSALL, M.D., Professor Clinical Medicine, Harvard University. HENRT B. FAVILL, M.D., Professor Clinical Medicine, Rush Medical College. J. H. KEULiOGG, M.D., Superintendent Battle Creek Sani- tarium. S. ADOLPHUS KNOPF, M.D., Professor of Medicine, De- partment of Phthislotherapy, New Tork Post Gradu- ate Medical School. WILLIAM J. MATO, M.D., Ex-President American Med- I pal A_S^OCi3,tiO»Tl VICTOR C. VAUGHAN, M.D., Dean, Dept of Medicine and Surgery, University of Michigan, Ex-President American Medical Association, HUGH HAMPTON TOUNG, M.D., Assoc. Professor of Uro- logical Surgery, Johns Hopkins University and Hos- pital. ChemlBtry, Bacteriology, Patbologry, Phyaiologry, BI0I0K7 JOHN F. ANDERSON, M.D., Director Hygienic Labora- tory, United States Government. HENRT G. BETER, M.D., Medical Director, U. S. Navy. WALTER B. CANNON, M.D., Professor of Physiology, Harvard University. RUSSELL H. CHITTENDEN, Professor of Physiological Chemistry, Director Sheffield Scientiflc School, Tale University. OTTO FOLIN, Professor of Biological Chemistry, Harvard Medical School. M. E. JAFFA, M.S., Professor of Nutrition, University of California. LAFATETTE B. MENDEI* Professor of Physiological Chemistry, Sheffield Scientiiic School, Tale University. RICHARD M. PEARCE, M.D., Professor of Research Med- icine, University of Pennsylvania, [XX] HYGIENE REFERENCE BOARD MAZTCK P. RAVENEL, M.D., Director Laboratory of Hygiene, Professor of Preventive Medicine and Bac- teriology, University of Missouri. L.BO P. RBTTGER, Professor of Bacteriology and Hy- giene, Sheffield Scientific Scliool, Tale University. M. J. ROSENAU, M.D., Professor of Preventive Medicine, Harvard Medical School. WILLIAM T. SEDGWICK, Professor of Biology and Pub- lic Health, Massachusetts Institute of Technology. HENRY C. SHERMAN, Professor of Food Chemistry, Columbia University. THEOBALD SMITH, M.D., Director Division of Animal Pathology, Rockefeller Institute for Medical Re- S 6 £L I? Ch CHARLES' W. STILES, M.D., U. S. Public Health Service; Scientific Secretary International Health Commission. A. E. TAYLOR, M.D., Professor Physiological Chemistry, University of Pennsylvania. WILLIAM H. WELCH, M.D., Professor of Pathology, Johns Hopkins University; President Board of Health, State of Maryland. EuKenicB ALEXANDER GRAHAM BELL, M.D., Board of Scientific Directors, Eugenics Record Office. C. B. DAVENPORT, Director Carnegie Station for Ex- perimental Evolution; Director Eugenics Record Office. DAVID STARR JORDAN, Chancellor Leland Stanford Junior University; Chief Director World Peace Foundation. ELMER E. SOUTHARD, M.D., Professor of Neuropathol- ogy, Harvard Medical School; Pathologist to Massa- chusetts State Board of Insanity. Organized PhUantbropy MRS. S. S. CROCKETT, Ex-Chairman Committee on Health, General Federation of Women's Clubs. HENRY W. FARNAM, Professor of Economics, Yale Uni- versity LEE K. FRANKBL, 6th Vice-President and Head of Welfare Department, Metropolitan Life Insurance Company. „ „, „. , LUTHER H. QULICK, M.D., President Camp Fire Girls of America- _ ^, ^ « THOMAS N HEPBURN, M.D., Secretary Connecticut So- ciety for Social Hygiene. », „, xt»oi*>, n,,™ WICKLIFFE ROSE, Director International Health Com- WM."jAY SCHIEPFELIN, Chairman Executive Commit- tee. Committee of One Hundred on National Health. MAJOR LOUIS LIVINGSTON SEAMAN, M.D., President The China Society. [xxi] HYGIENE EEFERENCE BOARD WILLIAM F. SNOW, M.D., General Secretary, The Amer- ican Social Hygiene Association, Inc. LAWRENCE VEILLBR, Secretary and Director, National Housing Association. Educational SAMUEL HOPKINS ADAMS, Author. W. H. BURNHAM, Professor of Pedagogy and School Hygiene, Clark University. CHARLES H. CASTLE, M.D., Editor Lancet Clinic. W. A. EVANS. M.D., Professor Sanitary Science, North- western University Medical School; Health Editor, Chicago Tribune. BUENSIDB FOSTER, M.D., Editor St. Paul Medical Journal. FREDERICK R. GREEN, M.D., Secretary Council on Health and Public Instruction, American Medical As- sociation. NORMAN HAPGOOD, Editor Harper's Weekly. ARTHUR P. KELLOGG, Managing Editor, The Survey. J. N. McCORMACK, Chief Sanitary Inspector, Board of Health, State of Kentucky. M. V. O'SHEA, Professor of Education, University of Wisconsin. HON. WALTER H. PAGE, Ambassador to England. GEORGE H. SIMMONS, M.D., Editor Journal American Medical Association. HARVEY W. WILBT^ M.D., Director Bureau of Foods, Sanitation and Health, Good Housekeeping Magazine. HENRY SMITH WILLIAMS, M.D., Author. Industrial Hyelene JOHN B, ANDREWS, Secretary American Association for Labor Legislation. THOMAS DARLINGTON, M.D., Secretary American Iron and Steel Institute. NORMAN E. DITMAN, M.D., Trustee, American Museum of Safety. GEORGE M. KOBBR, M.D., Dean Medical School of Georgetown University. W. GILMAN THOMPSON, M.D., Professor of Medicine, Cornell University Medical School. WILLIAM H. TOLMAN, Director The American Museum of Safety. Month Hyslene W. G. EBERSOLE, M.D., D.D.S., Secretary-Treasurer, The National Mouth Hygiene Association. ALFRED C. PONES, D.D.S., Chairman Dental Committee, Bridgeport Board of Health. Physical Training WM. G. ANDERSON, M.D., Director Gymnasium, Yale University. GEORGE J. FISHER, M.D., Secretary International Com- mittee, Y. M. C. A. [ xxii ] HYGIENE REFERENCE BOARD R. TAIT MoKENZIB, M.D., Professor of Physical Educa- tion and Director of the Department, University of Pennsylvania. EDWARD A. RUMELT, M.D., President The Interlaken School. DUDLEY A. SARGENT, M.D., Director Gymnasium, Har- vard University. PROP. ALONZO A. STA6G, Director Gymnasium, Univer- sity of Chicago. THOMAS A. STOREY, M.D., Professor of Hygiene, Col- lege of the City of New York. Forelsn AdTlaory Board AUSTRIA liUDWIG TELBKY, M.D., Department of Social Medicine, Vienna University. CANADA JOHN GEORGE ADAMI, M.D., Professor of Pathology and Bacteriology, McGill University, Montreal. ENGLAND SIR THOMAS OLJVER, Professor of Physiology, Durham University. FRANCE ARMAND GAUTIBR, M.D., Professor of Chemistry, Fac- ulty of Medicine, Paris. GERMANY PROF. DR. KARL FLUGGE, Director Hygienic Institute, Berlin. ITALY LEONARDO BIANCHI, Professor of Psychiatry, Univer- sity of Naples. JAPAN PROF. DR. S. KITASATO, Chief of the Kitasato Institute for Infectious Diseases, Tokyo. RUSSIA IVAN PETROVIC PAVLOV, Prof, of Physiology, Imperial Military Academy of Medicine, Petrograd. [ jcxiii ] Samuel Hopkins Adams L, BY MOFfETT STUDrO. CHIi;. Mrs. S. S. Crockett Dr. Oscar Dowlir Dr. Henry B. Fa ^ Q>J f1 2^ I ^ Dr. Frederick R, Green Dr. John S. Fulton Mi. William J. Harris Pro(. R. Talt McKenzle Prot. Mazyck P. Ravenel Dr. Edward A. Rumely Dr. W. F. Snow Dl. Wiltam H. Tolman. Dr. Harvey W. Wiley HOW TO LIVE INTRODUCTION The purpose of the Life Extension Insti- tute embraces the extension of human life, not only as to length, but also, if we may so express it, as to breadth and depth. It en- deavors to accomplish this purpose ia many ways, but especially through individual hy- giene. Thoroughly carried out, individual hygiene implies high ideals of health, strength, en- durance, symmetry, and beauty ; it enormous- ly increases our capacity to work, to be happy, and to be useful; it develops, not only the body, but the mind and the heart ; it ennobles the man as a whole. We in America inherit, through centuries of Medieval European tradition, the medieval indifference to the human body, often amounting to con- tempt. This attitude was a natural outgrowth of the theological doctrine that the "flesh [IJ HOW TO LIVE The Present Health Movement Medical Practise is in league with the devil" and so is the enemy of the soul. In the Middle Ages saint- liness was often associated with sickliness. Artists, in portraying saints, often chose as their models pale and emaciated consump- tives. We are beginning to cut loose from this false tradition and are working toward the establishment of more wholesome ideals. It is probably true, for instance, that the man or the woman who is unhealthy is now handi- capped in opportunities for marriage, which may be considered an index to the ideals of society. A great health movement is sweeping over the entire world. Hygiene has repudiated the outworn doctrine that mortality is fatality and must exact year after year a fixed and inevitable sacrifice. It aims instead to set free human life by applying modern science. Science, which has revolutionized every other field of human endeavor, is at last revo- lutionizing the field of health conservation. The practise of medicine, which for ages has been known as the "healing art," is un- dergoing a gradual but radical revolution. This is due to the growing realization that [2] INTRODUCTION an ounce of prevention is worth a pound of cure. As teachers and writers on hygiene, as trainers for college athletes, as advisers for the welfare departments of large indus- trial plants, and in many other directions, physicians are finding fields for practising preventive medicine. Even the family phy- sician is in some cases being asked by his patients to keep them well instead of curing them after they have fallen sick. Furthermore, the preventive methods of modem medicine are being applied by the people themselves, as witness the great vogue to-day of sleeping out of doors; the popu- larity, not always deserved, of health foods and drinks; the demand for uncontaminated water supplies, certified milk, inspected meat and pure foods generally; the world-wide movement against alcohol, and the legislation to correct wrong conditions of labor and to safeguard the laborer. Labor itself to-day is being held in honor, and idleness in dishonor. Ideals are being shifted from those of "leisure" to those of "service." Work was once considered sim- ply a curse of the poor. The real gentleman was supposed to be one who was able to live [3] HOW TO LIVE without it. The king, who set the styles, was envied because he "did not have to work," but had innumerable people to do work for him. His ability to work, his efficiency, his endurance, were the last things to which he gave consideration. To-day kings, emperors, presidents are trying to find out how they can keep in the fittest condition and accom- plish the greatest possible amount of work. Even among society women, some kind of work is now "the thing." High Ideal. One of the most satisfying tasks for any man or woman to-day is to take part in this movement toward truer ideals of perfect manhood and womanhood. Our American ideals, though improving, are far inferior to those, for instance, of Sweden; and these, in turn, are not yet worthy to be compared with those of ancient Greece, still preserved for our admiration in imperishable marble. With our superior scientific knowledge, our health ideals ought, as a matter of fact, to excel those of any other age. They should not stop with the mere negation of disease, degener- acy, delinquency, and dependency. They should be positive and progressive. They should include the love of a perfect muscular [4] INTRODUCTION development, of integrity of mental and moral fiber. There should be a keen sense of enjoyment of all life's activities. As William James once said, simply to live, breathe and move should be a delight. The thoroughly healthy person is full of optimism; "he rejoiceth like a strong man to run a race." We seldom see such overflowing vitality except among children. When middle life is reached, or before, our vital surplus has usually been squandered. Yet it is in this vital surplus that the secret of personal magnetism lies. Vital surplus should not only be safeguarded, but accumulated. It is the balance in the savings bank of life. Our health ideals must not stop at the avoidance of invalidism, but should aim at exuberant and exultant health. They should savor not of valetudinarianism, but of athletic development. Our aim should be not to see how much strain our strength can stand, but how great we can make that strength. With such an aim we shall, inci- dentally and naturally, find ourselves accom- plishing more work than if we aimed directly at the work itself. Moreover, when such ideals are attained, work instead of turning [5] HOW TO LIVE into drudgery tends to turn into play, and the hue of life seems to turn from dull gray to the bright tints of well-remembered child- hood. In short, our health ideals should rise from the mere wish to keep out of a sick bed to an eagerness to become a well-spring of energy. Only then can we realize the intrin- sic wholesomeness and beauty of human life. re] CHAPTER I AIR Section I — Housing AiB is the first necessity of life. We may live without food for days and without water for hours ; but we cannot live without air more than a few minutes. Our air supply is there- fore of more importance than our water or food supply, and good ventilation becomes the first rule of hygiene. Living and working rooms should be ven- tilated both before occupancy and while oc- cupied. It must be remembered that the mere con- struction of the proper kind of buildings does not insure ventilation. We may have model dwellings, with ideal window-space and ven- tilating apparatus, but unless these are ac- tually used, we do not benefit thereby. The most important features of ventilation Features of . . 1 T J 1 T Ventilation are motion, coolness, and the proper degree of humidity and freshness. [7] HOW TO LIVE [CH. I. Drafts Air and Catch- ing Colds There is an unreasonable prejudice against air in motion. A gentle draft is, as a matter of fact, one of the best friends which the seeker after health can have. Of course, a strong draft directed against some exposed part of the body, causing a local chill for a prolonged time, is not desirable; but a gen- tle draft, such as ordinarily occurs in good ventilation, is extremely wholesome. It goes without saying that persons unac- customed to ventilation, and consequently over-sensitive to drafts, should avoid over- exposure while they are in process of chang- ing their habits. But after even a few days of enjoyment of air in motion, with cautious exposure to it, the likelihood of cold is greatly diminished; and persons who continue to make friends with moving air soon become almost immune to colds. The popular idea that colds are derived from drafts is greatly exaggerated. A cold of any kind is usually a catarrhal disease of germ origin, to which a lowered vital resist- ance is a predisposing cause. The germs are almost always present in the nose and throat. It is exposure to a draft plus the presence of germs and a lowered [8] i 1.1 AIR resistance of the body wMch produces the usual cold. Army men have often noted that as long as they are on the march and sleep outdoors, they seldom or never have colds, but they develop them as soon as they get in- doors again. See Supplementary Notes, "Avoiding Colds." Of course, one must always use common sense and never grow foolhardy. It is never advisable that a person in a perspiration should sit in a strong draft. The best ventilation is usually to be had windows through the windows. We advise keeping windows open almost always in summer ; and often open in winter. One should have a cross-current of air when- ever practicable ; that is, an entrance for fresh air and an exit for used air at opposite sides of the room. Where there can not be such a cross-current, some circulation can be secured by having a window open both top and bottom. In winter, ventilation is best secured by window- means of a window-board. This is a board the edge of which rests on the edge of the window-sill, the ends being attached firmly to the window-frame. It affords a vertical sur- face three or four inches high and situated [9] HOW TO LIVE tcH.i. three or four inches in front of the window, so as to deflect the cold air upward when the window is slightly opened. The air will then reach the breathing-zone, instead of flowing on to the floor and ohilling the feet, which is the usual consequence of opening a window in winter. It seems tragic to think that for lack of some such simple device, which any one can make or buy, there is now an almost complete absence of winter ventilation in most houses. Mr-fans Air should never be allowed to become stagnant. When there is no natural move- ment in the air, it should be put in motion by artificial means. This important method of practising air-hygiene is becoming quite generally available through the introduction of electric currents into dwellings and other buildings and the use of electric fans. Even a hand fan is of distinct hygienic value. Heating A wood or grate fire is an excellent ven- tilator. A heating-system which introduces warmed new air is better than one acting by direct radiation, provided the furnace is well constructed and gas-proof. iooi Air The importance of coolness is almost as lit- tle appreciated as the importance of motion. [10] * 1] AIR Most people enervate themselves by heat, es- pecially in winter. The temperature of liv- ing-rooms and work-rooms should not be above 70 degrees, and, for people who have not al- ready lost largely in vigor, a temperature of 5 to 10 degrees lower is preferable. Heat is depressing. It lessens both mental and mus- cular eflSciency. Among the employes of a large commercial organization in New York who were examined by the Life Extension In- stitute, some of the men in one particular room were suffering from an increase of body temperature and a skin rash. On investiga- tion it was found that the room in which they worked was overheated. There was no special provision for ventilation. A window-board was installed, with the result that the men recovered and no other cases of skin rash occurred in that room. As to dryness of air, there is little which Dry Air the individual can do except to choose a dry climate in which to live or spend his vacations. Unfortunately, there is not as yet any simple and cheap way of drying house air which is too moist, as is often the case in warm weather. In the cold season, indoor air is often too Humidity [11] HOW TO LIVE [cH.i. dry and may be moistened with advantage. This may be done, to some extent, by heating water in large pans or open vessels. But for efficient moistening of the air, either a very large evaporating-surface or steam jets are required. The small open vessels or saucers on which some people rely, even when located in the air-passages of a hot-air furnace, have only an infinitesimal influence. Vertical wicks of felt with their lower ends in water kept hot by the heating apparatus yield a rapid sup- ply of moisture. Evaporation is greatly fa- cilitated if the water or wicks are placed in the current of heated air entering the room. By a suitable construction, the water may be replenished automatically. In very cold dry weather, the air-supply of an ordinary me- dium-sized house requires the addition of not less than 10 gallons of moisture every 24 hours, and sometimes much more. Some authorities doubt any ill effects from extreme dryness. This is a subject yet to be cleared by experimental research. Preshneas It Is obvlous that frcsh pure air is prefera- ble to impure air. Air may be vitiated by poisonous gases, by dust and smoke, or by germs. Dust and smoke often go together. [12] * 1] AIR Lighting by electricity is preferable to lighting by gas, as some of the gas is liable to escape and vitiate the air. A very common and at the same time inju- Tobacco rious form of air-vitiation is that from to- bacco smoke. Smoking, especially in a closed space such as a smoking-room or smoking- car, vitiates the air very seriously, for smoker and non-smoker alike. As to dust, the morbidity and mortality Dust rates in certain occupations, particularly those known as the dusty trades, are appreciably and even materially greater than in dustless trades. An accumulation of house-dust should be avoided. The dust should be removed — not by the old-fashioned feather duster which scatters the dust into the air — but by a damp or oiled cloth. Dust-catching furniture and hangings of plush, lace, etc., are not hygienic. A carpet-sweeper is more hygienic than a broom, and a vacuum cleaner is better than a carpet-sweeper. The removable rug is an im- provement hygienically over the fixed carpet. The bacteria in air ride on the dust-par- Bacteria tides. In a clean hospital ward, when air was agitated by dry sweeping, the number of col- [13] HOW TO LIVE [CH. I. onies of bacteria collected on a given expo- sure rose twenty-fold, showing the effect of ordinary broom-sweeping. Sunlight The air we breathe should be sunlit when possible. Many of our germ enemies do not long survive in sunlight. Section II — Clothing Air may be shut out not only by tight houses but also by tight clothes. It follows that the question of clothing is closely related to the question of ventilation. In fact it is a reasonable inference from modern investiga- tions that air-hygiene concerns the skin quite as much as the lungs. Therefore the hygiene of clothing assumes a new and hitherto imsus- pected importance. A truly healthy skin is not the waxy white which is so common, but one which glows with color, just as do healthy cheeks exposed to the open air. Porous The hygiene of clothing includes ventilation and freedom from pressure, moderate warmth, and cleanliness. Loose, porous underclothes are already coming into vogue. But effective ventilation, namely such as will allow free access of air to the skin, requires that our [14] «2.] AIE outer clothes — including women 's gowns and men's shirts, vests, vest-linings, and coat-lin- ings — should also be loose and porous. Here is one of the most important hut almost wholly neglected clothing reforms. Most linings and many fabrics used in outer clothes are so tightly woven as to be impervious to air. Yet porous fabrics are always available, including porous alpacas for lining. To test a fabric it is only necessary to place it over the mouth and observe whether it is possible or easy to blow the breath through it. At times we can enjoy relief from clothing Air-baths altogether. An air-bath promotes a healthy skin and aids it in the performance of its normal functions. Not every one can visit air-bath establishments or outdoor gymnasia or take the modem nude cure by which ju- venile consumptives are sometimes treated (even in winter, after becoming gradually accustomed to the cold) ; but any one can spend at least a little time in a state of nature. Both at the time of rising in the morning and upon retiring at night, there are many things which are usually done while one's clothes are on which could be done just as well while they are off. Brushing the teeth, [15] HOW TO LIVE [CH. I. washing the hands, shaving, etc., necessarily consume some time during which the luxury of an air-bath can be enjoyed. Exercises should also be taken at these times. Exercis- ing in cold air, if not too cold, with clothing removed, is an excellent means of hardening the skin and promoting good digestion. Tight Clothing Thc constrictiou from rigid or tight cor- sets, belts (the latter in men as well as in women), tight neckwear, garters, etc., in- terferes with the normal functions of the organs which they cover. All such constric- tion should be carefully avoided. The tight hats generally worn by men check the cir- shoes culation in the scalp. Tight shoes with ex- tremely high heels deform the feet and inter- fere with their health. The barefoot cure is not always practicable, but any one can wear broad-toed shoes with a straight inner edge and do his part to help drive pointed toes out of fashion. Such a reform should not be so difficult as to rid the women of China of their particular form of foot-binding. Several anatomical types of shoes, that is, shoes made to fit the normal foot instead of to force the foot to fit them, are now available. In all except cold weather, low shoes are preferable [16] « 2.] AIR to high shoes. When possible, sandals, now fortunately coming into fashion, are prefer- able to shoes, especially in early childhood (but the adult, whose calf-muscles and foot- structure are not often adapted to such foot- gear, must be cautious in their use lest flat- foot result). Only the minimum amount of clothing that cotton.,Lin- will secure warmth should be worn. Woolens protect most, but they require the least exer- cise of the temperature-regulating apparatus of the body. While wool is also highly ab- sorbent of moisture, it does not give off that moisture quickly enough. Hence, if worn next to the skin, it becomes saturated with perspiration, which it long retains to the dis- advantage of the skin. Consequently woolen clothing is best confined to overcoats and outer garments, designed especially for cold weather. The underclothes should be made of some better conducting and more quickly drying material, such as cotton or linen. In winter light linen-mesh and medium wool over that, or "double-deck" linen and wool underclothes, can be worn by those who ob- ject to either linen or wool alone. As to color, the more nearly white the coior [17] HOW TO LIVE [CH.I. clothes the better. This is especially true in summer, but there is believed to be some advantage in white at all seasons. Those who have learned to clothe them- selves properly find that they have grown far more independent of changing weather condi- tions. They do not suffer greatly from ex- treme summer heat nor extreme winter cold. Especially do they note that "raw" or damp cold days no longer tax their strength. Section III — Outdoor Living Out-of-door But we must not depend altogether on ven- tilating our houses and our clothes. We must turn our thoughts toward an outdoor life. The air of the best ventilated house is not as good as outdoor air. Those who spend much of their lives in the open enjoy the best health and the greatest longevity. It is a great ad- vantage to go into camp in simamer and to live in the country as much as possible. Climate, of itself, is a secondary .considera- tion. Not every one can choose the best cli- mate in the world, and, after all, the main ad- vantages of fresh air can be enjoyed in almost any locality. Even, in a city, outdoor air is, [18] Air « 3.] AIR under ordinary circumstances, ■wonderfully- invigorating. The common prejudice against damp air Dampness greatly exaggerates its evils. While moder- ate dryness of air is advantageous, it seems nevertheless true that to live in damp, even foggy, air out-of-doors is, in general, more healthful than to live shut up indoors. Observations have shown that the pupils in outdoor outdoor and open-window schools are not only kept more healthy but learn more quickly than those in the ordinary schools. It is even claimed that tuberculous children in an out- door school may make more rapid progress in their studies than the more normal children in a badly ventilated school. Parents should insist on fresh air for their children when at school. They should also insist on outdoor playgrounds. For themselves, also, they should not neglect outdoor . . . . n • • i i 1 ■ ■ .. Recreations outings, picnics, and visits to parks. When- ever practicable, outdoor recreation should be chosen in preference to indoor recreation. Above all, outdoor occupations should, when occupations possible, be chosen in preference to indoor oc- cupations, such as working on a farm rather than in a factory. It would help solve some [19] HOW TO LIVE [CH. I. of the greatest problems of civilization, if, in consequence of an increased liking for out- door life, larger numbers of our population should join the "back-to-the-farm" move- ment. Leaving the country for the city is often disastrous even for the purpose in view, namely to gain wealth. For wealth gained at the expense of health always proves in the end a bitter joke. The victim proceeds through the rest of his life to spend wealth in pursuit of health. Section IV — Outdoor Sleeping Unfortunately most people can not live out of doors all of the time, and many are so sit- uated that they can not even secure ventila- tion, granted that they want it. But there is one important part of the twenty-four hours when most people can completely control their own air supply. This is at night. We spend a third of our time in bed. Most of us live such confined lives during the day that we should all the more avail ourselves of our opportunities to practise air hygiene at night. It is the universal testimony of those who [20] *4] AIK have slept out-of-doors that the best venti- lated sleeping-room is far inferior in health- fulness to an outdoor sleeping-porch, open tent, or window tent (large enough to include the whole bed). For generations, outdoor sleeping has occasionally been used as a health measure in certain favorable climates and sea- sons. But only in the last two decades has it been used in ordinary climates and all the year round. Dr. Millet, a Brockton physician, began some years ago to prescribe outdoor sleeping for some shoe-factory workmen who were suffering from tuberculosis. As a conse- Tuberculosis quence, in spite of their insanitary working- places (where they still continued to work while being treated for tuberculosis), they often conquered the disease in a few months. It was largely this experience which led to the general adoption, irrespective of climate, of outdoor sleeping for the treatment of tuber- culosis. The practise has since been intro- duced for nervous troubles and for other dis- eases, including pneumonia. Latterly the value of outdoor sleeping for well persons of weii person. all classes, infants and children as well as adults, has come to be widely recognized. Outdoor sleeping inci^eases the power to re- [21] HOW TO LIVE [CH. I. Vital Resis- tance Night Air Protection From Cold sist disease, and greatly promotes physical vigor, endurance, and working power. Many people are still deterred from sleep- ing out by a mistaken fear of night air and of the malaria which they imagine this dreaded night air may bring. To-day we know that malaria is communicated by the bite of the anopheles mosquito and never by the air. The moral of this is not to shut out the night air, but, when necessary, to shut out the mosquito by screens. The experiment has been made of sleeping out-of-doors in screened cages in the most malarial of places and no malarial infection resulted, though those who were unprotected and were consequently bit- ten by mosquitoes contracted malaria as usual. The truth is that night air, especially in cities, is distinctly purer than day air, on account of the fact that there is much less traffic at night to stir up dust. It is very important, in any sleeping bal- cony, to be protected from the wind by a sash on one or two or — in very windy places — three sides. But of course sleeping out-of- doors does not reach its maximum efficiency if there is too much protection, that is, if the sleeping-out place is so shut in that very free [22] ?4.1 AIR currents of air are not secured. An outdoor porch really ceases to be an outdoor porch when enclosed on four sides. A roll curtain (preferably rolling from the bottom) can be arranged on the open side or sides, to be used in case of storms only. In cold weather a thick mattress, or two mat- tresses, should be used. It is not only what is over the sleeper, but also what is under him, that keeps him warm. The body should be warmly clad, and the head and neck protected by a warm cap or helmet or hood. To pre- vent the entrance of cold air under the bed- clothes, one or more blankets should be ex- tended at least two feet beyond the head, with a central slit for the head. Early awakening by the light may, if necessary, be prevented by touching the eyelids with burnt cork, or by bandaging the eyes with a black cloth or stock- ing. Sheets should be well warmed in the winter-time before being used. They can easily be warmed with a hot-water bag, flat- iron, or soapstone. Blankets next to the skin are not hygienic. Sleeping out is really much easier than sieepine-tent» most people imagine. In fact, few, if any, of the other cardinal rules of hygiene are so [23] HOW TO LIVE [CH.1. easy to obey. Where a sleeping-porch is not available, an inward window tent can always be had which puts the sleeper practically out-of-doors and at the same time cuts off his tent from the rest of the room. Outdoor Tents An outdoor tent must be kept well opened. Otherwise it fails of its purpose. The com- mon opinion that a tent is ventilated through the "meshes" of the canvas is erroneous. Canvas is a tightly woven fabric and im- pervious to air. That is why it makes good sails. One of the most modem boys' camps has given up the use of tents altogether, em- ploying instead open wooden "shacks," be- cause of the difficulty of keeping the tents sufficiently open, especially in rainy weather. Complete directions for convenient out-of- door sleeping will be furnished, upon appli- cation, by the Life Extension Institute. Section V — Deep Breathing Ordinarily breathing should be unconscious, but every day deep breathing exercises should be employed. "A hundred deep breaths a day" is one physician's recipe for avoiding tuberculosis. A Eussian author, who [24] * 5.] AIR suffered a nervous breakdown, found — after trying many other aids to health without suc- cess — that a retired life for several months in the mountains in which simple deep-breath- ing exercises practised systematically every day formed the central theme, effected a per- manent cure. Deep breathing is a great re- source for people who are shut in most of the day. If they will seize the chance, when- ever it