Columbia SBntbersJitp intf)eCttpofj£eto§ork COLLEGE OF PHYSICIANS AND SURGEONS Reference Library Given by Ltfuh^LLuJuJ* ^f~~- WHY DIE SO YOUNG? Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/whydiesoyoungOOhube WHY DIE SO YOUNG? By JOHN B. HUBER, A.M., M.D. Sometime Professor of Pulmonary Diseases, The Fordham University Medical School; Fellow of The American Medical Associ- ation; Fellow of The New York Academy of Medicine; Writer on Hygiene, Sanita- tion and Prophylaxis. HARPER & BROTHERS PUBLISHERS NEW YORK AND LONDON Why Die So Young? Copyright, 192 1, by Harper & Brothers Printed in the United States of America To My Wife's Mother young at fourscore with warm affection CONTENTS CHAP. Prologue . PAGE ... 1 Heredity — The Marriage of Blood Relations — The Alcoholic Taint — Good Blood — "Blood Disease" — Tuberculosis — Scrofula — The Rectification of Con- genital Defects — Imitation — Who Are the Fit? — An Aristoracy — Sickly Infants — Diet of the Nurs- ing Mother — Weaning — Pure Milk — Bottle-feeding Is Unnatural Feeding — A Precious Possession. II. Childhood 31 The Universal Paramount — The Healthful Home — The Air We Breathe — Pure Water — Food — Harden- ing — The School Child — The School — Exercise — Sense-Training — Medical School Inspection — Nutri- tional Disorders — The Appendix — Heart Disease in Children — Tuberculosis in Children — Deformities — Infantile Paralysis — Immunity — Aural Disease — Eye Defects — The Teeth — Snuffles — Adenoids — Enlarged Tonsils — St. Vitus's Dance — Night Terrors — Tantrums — Mental Defects — Morality and Physi- cal Deficiency. HI. Youth 87 The Soul's Awakening — Those Yellow Finger Tips — John Barleycorn — He That Ruleth His Spirit — The Common Cold — Influenza — Bronchitis — Pneu- monia — A Case of Tuberculosis — The Physiological Principles — The Consumptive Patient — The Con- sumptive's Doctor — Bathing — Skin Cancer — Great Aches from Little Toe Corns Grow — Exercise — Walking — Physical Training — The Militia— The Hygienic Life — Back to the Land — Marriage. CONTENTS CHAP. PAOB IV. Maturity 142 Human Wear and Tear — The Stout and the Lean — The Blood Pressure — Auto-intoxication — ■ The Athlete's Heart — The Use and Abuse of Drugs — Tea and Coffee — Nerve Tests — The Shoddy Ner- vous System — Fatigue Dyspepsia — Hysteria — The Emotions — Phobias — How to Rest — Neuritis — Catarrh — Typhoid Fever — Malaria — Vaccination — The Body's Sentinels — Infection Centers — The Per- fect Human Being? — The Industrial Surgeon — Fatigue and Efficiency — Alcohol and Efficiency — The Benefit of Alcohol— The Public Health— The Sanitary Conscience. V. The Prime of Life 197 Life Expectancy After Forty — Cancer — The Pre- cancerous Stage — The Chief Danger Signal — The Only Cure To-da.> — The Moderate Drinker — We Eat Too Much — Temperance in Eating — Gout — Overweights — Banting — The Underweights — Func- tional Stomach Disorders — Gastritis — A Good Cook — Bright's Disease — Diabetes — Rheumatism — Functional Heart Disturbances — Valvular Heart Disease — The Pace That Kills — Hardened Ar- teries — Exercise for the Middle Aged — Does God Fix the Death Rate? VI. Threescore and Ten 253 Lagging Superfluous? — The Tragedy of Deafness — Visual Defects — Cataract — Asthma — Chronic Bron- chitis — The Pneumonia of the Elderly — Terminal Affections — Apoplexy — Sleep — Factors of Safety. VII. Old Age 283 What Does It Mean to Grow Old?— The Body Cells — Dietary — Exercise and Warmth — Hobbies — Mu- sic — A Good Habit — A Welcome Friend. Appendix A 297 Appendix B 301 Index ? 303 PROLOGUE The theme of this book is the Healthful Life, to the end that length of well-lived days may be assured us. I, a physician, am urging my readers to emulate the oyster, which, I am more or less credibly informed, has no diseases, is either healthy or dead. Before the war a great deal was written about the efficient life. An eminent statesman, now passed away, through many years urged his compatriots to lead the strenuous life. Then there is the religious life, which should, of course, be led; the moral, the spiritual, the intellectual life, and so on. It is very likely, indeed, that all these kinds of life shall be assured him who will but live the physiological, the hygienic life. The human being in good health is pretty sure to be efficient in his business and vigorous in his employments. The cleanliness of his body will either make him godly, as that clergyman-physician, John Wesley, assured us, or as nearly so as the most of us can hope to be. The man pure in body is pretty sure — anyway, more likely than not — to be clean as to his morals. And in the sound body the intellectuals can safely be left to take care of them- selves, as the ancients recognized better than we do to-day. The pessimist will get no pabulum in the fol- lowing pages. My readers, men and women, will PROLOGUE find nothing to perturb, but much, I hope, provoc- ative of thought, to the end that they may safely and pleasantly attain fourscore, perhaps the cen- tury mark. For, as we shall observe, the latter appears to have been the intended natural human span. I have begun each division of this book with familiar lines of Shakespeare; indeed, the work is a consideration, from a doctor's viewpoint, of humankind's Seven Ages. WHY DIE SO YOUNG? WHY DIE SO YOUNG? i INFANCY " At first the infant Mewling and puking in the nurse's arms.'