offers, to step out-of-doors and take a dozen deep breaths, they can partly compen- sate for the evils of indoor living. In ordinary breathing only about 10 per cent, of the lung contents is changed at each breath. In deep breathing a much larger per- centage is changed, the whole lung is forced into action, the liver and abdominal circula- tion is promoted, and any stagnant blood in these regions is set in circulation and oxy- genated. The blood-pressure is also favora- bly influenced, especially where increased pres- sure is due to nervous or emotional causes. Breathing exercises should be deep, slow, Breathing rhythmic, and through the nose, not through the mouth. A certain Oriental deep-breathing exercise is particularly valuable to insure slowness and evenness of the breath. It con- [25] HOW TO LIVE [CH. I. Auscular Exercise Singing t;Iental State sists of pressing a finger on the side of the nose, so as to close one nostril, breathing in through the other nostril, breathing out of the first nostril in the same manner and then re- versing the process. Attention to the slight sound of the air, as it passes through the nose, enables one to know whether the breathing is regular or is slightly irregular. Such breath- ing exercises can be taken at the rate of three breaths per minute, and the rate gradually reduced until it is only two or even less per minute. Muscular exercises stimulate deep breath- ing, and, in general, the two should go to- gether. But deep breathing by itself is also beneficial, if very slow. Forced rapid breath- ing is comparatively valueless, and indeed may be positively harmful. Oxygen is ab- sorbed only according to the demand for it in the body and not according to the supply. Singing requires deep breathing, and is for that and other reasons an excellent hygienic practise. The mode of our breathing is closely re- lated to our mental condition; either influ- ences the other. Agitation makes us catch our breath, and sadness makes us sigh. Con- [26] * 5.] AIR versely, slow, even breathing calms mental agitation. It is not without reason that, in the East, breathing exercises are used as a means of cultivating mental poise and as an aid to religious life. [CH. II. CHAPTER II FOOD Section I — Quantity of Food The body has often been compared to a blacksmith's forge, the lungs being the bel- lows and food the coal. The comparison is a good one, for food is actually burned in the body by the aid of the air we breathe. caiorieB All food is Capable of being used as body- fuel and by far the greater part of it is so used. Consequently, food is measured in fuel- units, called calories. Many people eat too much, that is, too many calories; some eat too little, that is, too few calories. In both cases the person is usually unaware of the fact, because he makes the mistake of meas- uring his food by its weight or bulk. Some foods are concentrated, that is, contain many calories of food value in a given bulk ; others are bulky, that is, contain few calories in a . given bulk. For instance, olive oil is concen- [28] « 1] FOOD trated, and most vegetables are bulky. A third of an ounce of olive oil contains 100 calories, which is as much as is contained in a pound or more of tomatoes, lettuce, celery, cucumbers, string beans, asparagus, or water- melon. It will help to give a picture of food values if, before going further, we note how much it takes of some of the common foods to make a given amount of food value, say 100 ca- lories. It is surprising in how many cases the ordinary amount of food served at table happens to contain about 100 calories. We find 100 calories in a small lamb chop (weigh- ing about an ounce) ; in a large egg (about 2 ounces) ; in a small side-dish of baked beans (about 3 ounces) ; in IV2 cubic inches of cheese (about an ounce) ; in an ordinary side- dish of sweet corn (about 3% ounces) ; in one large-sized potato (if baked, about 3 ounces; if boiled, about 4 ounces) ; in an or- dinary thick slice of bread (about 1% ounces) ; in one shredded wheat biscuit (about an ounce) ; in a very large dish of oatmeal (about 6 ounces) ; in a small piece of sponge-cake {about an ounce) ; in a third of an ordinary piece of pie (about 1% ounces) ; in three tea- [29] HOW TO LIVE [OH. n. spoonfuls or 11/2 lumps of sugar (about 1 ounce) ; in a dozen peanuts (about % of an ounce) ; in eight pecans (about % an ounce) ; in four prunes (about 1 ounce) ; in two apples (about 7 ounces) ; in a large banana (about 4 ounces) in half a cantaloup (about 9 ounces) ; in seven olives (about 1% ounces) ; in a very large orange (about 10 ounces) ; in an ordinary pat of butter (about y2 an ounce) ; in a quarter of a glass of cream (about 2 ounces) ; in a small glass of milk (about 5 ounces). (See Supplementaey Notes for "Table of Food Values.") The ordinary sedentary man needs about 2,500 calories per day. But the larger the person (provided the bulk is due to muscle and active tissue and not to fat) or the more mus- cular the work he does, the more food he needs. It has been found that the number and activity of cells forming the organs and muscles and blood affect the food require- ment. Favorable Life Insurance experience has clearly shown "Weight that weight, especially in relation to age, is an important factor in influencing longevity. Except in the earlier ages of life, over- weight (reckoned relatively to the average [30] « 1] FOOD for that age) is a more unfavorable condi- tion, in its influence on longevity, than under- weight. The question of whether an individual is really underweight or overweight can not be determined solely by the life insurance tables. (See SuppLEMENTAEY NoTES, "Influence of Build on Longevity.") Some types who are of average weight according to the table, may be either underweight or overweight when considered with regard to their framework and general physical structure. Nevertheless, it should be remembered that notwithstanding the effort of life insurance companies to care- ' fully select the favorable types of overweight and underweight, the mortality experience on youthful underweights has been unfavorable, and the mortality experience on middle aged and elderly overweights has been decidedly unfavorable. The lowest mortality is found among those who average, as a group, a few pounds over the average weight before age 35, and a few pounds under the average weight after age 35. That is, after the age of 35, overweight is associated with an increasingly high death rate, and at middle life it becomes a real menace to health, either by reason of [31] HOW TO LIVE [CH. II. verweight Accessories its mere presence as a physical 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 considerable over- weight is already present, caution is necessary 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. Constant vigilance is necessary, yet it is worth while when one considers the incon- venience as well as the menace of obesity. After the age of 35, 15 to 20 pounds over the average weight should prompt one to take careful measures for reducing weight. Habits should be formed that will keep the weight down automatically, instead of relying upon intermittent attempts that are more than likely to fail. No matter how well one feels, one should take steps to keep out of the class that life insurance companies have found to be undesirable as risks. One reason why many people eat great quantities of food without realizing it, is the common delusion that many articles such as [32] § 1] FOOD candy, fruits, nuts, peanuts, popcorn, often eaten between meals, "do not count." An- other common oversight is to overlook ac- cessories, such as butter and cream, which may contain more actual food value than all the rest of a meal put together. Ice-cream and other desserts also have more food value than is usually realized. Nature counts every calory very carefully. If the number of ca- lories taken in exceeds the number used by the body (or excreted unused), the excess ac- cumulates in fat or tissue. Thus, if some 3,000 calories are taken in each day and the calories used up or excreted are only 2,800, then 200 must be retained and accumulated in the body. A person who is not heavy enough can underweight usually gain weight by following the general rules of hygiene, especially in the matter of increasing the fuel or energy foods. But he should not force himself to eat beyond his natural capacity to digest and assimilate the food, while overfatigue and exhausting phys- ical exertion should be carefully avoided. As age advances, the consumption of meat met in Middle and all flesh foods should be decreased and that of fruit and vegetables, especially those [33] HOW TO LIVE [CH. n. Diet in Hot Weather Brainwork and Eating of bulky character and low food value, such as lettuce, tomatoes, carrots, turnips, salsify, oyster-plant, watercress, celery, parsnips, should be increased. Generally the quantity of food should be slightly decreased in hot weather, when fewer calories are needed to sustain the heat of the body. In particular, less meat should be eaten in the summer, on account of what is called the "specific dynamic action of pro- tein," that is, the special tendency of meats and like foods to produce immediate heat. Each individual must decide for himself what is the right amount of food to eat. In general, that amount is right which will main- tain the most favorable condition of weight. If the weight, endurance, and general feeling of well-being are maintained, one may as- sume that sufficient food is taken. • It is physical, not mental work, which uses up the greater part of our food. The com- mon impression that brain-work or expendi- ture of mental energy creates a special need for food is erroneous. The sedentary brain- worker often gains weight without eating very much. What he really needs is exer- cise, to use up the food, but if he will not [34] S 2.] FOOD take exercise, then he should reduce his food even below the small amount on which he gains weight. Which meal in the day should he heavy Eating when and which light depends largely on one's ^^*'^"^^ daily program of work, the aim being to avoid heavy meals just before heavy work. "When very tired it is sometimes advisable to skip a meal or to eat only lightly, as of fruits and salads. A man who eats heartily when he is very tired is likely to be troubled afterward with indigestion. (See Supplementary Notes for specific directions regarding diet for underweight and overweight.) Section II — Protein Foods In the last section it was stated that food protein, Fat. is fuel. But there is one constituent of food hydrate which, while it can be used as fuel, is espe- cially fitted for an entirely different purpose, namely, to build tissue, that is, to serve for the growth and repair of the body. This tissue-building constituent in food is called protein. The two other chief constituents in food are fat and carbohydrate, the last term [35] HOW TO LIVE [cH. n. embracing what are familiarly known as starcli and sugar. Fats and carbohydrates are only for fuel and contain carbon as the essential element. Protein contains nitrogen as the essential element in tissue-building. The white of egg and the lean of meat afford the most familiar examples of protein. They consist entirely of protein and water. But meat and eggs are not the only foods high in protein. In fact, most ordinary foods con- tain more or less protein. The chief excep- tions are butter, oleomargarine, oil, lard, and cream — which consist of fat (and water) — and sugar, sirups, and starch, which consist of carbohydrate (and water). Proportion of Foods shouM be so selected as to give to the ration the right amount of protein, or repair-foods, on the one hand, and of fats and carbohydrates, or fuel-foods, on the other. A certain amount of protein is abso- lutely essential. While, for a few days, pro- tein may be reduced to little or nothing with- out harm, if the body be long deprived of the needed protein it will waste away and ulti- mately death will result. Therefore, too little protein would be a worse mistake than too much. [36] «2.] FOOD The right proportion of protein has been the subject of much controversy. According to what are regarded as the best investiga- tions, it is generally about 10 per cent, of the total number of heat-units consumed. This does not, of course, mean 10 per cent, of the total weight nor 10 per cent, of the total bulk, but 10 per cent, of the total nutriment, that is, 10 calories of protein out of every 100 calories of food. Most persons in America eat much more protein than this. But that 10 calories out of 100 is not too small an allowance is evidenced by the analysis of human milk. The growing Human Mut infant needs the maximum proportion of pro- tein. In the dietary of the domestic animals, the infant's food, the mother's milk, is richer in protein than the food of the grown animal. Consequently an analysis of human mother's milk affords a clue to the maximum protein suitable for human beings. Of this milk 7 calories out of every 100 calories are protein. If all protein were as thoroughly utilized as milk-protein or meat-protein, 7 calories out of 100 would be ample, but all vegetable proteins are not so completely available. Mak- ing proper allowance for this fact, we reach [37] HOW TO LIVE [oh. II. Bzcessive Use of High- Protein Foods the conclusion that 10 calories out of every 100 are sufficient. A chief and common error of diet consists, then, in using too much protein. Instead of 10 calories out of every 100, many people in America use something like 20 to 30. That is, they use more than double what is known to be ample. This excessive proportion of protein is usually due to the extensive use of meat and eggs, although precisely the same dietetic error is sometimes committed by the excessive use of other high-protein foods such as fish, shell-fish, fowl, cheese, peas and beans, or even, in exceptional cases, by the use of foods less high in protein when combined with the absence of any foods very low in protein. The idea of reducing the protein in our diet is still new to most people. Prof. Eubner of Berlin, one of the world's foremost students of hygiene, said, in a paper on "The Nutrition of the People," read be- fore the recent International Congress on Hygiene and Demography: Injuries From Over-abun- dance of Protein "It is a fact that the diet of the well-to-do is not in itself physiologically justified; it is not even, healthful. For, on account of false notions of the strengthening effect of meat, too much meat is used [38] $2.] FOOD by young and old, and by children, and this is harm- ful. But this meat is publicly sanctioned; it is found in all hotels; it has become international and has supplanted, almost everywhere, the characteristic local culinary art. It has also been adopted in countries where the European culinary art was un- known. Long ago the medical profession started an opposition to the exaggerated meat diet, long before the vegetarian propaganda was started. It was main- tained that flour foods, vegetables, and fruits should be eaten in place of the overlarge quantities of meat." When protein is taken in great excess of the body's needs, as is usually the case in the diet of Americans, added work is given the liver and kidneys, and their ' ' factor of safety" may be exceeded. Flesh food — ^fish, shell-fish, meat, fowl — when used in great abundance, are subject to additional objections. They tend to produce an excess of acids, are very prone to putre- faction, and contain "purins" which lead to Animai the production of uric acid. This is especially true of sweetbreads, liver and kidney. The well-known deficiency in flesh foods of lime often needs to be taken into consideration in the dietary. Some of the vegetable foods, such as peas and beans, rich in protein, are likewise not free from objection. Their pro- tein is not always easily digested and is, there- [39] HOW TO LIVE [CH. n. fore, likewise liable to putrefaction. Unlike most vegetable foods, they contain some pu- rins. Tbese foods are, however, rieb in iron, which renders them a more valuable source of protein for children and anemic people than meat. Also, an excess of protein is not so likely to be derived from such bulky foods as from meat, which is a concentrated form of protein. We have spoken thus far only of the needed proportion of protein. The remainder of the diet, say 90 per cent, of the calories, may be divided according to personal preference be- tween fats and carbohydrates in almost any proportion, provided some amount of each is used. A good proportion is 30 per cent, fat and 60 per cent, carbohydrate. Section III — Hard, Bulky, and Uncooked Foods The wise choice of foods does not consist entirely in balancing the ration as to protein, fat, and carbohydrate. Hard Food. Hard foods, that is, foods that resist the pressure of the teeth, like crusts, toast, hard biscuits or crackers, hard fruits, fibrous vege- [40] MO FOOD tables and nuts, are an extremely impor- tant feature of a hygienic diet. Hard foods require chewing. This exercises and so pre- serves the teeth, and insures the flow of saliva and gastric juice. If the food is not only hard, hut also dry, it still further invites the flow of saliva. Stale and crusty bread is preferable to soft fresh bread and rolls on which so many people insist. The Igorots of the Philippines have perfect teeth so long as they live on hard, coarse foods. But civ- ilization ruins their teeth when they change to our soft foods. Most of the ordinary foods lack bulk; they Buik versus are too concentrated. For this purpose it is Foods found that we need daily, at the very least, an ounce of cellulose, or ' ' woody fiber. ' ' This is contained in largest measujre in fibrous fruits and vegetables — ^lettuce, celery, spin- ach, asparagus, cabbage, cauliflower, corn, beets, onions, parsnips, squash, pumpkins, to- matoes, cucumbers, berries, etc. Until recently would-be food reformers have made the mistake of seeking to secure concen- trated dietaries, especially for army rations. It was this tendency that caused Kipling to say, "compressed vegetables and meat bis- [41] HOW TO LIVE [CH. II. Raw Foods t/itamins Kaw Milk cuits may be nourishing, but what Tommy Atkins needs is bulk in his inside. ' ' Cooking is an important art; but some foods when cooked lose certain small com- ponents called vitamins, which are also found in the skin or coating of grains, especially rice, also in yolk of egg, raw milk, fresh fruit, and fresh vegetables, especially peas and beans. These vitamins are very impor- tant to the well-being of the body. Their absence is probably responsible for certain diseases, such as beriberi, scurvy, and possi- bly pellagra, as well as much ill health of a less definite sort. Some raw or uncooked foods, therefore, such as lettuce or tomatoes, celery, fruits, nuts, and milk, should be used in order to supply these minute and as yet not well-understood substances which are destroyed by the prolonged cooking at high temperature which is employed in order to sterilize canned foods. They are also dimin- ished by ordinary cooking. It is true that only very clean milk is en- tirely safe in an absolutely raw state, and that heat is usually needed to kill the germs. But this heat need not be enough to cook the milk. The modem method of pasteurization [42] $3.] • FOOD is conducted at such a low temperature (140° to 155° F.) that the milk after pasteurization is still essentially an uncooked food. Not all foods can be taken raw with advan- tage. Most starchy foods, such as cereals and potatoes and unripe fruit must, of course, be cooked in order to be made fit to eat. Raw foods have dangers of their own in carrying germs and parasites, and it is ex- tremely advisable that all raw foods should be washed and disinfected before eating. This Disinfection can be accomplished without applying heat by simply immersing all the raw foods in a 5 per cent, solution of peroxide of hydrogen for from three to five minutes. In addition to protein, fat, carbohydrate, and vitamins, there are other elements which the body requires to maintain chemical equi- librium, and for the proper maintenance of organic functions. These are the fruit and vegetable acids and inorganic salts, especially Adds and_ lime, phosphorus, and iron. These substances are usually supplied, in ample amounts, in a mixed diet, containing a variety of fruits and vegetables and an adequate amount of milk and cream. Potatoes are especially valuable because of their alkalinity. [43] Inorganic Salts HOW TO LIVE [CH. II. Section IV — Thorough Mastication ■Whether it be from lack of hard foods, re- quiring prolonged chewing, or from the nerv- ous hurry of modem life, or from other causes, it is undoubtedly a fact that most people in America eat too rapidly. The cor- rection of this habit will go far toward reform- ing an individual's diet in every way. Thorough mastication means masticating up to the point of involuntary swallowing. It does not mean forcibly holding the food in the mouth, counting the chews, or other- wise making a bore of eating. It merely means giving up the habit of forcing food down, and applies to all foods, even to liquid foods, which should be sipped. Kvusof The consequences and evils of insuflScient Insufficient j- j^> n i Mastication mastication are many, and may be enumer- ated as follows: Insufficient use of the teeth and jaws (and hence dental decay as well as other and worse dental evils) ; insufficient saliva mixed with the food (and hence im- perfect digestion of the starchy substances) ; insufficient subdivision of food by mastication (and hence slow digestion) ; the failure of the taste nerves to telegraph ahead, as it were, [44] i 4.] FOOD to the stomach and other digestive organs an intimation of the kind and amount of digest- ive juices required (and hence indigestion) ; the overseasoning of food to make it relish- able even when bolted (and hence overeating and irritation of the mucous lining) ; the ex- cessive use of meat and eggs and like foods, which can be eaten rapidly with relative im- punity, and the corresponding neglect of other foods, like bread, grains, vegetables, and salads, which require more mastication (and hence intestinal poisoning). The habit of insufficient mastication is subtle, because it has become ' ' second nature ' ' with most of us. To free ourselves of it we must first of all allow plenty of time for our meals and rid our minds of the thought of hurry. A boy's school in which the principal Prolonged »' •' JT X Relish of Food is endeavoring to fight the habit of food-bolt- ing has wisely ordained that no boy may leave the dining-room until a certain hour, even if he has finished eating long before. In this way the boy soon learns that there is nothing to be gained by fast eating, and, in fact, that the pleasantest way of spending the meal- time is to prolong the relish of the food. It would be well if all of us would adopt a simi- [45] HOW TO LIVE [CH. n. The First Three Alouthfuls Careful Tasting Increased Enjoyment lar rule for ourselves. Mr. Gladstone did something of the sort and was noted for the slow mastication of Ms food. Latterly Mr. Horace Fletcher set such a rule for himself, and revived the interest of the public in the subject. At first one must give some conscious at- tention to his efforts to reform; but if one will merely attend carefully to the first three mouthfuls of a meal, the slow pace can often be established for the rest of the meal with- out further thought. Slow eating is important not merely as a matter of mastication, but also as a matter of taste and enjoyment. Food must have a pleasing taste and flavor and then must be enjoyed in order to be most readily assim- ilated. There is a mistaken notion that the hy- giene of food means "giving up all the things that taste good." While it is true that, in many cases, sacrifices have to be made, the net result of reforming one's diet is not to diminish but to increase the enjoyment of food. In general, it is extremely unhygienic to eat foods which are not relished. Experi- ments by Pavlov and others have shown that [48] * 4.] FOOD the taste and enjoyment of food stimulate the flow of digestive juices. Finally, slow eating is a great aid in the choosing proper choice of foods. Some suggestions have already been given as to the wise choice of foods, but no rules can be formulated which will completely insure such a choice. Even the wisest physiologist can not depend alto- gether on his knowledge of food values, while, to the layman, the problem is so complicated that his main reliance must be on his own instincts. Animals depend exclusively on in- stinct except when under domestication. Civ- ilized man should not and can not altogether depend upon instinct, but his food instincts are far more keen and correct if he obeys the rule of eating slowly than if he bolts his food. In the choice of foods it is as difficult to ;;Good" ancj distinguish absolutely between what are "good" and "bad" foods as it is to classify human beings into "good" and "bad." All we can say is that some foods are better than others, remembering that it is usually more important to be satisfied, even if the foods are not "ideal," than to be unsatisfied with what in the abstract seem "ideal" foods. [47 1 HOW TO LIVE [CH. 11. 3a\t, Pepper, 'Spices jugar and 'Candy Water with Meals Among the best foods for most people are fruits, potatoes, nuts (if well masticated), milk, sour milk, and vegetables. Among the worst foods are putrefactive cheeses, sweet- breads, liver, kidneys, "high" game or poultry. But a fastidious study of foods will find some faults as well as some virtues in almost any food. The best way to help the ordinary man choose his foods is to advise him to use as much as possible of the "better" and as little as possible of the "worse" without at- tempting to draw a hard and fast line between the "good" and "bad." Salt, pepper, and hot condiments should be used very sparingly, if at all. A great cause of ill health is overuse of sugar in concentrated form, candy, etc., espe- cially by the sedentary. One reason why sugar has a high food value is that it is read- ily utilized for combustion, and if taken be- tween meals greatly increases the calories and may lead to overnourishment. There is, for normal people, no objection to drinking a moderate amount of water at meals — say one or two glassfuls — ^provided it is not taken when food is in the mouth and used for washing it down, [48] « 4] FOOD The sdence of dietetics will develop rapidly The Digestibu- in the future, and in a few years it will prob- " indigesubie- Foods ably be possible to be more definite than we have been here. At present there is much unknown, especially as to how far our rules have to be modified for the particular indi- vidual. Personal idiosyncrasies have to be taken into account. Sometimes "What is one man's meat is another man's poison." On the other hand, many have mistaken ideas as to their own idiosjracrasies. For instance, many people think that nuts never agree with them, when the trouble really is that they do not masticate them properly. Many think peanuts indigestible, not realizing either the importance of mastication or the importance of avoiding over-roasting. The ordinary pea- nuts are over-roasted. Peanuts very slightly roasted and very thoroughly masticated sel- dom disagree vith one. Others believe that bananas never agree with them, when the fact is they eat them too green. The banana vender usually finds that the ignorant public buys his fruit best when its color is an even yellow, and he puts aside for himself the only bananas ripe and fit to eat, namely those which are mottled with black. [49] HOW TO LIVE [CH. n. Avoidance of Fads Necessity of Medical Exam- ination Each individual must use his own intelli- gence and common sense, avoiding so far as he can the mistake of following a "fad" and accepting a theory without sufficient evidence ; and the opposite mistake of accepting as hy- gienic the customs about him simply because they are customs, and thus mistaking for fads any conclusions of science which are discor- dant with current custom. It is a good idea to consult a physician in regard to one's diet, and endeavor intelli- gently to follow his advice and not insist on one's own diet, selected from the standpoint of mere self-indulgence or custom. Moreover, since many, without being aware of the fact, are affected with Bright 's disease, diabetes, etc., in their early stages, in which dietetic precautions are especially necessary, it is well, even for those who are apparently in good health, to be medically examined as a prelim- inary to a rearrangement of their diet along the best lines. [60] Si-i CHAPTER III POISONS Section I — Constipation If the human body be likened to a steam- engine, its wastes correspond to the ashes. The injury which comes from the retention Retention of of the body 's waste products is of the greatest importance. The intestinal contents become dangerous by being too long retained, as pu- trefying fecal matter contains poisons which are harmful to the body. Abnormal condi- tions of the intestines are largely responsible for the common headache malady, and for a generally lowered resistance, resulting in colds and even more serious ailments. Con- stipation is extremely prevalent, partly be- cause our diet usually lacks bulk or other needed constituents, but partly also because we fail to eliminate regularly, thoroughly, and often. Constipation, long continued, is by no means a trifling matter. It represents a constant [51] HOW TO LIVE [CH. III. Water- Drinking Laxative Fooda Bran and Agar- Agar and cumulative tax which often ends in very- serious consequences. Free water-drinking when the stomach is empty, especially before breakfast, is bene- ficial in constipation. Free water-drinking at meals may prove constipating. Excess of wa- ter should be avoided by the very feeble or those suffering from heart trouble or dropsy. The best regulators of the bowels are foods. Foods should possess sufficient bulk to pro- mote the action of the intestines and should contain a due amount of laxative elements. Foods which are especially laxative are prunes, figs, most fruits except bananas, fruit juices, all fresh vegetables, especially greens of all sorts, wheat, bran, and the whole grain cereals. Oils and fats are also laxative but can not be used in sufficiently large quantities to produce very laxative effects without pro- ducing loss of appetite. Foods which have the opposite tendency are rice, boiled milk, fine wheat-flour in bread, corn-starch, white of egg. The use of wheat-bran in cereals, in bread, and even in vegetables is a preventive of constipation, as is also the use of agar-agar, a Japanese seaweed product. This is not di- [52] « 1] POISONS gested and absorbed, but acts as a water- carrier and a sweep to the intestinal tract. It should be taken without admixture with laxative drugs. Paraffin oil is especially good as an intes- Mineral oiis tinal lubricant to assist the food to slip through the intestinal tube at the proper rate of progress, provided the oil is first freed, by long-continued shaking with water, from certain dangerous impurities. Many refined preparations are on the market for use in constipation. Underweight people should not use these oils unless properly prescribed by a physician. It is advisable, in general, to avoid cathar- Avoiding tics except under medical supervision, since certain drugs are often very harmful when their use is long continued and the longer they are used the more dependent on them the user becomes. Laxative drugs, even mineral wa- ters, should never be used habitually. The occasional, but not habitual, use of an Enemas enema (with warm water followed always by a second enema of cool water, to prevent re- laxation) is a temporary expedient. Massage of the abdomen, deep and thor- Maaaage of the : ough, with a creeping movement of the ends [53] HOW TO LIVE [CH. III. Low Seated Water CloBetB Number of Defecations of the fingers on the left side of the abdomen from above downward, also promotes the process of defecation. The normal man and woman should find no difficulty in having complete movements regu- larly two or three times a day by merely liv- ing a reasonable life, being careful especially to avoid overfatigue, to include sufficient bulk in the food, to take regular exercise, includ- ing, in particular, breathing exercises, and to maintain an erect carriage. High-seated water closets, so often found in institutions, hotels and private houses, often favor constipation, as they do not permit of the proper physiological attitude in defe- cation. They prevent the individual from exercising abdominal pressure so essential for this function. Such seats should be made much lower than they are, or the feet should rest on a foot stool, in order to attain the proper attitude for thorough emptying of the intestine. Observations on the manlike apes show that they defecate three or four times a day. Few of the human family have such ideal move- ments. Millions are conscious of some short- coming in this regard, and doubtless millions [54] Proper Habits «!■] POISONS more suffer from some shortcomings of which they are not conscious. Many believe they have free movements when actually they are suffering from a sluggishness in the rectum and other parts of the lower intestine. A rectal examination often reveals unsuspected fecal residues. The natural instinct to defecate, like many BstabUii^_ other natural instincts, is usually deadened by failure to exercise it. Civilized life makes it inconvenient to follow this instinct as prompt- ly as, for instance, a horse does. The impulse to go to stool, if neglected even five minutes, may disappear. There are few health meas- ures more simple and effective than restoring the normal sensitiveness of this important impulse. It may require a few weeks of spe- cial care, during which cold water enemas at night, following evacuation by paraffin oil injection, may be needed. It would be an excellent rule to visit the closet immediately after the noon and evening meals, as faithfully as most people do after the morning meal, until the reflex is trained to act at those, the most natural, times for its action. Before leaving the subject of intestinal poisoning, we may here again mention the im- [55] HOW TO LIVE [CH. m. portance of avoiding the poisoning wMch comes from too much protein. This poisoning is probably due largely to the decomposition of protein in the colon. One proposed method for reducing this de- composition of protein is through the use of Use of Sour sour milk. Lactic acid, the acid of sour milk, Milk . . . . constitutes a medium in which putrefactive germs do not thrive. Hence, if sufficient sour- milk germs can be kept in the intestines to constantly manufacture lactic acid, putrefac- tion will be reduced. But, as Professor Rett- ger and others have shown, the mere swallow- ing of a little sour milk or of sour-milk tablets is seldom sufficient. The "good germs" swal- lowed die of starvation before they do much good. To keep them alive and enable them to multiply, we must feed them. The free use of milk and of milk sugar, a little raw starch, or partially cooked cereal such as Scotch brose (oatmeal cooked only ten minutes) will feed the germs. Evidences of The odor, aud character of the stools are indicative of the extent to which our diet is injuring us. The odor is less offensive if the diet is low in protein and thoroughly masti- cated. [66] S2.] POISONS Section II — Posture One of the simplest and most effective methods of avoiding self-poisoning is by maintaining an erect posture. In an erect posture the abdominal muscles tend to re- main taut and to afford proper support or pressure to the abdomen, including the great splanchnic circulation of large blood-vessels. In an habitual slouching posture, the blood of the abdomen tends to stagnate in the liver and the splanchnic circulation, causing a feel- ing of despondency and mental confusion, headache, coldness of the hands and feet, and chronic fatigue or neurasthenia, and often constipation. A slouching attitude is often the result of disease or lack of vitality; but it is also a cause. There is some reason to believe that "the The consumptive stoop" leads to tuberculosis stoop- partly through the lowering of resistance resulting from the poisoning produced by a chronically relaxed abdomen. Many persons who have suffered for years from the above-named symptoms have been relieved of them after a few weeks of correct [57] HOW TO LIVE [cH. m. /breathing and Posture fjtanding and Walking posture, sometimes reenforced by the arti- ficial pressure of an abdominal supporter and by special exercises to strengthen the abdom- inal muscles. Lying face downward with a pillow under the abdomen presses the blood out of the con- gested splanchnic circulation. Breathing exercises are also very useful for correcting the chronic evils of bad posture. Exercises taken when lying on the back, by raising the legs or head, strengthen the ab- dominal muscles. Slow, deep breathing, through the nose, while lying on the back, with a weight on the abdomen, such as a bag of sand — 2 to 4 lbs. — is beneficial. In walking, the most common error is to slump, with the shoulders rounded, the stom- ach thrust out, the head thrust forward, chin up, and the arms hanging in front of the body. To those who walk or stand in this fashion, let it be known that this is the "hab- itus entero;^toticus, ' ' or asthenic droop. It is characteristic of those with weak muscular and nervous systems. To set the shoulders back and square them evenly, to keep the chest high and well arched forward, the stomach in and the neck per- [58] « 2.] POISONS pendicular, like a column, and the chin in, are simple fundamental measures that most people know and many people disregard. One should have a sense of the firmness or tautness of the abdominal muscles and not of flabby relaxation. When one changes a slouch- ing posture into an erect posture, there is a sense of having reversed the way the body hangs, as it were, on the spinal column. Whether sitting, standing, or walking, these principles, that involve a correct and pleasing carriage and a healthful relation of the or- gans and structures of the body, should be ob- served by both men and women. This perfect physical poise which places the muscles, organs, circulation, and even the brain and nervous system in harmonious re- lationship, adjusted for the best achievement, is well expressed in sculpture dating back to 500-600 B. C, when the Spartans attained su- premacy in Greece. This same poise and sym- metry is shown in modern sculpture of fine types of manhood and womanhood. It is not enough to have an erect carriage The Feet and a well-poised head. We must also have well-directed feet. It is pitiable to think how the work of a fine head may be spoiled by mis- [59] HOW TO LIVE ["H™- directed feet. Weak foot, and its final stage, flat foot, are more common among women than they are among men, because it is not a purely local condition in the arch of the foot, as so many suppose, but primarily due to a general weakened condition of the leg muscles that support the arch. The more vigorous exer- cise of boys as compared to that of girls pro- tects them in some degree from this malady. Toeing Weak feet are gradually converted into forward' flat feet by faulty standing and walking pos- ture and lack of leg exercise. Toeing out, whether walking or standing, so commonly noted among girls and women, places a great strain upon the arches of the foot. The cor- rection of this fault by persistent toeing in, Indian fashion, and daily exercise of the leg muscles (rising on the toes twenty to forty times night and morning), will do much to prevent flat foot. Not only in standing, but in sitting, erect posture has been found to be a much more important factor in the maintenance of good health than is generally supposed. A rocker, or any other chair which tilts, is restful to the abdominal circulation, if the lower back is properly supported. Bad posture is com- [60] §2.] POISONS mon among sedentary people. The ordinary chair invites it. Every chair should be mod- chairs eled like most modern automobile seats, on a curve to fit the back. Almost any chair can be corrected by placing a cushion so as to support the hollow of the back of the sitter. The responsibility for correct posture rests, however, on the individual and not on the chair. In sitting at a desk or table, when reading sitting or working, the common fault is to adopt a sprawling attitude, with the shoulders hunched up, the elbows stretched outward, the body too far away from the desk or table, and the weight resting on the buttocks. Very often the desk or table is too high and the arms can not rest easily upon it, thus causing a continuous strain on the structures around the shoulder- joints. To correct this fault, use if possible a chair with a back that curves forward. Sit well back in the chair, but close to the desk, so that the fleshy inner part of the forearms may rest easily upon its surface without pushing up the shoulders. When it is necessary to lean over a desk, acquire the habit of inclining the body for- [61] HOW TO LIVE [cH. m. ward by bending at the hips and not by dis- torting the chest. The arms should hang easily from the shoulder and the elbows should not rest upon the table. The shoulders should be evenly square, as in the correct standing posture. In right-handed people, the light should fall over the left shoulder or directly from above. The body should rest upon the full length of the thighs, not solely on the buttocks, and the feet (not legs) be crossed and resting lightly on the ground on their outer edges. In other words, the position should be freed from strain, espe- cially strain of special groups of muscles. Pains, erroneously ascribed to rheumatism or sciatica, are often due to faulty posture. Writer's cramp and many other needless miseries are caused by neglect to develop proper postural habits in working or reading. In children faulty posture may mar the Porturein future of the individual by causing spinal curvature and physical deformities that in- terfere with physical and mental efficiency throughout life, and often lower the resis- tance to disease. Deep breathing through the nose and ' ' setting up ' ' exercises are of incal- culable importance in such cases. [62] $2.] POISONS The various types of faulty posture are so numerous that they can not be listed here. Having once grasped the meaning of correct posture, however, we can form a standard for . ourselves, and any departure from this stand- ard should be looked upon as a menace to health. As in the case of eye-strain, flat foot, work, worry, and drink, much depends on the original physical and mental endowment of the individual as to how much harm results from faulty posture. But always some harm results. The teaching of proper standing, proper Teaching walking and proper sitting should be a part Posture of all school discipline as it is at military schools, especially as there is the temptation to crouch over the school-desk — which is usually the source of the first deviation from natural posture. An infant before it goes to school usually has a beautiful, erect car- riage, with the head resting squarely on the shoulders. An erect posture is attractive from an Posture and esthetic point of view, and for that reason is sure again to become fashionable with women, after a due reaction from the present slouching vagary. It is also closely associated [63] HOW TO LIVE [CH. HI. witli self-respect. We know that any physi- cal expression of an emotion tends reflexly to produce that emotion. Therefore, not only does self-respect naturally tend to brace a man's shoulders and straighten his spine, but, conversely, the assumption of such a braced-up attitude tends to "brace up" the man's mind also. Tramps and other persons who have lost their self-respect almost invariably slouch, while an erect carriage usually accompanies those feeling their respectability. We jokingly refer to those whose self-respect verges on conceit as "chesty," while we compliment one who is not so extreme by saying, "He is no slouch." Between the slouch and slink of the dere- lict and the pompous strut of the pharisee, or the swagger of the bully or the dandy, there is the golden mean in posture, which stands for self-respect and self-confidence, combined with courtesy and consideration for others. Section III — Poisons from Without The poisons which hitherto have been men- tioned are those developed within the body, [64] « 3 •] POISONS especially in the intestine. It is not alone important to keep down the total amount of poisons produced within the body. It is equally important to exclude the entrance of any additional poisons from outside. Among the poisons which must be kept out Habit-forming of the body should be mentioned habit-form- Pateft"' . T . . Medicines mg drugs, such as opiimi, morphme, cocam, heroin, chloral, acetanilid, alcohol, caffein, and nicotin. The best rule for those who wish to attain the highest physical and men- tal efficiency is total abstinence from all substances which contain poisons, including spirits, wine, beer, tobacco, many much- advertised patent drinks served at soda-water fountains, most patent medicines, and even coffee and tea. Many so-called patent or proprietary medicines contain habit-forming drugs, especially morphine, coal-tar prepara- tions, caffein, and alcohol, and depend largely for their sale upon the effects of these harm- ful substances. Harmful preservatives and adulterants in foods, such as saccharin, should also be avoided. For some persons the inevitable mode of Reducing the improvement will be by substituting the milder drugs for the stronger — beer for [65] HOW TO LIVE [cH. III. spirits, weak tea for beer. The exact extent to which the milder poisons are injurious has not yet been scientifically settled. Tea, for instance, if very weak and used moderately, is, presumably, not injurious to any marked degree to healthy persons. The trouble is, however, that sensitive people do not keep moderate. In fact, the natural tendency of drug-craving is in the opposite direction, from weak drugs to strong ones, as from beer to spirits. In actual fact, it is much easier to abstain than to be moderate. It should also be noted that the lax spirit in which many people make an exception to the rules of health in favor of some mild indulgence is very likely to lead to the making of many other exceptions until they are, without know- ing it, carrying a heavy load made up of scores of little items of harmful indulgence. Moreover, experiments at the Pasteur Insti- tute have shown that the long-continued use of very minute doses of poison ultimately produces appreciable harm. Each person must decide for himself how far he chooses to depart from previous habits or common customs for the sake of physical efficiency. The object here is to state exactly what, in [66] $3.] POISONS our present state of knowledge, is believed to be the truth. Those with feeble digestions or unstable nervous systems are especially harmed by these poisons. A family history of nervously inclined people calls for rigid care in such matters. Scientific experiments have resulted in Aicohoi the interesting discovery that the alleged "strength" obtained from beer, ales, and all intoxicating beverages is a delusion and a snare. The poison simply gives a temporary feeling of greater strength through paralysis of the sense of fatigue. But the strength does not exist. On the contrary, the user of alcohol in excess is weaker after taking it. Special classes of workmen have been tested as to their efficiency under liquor in small amotmts and without it entirely, and it was invariably found that the liquor was a handi- cap, but that, also invariably, the workmen thought they could work harder by its aid! Alcohol numbs the sense of fatigue and so deceives the user. It is not a stimulant but a narcotic. The habit of taking a cocktail before meals is doubly harmful, because it is often taken on an empty stomach and because [67] HOW TO LIVE [CH. III. Alcohol and Infectious Diseases Tobacco it poisons the system more quickly than when mixed with food and retained in the intes- tines. It is well known that people who indulge in alcohol show less resistance to infectious diseases than ahstemious individuals. The paralysis of the white blood-corpuscles is one of the strong arguments against the use of alcohol. The experience of life insurance companies in England and America has clearly shown that even the "moderate" use of alcoholic beverages shortens human life. (See "Alcohol" in Supplementary Notes.) Dr. Stockard has also shown in mice, on which he has experimented, that the effect of alcohol on the germ-plasm is distinctly in- jurious. It is a fair inference that the use of alcohol by parents tends to damage their offspring. The evils of tobacco have not been so much studied and are not so well understood as those of alcohol. But every athletic trainer observes that the use of tobacco lessens physi- cal fitness. The ordinary smoker is uncon- scious of this and often denies it. He some- times says, "I'll stop smoking when I find it hurting me; it doesn't hurt me now." The 168] M] POISONS delusive impression that one is well may con- tinue long after something has been lost from the fitness of the body, just as the teeth do not ache until the decay has gone far enough to reach the nerve. At Yale and at Amherst it has been found, by actual measurement, that students not using tobacco during the college course had gained over the users of tobacco in weight, height, growth of chest, and lung capacity. Prof. Pack, of the University of Utah, finds that tobacco-using athletes are distinctly in- ferior to those who abstain. Prof. Lombard, of the University of Michigan, finds that to- bacco lessens the power of the voluntary mus- cles, presumably because of the depressing effect on the central nervous system. There is also much experimental evidence to show that tobacco in animals induces arterial changes. The present well-marked upward trend of mortality from diseases of the ar- teries offers a good reason for heeding such evidence and taking the safe side in every controversy regarding it. (See "Tobacco" in SUPPLEMENTAEY NoTES.) The poisons so far mentioned are limited to Germs the amounts taken. Infections with germs, [69] HOW TO LIVE [CH. in. however, bring in poisons, the quantities of which tend to increase with the multiplication of the germs. It is, therefore, especially im- portant to avoid infections. We should not depend altogether on the protection of our health officers. We must guard our own indi- vidual bodies. Colds and La lufectious cutcr the body through the skin or mucous lining. The common cold is be- lieved to enter by the nose. We may avoid exposure to infection from grippe and com- mon colds by keeping away from congested public places when there is an epidemic of grippe or colds, or when we are ourselves fa- tigued or for any reason likely to catch cold. The infections of common colds are always to be found in the nasal passages and become active when the individual is subject to fa- tigue or indigestion or both. The liability of catching cold is greater when the mucous lin- ing is injured. Nasal douches are injurious and impair the protective abiUty of the mu- cous membrane. They should be used only on prescription. A very gentle, warm spray of weak salt and water may be used when the nose is filled with soot and dust. The fingers should be kept from the nose. Handkerchiefs [70] Fever «3.] POISONS should be frequently changed, or small squares of gauze used and subsequently burned. The germ of tuberculosis is probably con- Tuberculosis veyed oftenest through the sputum of con- sumptives, when this sputum has been allowed to dry, has become pulverized and is breathed into the system. All sputum should be burned. It is well to avoid rooms occupied by con- sumptives who are not careful with their sputum. Suitable wire netting will guard us from Mosquito- malaria and yellow fever, the infections and veiiow brought by mosquitoes and flies. The mos- quito often carries malaria, and in the tropics carries yellow fever and other diseases. As some one has said: "A yard of screen in the window is better than a yard of crape on the door." The greatest triumph in connection with the building of the Panama Canal was not the engineering but the reduction in the death-rate among the workers, which, on ac- count of these insect-borne diseases, had pre- viously prevented the successful execution of the undertaking. Not only is it desirable to screen from mos- quitoes, but to put oil on any body of water where they breed. Even a small puddle can [71] Water HOW TO LIVE [CH. m, breed millions of mosquitoes. No empty tin cans should be allowed to collect about the kitchen door ; they gather rain-water and soon breed mosquitoes. Typhoid-free Wc take iu many disease germs through food or drink. Every year 300,000 people in the United States enlist under the typhoid banner. To elude the typhoid-germ we need first of all pure water. But when one is in doubt as to the purity of water, it is advisable to boil water in order to destroy possible typhoid germs and other dangerous germs and impurities. Where hygienic water has been used a very large proportion of the deaths from typhoid has been eliminated. Where this is not feasible, it is desirable to use chlo- rinated lime (ordinary bleaching powder) in the drinking water (one part to 200,000 — shake up and leave several minutes). If water of doubtful quality has to be drunk, it should be at the middle or end of a meal when the healthy stomach contains plenty of gastric juice, which to a limited extent has the power to kill germs. It is safer to keep out of swimming tanks that are not filtered or refilled constantly, or chemically purified as by chlorinated lime. [72] fly' «3.] POISONS Another measure for avoiding typhoid is to Typhoid-free pasteurize milk. Food that is liable to con- tain typhoid or other dangerous germs, such as raw oysters, and milk from typhoid-infected localities, should be avoided. In protecting the food against all kinds xhe'-xyphoid- of impurities which injure the body, we must remember that the carrier of typhoid fever, the common house-fly, deposits typhoid germs on the food, through which the germ is taken into the system. The most effective method of fighting flies is by preventing their breed- ing. Their favorite places for this are horse- manure, but they will breed in almost any mass of fermenting organic material. Ma- nure piles and stables should be screened, and the manure removed at least once in seven days. Garbage-pails should be kept tightly covered. Fly-paper and fly-traps should be used. Houses should be screened, and, in par- ticular in the pantry, the food itself should be screened. Flies are usually thirsty in the morning. By exposing a saucer of one per cent, of formalin solution, the flies will be tempted to drink this morning cocktail and pay the death-penalty. A fly-trap has been invented by Professor [73] HOW TO LIVE [CH. HI. Clifton F. Hodge, of the University of Oregon, Eugene, Ore., which any one is free to con- struct and which, if used universally about stables early in the season, would greatly help toward banishing the fly altogether. Flies occasionally gain entrance to the house in spite of the most careful screening. The fumes of burning Pyrethrum powder (Persian insect powder), used in the propor- tion of 2 lbs. per 1,000 cubic feet of air space, will either kill or stupefy flies and mosquitoes, so that they may be swept up and effectually destroyed. It may be distributed in pots and pans, and ignited after sprinkling with al- cohol, other Vermin Tlcks should also be carcfuUy extermi- nated, as they are sometimes responsible for such diseases as Eocky Mountain spotted fever, African tick fever, and other infections. The bedbug is also by no means the harmless creature which it is generally regarded. To its credit are placed such maladies as relaps- ing fever. The flea has been responsible for such terrible diseases as the plague. It often operates by means of rats as its carrier to the human being. The louse is one of the direst offenders in the insect line, as it must [74] «3.] POISONS take the responsibility not only for many cases of typhoid fever, but for the dread plague of typhus, which is ravaging the European armies. Hookworm disease is to be avoided by not Hookworm treading barefoot on ground polluted by vic- tims of the disease, by preventing soil-pollu- tion through the proper disposal of human excrement, and by screening all water-closets. Cleanliness is important for avoiding infec- aeaniiness tions, and bathing is important for cleanli- ness. The hands, the face, and finger-nails should be kept clean, especially before meals. Any cut or crack in the skin or mucous mem- brane may let in germs when the spot is dirty or is touched by dirty hands. This is why surgeons are so scrupulously clean. Super- cleanliness probably also explains the ex- traordinarily low mortality of Jewish rabbis as a class. The need of cleanliness is particularly great for those who work in factories, mines, and other places where dirt is likely to be carried to the mouth by the hands. Probably many diseases get a foothold in this way without the victim realizing in the least that they were due to his carelessness and lack of cleanliness. [75] HOW TO LIVE [CH. m. Here, as elsewhere, esthetics and health go hand in hand. A person who does not bathe daily is pretty certain to carry on his skin some perspiration which, while he may be unaware of it, gives forth an offensive odor. Cleanliness is promoted by perspiring prior to bathing. Every one knows the exhilaration which follows a healthy perspiration. Of course, the most beneficial method of securing Perspiration perspiratiou is the method applied to the trot- ting horse — vigorous exercise. In fact, one of the benefits of exercise is perspiration. When a person can not or will not take exer- cise, perspiration can be induced by hot baths. Such extreme measures ought not, however, to be taken too often. How often will depend on the corpulence and other circumstances of each individual. Sweating may be overdone, and should never be pushed to the extent of exhaustion. The function of the skin in re- moving wastes from the body is much less im- portant than formerly supposed. The advice of a physician is desirable. It should be re- membered that all of us perspire insensibly as well as visibly. Some of the most serious and widespread [76] «3.] POISONS although usually unmentioned infections are sm infecBon those from the venereal diseases, with a whole train of terrible consequences, such as blind- ness, joint-diseases with heart-complications, peritonitis, paralysis, and insanity. They are to be avoided by living a life hygienic and clean, not only in body but in mind and heart. From even the narrowest interpretation of hygiene, a decent life is necessary for the maintenance of health. This is a special sub- ject on which most people are extremely ig- norant. It is seldom realized, for instance, that all prostitutes are diseased. This was found to be the case in an investigation in Glasgow. Dr. Eosenau says : "Every boy and girl, be- fore reaching the age of puberty should have a knowledge of sex, and every man and woman before the marriageable age should be in- formed on the subject of reproduction and the daugers of venereal diseases. Superficial information is not true education. On the other hand, it is a mistake to dwell unduly upon the subject, for in many instances the imagination and passion of youth are inflamed by simply calUng attention to the subject." The Life Extension Institute can furnish [77] HOW TO LIVE [CH. III. special pamphlets covering this important topic. The loss of citizens to the State from the sterilizing influence of gonorrhea upon the productive energy of the family, and the blighting destructive effect of syphilis upon the offspring offer extremely serious prob- lems for preventive work. Section. IV — Teeth and Gums There is one source of poisoning and infec- tion so universal as to need special mention. This is infection through the mouth. Consid- ered from the standpoint of efficiency, the modern mouth is out of adjustment with mod- em conditions — or, perhaps we should say, modem conditions are out of adjustment with it. Notwithstanding the numerous bacteria that flourish within its portals, mouth secre- tions and the mucous membranes do not seem to have the protecting power which is often manifest in other regions of the body and which protects an animal in a state of nature. Wild animals are not subject to caries or dental decay, as are man and domesticated animals. [78] M] POISONS There are two forms of mouth-danger that Momh- should be clearly differentiated. Dental caries, or decay, is at first largely a chemical process and affects the tooth proper. Pyor- rhea, or Eiggs's disease, affects the tissues surrounding the root of the tooth, and is ac- companied with infection by pus bacteria, and possibly also by animal parasites, termed en- dameba. Scrupulous cleanliness of the mouth largely prevents both of these maladies. In caries, or dental decay, plaques or films oentai Decay of mucin from the saliva form on the tooth- surfaces and enclose bacteria and particles of carbohydrate food, which undergo fermenta- tion with the formation of lactic acid, which dissolves the lime salts on the surface of the teeth, leaving only the organic matter. This organic matter is then attacked by bacteria. Putrefaction sets in, and you have a cavity. This cavity is, of course, a menace, as it har- bors various forms of bacteria, which may infect the general system through the root canals, or the digestive system by being swallowed with the food, and also gives rise to abscesses at the root-tips. Pyorrhea is an infection of the gums or pyorrhea tooth-sockets. It begins beneath the edges of [79] Infection HOW TO LIVE [CH. m. the gums that have been injured and espe- cially where there has been an accumulation of tartar or lime-deposit. As the infection progresses and destroys the membranes that attach the root of the tooth to the socket, a pocket is formed aroimd the root, and the tooth becomes loosened. It is said that this disease is responsible for far more loss of teeth than is decay. Systemic In- But tMs is uot the duly evil. In the pocket Mo_^_™'" pus is continually being formed and dis- charged into the mouth and swallowed. Also, as the teeth rise and faU in their diseased sockets in ordinary chewing, bacteria are forced into the circulation and may be carried to distant parts, where they work harm ac- cording to their nature, selecting tissues for their operation in which they can best thrive. It was formerly supposed that the ill effects from such conditions as dental abscess and other pus foci were wholly due to the toxins or poisonous products thrown into the blood- stream by the bacteria at the focus. It is now known, however, that the bacteria migrate into outside tissues through the blood- and lymph-streams. In joint affections, they clog and obstruct the small blood-vessels, inter- [80] cation « 4] POISONS fering with the nutrition of the joint-tissues, causing deformity and enlargement, as in arthritis deformans, as well as in acute inflam- mation, such as rheumatic fever. Indeed, this condition of subinfection, or "focal infec- Focai tion," is coming to be recognized as a far more important cause of disease than the time-honored autointoxication, a term which has been greatly abused and misused. The term "autointoxication" should prop- Automtoii- erly be restricted to conditions where poison arises from changes in the tissues or in the activities of cells or organs, whereby sub- stances are released into the circulation in quantities harmful to the organism; in other words, where the secretions of the body are altered, either in character or quantity, to such a degree as to cause injurious effects, such as overactivity or underactivity of the thyroid gland, or suprarenal gland. The poison from undigested food, or from decomposing intestinal contents, should be termed "intestinal intoxication," or "tox- aemia," rather than "autointoxication," or ' ' self -poisoning, " as it is actually due to infec- tion from outside sources. This latter condi- tion is, no doubt, a fairly frequent cause of ill- [81] HOW TO LIVE [CH. in. ness, but it has lately been shown that stag- nant bowels may cause true infection by micro- organisms that penetrate the tissues, and that many conditions ascribed to intestinal stag- nation and the resultant chemical poisoning may actually be due to focal infection, or sub- infection, arising in other regions. The light that has lately been thrown on chronic sources of focal infection has cleared up many of the mysteries surrounding the causation of certain obscure affections — chronic rheumatism, arthritis deformans, cer- tain forms of anemia, goitre, chronic heart and kidney troubles, diabetes, ulcer of the stom- ach, duodenum, etc., and other forms of chronic disease, especially those that have proved re- sistant to known methods of treatment. Lowered There are many cases where the so-called focus has apparently become established be- cause of general bodily neglect and a general lowering of resistance, in which the focus, even though it be the mouth, has participated, and permitted the successful activities of germs or parasites. After the focus has been established, however, it is often an important and may be a deciding factor in keeping up the general diseased condition of the body. [82] §4.] POISONS This principle of focal infection, well es- tablished as it is, should not be accepted too literally, or given too wide an application, but no one can question the importance of preventing the bacterial hosts of the mouth from getting into the system, or the impor- tance of getting them out, if we have unwarily permitted them to enter. All the ills that flesh is heir to are not caused by mouth-infection, but enough of them are to more than justify a vigorous and world-wide campaign for the better care of the teeth and for a thorough search for mouth- infection in every case of obscure disease. Gum infection is not always due to con- Keeping the scions neglect. Some people do not know Aa^ac how to properly cleanse the teeth. Others have tissues of low resistance, and need to give extra care to tooth- and gum-cleansing under the closest dental supervision. Others over- have spent large sums for dental work that tmiS has filled the mouth with crowns and bridges difficult to keep aseptic or surgically clean. There are various means which the individual can use to prevent or cure these dental evils. First, the importance of thorough attention General to general personal hygiene, in order that a [83] HOW TO LIVE [CH. III. VigoroUB Use of Jaws Cleansing Kind of Brush general resistance to mouth-infection may be built up, can not be overemphasized. The cultivation of normal eating habits with respect to the vigorous use of the jaws by thorough mastication, and the eating of hard, resistant, crusty foods every day is the next desirable means of tooth and gum hygiene. A leading dentist expresses the hope that some day the human animal, like other ani- mals, will, through a correct diet, be able to get along without the aid of the tooth-brush; but he adds that, in the meantime, we need to advocate more tooth-, gum- and tongue- cleaning rather than less. They should be cleaned night and morning and after each meal if possible by rapid rotary brushing. Strong pressure is not advisable. Eapidity of movement is the important point. This stimulates the circulation and increases the resistance of the gums and cleanses the teeth at the gum margins from the accumula- tions of tartar which are at first soft and easily removable by a brush. A brush should be used with bristles that are stiff and of different lengths, so that the innermost crevices of the teeth may be [84] « 4.] POISONS reached. If the gums are sensitive, a moder- ately stiff brush can be used until the gums can bear the more vigorous treatment. The tongue should also be carefully cleansed Tongue with the tooth-brush. By taking care not to '"^ "* hit the roof of the mouth, gagging is avoided. Tooth-powders and -pastes may be used, Tooth-powdera but should not be the main reliance. Perhaps once a day for their use is often enough. Some powders, if used too freely, are liable to unduly thin the enamel of the teeth. The use of dental floss silk between the teeth, Dentai fioss provided care is taken not to press it against the gums, is also helpful. A number of investigators have reported Emetin the presence of an animal parasite, the endameba buccalis, in all cases of pyorrhea, and it is thought that this parasite may be one of the principal causes of this disease. Emetin, the active principle of ipecac, which has been successfully used in amebic dysen- tery, is now employed in the treatment of this trouble. Such a remedy should only be used in connection with thorough surgical treatment and dental prophylaxis. It is claimed that in the early stages of pyorrhea a mouth-wash composed of two drops of fluid [85] HOW TO LIVE [CH. m. Alkaline Dentifrice Food Acids Periodic IGxBinination extract of i^pecac to a half-glass of water is very serviceable, and as at that stage a mouth- wash is entirely harmless, it should be tried, especially as it is now claimed that some degree of pyorrhea or of endamebic infection is almost universally present. For an alkaline dentifrice, there is nothing better than lime-water, made from coarse, unslaked lime. Alkaline washes are very superficial in their action, however, while fruit acids curdle and thus render removable the mucin plaques and prevent the formation of tartar. They also cleanse the tongue and membranes of the mouth generally, whioh may be important sources of infection. These acids are found in grape-juice, orange-juice, apples, and vinegar. Such mechanical cleans- ing is particularly important before retiring, as it is usually during the night that the most damage is wrought. The advice of the dentist should be sought as to the condition of the teeth, especially as to whether there is any erosion or destruc- tion of enamel, before using either acid or alkaline washes exclusively. Periodic examinations and cleanings by the dentist are the only safe measures. If the [86] U.-] POISONS dentist has facilities for giving preventive treatment by specially cleaning the teeth, he should be visited every other month. If such a program is adopted, it will generally be found unnecessary to visit him for any other purpose. Some dentists and physicians have until saving Teeth lately given too much attention to the saving of teeth, without fully realizing the dangers of infection from the mechanical devices em- ployed. The teeth should not be extracted on mere suspicion and without proper effort to save them, but it is far more important to save a heart or a kidney or a set of joints than it is to save a tooth. This is not to say that all bridge- and crown-work is improper, but that such work should only be of a char- acter that will permit of surgical cleanliness in the mouth, and that such teeth should al- ways be examined by the X-B-ay, when there is evidence of systemic disease in order to be sure that the roots and sockets are not in- fected. In early life the jaws should be carefully irregularities examined by both dentist and doctor in order to determine whether or not the proper de- velopment is taking place. If upper and [87] HOW TO LIVE [CH. in. lower teeth fail to fit well together, extra strain is placed upon certain teeth and the sockets are liable to injury and infection. Faulty development can often be corrected and deformities that interfere with proper mastication and place a strain on certain teeth can thus be avoided. The Temporary The temporary teeth should not be allowed to be removed by decay. Thorough dental and home care should prevent this.. If cavi- ties form, they should be filled under proper precautions and the teeth should be saved until the last minute, unless they are causing infection. Teeth and Amaziugly good results from teeth-hygiene Infectious , . ti-i Diseases have oeevL shown m a Boston asylum, which cares for over 300 children. Before the in- troduction of a dental clinic into this asy- lum, infectious diseases — diphtheria, mumps, scarlet fever, pneumonia, measles, whooping cough, tonsillitis, chicken-pox, croup, etc. — had been occurring for four years at the rate of over 80 cases per year, but for three years after the dental clinic was established the average was only 3 per year. [88] H.] CHAPTER IV ACTIVITY Section I — ^Work, Play, Rest and Sleep In order to live a hygienic life it is not only necessary, as shown in the foregoing three chapters, to supply the body with wholesome substances and to exclude unwholesome sub- stances, but it is also necessary that the body should at times act, and at other times be in- active. There are two great forms of activ- ity, work and play; and two great forms of inactivity, rest and sleep. All four of these are needed in the healthy life and in due rela- tion to each other. The whole personality should be utilized The oaiiy and energized in a daily rhythm. When, as too often happens, the equilibrium and mu- tual proportions of the various wholesome ele- ments in a well-rounded life have been lost, the balance should be restored if possible the next day. If a physician has had his sleep broken, he should aim to make it up at the [89] HOW TO LIVE [cH. IV. earliest opportunity. If the afternoon exer- cise has had to be omitted, an extra amount should be taken as soon as possible. Some people find that while it is difficult to live a complete life every single day, it is quite within their power to give every element its due proportion in each week, taken as a whole. To go a step farther, when the balance has not been left even in a week as a whole, the next week should be modified to compensate. But it is ideal to make the day, not the week, the unit. It is almost as absurd to relegate all our exercise to Saturday afternoon as to do all our eating on Sunday. Adjusting the It is dlstluctly unhealthful either to overdo wo?kandP°ay Or to uuderdo work, play, rest, Or sleep. "Mod- eration in all things" is a rule that is par- ticularly important in this realm. Not all people are in need of exercise, nor are all in need of rest; but almost every one needs to change his proportion between the two. To- day many people are suffering from too much or too little work. For instance, the increase in diseases of the heart is often due to ner- vous overstrain combined with either too much or too little physical exertion. The remedy for the evils of idleness is [90] 5 1] ACTIVITY obviously to find some useful work whicli will Need of work inspire real interest and enthusiasm. There are few things more necessary to a normal healthy life than to have purposeful work. A great dream or ambition in life often obviates personal ailments and nullifies their potency. Work, when done with zest, is a wonderful tonic. Exertion of any kind is usually pleas- urable at first, and becomes drudgery only when too far protracted. Normal work is one of the greatest bless- ings of life, but too many miss the joy of it, some because their work has gone to the ex- treme of drudgery and others because it has shrunk into nothingness and futility. Some- times people become ill because their person- ality, hungry for work, is given nothing but introspection to feed upon. This is the self- imposed curse of the idle rich. Methods of preventing or correcting over- Prevention of strain vary greatly, according to the kinds of ''"^ ^"^ overstrain. In general, overstrain of any kind tends to overfatigue. Overstrain is to be avoided, therefore, by paying heed to Na- ture's fatigue-signals as soon as they appear. A very moderate degree of fatigue is per- haps normal, but anything that approaches ex- [91] HOW TO LIVE [CH. IV. Variety of Work haustion should be avoided with, the utmost care. Working Hours WorMug hours should be so arranged as to enable the worker to fully recuperate over- night, partly from sleep and partly from the recreation enjoyed in leisure between work and sleep. Variety of work is especially needed in modern times, when specialization tends to lead men to extremes. Changes in work which prevent a sense of monotony will greatly in- crease the power to work. A clerk will do more work, and do it more effectively, if he is occasionally allowed something else to do than to foot up columns. If the monotonous strain of performing numerical additions is interrupted a few times daily, the adding faculty of the brain is given much needed rest. Many men in the higher rank of workers complain of the many inter- ruptions which they suffer, but if they would welcome these interruptions instead of allow- ing themselves to be irritated by them, each interruption would serve the purpose of a va- cation. It is in this way that some of the greatest workers, like Gladstone, have been enabled to accomplish so much. [92] Monotony and Interruption i 1] ACTIVITY The strain of modern life is sometimes spe- cial rather than general. Often the strain comes on some one muscle or organ. Modern industry is so constituted that the individual strains one part of the body while other parts are in need of exercise. One of the organs which is most commonly Eye-strain strained in modem life is the eye. In its modern use, the eye is constantly focusing at a short distance. To look at the horizon is a rest. The reflex evils from eye-strain are great and numerous and are often incorrectly ascribed to entirely different causes. Head- aches, nausea, and dizziness are especially fre- quent results of eye-strain. Probably some of the breakdowns in middle life are due primarily to the reflex effect of eye-strain. Eye-strain is to be prevented by scien- tifically adapted spectacles, by care to secure the right kind of illumination, and in some cases by systematically resting the eyes. Reading on moving trains or looking for a long time at moving pictures may overstrain the eye. One should be especially careful not to read in a waning light or, on the other hand, to read in the glare of the sun. If one works facing a window, it is advisable to wear an [93] HOW TO LIVE [oh. IV. Mechanical Home Exerciser Stimulating Heart and Lunga JBxercise after Meals eye-shade; otherwise there is a struggle be- tween the tendency of the bright light to close the pupil and the tendency of the work re- quirement to keep it open. To offset the evils of a sedentary life, it is advisable to spend one hour daily, or at least 15 minutes, in some kind of vigorous physical exercises. The rowing-machine is probably the most beneficial form of mechanical home exercise that is likely to be followed faithfully. Sim- ple stretching in bed when one wakes up is helpful, especially if combined with breathing exercises. The most beneficial exercise, as a rule, is that which stimulates the heart and lungs, such as running, rapid walking, hill-climbing and swimming. These should, of course, be graduated in intensity with varying age and varying degrees of vitality. Gentle muscular activity after meals pro- motes normal digestion and should be prac- tised for a quarter or half an hour after each meal, but violent exercises immediately after meals should be avoided, as a large amount of blood is then engaged by the digestive system. A very important fact for the average man [94] $ 1.] ACTIVITY to take into consideration is that, whereas he outdoor naturally gets considerable out-of-door exer- wlnt«"" cise in summer, he allows it to lapse in the winter. Such a decided change in the amount of exercise is dangerous and should be avoided by taking regular gymnasium ex- ercise. Even though a gymnasium is not elaborately equipped, use .can be made of such games as hand-ball, volley-ball and other available games. Systematic exercise is important and bene- Enthusiasm in ficial, even when the individual finds it unin- teresting. The idea, which is now spread abroad, that exercise in which one is not emo- tionally interested is of no benefit, is quite in- correct. A gentleman who had this opinion was challenged to test it and speedily changed his mind. For an entire winter he faithfully attended a gjmmasium, though it was an un- ceasing bore to him. To his surprise, he found that he had never spent a winter in such good health. But, although exercise when self-imposed is wholesome, exercise to which one is natu- rally attracted is more so. Golf, horse-back riding, tennis, usually inspire enthusiasm, and enthusiasm itself is healthful. Walking may [95] HOW TO LIVE [CH. IV. The Greek Ideal Injuries from College Athletics also do so, if the walk has an object, as in mountain-climbing, when often the artistic feelings may be enlisted in the sport. "Work- ing out an ideal stroke in rowing, perfecting one's game in polo or other sports, are other examples. The Greeks lifted their sports to a higher level than ours by surrounding them with imagination and making them a training in esthetics "as well as in physical excellence. The American idea is too closely connected with the mere wish to win and the perform- ance of mere "stunts" and not enough with the idea of beauty of physique and control of the body. There is accumulating considerable evidence that college athletics often seriously injure those who engage in them, although they were originated and encouraged for pre- cisely the opposite effect. The value of exer- cise consists not in developing large muscles nor in accomplishing athletic feats, but in at- taining physical poise, symmetry of form, and the harmonious adjustment of the various parts of the body, as well as in furthering the proper activity of cell-tissues and organs and the elimination of waste products. Even those whose work is largely muscular, [96] § !•] ACTIVITY unless it involves most of the musenlar sys- tem, may do well to exercise the unused muscles — although Nature herself produces to some extent the necessary compensation by what is known as the ' ' law of synergic move- ment, ' ' by which unused muscles profit by the exercise of those which are used. Not only the functions of the body but Exerdsc of tiw j-i J? J.1 • T • • • Mind, Will and tnose 01 tne mmd require exercise — exercise Emotions in thinking, feeling, and willing. A person who does not read or think loses some of his abihty to read or think. The physical worker, for instance, often allows his mind to become dull and sodden. The accountant adds up fig- ures all day and has no chance to exercise his judgment or other mental faculties. In the same way a person who does not exercise his artistic, poetic, or affectional side will suffer its atrophy. The plaint of Darwin that he had allowed his taste for music and poetry to atrophy could to-day be made by many in- tellectual specialists. Good music is especial- ly healthful. The exercise of the will is of first impor- tance. Many young people to-day are brought up so well protected that they have lost the power to decide for themselves. Will is ex- [97] HOW TO LIVE [CH. nr. ercised every time a decision is made. One of the advantages of all games is that they require decision by the players. A game like baseball calls out the exercise of almost every power. It requires the mind to play, the emo- tions to enjoy, the will to decide, the muscles to act, and all in mutual coordination. The Avocation Sinco the work of most people is likely to produce some unhygienic element which can not be avoided, a compensation should be sought in an avocation or "hobby," to be prac- tised out of regular working hours. The avo- cation should be far removed from the nature of the regular work. Often the avocation can serve a productive purpose. Gladstone and Horace Greeley sawed wood or chopped down trees for recreation. A well-known engineer divided his recreation between writing stories and painting pictures. Enjoy But ouc shouM bcwarc of turning his play ecrea ion j^ggif £^^0 work. Some people read Shake- speare to "improve their mind," and make as hard work of it as though they were studying geometry. We should enjoy our recreations for their own sake, or else they are not recrea- tions. All work and no play make not only dull boys but dull men and women. [98] 5 1] ACTIVITY In some form, every one can secure recrea- Pleasures of tion. If one can not play golf, or polo, or tennis, or swim, or climb the Alps, at least lie can walk, and, if he tries, he can do so in good company on interesting highways and byways. Recreations in which more persons than one Games take part are far superior in this respect to those of a solitary nature. They require a give and take, a matching of wits, a feeling of rivalry, and at the same time, companionship. Plays and moving pictures of the right character and free from morbid suggestions, if enjoyed in moderation, are hygienic. Com- edy is generally more wholesome than tragedy. Laughter lengthens life ; tears do not. The proper kind of reading is often a most beneficial type of recreation. It is best for the average individual to avoid Morbid literature that deals with the morbid and ' "^ ""* pathological, that depicts and analyzes abnor- mal psychological conditions. Such studies are better left for alienists. Literature of mawk- ish sentimentality should also be avoided. Within the range of sound literature there is a wide choice of abundant material affording 'healthful mental suggestions. Dancing combines wholesome exercise, so- [99] HOW TO LIVE [CH. IV. Dancing Card-playing Suicidal Amusement cial enjoyment, and the acquirement of skill and grace, but it is seldom of much hygienic value because it is frequently overdone, and often involves bad air and loss of sleep. In one large plant where the employes were ex- amined by the Life Extension Institute, the management regarded the harmful effect of dancing as their chief obstacle to efficiency. Many of the large force of girls and women were accustomed to dance until late in the night, bringing on a condition of chronic fatigue. Card-playing and similar games afford wholesome mental recreation for some per- sons. However, they, too, are liable to be associated with late hours, and other disad- vantages even when they do not degenerate into gambling. Card-playing, dancing, and many other popular forms of amusement often border on dissipation. Amusements which weaken and degrade are not hygienic. Many who need amusement make the fatal mistake of getting it in suiddal ways, in the saloons, dives, and the low dance- haUs. Play is simply a half way stage between work and rest. In a hygienic life there must [100] $ 1] ACTIVITY be a certain amount of actual rest. Every bodily power requires rest after exertion. The heart rests between beats. The muscles require relaxation after every contraction. The man who is always tense in muscle and nerve is wearing himself out. The power to relax, when fatigue requires Relaxation it, is one of the most important safeguards one can possess. Lying down when tired is a good rule. A very hard-working college president when asked about the secret of his working-power and length of life replied, "My secret is that I never ran when I could walk, never walked when I could stand, never stood when I could sit, and never sat when I could lie down." Such rules as these are valuable, of course, ARuiefor only when the requirements of one's occupa- ' °^ tion tend toward ceaseless activity. For idle and lazy people the rule should be reversed — never to lie down when one could sit, never to sit when one could stand, never to stand when one could walk, and never to walk when one could run ! A complete life must have all in due proportion. Eelaxation is only a short vacation, as it were, between two activities. Bathing and swimming supply, in their nu- [101] HOW TO LIVE [CH. IV. Bathing and merous forms, examples of both healthful wimming actlvitj aiid relaxation. A cold spray or shower, alternated with hot, affords excellent gymnastics for the skin. A very hot bath, lasting only a minute, or even a hot foot-bath, is restful in cases of general fatigue. The most restful of all is a neutral, that is, tepid, bath of about the body-heat (beginning at 97 or 98 degrees and not allowed to drop more than 5 degrees and continued as long as con- venient). How to Induce The wouderful nervous relaxation induced by neutral baths is an excellent substitute for sleep in case of sleeplessness, and often in- duces sleep as well. Neutral baths are now used not only in cases of insomnia and ex- treme nervous irritability, but also in cases of acute mania. When sleep occurs in a neu- tral bath, it is particularly restful. A phy- sician who often sleeps in the bath tub ex- presses this fact by saying that "he sleeps faster" there than in bed. Sleep may also be induced by monotonous sound, or lack of sound, or the monotonous holding of the attention. Keeping awake is due to continued change and interruption or arrest of the attention. [102] « 1.] ACTIVITY Exercise taken in the afternoon will often promote sleep at night in those who find sleep difficult. Slow, deep, rhythmic breathing is useful when wakeful, partly as a substitute for sleep, partly as an inducer of sleep. Sleep is Nature's great rejuvenator, and the health-seeker should avail himself of it to the full. Our sleep should not only be suffi- cient in duration but also in intensity, and should be regular. The number of hours of sleep generally Hours of sieep needed varies with circumstances. The aver- age is seven to nine. In general one should sleep when sleepy and not try to sleep more. Growing children require more sleep than grown-ups. Parents often foolishly sacrifice their children's sleep by compelling them to rise early for farm "chores," or in order to sell papers, or for other "useful" purposes. One 's best sleep is with the stomach empty. Eating before It is true that food puts one to sleep at first, "^"""^ by diverting blood from the head ; but it dis- turbs sleep later. Water, unless it induces bladder-action during the night, or even fruit, may be taken without injury before retiring. If one goes to bed with an empty stomach, he can often get along well with six or seven [ 103] HOW TO LIVE [cH. rv. Place of Sleep Pillowa Type of Bed Character of Tboushts hours ' sleep, but if lie goes to bed soon after a hearty meal, he usually needs from eight to ten hours' sleep. It has already been pointed out that sleep- ing outdoors is more restful than sleeping indoors. A pillow is not a necessity if one sleeps lying prone with one arm extended above the head and the leg opposite drawn up. This sleeping attitude can easily be reversed to the opposite side. It has one advantage over pil- low-sleeping, that of not tending to round shoulders. This prone position is often used now for infants, but is seldom enjoyed by adults. A modern "hard" bed is far preferable to the old-fashioned soft (and hot) feather bed. The character of sleep depends largely on the mental attitude on going to bed. One should get into the habit of absolutely drop- ping work and cares at bed-time. If then one suggests to himself the pleasantest thought which memory or imagination can conjure up, his sleep is likely to be far more peaceful and restful than if he takes his worries to bed, to keep him awake until sleep comes in spite of them, and to continue to plague him in his [104] « 2.] ACTIVITY dreams. If one is worried, it is a good plan to read something diverting, but not exciting, just before retiring. Section II — Serenity and Poise As we have seen, not only the body but the mind needs its due activity and rest. As to the mind, the important question is the quality of the activity rather than the quantity. If we are to be really healthy, our mental atti- tude must be healthy. A healthy mental atti- tude implies many elements, but they are all roughly summed up in the word "serenity." Probably no other one hygienic requirement is of greater importance than this. More- over, the attitude of "healthymindedness" should be striven for not only in order to pro- duce health, but as an end in itself, for which, in fact, even health itself is properly sought. In short the health of the body and the health of the mind act and react on each other. We may generally keep serene through fol- influence of lowing the other measures already described, character Discontent is undoubtedly very often the con- sequence of wrong conditions in the body, and though melancholy, worry, peevishness, fear [105] HOW TO LIVE [CH. IV. generally appear as arising from outward con- ditions, there are usually real physical sources, existing within the body itself. These are at times most difficult of recognition. A person who is physically ill is likely to be ill-satisfied with everything, without suspecting the fun- damental cause of the discontent. When the apparent "cause" is removed, the discon- tent remains none the less, and fastens itself on the next thing that comes along. The "Cause" Although somc Httlc event such as the mis- take of a tradesman or a cross word of a friend may seemingly "cause" a disagreeable reac- tion in a man if he is ill (whether he knows he is or not), the same "cause" does not nec- essarily produce that same reaction at all times. When he is in a healthy mood, the "cause" may be entirely inadequate to bring about the same result. Approach of The ucar approach to the menstrual period Menstrual . • pj • n i j. t ^ Period m women is oiten accompanied by mental de- \ pression and physical fatigue which it is al- most impossible for the sufferer to recognize at the time as caused by anything but "real" or outside misfortunes. Other physical conditions act in the same way. The hidden cause may be constipation, [106] 52.] ACTIVITY eye-strain, or the effects of alcohol or other Hidden causes drugs, a sedentary life, a bad posture, or weak abdominal muscles; and the proper remedy may be an enema, a pair of glasses, a vigor- ous swim, deep breathing exercises or an ab- dominal supporter, an erect carriage or a gen- eral change of daily habits. A young man returning from a surveying trip in the moun- tains of Colorado in which an ideal hygienic out-of-door life was lived, said, ' ' I never saw so good-natured a crowd of rough men. Noth- ing ever seemed to make them angry. They were too full of exultant health. ' ' Health for the body awakens mental capaci- Mental Re- ties where they exist. Failure in mental work Health can often be traced to failure in physical health; and the restoration of bodily health is often essential to success in the tasks of the mind. This is especially true of the artistic professions, where the kind of product is de- pendent so largely upon the state of the emo- tions, upon exhilaration and enthusiasm. A noted sculptor who, a number of years ago, was "down and out" in the artistic world, after a period of years "came back" with a masterpiece, having adopted a more hygienic life. [107] HOW TO LIVE [OH. IV. Epictetus taught that no one could be the highest type of philosopher unless in exuber- ant health. Expressions of Emerson's and Walt Whitman's show how much their spir- itual exaltation was bound up with their health conditions and ideals. * ' G-ive me health and a day, ' ' said Emerson, ' ' and I will make the pomp of emperors ridiculous." Influence of the But what most coucerns us in this section Health is that the mind has an important influence over the condition of the body. A Kansas poultryman, who owns a hen which he claims to value at $10,000 because of her qualities as a breeder, a few years ago knew a great deal more about how to maintain the health of his poultry than he did about how to maintain his own health. Long and bitter experience had taught him that he obtained freedom from sickness among hens only by being very care- ful to feed them on a special diet; to give them drinking water at regular intervals — warmed in winter; to supply them with well ventilated and cleanly houses, and so on. But, after all this, he found there was one condi- tion, which, if unfulfilled, still precluded the realization of maximum possibilities. "A discontented hen won't lay eggs," was the [108] ♦ 2.] ACTIVITY startling discovery. "When I see a man go into the yard and 'holler' loudly at the hens, and wave his arms, making them scatter, frightened, in all directions, I say to that man: 'You call at the office and get your pay and go.' But when I see a man go into the yard, and call gently to the hens, so that they all gather around him and coo and cluck and eat out of his hand, I raise that man's pay." It can not be too much emphasized that Physical , 1 1 T •• jMiAl IT- Manifestations mental perturbation affects the body m many ways. Shame fills our cheeks with blood. Fear drives the blood away. Excitement quickens the heart-beat. Grief brings tears, the reaction of glands about the eyes, and sighs, the disturbances of regular breathing. A great shock to the mind may cause faint- ing, the rush of blood from the head into the abdomen. "Worry will interfere with diges- tion and sleep. The X-ray has detected the arrest of the peristaltic movement of the stomach and intestines because of a strong emotion. Some peculiarly constituted people, who take their work and obligations with a kind of seriousness that amounts almost to fear, can not eat anything of consequence un- [109] HOW TO LIVE [CH. IV. til their day's work is ended. The digestive processes seem to be at a standstill until then. A curious fact is that strong emotion may lead to a great increase in the sugar in the blood, sometimes enough to cause its appear- ance in the urine as though the person had diabetes. One man expresses this by saying, "bitterness of soul banishes sweetness even from the body." The Demands It is doubtless On accouut of such influences of the mind on the body that some persons who have attempted to improve their health by what they call "thoroughly masticating" their food — but who have interpreted this phrase as having a purely mechanical mean- ing — have wondered why they were not benefited when they forcibly held their food in their mouths until they performed a cer- tain number of chews, while in fact they were making a bore of eating and were forgetting to taste and enjoy. The mind and the emo- tions refuse to be ignored in this way, and exact due penalty from the body when they are not satisfied. To attain the desired re- sults from any hygienic measure, it is appar- ently necessary, in some degree at least, to satisfy the mind along with the body. [110] «2.] ACTIVITY There is in fact a danger to which some peo- Hypochon- dnacs pie are especially subject — the danger of be- coming hypochondriacs from paying too much attention to physical hygiene. Such a person becomes fearful lest he is not doing exactly the right thing. He looks suspiciously at every article of food and fears that it will disagree. He fears that he has strained his heart; he worries over the loss of an hour's sleep ; he chafes because his employer has not given him a vacation at the right time or of the right length. The hypochondriac thus neutralizes practically all the benefit of other hygienic measures by disregarding this special measure of keeping serene. It might, in many cases, be better to disregard some rules of hygiene than to worry over them. On this theory the devotees of mind-cure "Mind-cure- cults have derided every hygienic measure but one — their "mind-cure." They some- times succeed in the "real cure of imaginary ailments," and the "imaginary cure of real ailments." In the latter case, the men- tal contentment lasts only until the real ail- ment becomes too aggressive to be ignored. But it is a great mistake to stake everything on the simple resource of mental equanimity. [Ill] HOW TO LIVE [CH. IV. In some cases it is criminal, as for instance to refuse surgery for cancer, or outdoor living for tuberculosis. In its proper place, "mind-cure" is an es- sential part of individual hygiene. In order to get the benefit of the other rules, there must be no worrying or watching of symptoms. After the regimen of exercise, baths, diet, etc., has been selected, it must be followed as a matter of course, with confidence that it will help, and with patience as to the rate of im- provement which will follow. Worry It would secm that incessant, even if mild, worry is more exhausting than occasional fits of intense anger or fright or overexcitement, just as we waste more water from a spigot left slightly open all the time than from one which is alternately closed and wide open. Worry, if unceasing, will often drain away the largest store of nervous energy. Worry seems, as it were, to short-circuit nerve cur- rents in the brain, which normally form a long circuit through the body. One man, with this simile before him, has found he can stop wor- rying almost at will, avoid the supposed con- tinuous short circuit and save up his nervous energy until it is needed. [112] 5 2.] ACTIVITY We must rejoice at things as they are ; they Rejoice at might be worse! If we should count up we They Are should be surprised to find how seldom the things we fear or worry about really happen. It is a true proverb that "half the trouble never comes." Each must learn for himself how best to serenity an avoid anger, fear, worry, excitement, hate, envy, jealousy, grief, and all depressing or abnormal mental states. To do so is an art which must be practised, like skating or bicy- cle-riding. It can not be imparted merely by reading about it. When, as unfortunately is often the case, -pnepayata the difficulty of maintaining one's serenity ""* seems insuperable, the battle can often be won by "living one day at a time." Almost any one in ordinary conditions of adversity has it within his or her power, for merely one day or at any rate one hour, or one minute, to eliminate the fear, worry, anger, or other un- wholesome emotions clamoring to take pos- session. At the expiration of say the hour, or minute, the same power can be exercised for the next ensuing period, and so on until one is caught napping, after which he must pick himself up and patiently try again. [113] HOW TO LIVE [CH. IV. The Hurry Habit Religion and Philoaophy " Religion of Healthy- mindedness '* In modem life, whicli has been gradually speeded to the breaking-point, many people are suffering from a constant oppressive sense of hurry. Most people have "so much to do," that they can not do it. This fact is of much annoyance and at the same time spurs them on in the vain endeavor to catch up. When once it is realized that the sense of hurry actually reduces the effective speed of work — in other words, that "the more haste, the less speed " — the situation has been reached in which the individual can teach him- self some practical philosophy. An immense help in the field of mental hy- giene is to be obtained from religion and philosophy, although this is not the place to advocate any particular form of either, and from the standpoint of hygiene, it does not greatly matter! One may get his chief help from the Bible, from faith-healing cults, from writers like Emerson, from Tagore and other Orientals, or from Marcus Aurelius and Epic- tetus. Professor William James commends the adoption of a "religion of healthyminded- ness ' ' in which we renounce all wrong or dis- eased mental states, cultivating only the [114] §2] ACTIVITY healthy ones, such as courage, patience, op- timism, and reverence. When the mind turns from shadow to sun- The Habit of shine, the body will tend also to assume the radiance of health. Stevenson said that there is no duty we so much underrate as the duty of being happy. The habit of being happy enables one to be freed, or largely freed, from the domination of outward conditions. Though the trait is apparently totally lacking in some, while existing to a high degree in others, ex- perience has shown that conscious cultiva- tion will develop it to an appreciable degree, even in very stubborn cases. As in little Pol- lyanna's "Glad Game," it is possible to find something to be glad about in every situation in life. The secret of equanimity consists not so control of . ' n t* ' Attention much m repressmg the fear or worry, as m dropping or ignoring it — that is, diverting and controlling the attention. It does no good to carry a mental burden. ' ' Forget it ! " The main art of mental hygiene consists in the control of attention. Perhaps the worst de- fect in the Occidental philosophy of life is the failure to learn this control. The Orien- tal is superior in such self-training. The ex- [115] HOW TO LIVE [CH. nr. ceptional man in Western civilization who learns this control can do the most work and carry the most responsibility. On much the same principle as the Indians used when their young men were trained to endure pain self- inflicted, we might well devote a few minutes each day to the difficult task of changing at will our attention from the thing which is en- grossing it to anything else we choose; or, what is more difficult still, to blank nothing- ness. When we have sufficiently strength- ened this power, we can turn off the current of our thoughts as we turn off the lights and lie down to sleep in peace, as a trained sailor does in a storm. Making Up If a poTsou's work is drudgery but has to be endured, the making up of the mind to en- dure it cheerfully, the relinquishment of the doubtful but fascinating pleasure of dwelling upon one's misery, is found to largely obviate the burden. It is the making up of the mind which presents the difficulty. The truth is that we instinctively shrink from making, without reservation, important decisions as to our future course of conduct. We balk even at really committing ourselves not to worry. A man who, when he complained of his lot, [116] ?2.] ACTIVITY was advised to "grin and bear it," replied that he 'd have to bear it, but he 'd be hanged if he'd grin! The decision which is perhaps the hardest intensity of to make and, at the same time, the most im- portant from the standpoint of health and working-power, is the decision not to care too much about the objects we are seeking to achieve. We need not subscribe to the Nir- vana philosophy. A certain intensity of de- sire is normal, but modem life tends to a mor- bid frenzied intensity. Most of us need, in the interest of mental health or sanity, to moderate our desires. A business man who had set his heart on fulfilling a large respon- sibility nearly wrecked his health from worry over the outcome. His wise physician pre- scribed that, before sitting down to his desk each day, he should spend five minutes repeat- ing and impressing on his mind the words, "I don't give a hang! I don't give a hang!" The truth is many people fail because of over- anxiety lest they fail. Some invalids die from an exaggerated desire not to die. A helpful precept, when one is failing in some crucial undertaking from his very over- anxiety to succeed, is to replace the ambition [117] HOW TO LIVE [OH. IV. to succeed by a determination to pass the cri- sis unruffled, whether one succeeds or fails, Ruling "He that ruleth himself is greater than he Ourselves " that taketh a city," and incidentally if we rule ourselves we are far more likely than other- wise to take the city, if that be possible at all. An ideal course of conduct implies a con- stant readiness, after all has been done which can be done, to renounce one's feverish de- sires and accept whatever higher powers de- cree, even if it be death. This is one of the supreme aims of every great philosophy or re- ligion. The Psalmist said, ' ' Though He slay me, yet will I put my trust in Him," and Christ exclaimed, "If it be possible let this cup pass from me ; nevertheless, not as I will, but as Thou wilt." [118] $1.] CHAPTER V HYGIENE IN GENERAL Section I — The Fifteen Rules of Hygiene The aids to health discussed in the preced- ing chapters may be summarized in specific formulas classified under the four heads, Air, Food, Poisons, and Activity, corresponding to the four chapters, and under fifteen sub- heads, corresponding to the fifteen sections. I. AlB. 1. Ventilate every room you occupy. 2. Wear light, loose and porous clothes. 3. Seek out-of-door occupations and recre- ations. 4. Sleep out, if you can. 5. Breathe deeply. II. Food. 6. Avoid overeating and overweight. 7. Eat sparingly of meats and eggs. 8. Eat some hard, some bulky, some raw foods. 9. Eat slowly. [119] HOW TO LIVE [cH. V. III. Poisons. 10. Evacuate thoroughly, regularly and fre- quently. 11. Stand, sit and walk erect. 12. Do not allow poisons and infections to enter the body. 13. Keep the teeth, gums and tongue clean. IV. Activity. 14. Work, play, rest and sleep in modera- tion. 15. Keep serene. The application of these rules to one's daily life must be varied with each individual. The most practical method is for the individual to begin the improvement he would seek by con- structing a tjrpical day's program in which time is provided for, say, breathing and other exercises in bed, bath, toilet, walk to business, meals, amusement, etc., with special notes and memoranda as to the particular faults of omis- sion and commission to be corrected. One might also, as Benjamin Franklin records in his autobiography, keep a daily record for a week as to how nearly the program is lived up to. By dint of such and other stimuli, the [120] §2.] HYGIENE IN GENERAL transition in habits can be made, after which the "rules" cease to be rules, as carrying any sense of restriction, and become automatic like putting on or taking off one's clothes. Section II — The Unity of Hygiene The above rules embody our preachment The Rules on individual hygiene. We have stated them as fifteen separate kinds of procedure. In actual life, however, our acts can not be so separated. The neglect or observance of one rule carries with it, to some extent, the neglect or observance of other rules. For in- stance, one can not take muscular exercise without, to some extent, taking breathing ex- ercises. Swimming serves as a means of cleanliness, of skin gymnastics, of general exercise and of amusement. A game of ten- nis implies the practise, to some extent, of at least five of the fifteen rules. The human body is a "harp of a thousand strings," which are intended to harmonize. If one of them is out of tune, it is likely to cause discord throughout, while to tune up one helps the harmony of all. Any one ailment has a far-reaching effect [121] HOW TO LIVE [cH. V. Medical throughout the system. It is because of this far-reaching effect that the "one idea" spe- cialist in medicine has so often thought his particular specialty to be the one and only gateway to all therapeutics and hygiene. The oculist is liable to look at all ailments as re- lated to the eyes ; the dentist as related to the teeth; the mental hygienist as related to wrong attitudes of mind. If we examine their claims, we find that they are usually right in their aflSrmations, though wrong in their de- nials. It is their affirmations in which we are here interested. They find that the ailments within their own special province extend in unsuspected ways, and to a surprising degree into seemingly remote fields; and that to remedy the special defect which they can treat, will often go a long way toward reme- dying numerous other ailments. Remote Effects It has already been noted that eye-strain of Ailments in, j • t • t o • leads to an astonishmg number of serious nervous affections, and that corrective eye- glasses will often work wonders for remedy- ing those ailments and improving the general health. There may be other unhygienic con- ditions equally responsible for these symp- toms, and the correction of which may produce [122] *2.] HYGIENE IN GENEEAL equally wonderful improvement. Vertigo may be due to eye-strain, or it may be due to wrong posture or to pressure of wax on the ear-drum. Diabetes may be aggravated by too much sugar, by infected tooth-sockets, or by too much worry. Tuberculosis may be due jointly to indoor-living, lack of exercise, wrong diet, wrong posture, sexual excess, alcohol, nerve-strain, and numerous other pre- conditions, besides infection with the tubercle bacillus. The social evil can be fought not only directly by attack on prostitution, and by appeals to self-control and moral ideals, but also indirectly by diminishing the con- sumption of alcohol and other drugs, for al- cohol not only produces abnormal sexual de- sire but reduces the strength of will by which that desire is repressed. Forel asserts that the social evil can not be controlled until the use of alcohol as a beverage is abolished. It is not uncommon for people to attribute popuur their ailments to the less important rather than the more important cause, and so fail to get the best benefits of hygiene. Many peo- ple bemoan the fact that they sat in a draft and ' ' therefore ' ' caught cold, when what they most needed was not to keep out of drafts but [123] HOW TO LIVE [cH. V. to keep in sucli condition that drafts would do them good, not harm. Benjamin Franklin, a century ago, believed, what we now know to be true, "that people who live in the forest, in open bams, or with open windows, do not catch cold, and that the disease called *a cold' is generally caused by impure air, lack of exercise, or overeating." So-called __ Most pcople who are "overworked" are, more properly speaking, simply the victims of bad air, bad diet, poisons, or worry. They believe that because they are tired it must be work which is hurting them. The man who breaks down in middle life commonly imagines that he has ruined his health by overwork. The college girl thinks she has ruined her health by study. All these "overworked" people prove their case by showing that they improve in health when given a vacation. This simply shows that a bad condition can often be remedied by improving the general health in any way whatever, even if the pri- mary source of the difficulty is not reached. They are undoubtedly working beyond their working capacity; but their working capacity is only a fraction of what it would be if they took exercise, were not constipated, did not [124] §2.] HYGIENE IN GENERAL eat too much, abjured alcohol, or ceased to worry continually. If they lived hygienically in these respects, the work which was a drag might be an inspiration. A physician of wide experience says that every day men come to him broken down in health, invariably tell- ing him that they have overworked; and yet upon questioning them he finds that none of them works as hard as he. Their breakdown was due to the terrible load of unphysiological habits which they had been carrying — a load so great that scarcely any work could be car- ried in addition. Other examples might be given of ascribing ailments and disabilities to the less important instead of the more important causes. The error is almost always made of resting the blame on only one cause. In consequence most health-seekers make the mistake of making only one correction in their daily regime of life. One will cease alcohol drinking, another will give up tobacco smoking, another will give up coffee; a third will cease using all "red meats," another turns vegetarian, another AnAu-round adopts a raw food diet ; another takes up out- door sleeping ; another adopts a daily game of golf; another embraces a mental healing cult; [125] Will HOW TO LIVE [OH. V. another takes up mastication. But great and permanent results require the adoption of an all-round, well-balanced regime. Section III — The Obstacles to Hygiene Effort of the It is not enough that the individual should know how to live. Knowledge is of no avail without practise. Mr. Moody, the evangelist, once said of religious conversion, "Merely to know is not to be converted. I once boarded a train going in the wrong direction. Some one told me my mistake. I then had knowl- edge, but I did not have 'conversion' until I acted on that knowledge — seized my travel- ing-bag, got off that train, and boarded one going in the opposite direction." Many peo- ple are on the wrong train in hygiene, as in religion, and know it. They are traveling fast to that kind of perdition which in the end unhygienic living always brings. In fact, a great many people practise unhygienic habits more through indifference than through ig- norance. Most people have acquired, by imi- tation of their neighbors, a great number of unhygienic habits and have continued in these habits for so many years, that they can not [126] ♦ 3.] HYGIENE IN GENERAL get rid of them, except througli a great effort of will. This effort they are usually unable or unwilling to put forth unless very strong incentives are brought to bear. Often — in fact, if the truth were known, usually — they wait until ill health supplies the incentive. The man who is most receptive on the sub- ject of health conservation, is, in the major- ity of cases, the man who has just had some ominous warning of coming ill health; al- though there is now a small but increasing number who do not wait so long, men who pride themselves on keeping "in the pink of condition." These are the men who are re- warded for their efforts by enjoying the high- est reaches of working-power. The ordinary man, in ordinary good health, cost of Good does not want or thinks he does not want to live hygienically. He sees all sorts of imag- inary objections to adopting a hygienic life, and closes his eyes to its real and great ad- vantages. One of the objections often trumped up is that the practise of hygiene costs too much — that it can only be a luxury of the rich. It is quite true that here, as elsewhere in human life, wealth confers great advantages. The death-rate among the rich is always less [127] HOW TO LIVE [CH. V. than that among the poor. And yet the rich have unhygienic temptations of their own, whUe the poor, on their part, are far from living up to their opportunities. There are really only two material disad- vantages from which the poor suffer in their opportunities to live a healthy life: One is unhygienic housing, both at home and at work ; the other is unhygienic toil. It must he ad- mitted that millions of unfortunates are un- able individually to remedy these two disad- vantages in their lot in life. Yet they can, even in these two respects, accomplish much if they take an intelligent interest in hygiene. The graduates of tuberculosis sanatoria are large- ly among the poor and they are doing much good missionary work in securing better ven- tilation, both in the home and in the work- room. They find this possible partly by in- Missionaries sistiug ou more Open windows in home and workshops, partly by changing their home to one better equipped with windows or situated in the suburbs instead of in the city, partly by changing their occupations, partly by get- ting the cooperation of their employer or simply by cooperating with him when he is ready to do his part. The workman can also [128] $3.] HYGIENE IN GENERAL accomplish something through the Trades Unions, especially in regard to hours of work. Employers will increasingly cooperate in this movement, as they come to realize that the securing of efficiency in their workmen is to their interest, and that monotony, long hours, and other unhygienic elements which are now, through sheer carelessness, often imposed on their workmen, bring back in the end big financial losses on themselves. Except for the evils mentioned — those of housing and working conditions — there are few people so poor that they can not buy the means of living a healthy life. In fact, hy- giene is one of the few precious gifts which can be had almost for the asking. Most peo- ple can sleep out-of-doors, if they will — if in no other way than by the so-called indoor window-tent — or can take deep-breathing ex- ercises without cost. It costs nothing to stand, sit, and walk erect, to evacuate thoroughly, regularly, and frequently. It costs less than nothing to avoid overeating and overweight, and to be totally abstinent from alcohol and tobacco. Almost all can allow enough time for meals cost of Food to eat slowly. Coarse and raw foods are al- [129] HOW TO LIVE [OH. V. ways to be had and are usually cheaper than the conventional soft, concentrated cooked foods. In fact, meat, eggs, and like foods are among the most expensive and the least de- sirable. If we compare the cost of flour and of the other cheapest food materials, with the cost of oysters, one of the dearest, we find that the latter is fifty times as expensive as the former for the same food value. This takes no account, of course, of the expenses involved in cooking either of them. It has been proved by actual experience that one can live in the best of health on food costing as low as ten cents a day, exclusive of the la- bor of preparing, cooking and serving. Mrs. Richards, in her "Oost of Food," says that this is possible anywhere in America within fifty miles of a railroad. The only real ob- jection to living on this minimum expense is the lack of variety. The following is a brief list of foods in ascending order of cost per 1000 calories of food value, the cheapest be- ing at the beginning and the dearest at the end: glucose, corn-meal, wheat-flour, oatmeal, cane-sugar, salt pork, rice, wheat bread, oleo- margarine, beans, peas, potatoes, butter, milk, cheese, beef-stew, ham, mutton-chops, beef, [130] J 3.] HYGIENE IN GENERAL eggs, and oysters. If the foods in this list be looked up in the table given in the Supple- MENTAEY NoTES f Or their protein, fat, and car- bohydrate contents, it will be seen that a well- balanced ration is possible without the use of expensive foods. In fact, among the cheap foods are some consisting mostly of protein, some consisting mostly of fat, and some con- sisting mostly of carbohydrate. For instance, cheap sources of protein are skim milk, beans, cheese, and peanuts. Cheap sources of fat are oleomargarine and cottonseed-oil. Cheap sources of carbohydrate, i.e., starch and sugar, are bread, bananas, potatoes, glucose, and even ordinary sugar. If a diet, selected for cheapness, is not at first well balanced, a judicious admixture of one or more of the foods just mentioned, will restore equilibrium. A cheap bulky food is cabbage. Most of the rules of hygiene cost nothing Repaid cost to observe. But even when hygiene is costly at first, the cost is usually repaid in the end many times over. To ventilate a house in winter always costs a certain additional ex- penditure for coal, but it is better to pay the coal bill than the doctor's bills. To sleep out- of-doors costs some extra blankets, bedding, [131] Time HOW TO LIVE [CH. V. clothing, and roll curtains, but these not only save the cost of heating an indoor sleeping- room, but save also the cost of ill-health. There is no better economy than to keep one 's work- ing-power. To lose it means to lose its earn- ings and to have, in addition, the heavy expenses of medical attendance, medicines, and nursing, and often to lose life itself with its potential earnings of every sort. In short, an unhygienic life, for the sake of economy, is "penny-wise and pound-foolish." i^Have No Many busy men object to hygiene because, they say, they have no time for it. They imagine that to devote an hour each day to exercise or relaxation is a waste of time and that they are really economizing their time by working that hour instead. We are here re- ferring, not to those who can not control their working-time, but to those who deliberately choose to work when hygiene would require them to play. It is often those who fix their own working-hours, rather than those whose working-hours are fixed for them, who over- work the most. If these could know the suf- fering which sooner or later follows inevitably as the consequence of this mistaken policy, they would not pursue it for a single day. A [132] «3.] HYGIENE IN GENERAL slight loss of working-power comes immedi- ately. A careful observer of mental workers found that an hour invested in exercise in the afternoon often pays for itself within a day, by rendering possible more rapid work. He also found an improvement in the quality of his work. The razor-edge of the mind needs daily honing through physical exercise. The same principle applies to all work. It is just as necessary to stop, at intervals, our physical and mental machinery for oiling and repairs, as to stop the machinery of a fac- tory. Another objection is that the practise of -TooMuch hygiene is "too much trouble." It is un- doubtedly true, that no one who has unhy- gienic habits can overcome them without a certain amount of "trouble." The people who get the best results are those who are never deterred by trouble so long as the trouble is worth while. For those who have not the necessary enthusiasm or self-control to break their unwholesome habits by sheer will power, the best advice is to so arrange their lives as to make the practise of hygiene inevitable. One physician in Chicago delib- erately got rid of his automobile and other [133] HOW TO LIVE [cH. V. means of locomotion in order to force himself to walk to all Ms patients, and so secure enough physical exercise. Another man in New York City, with the same object in view, selected the location for his dwelling so that there was no rapid transportation available to take him to his office, making the walking back and forth a necessity from which he could not escape, simpiidtyof The only difficulty lies in overcoming the Li^T" inertia of acquired habits. After one has changed his habits, it is just as easy to live rightly as to live wrongly. The rules of hy- giene are not restrictive, but liberating. They may seem at first restrictive, for they prohibit many things which we have been in the habit of doing; but they are really liberating, for the things we were doing were unrealized re- strictions on our own power to work, to be useful, or even to enjoy life. The "rules" of hygiene are thus simply the means of eman- cipating us from our real limitations. These so-called rules, when tried, will prove to be not artificial but natural, not difficult but easy, not complicated but simple. They are almost as simple as the direction to bathe in the river Jordan. It is, in fact, their very simplicity [134] H.] HYGIENE IN GENERAL and availability to wliicli is largely due their deplorable neglect and the failure to realize the wonderful benefits following their careful and continued observance. Not only a healthy mental attitude toward TheEviiof , - Romancing life, but a healthy mental attitude toward one's own unhygienic habits is essential. It is a very common thing for a man to romance over his shortcomings, or his unhealthy physical conditions, to make humor of them to his friends. Very often the first step toward a better physical condition is a change in this mental attitude. Section IV — The Possibilities of Hygiene Certain it is that more people would prac- The preyenta- tise hygiene if they could be made to realize andD'eath'^'^ in some vivid way how much they needed it. Few persons, even when they read and accept the statistics on the subject, really have a picture of the imperative need of hygiene as an integral part of every human life. It is not brought home to them how widespread is ill- ness, how numerous are preventable deaths, how many are the tendencies toward individ- ual and racial deterioration. [135] HOW TO LIVE [CH. V. The report of the Roosevelt Conserva- tion Commission on National Vitality, indi- cates that annually there are in the United States over 600,000 deaths which might be prevented if existing knowledge of hygiene were properly applied; that at least half of the 3,000,000 and more sick-beds constantly kept filled in the United States are unneces- sary; that the financial loss from earnings cut off by preventable disease and premature death amounts to over $1,500,000,000 annual- ly; and that over 15 years are lost to the average life through the lack of application of knowledge which already exists but which simply has not yet been disseminated and applied. Impairments Thc health cxaminations of the Life Exten- sion Institute have revealed unsuspected ail- ments in persons who considered themselves well, and to an extent which has astonished even those who have long been familiar with these subjects. Among large groups of clerks and employes of banks and commercial houses in New York City with an average age of 27 and all supposedly picked men and women, only 1 per cent, were found free of impairment or of habits of living invit- [136] M.] HYGIENE IN GENERAL ing impairment. Of those witli important physical impairments, 89 per cent, were, prior to the examination, unaware of impair- ment; 16 per cent, of the total number ex- amined were affected with organic heart trouble, 42 per cent, with arterial changes, ranging from slight thickening to advanced arteriosclerosis, 26 per cent, with high or low blood pressure, 40 per cent, had sugar, casts, or albumin in the urine, 24 per cent, had a combination of urinary and other serious impairment, 47 per cent, had decayed teeth or infected gums, 31 per cent, had faulty vision uncorrected. Among industrial groups, not exposed to any special occupational hazard or poisoning, the figures were as follows : With an average age of . 33, none were found to be free of impairment or habits of living inviting im- pairment. Of those with important physical impairments, 89 per cent, were, prior to the examination, unaware of impairment; 3 per cent, of the total number examined were affected with organic heart trouble; 53 per cent, with arterial changes, ranging from slight thickening to advanced arteriosclerosis ; 23 per cent, with high or low blood pressure ; [137] HOW TO LIVE [™- ^• 45 per cent, had sugar, albumin or casts in their urine; 26 per cent, had a combination of urinary and other serious impairment; 69 per cent, had decayed teeth or infected gums ; 41 per cent, had faulty vision uncorrected. Minor There are few persons in America to-day who reach the age of forty sound and normal in every part of the body, especially if we include among abnormalities the minor ail- ments. The extent to which minor ills are prevalent among those who pass for "well" people is not generally appreciated. Once we penetrate beneath conventional acquaintance we almost invariably learn of some functional trouble, such as impairment of heart, circula- tion, liver, kidneys, stomach; or gallstones, constipation, diarrhea; or insomnia, neuras- thenia, neuritis, neuralgia, sick-headache; or tonsillitis, bronchitis, hay fever, catarrh, grippe, colds, sore throat; or rupture, en- larged glands, skin eruptions ; or rheumatism, lumbago, gout, obesity ; or decayed teeth, bald- ness, deafness, eye ailments, spinal curva- ture, flat foot, lameness; or sundry other "troubles." These ailments, though regarded as "mi- [138] M.] HYGIENE IN GENERAL nor," should be recognized promptly and ac- cepted as the signal that the person is moving in the wrong direction. There is no need for alarm provided this warning is heeded. Other- wise disaster is almost certain sooner or later to follow. The laws of physiology are just as inexorable as the laws of physics. There is no compromising with Nature. No man can disobey the laws of health to which he has been bred by Nature without paying for it — any more than a man can sign a check against his bank account without reducing the amount. He may not be immediately bankrupt, and until he exhausts his account he may not ex- perience any inconvenience from his great ex- travagance, but Nature keeps her balances very accurately, and in the end all claims must be paid. It is true, of course, that some persons have The Personal Equation greater resistance than others. If we had a convenient barometer by which to measure daily the state of our vitality, we might regis- ter the effect of every unhygienic act. But it is so seldom that endurance is accurately meas- ured that few people appreciate the enormous differences in people and the variations of the same person at different times. These [139] HOW TO LIVE [CH. V. differences and variations have a range of many hundred per cent. Some people can not walk upstairs or run across the street without being out of breath, while others will climb the Matterhorn without overstrain. The fact that certain people have lived to the century- mark in spite of unhygienic living is some- times cited to prove that hygiene is ineffec- tive. One might as well cite the fact that certain trees are not blown down in a gale or are not quickly destroyed by insect-pests to prove that gales have no tendency to blow down or insects to destroy trees. Over- The truth is that a person who has so much vitality as to lead him to defy the laws of health and to boast that he pays no price no matter how he lives, is likely to be the very man to exhaust his account of health prema- turely. There was, a few years ago, a famous American, possessed of prodigious bodily vig- or. He ought to have lived a century. Tin- fortunately he had this ' ' insolence of health. ' ' He was warned several times against over- work, lack of sleep, and abuse of his digestion. But he merely smiled and claimed that such warnings were for others, not for him. He met an untimely end, due as his physicians be- [140] M] HYGIENE IN GENERAL lieved and as he himself acknowledged, when too late, to his abuse of the great powers with which Nature had endowed him and to the ne- glect of personal hygiene. Conversely, an observance of the laws of Possible Health 1 . I'n 1 T J- ^ li- 1 Attainment hygiene aiiords wonderiul results m produc- ing vitality and endurance. Insurance com- panies are discovering that even weak and sick people, will, if they take good care of themselves, outlive those with robust consti- tutions who abuse them. To those unfamiliar with the subject in its larger aspects, the possibilities seem almost beyond belief. As an example of the wonder- ful gains which can be secured by obeying the laws of hygiene may be cited the case of a young man who a few years ago was scarcely able to drag himself into the sun in Colorado, where he was endeavoring to rid himself of tuberculosis. He not only succeeded, but sub- sequently, by dint of following substantially all of the rules of hygiene here laid down, became an athlete and capable of running twenty-five miles for sheer love of sport and apparently without the overstrain experienced by "Marathon" runners. Kant and Hum- boldt are cases typical in different fields of [141] HOW TO LIVE [cH. V. achievement of many of the world's most vital men who have actually made over their consti- tutions from weakness to strength. Cornaro says that it was the neglect of hygienic laws which made him all but a dead man at thirty- seven, and that the thoroughgoing reform of his habits which he then effected made him a centenarian. His rules, drawn up four hun- dred years ago and described in his interest- ing work "The Temperate Life," are, so far as they are explained, almost identical with those given in this book. It is difficult to as- sign a limit to the good which can be accom- plished by practising these rules and so mini- mizing the poisons which usually narrow and shorten our lives. Immortal So far as science can reveal, there seems to be no principle limiting life. There are many good and bad reasons why men die, but no underlying necessary reason why they must die. The brilliant Carrel has kept tissue cells of animals alive outside of the body for the past three years. These cells are multiplying and growing, apparently unchanged by time, to all appearances immortal so long as they are periodically washed of poison and nour- ished in a proper medium. If we could at [142] $«.] HYGIENE IN GENERAL intervals thoroughly wash man free of his poisons and nourish him, there seems to be no reason why he should not live indefinitely. Section V — Hygiene and Civilization In view of the vast extent of human misery from ill health, the question naturally arises. How does it happen that the world is bur- dened with so colossal a load? Is it no more than is biologically normal? Is it true that in other organisms, animals and plants, ill health is the rule rather than the exception? Are all races of men subject to the same heavy load? These questions have not yet received suf- Natural ficient attention. The answer seems to be that upset man is suffering from his own mistakes made unconsciously and in ignorance. He has upset the equilibrium which Nature had established among the various powers and activities of his body, and between himself and the outside world. Man has done mischief for his own body similar to what he has done for the natural resources on which he lives. In Pro- fessor Shaler's epoch-making little book, "Man and the Earth," he shows, for instance, [143] HOW TO LIVE [CH. V. that the little layer of soil on the surface of the earth from which plants and animals de- rive their nutriment was, before the advent of man, replenished quite as fast as it was washed away, but that after man had put his plow into it and had taken off the pro- tective mat of vegetation, he unconscious- ly despoiled the accumulation of ages. "In a plowed field, an hour's torrential rain may wash off to the sea more than would pass off in a thousand years in the slow process of erosion which the natural state of the earth permits." He also shows that the constant croppings of the soil rob it of nitrogen, phos- phorus, and other elements faster than Nature restores them. The problem of conservation is to reestablish the balance which has been lost through the depredations of man, for in- stance, to lessen soil-wash by terracing, and to restore to the soil the lost elements by sup- plying nitrates and phosphates and by other methods of scientific farming. In the same way man has upset his pristine animal mode of living and needs to find scien- tific ways to restore the equilibrium. Most of the present-day problems of hygiene arise from introducing, uncompensated, the effects [144] *5.] HYGIENE IN GENERAL of certain devices of civilization. The inven- tions of civilization have done so much for man that he is apt to unduly glorify them and to overlook the injurious by-products. These by-products are often of prodigious significance to the race. The invention of houses introduced the problem of house hy- giene ; the invention of clothing, the problem of clothing hygiene ; that of cooking, the prob- lem of food hygiene ; that of division of labor, the problem of industrial hygiene ; and so on. To make these statements more concrete, we may consider some of them in more detail. The invention of houses has made it possi- Houses ble for men to live in all climates, yet this indoor living is responsible for much disease. The houses give comfortable shelter and warmth and protect us from the elements and from wild animals. But the protection has been overdone. Like his cousin, the anthro- poid ape, man is biologically an outdoor ani- mal. His attempt at indoor living has worked him woe, but so gradually and subtly has it done so that only recently have we come to realize the fact. At first, dwellings were really outdoor affairs, caves, lean-tos, tents, huts with holes in the roof and the walls. [145] HOW TO LIVE [cH. Y. These holes served to ventilate, though they were not intended for that purpose. The hole in the roof was to let out the smoke and the holes in the walls to let in the light. Gradu- ally the roof-hole developed into a chimney with an open fireplace, which, in turn, gradu- ally changed into a small flue for stoves where- upon it almost ceased to serve any ventilating function. The stove in turn has largely gone and is replaced in many cases by the hot-water or steam radiator, without any attempt at ven- tilation. The holes in the wall gave way, after the invention of glass, to windows which let in the light without letting in the air. Weather-strips, double windows, vestibule- doors, interior rooms, completed the process of depriving man of his outdoor air, shutting him into a cell in which he now lives — a sick- ened but complaisant prisoner — often twenty hours of the twenty-four. Tuberculosis, one of the worst scourges of mankind, is primarily a house disease. It is prevalent as indoor liv- ing is prevalent, and reaches its maximum in the tenement quarter of a great city. Effects on Ouly by generations of natural selection Different m j. j. i • j. i.1. Races could we cxpcct to make man immune to the evils of bad air. The robust Indian and the [ 146 ] 5 6.] HYGIENE IN GENEEAL Negro, whose races, until the last generation or two, roamed in the open, fell easy prey to tuberculosis as soon as they adopted the white man's houses and clothes. The Anglo-Saxons who have withstood the influence of indoor living for several generations have, probably by the survival of the fittest, become a little better able to endure it, while the Jews, a race which has lived indoors longer than any other existing race, are now, probably by the same law of survival, the least liable to tuber- culosis, except when exposed to especially un- favorable conditions of life. But we, of this generation, can not afford compensation to wait for natural selection to fit the race to an indoor environment ; hence the supreme im- portance to us of air hygiene. We must com- pensate for the construction of our houses by insisting on open windows, or forced drafts, or electric fans, or open-air outings, or sleep- ing porches, or the practise of deep breathing, or all of these things. In the same way, clothing has protected our ciothing bodies from the cold but enervated or con- stricted them as well. The aboriginal tribes, even in cold climates, seldom used clothing. The Eskimo is an exception. The tribes [147] HOW TO LIVE [CH. V. Cooking Artificial Soft Foods Artificial toward the South Pole in similarly cold cli- mates often have little more clothing than a blanket which they hang over their shoulders toward the wind. The weak, pale skin — ^to whose lack of adaptability we owe the chilling preceding a cold — the bald head, the distorted foot, the corns upon it, the cramped waist, are among the results of clothing ourselves wrongly. Hence we are discovering the need of restoring, as far as we can, the original conditions by making our clothes more light, more loose, and more porous, and, when pos- sible, by taking the "barefoot cure," or the air bath. We come next to foods, and note that civil- ization has invented cooking and artificial foods. These inventions have greatly widened the variety of man's diet, but the foods of civilization are largely responsible for the de- cay of our teeth and the abuse of our digestive and eliminating organs. Judging from man's teeth and digestive apparatus as well as his general kinship to the anthropoid ape, it is reasonable to believe that, before fire was discovered, man was pri- marily a frugivorous animal, whose ordinary diet consisted of fruits, nuts, and tender [148] §5.] HYGIENE IN GENERAL shoots. While man still uses these fruits, nuts, and salads, his chief reliance is on pre- pared food, bread, butter, meat, and cooked vegetables. The diet of our progenitors must have been largely one requiring chewing, con- sisting, as it did, of hard fruits and stalks and perhaps also grains and flesh. Observation of manlike apes shows that they chew their food more thoroughly than man. Doubtless nuts constituted a considerable part of primi- tive food and required cracking by the teeth. The work we now do in flour-mills or the kitchen or with the knife and fork, was then done with the teeth. We even have our cook mash our potatoes and make puddings and pap of our food after'it reaches the kitchen. Having already shirked most of the task of mastication by softening and cutting our food before it reaches our mouths, we shirk the rest of it by washing it down with water, or worse. An Italian dentist, who has had a wide range of observation, says that the knife and fork have committed "unpardonable crimes" by robbing the front teeth of their work of cutting. He sometimes prescribes for loose teeth the task of cutting a pound of bread daily. Whether any of it is swallowed [149] HOW TO LIVE [oh. v. Concentrated Food Artificial Hurry Artificial or not is not important, but he insists that it must be cut by the teeth. The deplorable lack of residue in modern food is one of the consequences of civilized life, for the bulky foods have been crowded out by concentrated foods, and, in many cases, the concentrated foods have been formed by getting rid of residue. Instead of chewing the sugar-cane, we use sugar, a concentrated extract which leaves no residue. We crush the juices from our fruits and throw away the pulp. We take the bran out of our grain and with it the vitamins essential to health. The bulky foods — fruits and fibrous vege- tables — are often dropped from our menus. The hurry habit, another unfortunate by- product of civilized life, is one of the chief promoters of indigestion. In civilization we live by the clock. We schedule our trains and crowd our meal-time to catch them. We make engagements in neglect of the requirements of digestion. We have, in consequence, as one of the institutions of civilization, the "quick-lunch counter." At first we bolted a meal purposely and consciously. Later we formed the habit of food-bolting, and it now seems quite natural. [160] §5.] HYGIENE IN GENERAL To the door of the hurry habit may also be use of Fieah laid the excessive use of flesh foods. Car- nivorous animals bolt their food. Frugivor- ous animals, to which class the human race properly belongs, eat slowly. But when, through the perversions of civilized life, fru- givorous man is forced to eat as fast as the carnivores, he instinctively adopts a similar diet. As someone has expressed it ' ' when we eat as fast as a dog, we naturally crave the food of a dog. ' ' Our apelike progenitors had few, if any, flesh foods and only those which they could catch with the hand and eat raw. Our eliminating organs, the liver and the kid- neys, have been framed to meet the demands of man's natural diet, but not adapted to handle the diet of civilized men in the ex- cessive use of flesh foods and the use of al- cohol. These organs are, fortunately or un- fortunately, provided with a large factor of safety and can stand a great deal of abuse, but the cumulative effect of this abuse, es- pecially when combined with an unhygienic life iu general, sooner or later leads to disaster. Our tastes have also been perverted. The Misled appetite is very likely to be innocently mis- led by the delicacies which civilization has [151 J Civilization HOW TO LIVE [CH. V. invented, as well as by the tricks of cooking, seasoning, and preparing. For this reason, we can not trust, as thoroughly as we would like, the ordinary leadings of taste. The solu- tion of this problem of nutrition, like the solu- tion of the housing problem, must be sought by retaining the advantageous food customs which we now find about us and substituting scientific customs for the disadvantageous ones, other Evils of It would be impossible to enumerate all the inventions of civilization which have brought us difficult problems of individual hygiene. We shall name only a few more. The inven- tion of chairs, though adding to human conve- nience, has tended to produce wrong posture, from which spinal, nervous and digestive dis- turbances follow. The invention of the alpha- bet and of printing has made possible the accu- mulation of knowledge, but has promoted eye- strain with a great train of attendant evils. The device of division of labor has created much wealth, but destroyed the normal balance of mental and physical work, recreation and rest. From this follow occupational dis- eases of overstrain, bad posture, industrial poisons, and a craving for narcotics. A eom- [152] 5 5.] HYGIENE IN GENERAL bination of conditions has lessened the oppor- tunities for prompt discharge of the body waste, and so led to dulling of the reflex which promotes defecation. We are only just be- ginning to realize how serious are the con- sequences. We have described many of the unhygienic "Remedies" •' . •'° that are Worse practises common to-day as direct results oi than the evHs upsetting Nature's equilibrium. Others are indirect results. These latter practises may be described as attempts to remedy the evils of the former, the "remedies," however, be- ing often worse than the diseases. Much of our drugging, some of our wrong food habits and not a little of our immorality are simply crude and unscientific attempts to compensate for disturbances or deviations from a normal life. We wake ourselves up, as it were, with caffein, move our bowels with a cathartic, in- duce an appetite with a cocktail, seek rest from the day's fatigue and worries in nieo- tin, and put ourselves to sleep with an opiate. In these practises we are evidently trying in wrong ways to compensate respectively for insufficient sleep, insufficient peristalsis, indigestion, overfatigue, and insomnia — evils due, as previously explained, to upsetting [153] HOW TO LIVE [CH. V. Nature's balance, between work, play, rest and sleep. So also our overeating is largely an un- scientific effort to compensate for overcon- centration of diet, — that is, an effort to get bulk. Again, too much protein is in large measure due to the need of compensating for rapid eating, for as has been remarked, pro- tein is the one kind of food which can be eaten fast with impunity. Again, a large part of our moral derelictions is due to an unbalanced life from which amuse- ments are largely omitted. The "bad" boy in the city streets is usually following his in- stinct for amusement, of which the lack of playgrounds has deprived him. Dissipations of many kinds are explained in a similar way. It is largely because workmen are so often drudges and lack normal recreations that they seek amusement in the concentrated form they find in saloons, gambling places, dives and dance halls. Finally those economic and social conditions of civilization which have resulted in deferring marriage beyond the best physiological age, lie behind prostitution and its terrible train of consequences including the venereal diseases. [154] }5.] HYGIENE IN GENERAL The worst of it is that these wrong reme- dies, instead of helping, aggravate the dis- ease. They become part of a vicious circle, which continues in an endless round. The combined effects of all the unhygienic shortened <. T ■ 1 T 1 Human Life modes of living are undoubtedly greatly to shorten human life. Most other mammals live about five times the growing period. In man, this would mean that the normal life- span should be about a century and a quarter, an age which is now reached only in one case out of millions. Yet it would be foolish, even if it were pos- no Return to sible, to attempt a complete "return to Na- ture" by abolishing all the ways and conven- tions of civilization. This would be throwing away our social inheritance and returning to barbarism. We must go forward, not back- ward. Just as the cure for the evils of De- mocracy is said to be more Democracy; so the cure for the evils of civilization must be more civilization. The equilibrium of Nature having been upset by civilization, science, one of the great products of civilization, must now work out the remedies. Just as the waste of the soil which civilization has brought is to be compensated by that great product of civ- [155] HOW TO LIVE [CH. V. ilization, scientific agriculture, so the waste of vital resources is to be compensated by scientific hygiene. The saving of civilization depends on following not those who repudi- ate it, like Thoreau, but those who make use of it, like Pasteur. What the world needs is not to abolish houses, but to ventilate them ; not to go naked, but to devise better clothes, which have all the advantages and none of the disadvantages of those we now wear; not to return to the diet of the anthropoid apes, but to remodel that which we have; not to give up chairs, but to improve the form of chairs ; not to abandon reading, but to employ cor- rective eyeglasses and clear printing; not to abrogate division of labor, but to shorten the hours of labor and provide wholesome recre- ations and special compensating advantages when needed. When, in future centuries, these come to be reckoned among the great triumphs of civilization, we may expect hu- man life to be longer and perhaps stronger than in any primitive state of Nature, just as where modem scientific forestry has been applied we find longer lived and better trees than ever grew in Nature's jungles. [156] §6.] HYGIENE IN GENERAL Section VI— The Fields of Hygiene The object of this book is primarily to PuWic versus instruct the individual as to what he can do Hygiene to maintain his own individual health. But individual hygiene is only one particular branch of hygiene, and it is well for the indi- vidual, partly out of public spirit, partly in self-defense, to have some idea of the other important branches, namely, public hygiene, the hygiene practised by the health officer, semipublic hygiene, the hygiene of schools, institutions, and industrial establishments, and race hygiene or eugenics, the most im- portant of all. All these branches are so closely related that it is impossible to mark any exact divid- ing-line. But, in a general way, there is a broad distinction between eugenics, which is the hygiene of future generations, and the other two, which relate to the present genera- tion, as also between these two themselves. Thus public hygiene is that which is practised by the government for its citizens, while in- dividual hygiene is that which is practised by the citizens for themselves. Public hygiene consists chiefly in efforts by the government [157] HOW TO LIVE [CH. 7. to maintain a wholesome environment in which to live, including good outdoor air — without smoke or foul odors — clean streets, pure water, good sewers, quarantine, and legal reg- ulations concerning houses, schools, prisons, hospitals, and other public institutions, foods sold in markets, and conditions of employ- ment. It is chiefly useful in preventing acute or infectious diseases, such as typhoid fever, scarlet fever, measles, whooping-cough, small- pox, yellow fever, and diphtheria, and in pre- venting accidents and occupational diseases. Individual hygiene is chiefly useful in prevent- ing the chronic or degenerative diseases, that is, diseases of nutrition and of circulation, such as heart and kidney affections, nervous prostration, insanity. Public hygiene has made much progress dur- ing recent years. In consequence, the num- ber of deaths from the acute or infectious dis- eases has been greatly diminished. Health officers are beginning to demonstrate the truth of Pasteur's words, "It is within the power of man to rid himself of every parasitic disease. ' ' It is this work which has reduced the gen- eral death-rate in civilized countries and [168] «6.] HYGIENE IN GENERAL sometimes cut it in two, as at Panama. The United States Public Health Service, on in- vitation of the Peruvian Government, recently cut the death-rate in two in one of Peru's disease-ridden cities. Individual hygiene, on the other hand, has been greatly neglected, especially in the United States, and, doubtless largely as a consequence, the death-rates from the chronic or degenerative diseases are increasing rap- idly. A further consequence is that, in the United States, while the death-rate in the early years of life (when infectious diseases do most of the killing) has been decreasing, the death-rate in later life (when the chronic diseases do most of the killing) is increasing. In Sweden, on the other hand, where indi- vidual hygiene is more generally applied, the death-rate is declining at all times of life. (See "Signs of Increase of the Degen- erative Diseases," Supplementaey Notes.) Both public and individual hygiene are be- ing invoked in the fight against tuberculo- sis, a disease at once infectious and chronic, due to germs and to wrong methods of living. No matter how thoroughly an individual cooperation attempts to care for his own health, he will [159] HOW TO LIVE [cH. V. find it almost impossible to avoid infections, at times, without tlie organized help of the community in which he lives. A man may do his best to keep his windows open, to breathe deeply, to eat hygienically, to hold his activities within the limits of overfatigue, to screen his house against flies and leave no tin cans about his kitchen door to breed mos- quitoes ; but if the city in which he lives has no good air for him to breathe, if his city's water supply is contaminated, if neighboring malarial swamps are not drained or covered with oil, if flies alight on the food before it comes to his own house, if the food contains disease germs or dangerous preservatives, or if his next-door neighbor visits him and leaves infection behind him, mere personal defenses will hardly be adequate. Even in so private a matter as moving the bowels, sometimes the fault lies partly with circumstances beyond the control of the in- dividual. Unfortunately in most of our cities and small towns "Comfort Stations" are rare or unknown, and when they are available they are often in such an insanitary condition as to be a source of danger through the spread of communicable disease. Constipation, as we [160] 5 6.] HYGIENE IN GENERAL have seen, is a far more serious matter than it is sometimes thought to be. It is therefore incumbent on the individual to contribute his share to the hygienic work of society as a whole, in particular to take an active interest in health legislation and ad- ministration. A man can not live to the best advantage in a life isolated from all social obligations, any more than could Robinson Crusoe, who was unable to launch his canoe in the ocean, after he had been at great pains to construct it, because he had no one to help him. Each man should take part in the great social hygienic struggle, if he is to reap the highest rewards in his own personal hygienic struggle. And he can do a great deal if he will be patient and persistent. If, for instance, he would always insist on suitable air condi- tions in public buildings, electric cars, thea- ters, and churches, and encourage others to do so, it would not take long to make air reform general. In fact, it is the common public, constituting The .1 ii*i.i* if. Consumer's the consumer, who has it m his power to bring Duty about most of the necessary reforms in pub- lic hygiene. When the consumer really val- ues hygienic environment, the producer will [161] HOW TO LIVE [cH. V. supply it. The great improvement in recent years in drinking water was brought about through the appreciation, by the consumer, of the danger from impure water. His com- plaints produced the change. Hotels found it profitable to provide and advertise pure water. So also the education of the public as to the dangers of a common public drinking cup led to the invention of bubbling fountains and cheap individual cups and to the introduction of these conveniences in railway stations and other public places. We need to concern ourselves particularly with the character of our public water supply, air supply and food supply, the number of bacteria in milk, the fitness for human con- sumption of the meat, fowl, fish, and shell- fish sold in the public markets, and the use of adulterants and preservatives in canned and bottled goods. Quacks and Quacks and quackery should be vigorously fought by laymen as well as physicians. Quacks live by lying and misleading adver- tisements. Every one should cooperate to en- courage the movement by which newspapers and magazines are giving up quack and im- moral advertisements and the advertisements [162] J 6.] HYGIENE IN GENERAL of alcoholic beverages. Especially should we refuse to patronize the quack advertiser. When no one is deceived by him, he will cease to advertise.' A more immediate method is to change from the newspaper containing such advertising to one which does not. We should also appeal to the editors to reform their advertising, as many of them are now doing. Vaccination is now a known preventive vaccination against smallpox, typhoid fever, and other germ maladies. Its use should be advocated and the ignorant prejudice against it should be overcome. Last but not least, the individual should co- sodai Kvii operate in the great movement against the social evil. As soon as an individual becomes interested in caring for his own health and for the health of his family, his interest will not cease at individual hygiene; he will wish to improve the efficiency of the public health service by increased appropriations, improved equipment and personnel; and to cooperate with the health officer. Race hygiene or eugenics, which has been Eugenics mentioned as the third and most important [163] HOW TO LIVE [OH. V. branch of hygiene, aims to conserve the health of future generations, through the action of those now living. Hygiene (individual and public) teaches us how to create for ourselves healthful conditions of living, but on every side we see evidences of the fact that we cannot entirely control conditions of health through hygiene only. Not all maladies by any means can be attributed to unnatural or unhygienic conditions of living. It is true that if followed out faithfully, the rules of hygiene will enable a man to live out his maxi- mum natural life-span, with the maximum of well-being, and to run no risk of allowing any inherent weakness to be brought out. But some persons, even if they followed what is very nearly the normal code for the human being, would scarcely be able to avoid dire physical and mental fates. In short, we find that besides the hygienic factor in life which we may call environment, there is something else on which the health of the individual de- pends. This something else is heredity, or "the nature of the breed." Back of all the individual can do by hygiene lies his inheri- tance. To change this the individual can do nothing, but the parents of the individual can [164] $6] HYGIENE IN GENEEAL affect his inheritance, and we as parents can affect the inheritance of our offspring. First, we can carry through life uninjured Trustees of the the essential germ plasm which has been en- Germ-pUsm trusted to our care. We should never forget that this germ plasm, which we receive and transmit, really belongs, not to us, but to the race; and that we have no right, through al- coholic or other unhygienic practises, to dam- age it ; but that, on the contrary, we are under the most solemn obligation to keep it up to the highest level within our power. We are the trustees of the racial germ plasm that we carry. Second, we can affect the life of our off- wise . , . . . __,, - . Combinations sprmg by our choice m marriage. The basis ^^^2=™'"*' of the development of desirable or undesir- able tendencies or traits lies, of course, in the mating from which the individual springs. On the kind of combinations of germinal traits that are made by marriage depends whether or not undesirable traits shall reappear in the offspring. For instance, a man may inherit a defect from his father because his father married a certain type of woman. Had the father selected a different type, the children might not have inherited the father's defect. [165] HOW TO LIVE [cH. V. The importance of choice in marriage results from certain laws of inheritance, which make it clear that by proper combinations of indi- viduals certain bad traits may be entirely "bred out." Choice in As soon 38 mcu and women acquire the knowledge that their choices in marriage largely determine whether or not their physi- cal and mental faults and virtues will reappear in children, they feel a sacred responsibility in that act of choosing. A little conscious knowl- edge of what kind of combinations of traits bring about their reappearance in offspring can not help but modify a person's taste, and thus automatically direct the choice of a mate, which choice will still be, and rightfully, an instinctive one. Upon the wisdom with which choices in marriage are now made depends in large degree the health and efficiency of all the individuals who will constitute society in the coming generations. As the science of eugenics gathers a greater wealth of evidence and subjects it to vigorous analysis, its ability to guide the race to higher levels will become more positive and far-reaching. This can be done without surrendering the general princi- ple of individual freedom. It will not reduce [166] ?6.] HYGIENE IN GENERAL but increase the number of natural love-mar- riages. The errors of crude and superficial or overenthusiastic eugenists should not ob- scure the enormous possibilities of the science for the human race. Eugenie knowledge is, therefore, not only a personal advantage but a social necessity. For society as a whole, a thoroughgoing eugenic program must include : (1) The prevention of reproduction by the sodai Progresi markedly unfit, such as the feeble-minded, by sterilization of the most unfit and by segrega- ting the remainder in public institutions. (2) The enactment of wise marriage laws. (3) The development of an enlightened sen- timent against improper marriages and the putting at the disposal of individuals contem- plating marriage the data accumulated and principles worked out by eugenic students. The Eugenics Eecord Office of Cold Spring Harbor, Long Island, N. Y., is now engaged in collecting such material. For us of the present generation, hygiene is of immediate concern ; but if we are to build for future generations, hygiene must give way to, or grow into, eugenics. The accomplish- ment of a true eugenic program will be the [167] HOW TO LIVE [CH. V. crowning work of the health movement and the grandest service of science to the human race. (For further comments on this subject see "Eugenics" in Stjpplementaey Notes.) [168] SUPPLEMENTARY NOTES ON SPECIAL SUBJECTS [169] SECTION I NOTES ON FOOD It will help to balance the ration and to Balancing avoid an excess of protein and also to avoid a ' " deficiency of either fat or carbohydrate, if we take a bird's-eye view of the various common foods in respect to the protein, fat and carbo- hydrate they contain. For this purpose the following table has been constructed. COMMON POODS CLASSIFIED Poor in Fat. Rich in Fat. Very rich in Pat. Very high in Protein White of Eggs Cod Pish Lean Beef Chicken Veal High hi Protein Shell-flsh SkunMilk Lentils Peas Beans Most Fish Most Meats Most Fowl Whole Egg Cheese Moderate or Deficient In Protein Most Vegetables Bread Potatoes Fruits Sugar Peanuts Milk Cream Soups Most Pies Doughnuts Pat Meats Yolk of Eggs Most Nuts Cream Butter Common Foods Classified [171] HOW TO LIVE [«i. The foods given in the uppermost compart- ment are those "very high" in protein (above 40 per cent, of their total calories, or food value, being protein). Those in the two com- partments next below are merely "high" in protein (20 to 40 per cent.), while the lowest three compartments contain those "moderate or deficient" in protein (zero to 20 per cent.). The compartment farthest to the right eon- tains a list of those foods "very rich in fat." The two compartments next to the left con- tain those "rich in fat," and the three com- partments to the extreme left contain those "poor in fat." With reference to carbohydrates (starch or sugar), we can say that the foods in the lower left compartment are very rich in carbohy- drate. Those in the two neighboring compart- ments (the one beginning "shell-fish" and the one beginning "peanuts") are moderate, and those in the remaining compartments are those poorest in carbohydrate. Thus, practically, the nearer the name of any food is to the upper corner of this tri- angular table, the more protein that food contains; the nearer it is to the right hand corner, the more fat ; and the nearer to the re- [172] Proportions H.] NOTES ON FOOD maining corner (lower left), the more carbo- hydrate (starch and sugar). An ideal proportion of the three food ele- weai Food ments is to be had only in the middle com- partment of the lowest row. But it is by no means necessary or advisable to confine one's diet to the few foods which happen to fall in that compartment, provided foods chosen from other compartments balance each other. Thus, fruit and nuts balance each other, the one being at the left and the other at the right of the ideal compartment. In the same way, potatoes and cream balance each other, as do bread and butter. Instinc- tively these combinations have been chosen, especially bread and butter. This combina- tion is, however, slightly too low in protein, and a better balance is obtained by adding a little from the compartment vertically above the ideal. In this way we obtain the familiar meat-, egg-, or cheese-sandwich, constituting of itself a fairly well-balanced meal. In short, in order to maintain a diet correct as to protein, it is only necessary to make our main choices from the lowest row and, in case the foods so chosen are near the bottom, to supplement these by a moderate use from the [173] HOW TO LIVE [Ji. row above and a still more sparing use of those in the top compartment. The following more detailed and specific table of food values will prove helpful to those who desire intelligently to balance their diet or to provide balanced menus for their fami- lies. A very little attention to this subject will enable one to acquire sufficient knowledge of dietetic needs to successfully govern the diet in a general way without weighing or measuring the food. In the following table the number of calories available in ordinary food portions is stated. Such a table should not, of course, be memorized, but an occa- sional reference to it will enable one soon to acquire a working knowledge of the food values of the main articles in the dietary. [174] $1.] si Q O O go « r ^ 5 is ss NOTES ON FOOD ^ 0) (SAB S g ■■gOH oo pi(5 o OOOlOCOOlOOirt-^WOOiWOOllOWO Cp^ONNOO-^HiMCOr-t-^OSSOUSOOOrHO ■^lON 1-1 -.J* W CO « iH CC >0 10« U3MW 8 S fl- op o III assise Is ■is 23' 9 t^ t3o,5j ao •J3 o as llliiillgglteiSilll [175] HOW TO LIVE [M. 1. OS 1 8i PS is 00 Hi hi 1 o •s 00 U3 lO CO CO CO n CC CO O IN COQO W «D M Oi W t^ 01 O O ■^ O Q O rt ® CO P 0} t^ X lO iH 0! =0 O Ttl Tj< 10 CO 00 iO <0 01 1> tD'#WQ0iHOOC0i0C0THOC0»0O'-li0c0Nt*O00OOOC0e0eDtD«OO Offir-(CDC0Ot^lMtD"*CqiHC0rHWC0'H'^Tt1C0N0005C0e0t-i- o SaggoS 4JifiJ-c8i> ts -s -^ - ■oSg. ■§a" §!l|i^§ al^^S^a to 3 H^jo » »«»*•*♦ HOW TO LIVE [ji. i o I m Q O o o n Jt3 So 1^ is O E4 OO !?§ O Ok s B * to 5S Si hi 41 o ,0^ && u u ti OOO - (DO. © N fc* « :8'0 ^ o ^ i P00b.N. NCC «W>. 40 - 30 - , EIKCTEO HOIIWJTr ««% mil tuniNERS. II4TI0 HCTOM TO EXPECTED MOOTAirTY"-. «0% WTMim, MTIO WnUl TO EXPECttO M0I1TU.ITT— — — Snfc HOOTUJTr tmua. NOH-UtTAIKEIIt -STANDAIIO RISIB- 9.9% HICHED THAh AMONG AKTAINEM THE LIFE EXTENSION INSTIIIITE. INC [231] THE SCOTTISH TEMPERANCE LIFE ASSURANCE CO. OF GLASGOW HEALTHY MALES -WHOLE LIFE POLICIES IB83-1StB H M-W «9- 98 S3-97 9«-mB M-l" Ol-'t / ■/ UPECTED HORTAUTT 100% MON-ABSTUNERS. RATIO ACTUAI. TO EXPECTED HORTAUTT te% ABSTAINERS. RCTIO ACTUAL TO EXPECTED MORTALITY — — 46% MORTALITT AHDHIl NON-ABSTAINERS -STANDARD RISKS- 43.S% HIGHER THAN AMONO ABSTAINERS [232] COMPARATIVE MORTALITY AMONQ U8EB OF ALCOHOL 43 AMERICAN LIFE IM8UBANCE COMPAMIEB IRBB • 1908 DEATH RATE AMONB INSURED LIVES GENER- ii,i| ALLY-MEDICD ACTUAR- ""' lAL TABUE- DEATH RATE AMONS POLICVHOLOCRS USING nn ZGLASSES OF BEER "" OR 1 GLASS OF WHISKEY DAILY DEATH RATE AMONB POLICYHOLDERS GIVIHS HISTORY OF PAST IN- )50 TEMPERANCE, BUT AP- PARENTLY CURED DEATH RATE AMONG POLICYHOLDERS USINB MORE THAN BGLASSEB OF BEER DR IGLASS IBS DF WHISKEY DAILY. BUT, REGARDED AS TEMPER- ATE « BTANDARB RISKS [233] HOW TO LIVE [5 4. Now that accurate laboratory evidence is available regarding the physiological effect of alcohol in so-called moderate doses the insurance experience seems consistent, and the higher mortality among so-called moder- *ate drinkers is only what we would naturally expect to find in the light of the most recent knowledge regarding its effects upon the human organism, not only in the direct causa- tion of disease, but in lowering the defense to disease and increasing the liability to accident, and the tendency to careless living. Medico- In the recent medico-actuarial investigation. Mortality including forty-three American life insurance Investigation ^ *^ companies, the combined experience on users of alcohol has been compiled, with very inter- esting results. It may be subdivided as fol- lows: First : Those who were accepted as standard risks but who gave a history of occasional al- coholic excess in the past. The mortality in this group was 50 per cent, in excess of the mortality of insured lives in general, equiva- lent to a reduction of over four years in the average lifetime of the group. Second : Individuals who took two glasses of beer, or a glass of whisky, or their alcoholic [234] M.] NOTES ON ALCOHOL equivalent, each day. In this group the mor- tality was 18 per cent, in excess of the average. Third: Men who indulge more freely than the preceding group, but who were considered acceptable as standard insurance risks. In this group the mortality was 86 per cent, in excess of the average. In short, we find the following increase of mortality over the aver- age death rate among insured risks generally : Steady moderate drinkers but accepted as standard risks 86 per cent. Having past excesses 50 " " Very moderate drinkers 18 " " This means that steady drinkers who exceed two glasses of beer or one glass of whisky daily are not, on the evidence, entitled to standard insurance, but should be charged a heavy extra premium. In these groups, the death rates from Bright 's disease, pneumonia and suicide were higher than the normal. The per capita consumption of alcohol has consumpti. greatly increased in the United States in re- cent years, while in the United Kingdom it has materially decreased, as shown in the fol- lowing table. This factor must be considered in assigning a cause for the increasing mor- [235] ion of Alcohol HOW TO LIVE [H- tality from degenerative diseases in this coun- try as compared to a decreasing mortality from these maladies in Great Britain. ANNUAL PER CAPITA CONSUMPTION (IMPERIAL GALS.) OF ALCOHOL IN VARIOUS COUNTRIES 1896-1912 1896-1900. 1908-1912. n » 1 & 1 1 1 IB 1 Germany . 25.4 31.6 S.5 13.01 1.37 .39 19.9 .30 1.66 1.05 1.7 .81 28.43 33.04 27.1 14.12 22.4 26.65 8.6 16.62 1.09 .26 24.7 .52 1.29 .71 1.42 1.02 24.78 United Kingdom. . . France 27.62 34.72 United States 18.16 Laboratory and Clinical Evidence Relating to the Physiological Effects of Alcohol To interpret correctly the mortality statis- tics relating to moderate drinkers and total abstainers, one must have some knowledge of the physiological effects of alcohol in so- called moderate doses, a knowledge which is often lacking in those who assume to interpret such statistics. For example: If it could be shown that small doses of alcohol produce no ascertain- able ill effects upon the human organism, the higher mortality among the moderate drinkers as compared to total abstainers might have to [236] M] NOTES ON ALCOHOL be explained as due to some as yet unrecog- nized cause or causes other than alcohol. But if laboratory and clinical evidence shows that alcohol in so-called moderate quantities (social moderation) produces definite ill effects, such as lowering the resistance to disease, increas- ing the liability to accident and interfering with the efficiency of mind and body and thus lessening the chances for success in life, to say nothing of any toxic degenerative effect upon liver, kidneys, brain and other organs, the excess mortality that unquestionably obtains among moderate drinkers as compared to total abstainers must be ascribed chiefly to alcohol. It is not possible here to give all the evi- dence, but the following items will serve to clarify these questions. Kraepelin^" and his pupils have contributed Effect on Brain most extensively to our knowledge on this system subject. According to such authorities, a half to a whole liter of beer is sufficient to lower intellectual power, to impair memory, and to retard simple mental processes, such as the addition of simple figures. Habitual associa- tion of ideas, and free association of ideas are interfered with. As far back as 1895, Smith demonstrated the [237] HOW TO LIVE [M. influence of small doses of alcohol in impairing memory, and these results have been con- firmed by Kraepelin and quite recently by Vogt ^^ in experiments on his own person — 15 cc. (about 4 teaspoonfuls) of whisky on an empty stomach, or 25 cc. with food, being suflScient to distinctly impair the power to memorize. Careful and exact experiments have shown the influence of moderate doses of alcohol in lessening the amount of work performed by printing compositors. There has also been shown a disturbance in the sequence of ideas. The time that elapses between an irritation and the beginning of a responsive movement can be measured within one one-thousandth of a second. According to Aschaffenburg,^^ under the influence of even very small doses of alcohol this reaction period is disturbed and shortened. It is below the normal, the ac- celeration being attained at the expense of precision and reliability. Indeed, the reaction is often premature, and constitutes a false re- action — "the judgment of the reason comes limping along after the hasty action. " It is now conceded that alcohol is not a real brain stimulant, but acts by narrowing the [238] M] NOTES ON ALCOHOL field of consciousness. By gradually overcom- ing the higher brain elements the activities of the lower ones are released, hence the so-called stimulation and the lack of judgment and com- mon sense often shown by those even slightly under the influence of alcohol. The man who wakes up under alcohol is really going to sleep, as far as his judgment and reason are con- cerned. Complete abolition of consciousness is brought about by sufficient doses as when ether or chloroform is taken. Under moderate doses, muscular efficiency is at first increased a little and then lowered, the total effect being a loss in working power, as shown by the experiments of Dubois, Schnyder,^^ Hellsten,^* and others. Muller, Wirgin and others ^^ have shown influence on that alcohol restricts the formation of anti- Reaiunceto Disease bodies (the function of which is to resist in- fection in the blood) in rabbits, and Laitinen ^^ has shown that the prolonged administration of small doses in men (15 cc.) is sufficient to lower vital resistance, especially to typhoid fever. Rubin ^^ has demonstrated that alcohol, ether and chloroform, injected under the skin, render rabbits more vulnerable to streptocoo- [239] HOW TO LIVE [H- cus (blood poison) and pneumococcus infection (pneumonia) ; Stewart,^* that small amounts lower the resistance to tuberculosis and streptococcus infection; Craig and Nichols,^^ that moderate doses of whisky were sufficient to cause a negative Wassermann reaction in syphilitic subjects; Fillinger^" found the re- sistance of red blood cells much reduced after the administration of champagne to healthy human subjects. Similar results were found in dogs and rabbits. Weinburg ^^ confirmed these results -by the same methods, showing that 20 per cent, of the red cells lose their resistance after the ad- ministration of 450 cc. of champagne. Parkinson,^^ in a series of careful tests, failed to establish any influence on phagocy- tosis (capacity of the white blood cells to de- stroy bacteria), except when large doses or continuous moderate doses were taken. Effect on Ou the heart and circulation, alcohol acts as a depressant, increasing the rate, but not the force, of the pulse. It causes depression of the nerve center controlling the blood vessels and thus lowers blood pressure. Large doses cause paralysis of these nerves and of the heart. [240 J M] NOTES ON ALCOHOL Miller and Brooks ^^ found from small doses (6 to 12 cc. absolute alcohol) an increase in blood pressure in conscious (unanesthetized) animals, contrary to the findings of Crile,^* Cabot,^® Dennig,^^ Hindelang and Griinbaum, AlexandrofP '^'' and others, in man; but the amounts were small and variable, according to individual susceptibility, thus showing the drug to he, even on such evidence, uncertain and unserviceable as a heart stimulant. Atwater and Benedict,^® and Beebe ^* and Foodvaiue Mendel,^" have shown that alcohol is a "pro- tein sparer, ' ' and can, to some extent, take the place of fats and carbohydrates. This is what is meant by calling alcohol a ' ' food. ' ' Always, however, it fails to pass some test by which true foods are measured. Apart from its effect on the nervous system, among which must be figured its action on the blood vessels which causes a loss of body heat, Mendel has shown that in moderate doses (96 cc. daily) it increases the output of uric acid and allied (purin) bodies derived from the tissues, a fact which distinguishes it from all other foods. These poisonous or drug effects must always be considered, together with any al- leged nourishing effects. Alcohol is still used [241] HOW TO LIVE [H. by some as a rapidly available fuel-food in fevers, and when ordinary foods cannot be readily digested and made available. But this is done to a much less degree than formerly, now that its narcotic and poisonous effects are more fully understood. Sugar and water often serve quite as useful a purpose. It seems reasonable, on the evidence here- in presented, to class alcohol among the narcotic or "deadening" drugs, such as ether or chloroform. Indeed, Aschaffenburg ^^ has recently called attention to the growth of the ether habit in eastern Germany, where this drug is used as a so-called stimulant, while in reality the effects are well known to be narcotic, or deadening. The laboratory and the life insurance rec- ords simply give exact expression to what has long been a matter of common knowledge to the employer of labor and to leaders and commanders of men ; to wit, that the influence of alcohol on any large group of men, whether they be artisans or soldiers, is harmful and lowers the efficiency of the group. Individual susceptibility varies, but the man who thinks he is an exception and can indulge with safety may find that he is mistaken only after serious [242] M.] NOTES ON ALCOHOL damage to the body has been done and per- haps a definite loss sustained in happiness and achievement. Stockard,^^ in his experiments on animals, Effecton has demonstrated conclusively that the germ cells of males can be so injured by allowing the subjects to inhale the fumes of alcohol thdt they give rise to defective offspring, although mated with vigorous untreated females. The offspring of those so treated when reaching maturity are usually, nervous and slightly un- dersize. These effects are apparently con- veyed through the descendants for at least three generations. Such evidence establishes at least the probability of the transmission of serious ill effects to human offspring through alcoholic indulgence of the male parent. Much of the statistical evidence that has been produced on both sides of this question of the transmissibility of the effect of alcohol is misleading unless very critically analyzed, but the results of exact laboratory experiments can hardly be gainsaid. Those who trifle with alcohol should at least take the precaution to be periodically ex- amined in order to detect the earliest signs of ill-effect. One's own feelings are not safe [243] HOW TO LIVE [M. guides, and may fail to warn of danger until serious damage has been done. In 1914, at the annual meeting of the National Council of Safety, at which there were present representatives from several hundred large industries, the members unan- imously voted to abolish liquor from their plants. It has been well stated by Quensel ^* that "work and alcohol do not belong to- gether, especially when the work demands wideawakeness, attention, exactness and en- durance." The restrictive and prohibitive measures of the French and Russian governments, the well known opposition of the Kaiser to alcohol and the warnings uttered by Lord Kitchener and leading British statesmen, are sufficient evi- dence that the condemnation of alcohol repre- sents the deliberate judgment of the world's strong men. REFERETHCES 1. United Kingdom Temperance and General Provident Institution of London, Annual Report, 1910. 2. Sceptre Life Association, Annual Report, 1912. 3. Scottish Temperance Life Assurance Company, Annua] Report, 1912. 4. The Abstainers and General Insurance Company, Ltd., Annual Report, 1912. [244] M.] NOTES ON ALCOHOL 5. McMahon, T. F.: The Use of Alcohol and the Life In- surance Risk. Proceedings of the Association of the Life Insurance Medical Directors of America, 1911, Twenty-second Annual Meeting, p. 473; Medical Rec- ord, LXXX, p. 1121. 6. Lounsherry, E. L. ; Proceedings of the Life Assurance Medical Directors, October, 1913. 7. Moore, Roderick McKenzie: On the Comparative Mor- tality Among Assured Lives of Abstainers and Non- Abstainers from Alcoholic Beverages. Transactions of the Institute of Actuaries, 1913, XXXVIII, pp. 248-272. 8. Report of Medico-Actuarial Mortality Investigation, IV, pp. 11-13. 9. Statistical Abstract for the United Kingdom, Sixty- first Number, 1899-1913 (Wyman & Sons), London, 1914, p. 173; Statistical Abstract for the Principal and Other Foreign Countries, 1901-1912, Thirty-ninth Num- ber, pp. 505, 506, 507; Statistical Abstract of the United States, Thirty-sixth Number, 1913, p. 516. 10. Kraepelin, Emil: Ueber die Beeinflussung einfacher psychischer Vorgange durch einige Arzneimittel, Ver- lag von Gustav Fisher, Jena, 1892; AschaflFenburg, Gustav: Praktische Arbeit unter Alkoholwirkung, Psychologische Arbeiten, 1896, I, pp. 608-626; Kurz, Ernest, and Kraepelin, Emil: Ueber die Beeinflussung psychischer Vorgange durch regelmdssigen Alkohol- genuss, Psychologische Arbeiten, 1901, III, pp. 417-457; Mayer, Martin: Ueber die Beeinflussung der Schrift durch den Alkohol, Psychologische Arbeiten, 1901, III, pp. 535-586; Rudin, Ernst: Ueber die Dauer der psy- chischen Alkoholwirkung, Psychologische Arbeiten, IV, pp. 1-44. 11. Vogt, R. : Om virkningen af 15-50 cm3 koncentrert spiritus paa erindringsevnen, Norsk. Mag. f. Laege- vidensh., 1910, LXXI, pp. 605-626; The Lancet (Lon- don), 1910, II, p. 1040. 12. Aschaffenburg, Gustav: Grime and Its Repression, Lit- tle, Brown & Company, Boston, 1913, p. 84. [245] HOW TO LIVE [H- 13. Sehnyder, L. : Alkohol und Muskelkraft, Archlv fur Physiologie, 1902-3, XCIII, p. 451. 14. Hellsten, A. F. : XJeber den Einfluss von Alkohol, Zucker und Thee auf die Leistungsfahigkeit des Muskels, Munohen Med. Wchuschr., 1914, LI, pp. 18-94. 15. Bastedo, Walter A. : Materia Medica Pharmacology and Therapeutics, W. B. Saunders Company, Philadelphia and London, 1913, p. 333. 16. Laitinen, T. : The Norman Kerr Lecture on The Influ- ence of Alcohol on Immunity, Med. Rec, LXXVI, 1909, pp. 445-446. Read before the Twelfth International Anti- Alcoholic Congress, held in London, July, 1909; Vher die Einunrkung der kleinsten Alkoholengen auf die Widerstandsfahigkeit des tierischen Organismus mit besonderer Beriicksichtigung der Nachkommen- schaft, Ztschr. f. Byg. u. Infections-krankheiten, LVIII, 1907-8, p. 139. 17. Rubin, George: Tfte Influence of Alcohol, Ether, and Chloroform on Natural Immunity in its Relation to Leucocytosis and Phagocytosis) Jour. Infct. Dis., 1904, I, pp. 425-444. 18. Stewart, Chas^ E. : The Influence of Alcohol on the Op- sonic Power of the Blood, Mod. Med., 1907, XVI, pp. 241-246. Read before the American Society for the Study of Alcohol and Drug Neuroses, Atlantic City, June 4, 1907, and published in the Jour, of Inebriety. 19. Craig, Chas. F., and Nichols, Henry J.: The Ejfect of the Ingestion of Alcohol on the Result of the Comple- ment Fixation Test in Syphilis, Jour. A. M. A., 1911, LVII, pp. 474-76. 20. Fillinger, F. V.: Weitere Mitteilungen Uber Resistens:- verndnderung der Erythrozyten nach Alkoholgenuss, Deutach. Med. Wchnschr., 1912, XXXVIII, p. 999. 21. Weinburg, W. W. : The Lowering of Stability of Ery- throcytes in Alcoholic Intoxication, Russky Vratch, 1912, II, p. 1324; New York Med. Jour., 1912, XCVI, p. 1040. [246] H] NOTES ON ALCOHOL 22. Parkinson, P. R. : The Relation of Alcohol to Immu- - nity. The Lancet (London), 1909, VII, pp. 1580-82. 23. Brooks, Clyde: The Action of Alcohol on the Normal Intact XJnanesthetized Arwmal, Jour. A. M. A., 1910, LV, pp. 372-73. Read in the Section on Pathology and Physiology of the A. M. A. at the Sixty-first Session, St. Louis, June, 1910. 24. Crile, George W. : Blood Pressure in Surgery, J. B. Lippincott Company, Philadelphia, 1903. Cartwright Prize of the Alumni Ass'n of the College of Physicians and Surgeons, New York City. 25. Cabot, Richard C. : Studies of the Action of Alcohol in Disease, Especially upon the Circulation, Med. News, LXXXIII, 1903, pp. 145-153. Read before the Associa- tion of American Physicians, May 13, 1903. 26. Dennig, Hindelang und Grubaum: Vber den Einfluss des Alkohols auf den Blutdruck und die Herzarbeit in pathologisehen Zustanden, Namentlich beim Fieber, Deutsch. Arch. f. klin. Med., 1909, XCVI, pp. 153-162. 27. Alexandroff, Emilie: Ueber die a/njaleptische Wirkung des Alkohols bei pathologisehen Zustanden, Cor. Bl. f. schweiz. Aerzte., 1910, XL, pp. 465-475; Action of Al- cohol During Febrile and other Pathologic Conditions, Jour. A. M. A., 1910, LV, p. 174. 28. Atwater, W. A., and Benedict, F. G. : An Experimental Inquiry Regarding the Nutritive Value of Alcohol, Na- tional Academy of Science, 1902, Sixth Memoir. 29. Beebe, L. B. : The Effect of Alcohol and Alcoholic Fluids Upon the Excretion of Uric Acid in Man, Amer. Jour. Physiol., 1904, XII, pp. 13-37. 30. Mendel, L. B., and Hilditch, Warren W. : The Influence of Alcohol Upon Nitrogenous Metabolism in Men and Arwmals, Amer. Jour. Physiol., 1910, XXVII, pp. 1-23. 31. AschafFenburg, Ibid. 32. Stockard, C. R.: A Study of Further Generations of Mammals from Ancestors Treated with Alcohol, Proc. Soc. Exper. Biol, and Med., 1914, XI, p. 136. [247] HOW TO LIVE [M. 33. Quensel, Ulrik: The Alcohol Question from a Medical Viewpoint — Studies in the Pathology of Alcoholism, Year Book, United States Brewers' Association, 1914, p. 168. Bastedo, Walter A.: Materia Mediea Pharmacology and Therapeutics, W. B. Saunders Company, Philadel- phia and London, 1913, p. 318. Bertillon, Jacques: On Mortality and the Causes of Death According to Occupations, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, I, p. 345. Boos, William F. : The Relation of Alcohol to Indus- trial Accidents and to Occupational Diseases, Proceed- ings of the Fifteenth International Congress on Hy- giene and Demography, Washington, 1912, I, p. 829. Cabot, Richard C. : The Consumption of Alcohol and of Other Medicines at the Massachusetts General Hos- pital, Boston Med. Jour., CLX, 1909, pp. 480-81. Dixon, W. E. : Alcohol in Relation to Life, The Nine- teenth Century, 1910, LXVII, pp. 516, 523. "Ethyl Alcohol," The Dispensatory of the United States of America, J. B. Lippincott & Company, Phila- delphia, 19th edition, p. 102. Ewald: Alcohol in Relation to Infectious Diseases, Med. Rec, 1913, LXXXIV, p. 75. Read before the Fourth National Congress on Physiotherapy, Berlin, March 26, 1913. Horsley, Sir Victor: Disctission on Alcohol in Thera- peutics, Med. Rec, 1912, LXXI, p. 951. Read before the Hunterian Society. Hunter, Arthur: Can Insurance Experience he Applied to Lengthen Life? Proceedings of the Association of Life Insurance Presidents, Eighth Annual Meeting, 1914, pp. 27-37. Kelynak, T. M. : The Drink Problem, London, Methuen & Company, 1907. [248] M.$4.] NOTES ON ALCOHOL Landau, Anastazy: Beitrage zur hehre vom Purins- toffwechsel und zur Frage ilber den Alkoholeinfluss auf die Harnsaureausscheidung, Deutsch. Arch. f. klin. Med., XCV, 1908-9, pp. 280-328. Miller, Joseph L. : The Physiologic Action, Uses and Abuses of Alcohol in the Circulatory Disturbance of the Acute Infection, Jour. A. M. A., 1910, LV, pp. 2034- 2037. Read in the joint session of the Sections of Practice of Medicine and Pharmacology and Therapeu- tics of the A. M. A., Sixty-first Annual Session, held at St. Louis, June, 1910. NefF, Irwin H. : The Problem of Drunkenness, Proceed- ings of the Fifteenth International Congress on Hy- giene and Demography, Washington, 1912, IV, p. 510. Phelps, Edward Bunnell: The Mortality from Alcohol in the United States, Proceedings of the Fifteenth In- ternational Congress on Hygiene and Demography, Washington, 1912, Vol. I, p. 813. Proceedings: Association of Life Insurance Medical Directors, October, 1911. i Report of the Committee of Fifty on: Physiological Aspects of the Liquor Problem, Houghton, Mifflin & Company, two volumes, 1903. Togel, 0., Brezina, E., and Durig, A.: Ueber die koh- lenhydratsparende Wi/rkung des Alkohols, Biochem. Ztachr., 1913, I, 296; Editorial, Jour. A. M. A., 1913, LXI, p. 967. Williams, Henry Smith: Alcohol, How it Affects the Individual, the Community and the Race, The Century Company, New York, 1909. Woods, Robert A.: The Prevention of Inebriety: Com- munity Action. Proceedings of the Fifteenth Interna- tional Congress on Hygiene and Demography, Wash- ington, 1912, IV, p. 517. [249] SECTION V NOTES ON TOBACCO It is the purpose of this section to present as fairly as possible the evidence relating to the effects of tobacco on the human body, so that those who smoke may correctly measure the probable physical cost of the indulgence. The extremes of opinion on this subject are well expressed in the following verses: ' ' Hail ! Social Pipe — ^Thou foe to care. Companion of my elbow chair ; As forth thy curling fumes arise. They seem an evening sacrifice — An offering to my Maker's praise For all His benefits and grace. ' ' Dr. Garth. "A custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and the black stinking fume thereof nearest resembling the horrible Stygian smoke of the pit that is bottomless. ' ' James I. Tobacco is a plant, Nicotiana Tabacum of [250] $5.] NOTES ON TOBACCO the order Solanaceae, which includes Atropa what it is Belladonna, or "Deadly Nightshade," Hyos- cyamus, or "Henbane," Solanum Dulcamara, or "Bitter Sweet," all powerful poisons, and likewise the common potato and tomato, which are wholesome foods. The cured leaves are used for smoking and chewing, or when powdered, as snuff. Prior to the middle of the 16th Century, the History use of tobacco was confined to the American Indians. In 1560 the Spaniards began to cultivate tobacco as an ornamental plant, and Jean Nicot, the French Ambassador at Lisbon, introduced it at the court of Catherine de Medici in the form of snuff. Smoking sub- sequently became a custom which spread rapidly throughout the world, although often vigorously opposed by Governments. In the 17th Century, smoker's noses were cut off in Eussia. Tobacco contains a powerful narcotic poison, composiHon nicotin, which resembles prussic acid in the rapidity of its action, when a fatal dose is taken. The percentage of nicotin present varies according to the brand and the conditions under which it is cultured. [251] HOW TO LIVE [§5. The following figures have been given by the various authorities. London Lancet ^ 64 to 6.3 percent. French Dept. of Agriculture « 22 to 10.5 " " Connecticut Agricultural Experiment Stations 2.89 " " (Home grown — after fermentation.) U. S. Dept. of Agriculture^ 94 to 5. " '• (Domestic.) Aside from nieotin it also contains small quantities of related substances — nicotellin, nicotein, a camphoraceous substance termed nicotianin, said to give tobacco its character- istic flavor, and likewise a volatile oil de- veloped during the process preparation. On heating, pyridin (a substance often used to denature alcohol), picolin, coUidin, and other bases are formed, as well as carbolic acid, am- monia, marsh gas, cyanogen and hydrocyanic acid, carbon monoxide (coal gas) and fur- fural. Furfural is a constituent of fusel oil, which is so much dreaded in poor whisky. The smoke of a single cigaret may contain as much furfural as two ounces of whisky. The complex constitution of tobacco and the smoke from its combustion has caused much debate as to the substances that are re- sponsible for its charm and its ill effects, [252] *5.] NOTES ON TOBACCO which are to he deserihed. No one can doubt the seriojis injurious effects from such a powerful poison as nicotin if taken in any but the most minute quantities (one to three mil- ligrams have produced profound poisoning in man). It has been maintained by some that nicotin is practically destroyed in the process of smok- ing, and that the effects of tobacco are limited to the decomposition products resulting from the burning tobacco, especially pyridin. But pyridin is also formed in the burning of cab- bage leaves, and cabbage leaves do not possess any attractions for smokers, neither do they produce the well-known effects that smoking and chewing tobacco produce. No doubt pyridin and furfural are factors in the drug effects of tobacco, but recent painstaking ex- periments by high authorities have shown the presence of nicotin in tobacco smoke, and when we reflect that there is sometimes suf- ficient nicotin in an ordinary cigar to kill two men, it is not strange that enough of it may be absorbed from the smoke passing over the mucous membranes of the nose, throat and lungs to produce a distinct physiological effect. Investigators who claim to show by experi- , [ 253 i HOW TO LIVE [5 5. ments the absence of nicotin from tobacco smoke must explain why the palpable effects of smoking, in those who have not established a "tolerance," are those of nicotin poisoning, and why the symptoms produced by chewing tobacco are identical with those following the smoking of tobacco, which are : mild collapse, pallor of the skin, nausea, sweating, and per- haps vomiting, diarrhea, muscular weakness, faintness, dizziness, and rise in blood pressure followed by lowered blood pressure. Nicotin is undoubtedly decomposed by burn- ing, but it may become volatilized by heat and a certain amount absorbed before decomposi- tion takes place. Lehmann,* in 1908, found in tobacco smoke the following percentages of the nicotin con- tained in the tobacco: Cigaret smoke 82 per cent. Cigar smoke 85 to 97 " " The London Lancet^ (1912) gives the fol- lowing figures : Cigaret smoke 3.75 to 84 per cent. Pipe mixture smoke, smoked as cigarets 79 " " Pipe smoke 77 to 92 " " Cigar smoke 31 to 63 " " [254] 5 5.] NOTES ON TOBACCO The United States Department of Agricul- ture ® found in tobacco smoke about 30 per cent, of the nicotin originally present in the tobacco. Contrary to general opinion, Havana cigars contain less nicotin than the cheaper brands, which augurs ill for the large class of people who cannot afford to smoke higher priced brands. Many of the cheaper grades do, how- ever, show a low percentage of nicotin. By means of an ingenious apparatus, Zhe- brovski,'^ a Russian investigator, compelled rabbits to smoke cigaret tobacco for a period of 6 to 8 hours daily. Some died within a month, and showed changes in the nerve- ganglia of the heart. Others established a tolerance similar to that exhibited by habitual smokers, but upon being killed at the end of five months, degenerative changes similar to those produced by the injection of nicotin were found, viz., hardening of the blood vessels. There is, indeed, no difficulty in producing the Effects on characteristic effects of nicotin by adminis- Man tering tobacco smoke, either in man or in animals.* Nicotin causes brief stimulation of brain and spinal cord, followed by depression. There [255] HOW TO LIVE [$5. is an increased flow of saliva, followed by a decrease (large doses diminish it at once) and often nausea, vomiting and diarrhea. The heart action is at first slowed and the blood pressure increased. Subsequently there is a depression of the circulation, with rapid heart action and lowered blood pressure. In ha- bitual smokers, this preliminary stimula- tion may not occur. The stimulating effect on the brain is so brief that tobacco can not properly be termed a stimulant. Its effect is narcotic or deadening. Those who fancy that their thoughts flow more readily under the use of tobacco are in the same case with any other habitue whose thoughts can not flow serenely except under his accustomed indul- gence. That a sound healthy man, who has never been accustomed to the use of tobacco, can do better mental or physical work with tobacco than without it has never been shown. Indeed, such experiments as have been made on students and others show to the contrary.* The statistics presented by Prof. Fred. J. Pack are of interest in this connection. In six educational institutions the students competing for places on the football team were grouped as follows : [256] ,6.] NOTES ON TOBACCO Institution. Number Competing for Places. Number Successful. Per Cent. Successful. Institution A. ■^Tnokprs H 19 10 25 28 17 28 15 10 15 6 26 2 11 4 17 7 14 11 10 7 12 15 18 2 57.9 Institution B. Smolders 40 68 Institution C. 25 N^on-fTnokprs 82 Institution D. 39.3 68.6 Institution E. 70 N'on-smokers 80 Institution F. Smokers NTon-snudcers 57.7 Scholastic Standing Institu- tion. Smoker. Non- smoker. Institu- tion. Smoker. Non- smoker. A 65.2 69.8 G 74.0 75.0 B 64.7 74.6 H 75.2 79.4 C 78.8 81.1 I 81.6 88.4 D 75.8 77.6 J 78.5 81.3 E 84.6 84.8 K 74.0 84.6 P 69.6 71.3 L 77.3 77.6 The following table shows the relative scholastic standing of smokers and non- smokers : Nimiber of Men. Total Maxk. Average Mark. 81 101 6,034 8,021 74.5 Jlon-smokers 79.4 [257] Tobacco Smoking Athletes HOW TO LIVE Twelve institutions reporting: Number of Men. Highest Marks. Lowest Marks. Smokers 81 101 4 11 12 Non-smokers 6 Number of Men. Highest Marks. Lowest Marks. 101 non-smokers fumis 101 smokers would fun li 11 5 6 15 Number of Men. Total Conditions and Failures. Average. 82 98 70 43 .853 Non-smokers .439 Prof. Pack's conclusions were as follows: 1. Only half as many smokers as non-smokers are successful in the "try outs" for football squads. 2. In the case of able-bodied men smoking is asso- ciated with loss of lung capacity amounting to practi- cally 10 per cent. 3. Smoking is invariably associated with low scholar- ship. There have of course been many notable in- stances of high scholarship and prodigious mental achievement by heavy smokers. Such [258] «5.] NOTES ON TOBACCO exceptions, however, do not affect conclusions derived from the study of average groups. Hitherto figures on smoking and athletics have been open to question because com- parisons were made between groups that are not of necessity of the same physical and mental type, having no important difference except in the use of tobacco. But Prof. Pack has sought to avoid this objection. As he points out, the football squad is probably as nearly a homogeneous group as it is possible to find. It seems reasonable to account for the inferior physical and mental work of these particular groups of smokers on the theory that in the main the well known toxic effects of tobacco are sufficient to create this dif- ference. Dr. George J. Fisher,^** in a series of care- ful tests found: 1. Cigaret smoking caused an increase in the heart rate. 2. Cigaret smoking maintained a blood pressure which, under the circumstances of the experiment, would otherwise have dropped. 3. Cigar smoking caused a considerable increase in heart rate and blood pressiu-e. 4. In a number of instances, in the cigar test, the [259] HOW TO LIVE [J 5. heart was unable to maintain, with a vertical position, the increased blood pressure found in the horizontal position, showing a disturbance of the control of the blood vessels. This latter effect was more pronounced in tests taken on non-smokers. 5. It was also noted that smoking was not conducive to concentration upon the reading) which the men at- tempted during the tests. Bush,^^ in a series of tests on each of 15 men in several different psychic fields found the following conditions among smoking students immediately after the period of smok- ing was completed : 1. A lOj- per cent, decrease in mental efficiency. 2. The greatest actual loss was in the field of im- agery, 22 per cent. 3. The three greatest losses were in the fields of imagery, perception and association. 4. The greatest loss, in these experiments, occurred with cigarets. Bush ascribed these effects to pyridin, claiming that his experiments failed to reveal nicotin in the tobacco smoke, except in a very small proportion in that of cigarets. Tests for nicotin in smoke are beset with many difficulties and possible fallacies which have in the past misled investigators into ap- parently determining that tobacco smoke con- [260] *6.] NOTES ON TOBACCO tained no nicotin, but simply decomposition products. Pyridin is unquestionably present in to- bacco smoke, and is a poisonous substance, al- though less so than nicotin. It is not found, however, in chewing tobacco, and as the clinical effects of chewing tobacco are ap- parently identical with those of smoking to- bacco, very strong and universally accepted chemical proof of the absence of nicotin from tobacco smoke must be awaited before accept- ing such a conclusion. (See (*), (^), (®) in bibliography.) Cigaret smoking is a time waster; that is, it breaks up the power of attention, as few smokers are satisfied with one cigaret and the mere physical act of lighting a fresh cigaret disturbs the continuity of thought and work. Dr. W. J. Mayo ^^ calls attention to the fact that according to his observations research scholars who smoke cigarets have not done well. Only one insurance company, the New Eng- insurance land Mutual,^^ has published any experience |^^°^|'='=° on tobacco users. This covered a period of 60 years and a body of 180,000 policyholders, as follows : [261] HOW TO LIVE [$5. RATIO OF ACTUAL TO EXPECTED MORTALITY.* Abstainers. Rabely Use. Tempekate. Moderate. Tobacco, 59 % ... . Alcohol, 57 % ... . 71% 72% 84% 84% 93% 125% *The Btandaitl here used is the American Experience Table, which is largrely an artificial table upon which premiums are based, but which pro- vides for a much hierher mortality than the average companies sustain. For example, the actual mortality of the New England Mutual in 1913 was 67 per cent, of the expected. Interpretation Fifty-iiine per cent, of the expected mortality means that where, according to the premium tables, 100 were expected to die, only 59 actually died. The general class of risks in this company were of excellent quality, as the figures show. Nevertheless, the abstainers exhibited a far lower mortality than that experienced by the general class. Dr. Edwin Wells Dwight, who presented the figures, urged caution in their interpretation, suggesting that the low mortality among ab- stainers, both from alcohol and tobacco, might well be due to a more conservative habit of living. Furthermore, as the abstainers from alcohol were not separated from the abstainers from tobacco in this analysis a perfect com- [262] §5.] NOTES ON TOBACCO parison can not be made ; but our knowledge of the toxic effects of both these narcotics and the preceding statistics of Doctor Pack justify us in assigning to tobacco a positively unfavor- able effect. Experiments on animals with nicotin ex- Poisonous , Effects tracts from tobacco and inhalation of tobacco smoke have produced hardening of the large arteries. Clinical observation by some of the world's best authorities indicates that the same conditions are brought about in man by heavy smoking.^* Disturbance of the blood pressure, rapid heart action, shortness of breath, palpitation of the heart, pain in the region of the heart, are important effects. Tobacco heart is often lightly spoken of because the abandonment of the habit will often restore the heart to its normal condition, but tobacco heart sometimes causes death, especially under severe physical strain or in the course of acute disease, such as typhoid or pneumonia. Surgeons ^® have noted failure to rally after operation in tobacco users, who are, of course, deprived of their accustomed indulgence immediately be- fore and after operation. It is probable that many such cases pass imrecognized, although [263] HOW TO LIVE [«6. the alcoholic is usually supplied the narcotic his system demands. Cannon, Aub, and Binger ^* have also shoxvii that nicotin stimulates the adrenal glands, small organs adjacent to the kidneys, which secrete a substance that in excess powerfully affects the blood vessels, constricting them and temporarily increasing the blood pressure. This influence may be partly responsible for the change in the blood vessels noted in heavy smokers. Excessive smoking is often an important factor in causing insomnia. Blindness or tobacco amblyopia, a form of neuritis, is not an uncommon affection among smokers. There is also often an irritant effect on the mucous membranes of eyes from the direct effect of the smoke. Catarrhal conditions of the nose, throat and ear have also been noted. Acid dyspepsia is a common affection among smokers. Few people realize that so many ingredients in tobacco and tobacco smoke are deadly poisons. Few people know that one drop of nicotin on the unbroken skin of a rabbit will produce death.^'' Two drops on the tongue [264] 5 5] NOTES ON TOBACCO of a dog or cat will prove fatal; moreover, fatal poisonings have occurred in man from swallowing tobacco and even from external application of strong solutions. A case was recently reported from New Haven of fatal poisoning in a baby,^^ who had been fed from a milk bottle and milk-mixture in which some tobacco had been accidentally spilled. SUMMARY From the mass of evidence and opinion with which medical literature is loaded, a few salient facts stand out : First: Tobacco and its smoke contain powerful narcotic poisons. Second: It has never been shown to exert any beneficial influence on the human body in health, and it is not even included in the United States Pharmacopoeia as a remedy for disease, notwithstanding the claims that are made for its sedative effects and its value as a solace to mankind. If these benefits are real and dependable, they should be made avail- able in exact dosage and applied therapeuti- cally. If they are not real and dependable in [265] HOW TO LIVE [«5. a medical sense, they are not real and safe as a mere drug indulgence. Third: The symptoms following tobacco- smoking are identical with the effects of tobacco-chewing among those not accustomed to its use ; hence, any collateral psychic effect, such as the sight of smoke, the surrounding, etc., are of minor importance in establishing the habit. The main charm to the smoker is the drug effect, as in any other similar indul- gence. Nicotinless tobacco is not popular, notwithstanding the efforts of the French and Austrian Governments to make it so. Fourth: Fortunately, the sedative drug ef- fect is so slight, as compared to that of other narcotics — opium, alcohol, cocaine, etc. — that the tobacco habit is less seductive and may be broken with comparative ease and is therefore less harmful morally. Men who have smoked or chewed steadily for 40 years have been known to give up the habit without experien- cing much physical discomfort. Like any other habit, however, there is a tendency to increas- ing indulgence, and this is a risk that the smoker takes, just as does the alcohol user or the opium habitue who begins with so-called moderate indulgence. [266] J 6.] NOTES ON TOBACCO Fifth : The well-known effects of tobacco on the heart and circulation should lead one to pause and consider the possible cost of this indulgence, especially as — Sixth: It is difficult to determine, years in advance, whether or not one is endowed with sufficient resistance to render so-called mod- erate smoking comparatively harmless. Seventh: The vital statistics show that diseases of the heart and circulation are rapidly increasing in this country in which — Eighth: The per capita consumption has rapidly increased in recent years, while — Ninth : In the United Kingdom, where these diseases are decreasing, there has been no material increase in the use of tobacco, and the per capita consumption is less than one- third that of the United States. In 1880 the annual per capita consumption increase of of tobacco in the United States was about 5 lbs., while in 1914 it had risen to more than 7 lbs. In the United Kingdom the per capita consumption is about 2 lbs., and there has been no material increase in recent years. The cigaret bill, in particular, has grown enormously, having more than doubled in the past five years, while there has been a slight [267] HOW TO LIVE [$B. increase in the consumption of cigars, smoking tobacco, chewing tobacco and snuff, as shown in the following table :^® Fiscal Year Cigars Clgarets Tobacco, Chewing and Smoking Snufl 1910 1911 1912 1913 1914 8,213,356,504 8,474,962,786 8,350,119,103 8,732,815,703 8,707,625,230 7,884,748,515 9,254,351,722 11,239,536,803 14,294,895,471 16,427,086,016 436,608,898 380,794,673 393,785,146 404,362,620 412,505,213 31,969,111 28,146,833 30,079,482 33,209,468 32,766,741 Total. . 42,478,879,326 59,100,618,527 2,028,056,550 156,171,635 Tenth: The poetic effusions of the lovers of the weed are no safer guide than the ex- aggerated and intemperate denouncements of people who have idiosyncrasies against tobacco and simply hate it. Eleventh: Those who now smoke should have a thorough physical examination to de- termine the condition of the heart and blood vessels. This examination should be repeated at least annually, in order to detect any ad- verse influence on the circulation. REFERENCES 1. The Toxic Factor in Tobacco, The Laiioet (London), 1912, I, p. 944. 2. French Department of Agriculture, Compt. Rend. Acad, de Science, CLI, p. 23. [268] *5.] NOTES ON TOBACCO 3. Garner, W. W.: The Relation of Nicotin to the Burn- ing Quaiity of Tobacoo, U. S. Department of Agricul- ture, Bureau of Plant Industry, Bulletin No. 141, Sept. 30, 1909, p. 15; A New Method for the Determination of Nicotin in Tobacco, U. S. Department of Agricul- ture, Bureau of Plant Industry, Bulletin No. 102, July 6, 1907, p. 12. 4. Lehmann, K. B. : Untersuchungen uber das Taba- krauchen, Munchen, med. Wchnschr., 1908, LV, pp. 723- 25; The Physiological Action of Tobacco Smoke, Med. Eec, 1908, LXXIII, pp. 738, 739. 5. The Toxic Factor in Tobacco, The Lancet (London), 1912, II, pp. 944-947. 6. Garner, W. W.: The Relation of Nicotin to the Burn- ing Quality of Tobacco, V. S. Department of Agricul- ture, Bureau of Plant Industry, Bulletin No. 141, Sept. 30, 1909, p. 15. 7. Zhebrovsky, E. A.: The Effect of Tobacco Smoke upon the Blood Vessels of Animals, Eussky Vratch, 1907, VI, p. 189; 1908, VII, pp. 429-431; Med. Eec, 1908, LXXXIV, pp. 408, 409. 8. John, H.: Editorial, Jour. A. M. A., 1914, LXII, pp. 461-2; Ueber die Beeinflussung des systolischen und diastolischen Blutdrucks durch Tabakrauchen, Ztschr. f. exper. Path. u. Therap., 1913, XIV, pp. 352-365; Pa- winski, J.: Ueber den Einfluss unmassigen Rauchens (des Nikotins) auf die Gefasse und das Herz, Ztsoh. f. klin. Med., Berl., 1914, LXXX, pp. 284-305. 9. Pack, Frederick J.: Smoking and Football Men, Popu- lar Science Monthly, 1912, LXXXI, p. 336. 10. Fisher, George J. [Monograph not yet published.] 11. Bush, Arthur D.: Tobacco Smoking and Mental Effi- ciency, N. Y. Med. Jour., 1914, XCIX, pp. 519, 529. 12. Mayo, Wm. J.: Personal communication. 13. Dwight, Edwin Wells: Proc. Assoc. Life Ins. Med. Dir., Oct., 1911. II, p. 474. [269] HOW TO LIVE [«5. 14. Favarger, Heinrich: Experimentelle und klinische Bei- triige zur chronischen Tahakvergiftung, Wien. klin. Wchnschr., 1914, XXVII, pp. 497-501; Experimental and Clinical Study of Chronic Tohacco Poisonvng, Jour. A. M. A., 1914, LXII, p. 1764; Pekanovits, Effects of Tolacco Smoking, Jour. A. M. A., 1914, LXXII, p. 1907. 15. Bangs, L. Bolton: Some Observations on the Effects of Tolacco in Surgical PractieCi Medical Record, LXXIII, March 4, 1908, pp. 421-23-51. 16. Cannon, Aub. Binger: Effect of Nieotin Injection mi Adrenal Secretion, Jour. Pharm. and Exper. Therap., 1912, p. 381; Editorial, Nicotin and Adrenals, Jour. A. M. A., 1912, LXIII, p. 1287. 17. Hare, Hobart Amory: Fiske Prize Dissertation, No. 34, p. 1884. Dixon, A. S. : Proceedings of the Academy of Natural Sciences, Philadelphia, Nov. 11, 1884. 18. Reynolds, H. S.: Jour. A. M. A., May 30, 1914, LXII, p. 1723. 19. Annual Report of the Conmiiss.ioner of Internal Reve- nue, 1914, p. 34, Government Printing Office, Wash- ington, D. C. Bamberger, J.: Hygiene of Ciga/r Smoking, Abstr. Jour. A. M. A., 1904, XLIII, p. 706; Zur ,Hygienie des Rauohens, Munchen. med. Wchnschr., 1904, LI, pp. 1344-1345. Current Comment: Some Wew Evidence on the Toiacco Question, Jour. A. M. A., 1912, LIX, p. 1798. Editorial: The Pharmacology of Tobacco Smoke, Jour. A. M. A.. 1909, LII, p. 386. Editorial: The Use of Tobacco, Jour. A. M. A., 1910, LX, p. 32. Editorial: Tobacco-Smoking and Circulation, Jour. A. M. A., 1914, XLII, p. 461. Hochwart, L. Von Frankl: Die Nervosen Erkrankun- gen der Tabakraucher, Deutsch. med. Wchnschr., 1911, XXXVII, pp. 2273, 2321. [270] $5.]$ 5.] NOTES ON TOBACCO Index Catalogue of the Library of the Surgeon-Gen- eral's Ofiace, second series, XVIII, pp. 297-306. Larrabee, R. C. : Toiacoo and the Heart, Abstr. Jour. A. M. A., 1903, XLI, p. 50. Eead before the Massa- chusetts Medical Society, June, 1903. Pel: Un cos de psychose tabagique, Ann. med. Chir., 1911, XIX, p. 171. [271] [J 6. SECTION VI Infection Nasal Obstruction AVOIDING COLDS Bacteeia play a part in most colds. In some cases there is a general infection, with local symptoms, as in grippe; in others there is a local infection, with mixed classes of bacteria. It is probable that these various forms of bacteria are constantly present in the nasal secretions, but do not cause trouble until the local resistance or the general resistance is in some way lowered. In many, the susceptibility to colds is due to abnormalities in the nose or throat. Nasal obstruction is a very common condition. The nose, like the eye, is usually an imperfect organ. These obstructions are often the re- sult of adenoids in childhood, which interfere with the proper development of the internal nasal structures. Malformation of the teeth and dental arches in childhood are frequent and often neglected causes of nasal obstruc- tion. Such malformations are caused by the arresting of the growth of the upper jaw and [272] $6.] AVOIDING COLDS nasal structures. Correction of the deformity of the arches often renders nasal surgery un- necessary. Such conditions not only pre- dispose to colds, but increase their severity and the danger of complicating infection of the bony cavities in the skull that communicate ■with the nose. They also increase the liability to involvement of the middle ear and of the mastoid cells which are located in the skull just behind the ear. The importance, there- fore, of having the nose and throat carefully examined, and of having any diseased con- dition of the mucous membrane or any ob- struction corrected must be apparent. All who suffer from recurrent colds should take this precaution before winter sets in. If the nasal passages are put in a healthy General , . Resistance condition, strict obedience to the rules of in- dividual hygiene will almost wholly prevent colds. In fact, except where actual nasal de- fects exist, the frequency of colds is usually a fair indication of how hygienically a person is living. The following points need especial emphasis, though they repeat in some cases what has already been said in the text. It is a familiar fact that exposure and chill- skin Training ing will often produce a cold. This is usually [273] HOW TO LIVE [5 6. due to the fact that the nerve centers con- trolling the circulation of the skin are over- sensitive, and exhibit a sort of hair-trigger re- action to exposure, causing a disturbance of the circulation, and of the heat-regulating ma- chinery of the body of which the spongy shelf- like turbinated bones in the nose are an im- portant part. Skin training, then, appears to be the first hygienic steps toward establish- ing a resistance to colds. Such training for the skin may be secured by various means. One should first accustom himself to a gentle draft. Cool bathing, to a point that produces a healthy reaction, is another important feature of skin training. Cold bathing, by those affected with kidney trouble, is not advisable, but delicate indi- viduals, who cannot react well to the cold bath, can greatly increase their resistance by graduated cool bathing performed as follows : Standing in about a foot of hot water, one may rub the body briskly with a wash cloth wrung out of water at about 80 degrees F. and reduced day by day until it is down to 50 degrees F. Following this the cold douche or affusion may be taken (water quickly [274] i^'e.] AVOIDING -COLDS dashed from a pitcher^) ^beginning at 90 de- igrees F. and daily .reducing until 50 'degrees F. is reached, or just before 'the point 'where an agreeable "reaction ceases to follow. Qjhe -wearing of loose, porous clothing, and Light ciothing the aix bath — exercise in a cool room with- out clothing — aTe also valuable measures in skin training. Very heavy wraps and fur coats shoiild ibe worn only during unusual exposure, as in driving or motoring. Outer clothing should be adapted to the changes in the weather, and medium-weight undercloth- ing worn throughorlt the winter season. Office- workers 'andl others lemployed indoors are, during the greater part of "the ^ day, living in a summer rtemperature. The wearing of heavy underclothing under such conditions is de- bilitating to the skin and impairs the resisting power. ^Overheated rooms should also be avoided for the same reason. In rooms where people are onoving about, the temperature should not be allowed to rise above 65 degrees. In ordinary offices or dwelling rooms, the tem- perature should not be allowed to rise above 68 'degrees and adequate ventilation should be provided. [27S] HOW TO LIVE [J 6. Fresh Air Constipation Overeating Fatigue Nasal Toilet Living out of doors, especially sleeping out, gives the skin exercise, and further keeps fresh air in the lungs. It is one of the foremost methods of prevention against colds. Army- men remark that so long as they are out of doors, even if exposed to bad weather, they almost never catch cold, but do so often as soon as they resume living in houses. Long breaths taken slowly and rhythmically, say ten at a time and ten times a day are helpful. Constipation predisposes to colds, and should be vigorously combated by proper diet and exercise, and regular habits of attention to the bowel function. Overeating frequently leads to nasal con- gestion. Eat lightly, using little meat or other high protein foods such as white of eggs, and thoroughly masticate the food. Avoiding undue fatigue will help greatly in preventing colds. The regular use of nasal douches is not ad- visable. The mucous membrane of the nose is intolerant of watery solutions, and a chronic congested condition or even infection of air cavities in the skull can be brought about by the constant use of sprays and douches. [276] J 6.] AVOIDING COLDS Where special conditions render it necessary, these should be used only on the advice of a physician. When the nose is clogged with soot or dust, a very gentle spray of a warm, weak solution of salt and water, in the an- terior nostrils, may do no harm. Picking of the nose should be strictly avoided. This is a fertile cause of infection. In blowing the nose care should be taken to close one nostril completely and to blow through the other with- out undue force. Otherwise, infection may be carried into the ear passages or the cavities communicating with the nose and give rise to serious trouble. Wlien suffering from a cold, gauze or cheese-cloth should be used instead of a handkerchief and burned after use. Sneeze into the gauze, and thus avoid spraying infection into the surrounding at- mosphere. After one has actually caught cold the rules Emergency , . « . . - _ , . Treatment of above given for preventing a cold are m most cous particulars reversed. One should then avoid drafts, variable temperature and any severe "skin gymnastics." The paradox, that ex- posure to drafts is preventive of colds, but is likely to add to the cold after it is caught, is not more surprizing than the paradox that [277] HOW TO LIVE [H. exercise keeps a. man wellj but that when he is sick it is better to: rest; After a cold has actually been contracted, the great effort should be to beep the body thoroughly warm, especially the feet. To: ac- complish this it is often the wisest course for one who has a cold to remain in bed a full day at the outset. Medical treatment by a physician* can al- ways mitigate and shorteni the dnratioUi. of a cold and lessen the danger of complijaations> the symptoms of which, can not always be ap- preciated by the patient; Among the most effective home remedies' for a cold are the hot-foot bath, 110-115 de- grees F., a hot drink (e.g. hot. flaxseed tesif), a thorough purge, and rubbing' th& neck and chest with camphorated: oili The hot foot- bath should usually last 20 minutes-^ and be taken in a very thorough manner, the body en- veloped in a blanket. After taking the bath, the patient should go directly to bed, and not move about and neutralize its good cesults. A general neutral bath not above 100 or below 95 degrees is very restful to the skin, and nerves as they have absolutely nothing:- to do to cope with temperatures, above or belowi [ 278^] *6] AVOIDING COLDS that of the body, since the neutral bath has the same as that of the body. One can remain in such a bath even for hours, if one has the time, but in getting out, it is very important to be in a very warm room and to dress quickly. In fact there is very considerable danger of catching cold at this time if great care is not taken. If one does not remain in bed, it is generally safer to keep indoors. The air of the room should be kept as fresh as possible without subjecting one's self to a draft and should also be kept humidified, especially in winter when it is apt to be exceedingly dry. Either exces- sive dryness or excessive moisture is a strain on the mucous membrane, which is the directly diseased organ in the case of a cold. If the day is still and sunny, being out of doors, if well protected from any chill, may help to get rid of one 's cold, but on a damp windy day the chances are one will add to the cold. As to eating, it is sometimes wise to ab- solutely fast by skipping a meal or two, using nothing but water or water with agar-agar, or food which has bulk but little food value, such as green vegetables or fruit. The common idea that one should "stuff a cold and starve [279] HOW TO LIVE [$6. a fever" is most erroneous and comes ap- parently from a misunderstanding of the meaning of this adage which, originally, it would appear, was not meant in the impera- tive sense at all, but as follows : "If you stuff a cold, you will have to starve a fever." It should be added that whisky and heavy doses of quinine are distinctly deleterious and should be avoided, as should all quack remedies and catarrh cures; there are more effective remedies which carry no possibilities of harm. "When one is getting over a cold it is a good time to resolve to avoid catching colds alto- gether, which for the average person can be substantially accomplished by following the above suggestions. The tax on one 's time thus required is far less than the tax required by the colds themselves. The authors of this book know of persons who have scarcely lost a day's work from colds or other ailments for decades at a time simply by using a little self- control and common sense at critical times. [280] SECTION vn SIGNS OF INCREASE OF THE DEGENERATIVE DISEASES The fact that in the United States the general death rate has steadily fallen for the past several decades, a phenomenon common to all civilized countries, is accepted by many as evidence of a steady gain in National Vitality. That there has been a gain in vital- ity in the younger age groups is unquestion- ably true, but this gain has served to mask a loss in vitality at the older age periods. This latter phenomenon, a -rising mortality in elderly life, is something almost peculiar to the United States. It is not exhibited in the mortality statistics of the leading European countries. In those countries the fall in the death rate has not been due solely to a reduc- tion of mortality in infancy and adult life through the conquest of diseases of children, tuberculosis and other communicable diseases. England and Wales, Denmark, Norway, Swe- den and Prussia show improved mortality at every age period. [281] HOW TO LIVE [§7. The charts in this section show the trend of mortality in this country during 30 years at the various ages of life, and also the trend of morrtality in the two great classes of dis- eases: the communicahle, wiich affect more emphatically the young lives, and the degen- erative or regressive class of diseases, which affect chiefly those in middle life and old age. It seems evident: that unless this increased mortality is due to some unknown biologic in- fluence or to thfi amalgamation, of the various races that constitute our population, it. must be ascribed; iuiar, broad sense, to lack ofi adapt tation to our rapidly developing civilization. Whether or not there is one printapai cause that determines the unfavorable trend; of mortality in this country as compared.to: other civilized; nations has not yet. been conclusively shown. [282] n.] DEGENERATIVE DISEASES "Ehiat chart exhibits the trend: of the death rate ficom all causes^ by age periods. The deeaeases are below the center line and the increases above it. It will be noted, that the American decreases in the younger ages were not as great as in. England, and Wales, that they changed to in- creases' about age 45 and continued to increase in each age group thereafter, while in, England, and Wales the decline occurred at all ages. NoojE. — ^Maaaaolmsetts.. and New Jersey are used, as a basis because they were the only States in 1880 where sufficiently reliable comparative statistics could' be had] These records were accepted by the national government, and these States really constituted the registration area in that year. There were also fifteen cities outside these States where comparisons were possible. [283] HOW TO LIVE [*7. DEATH RATE REGISTRATION AREA (PER lO.OOO LIVING) ORGANIC DISEASES L.E.I. INC ENGLAND & WALES DOTTED LINES 1690 1900 1910 APOPLEXY 1890 1900 1910 KIDNEYS AND URINARY SYSTEM 1690 1900 1910 HEART AND CIRCULATORY SYSTEM 38. 1890 1900 1910 THE THREE COMBINED This chart shows that in the United States registration area, the mortality from diseases of the heart, blood vessels and kidneys in- creased 41 per cent, during the period 1890- 1910, while in England and Wales (shown by the dotted lines) during the same period there was a decrease in the mortality from these maladies. [284] *7.] DEGENEEATIVE DISEASES OCCUPIED MALES INCREASES- DECREASES FROM CERTAIN DISEASES DEATH RATE PER lOO.OOO 900 OVER 1890 L.E.I.INC. 40- APOPLEXY NERVOUS SYSTEM HEART KIDNEY & URINARY LIVER DIGESTION TYPHOID TUBERCU- LOSIS PNEUMQ. NIA INCREAE ■19 ^^■1 ^^^HHlflHflBI 2o-^B9IHHHBi3lii 1 o-^^^BI nHHj HBRj 10 r^^'BH ■ 20- DECREASES Si&SliS m 30 m HH 40- imiBi 30.6 38 43 22.5 5 1 43 4. This chart comparing 1900 with 1890 (1900- 1910 not yet available) shows the sharp upward trend in the mortality from organic disease among males in gainful occupations, and the downward trend in the mortality from communicable disease in the same group. This heavy and increasing loss from chronic dis- ease occurs among our most valuable lives — those of the breadwinners. [286] SECTION vin COMPARISON OF DEGENERATIVE TENDENCIES AiVIONG NATrONS DEATH BATE PER 1,000 OF POPULATION BY AGE PERIODS IN THE UNITED STATES* AND IN VARIOOB EUROPEAN OOUNTTRllES.t Ages U. S. Beg. Area 1900 ■P'sone Prussia 1900-01 Francb 1899-1902 'Italy : 1899^1fl02 SWEDEN 1891-00 Males Pem. Males Fem. Males Fem. Males Fem. Under 1 1 165.4 46.6 20.5 13.2 9. '4 52.1 5.2 3.3 5.2 7.5 8.6 9.4 11.0 12.2 15.2 19.1 '26.3 35.1 52.2 75.2 110.5 165.8 241.3 339.2 418.9 221.8 Mis 4.9 2.7 4.2 5.8 5.8 6.7 9:0 12.1 15.9 21.2 28.3 39.5 ■57.8 87.0 132.5 199.3 283.6 395.2 404.8 189.4 '23;4 5.1 3.0 3.7 4.7 6.0 6.7 7.8 8.6 10 ;0 13.8 20.4 31.4 50.3 78.9 125.3 186.6 271.4 345.6 402.1 seig 4.6 2.9 4.9 7.8 8.0 8.5 10.5 12.7 '15.1 19.1 26.6 37.4 54.5 86.9 130.7 22i.'9 ■■is! 5 4.6 3.5 5.2 6. A 8.0 7.8 8:8 9.7 10 .« 14.5 30.5 30.5 47.1 77.7 120.6 2i9!8 174.8 'ss'.i 6.1 3.2 4.6 6. -8 6.7 6.7 7.5 9.3 U.4 15.7 31i0 33.5 ■50/2 85.4 134.3 214.5 317.1 391! 7 158.3 39 is 6.7 3.8 5.4 7.0 7:6 7.9 8.6 ®.l B.'fi 12.9 17.7! 30.9 48.8 87.4 138.5 215.6 307.3 369 :i "i'.6 6.7 6.6 6.7 7;'6 8.8 '10 : 7 13.7 I18.'6 26.1 39.5 62.0 101.3 i97.'8 101.6 2 3 4 Under 5 5-9 36.9 6 9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 46-^9 60-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-over 3.6 4.7 5.7 6.1 6.5 7.2 7.9 8.6 10.9 14.3 21.3 33.8 64.8 90.1 179.6 Note: In 1900 or thereabouts, the death rates.:at the.midflle ages.oMlfe were heavier in the United States than In Prussia, "Fraace, Italy, an'd Sweden. Since then the death rates In the United States at these ages have grown even greater. In the foreign countries the death rate by persons can be approximated by adding the rates for males and females of same age and dividing by two. *12th Census. U. S., 1900, iU Vital Statistics, p. LXXIX. t F. Prinzlng Medizinische Statistik, Verlag von Gustav Fischer In Jena, 1906. 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