* HEREDITY FRANCIS GALTON was the English founder of the present science of eugenics, which he defined as the study of the agencies under social control that may improve or impair the racial qualities, either physical or mental, of future gener- ations. He was himself singularly fortunate in both his own heredity and in his after-birth environ- ment. Throughout his life his lines were cast in most pleasant places. And, being one of the very kindliest of men, he was enthusiastic for the per- petuation, as broadly and as fully as human life extends, of his own Olympian status. He was sympathetically desirous that all humanity should become eugenized — well-born in the very best meaning of the term — that there should, more than ever in human history, come into being races of gifted artists, saints, mathematicians, adminis- l WHY DIE SO YOUNG? trators, mechanicians, and the like. The perfect man — the physique of an athlete, the mind of a scholar, the soul of a saint — such was his ideal. Above all, he hoped that our kind should be free of such hereditary stigmata as tend, in turn, to de- generated offspring. The Galtonian would have the eugenic principles go hand in hand with love, to the end that mar- riages may make ever for happier homes and healthier children, and for the establishment, in so far as is humanly possible, of a posterity free from insanity, disease, pauperism, and crime. Love, in a mature and sensible human being (but who, in love, whatever his years, has ever been sensible), may be in itself a eugenic choice. The fact of two wholesome beings wishing to spend their lives together is likely to be based on instinctive traits that will make for good inheritance, to be enjoyed by a normal posterity. But love, of itself, unserved by eugenic principles, "offers no more than an even chance." Understand that your thoroughgoing eugenist, wise and mellow-natured man as he is, would not, if he could, do away with love; he would preach no doctrine of scientific mat- ing as opposed to the marriage of personal choice; but he would combine with love, if such a thing were possible, common sense and forethought. This science of eugenics promises to do a great deal of good. But remember that nature has, in a way of her own, been practicing it these some six hundred thousand years or more, and doing pretty well at it, considering how much human civiliza- tion has been trying to frustrate her. Darwin ex- pressed this universal phenomenon in his law of INFANCY the survival of the fittest. By far the most of our forbears have mated well, simply because they have fallen hopelessly in love with one another, without regard to any other consideration and under nature's uninterfered-with, wonderful, and generally wise and beneficent influence. Falling in love is the romantic phrase the coldly scientific equivalent of which is "natural selection." For my part, I maintain that in this business of eugenics the psychic, the spiritual, is the all-impor- tant, the supreme factor; the essence of good birth in a child lies in the noble souls of its parents. That factor obtaining, the right human organism should surely follow: " For of the soul the body form doth take; Since soul is form and doth the body make." 1 If people will only just fall in love, without re- gard to other and more or less worthy considera- tions, the eugenic principles may pretty safely be chanced to take care of themselves. The trouble really is that very frequently considerations other than natural affection do enter into marriage en- gagements. Many matches are made for and not by the couple who are to marry; great wealth or considerable social position offsets a corrupt body or prevails despite disparity in years — and so on. Thus does what we may here term the negation of eugenic principles frustrate love, and so make for a debased rather than an improved race. Let us here note some of the results of such unfortunate unions, as tabulated, both before Galton. and 1 Edmund Spenser. WHY DIE SO YOUNG? since his establishment of the modern science of eugenics. THE MARRIAGE OF BLOOD RELATIONS If two epileptics marry, their children will be all epileptics; the same is true of imbeciles. If an epileptic or one insane marries a normal individual, only one-half or one-fourth of the progeny will usually inherit the parental abnormality; the others, according to the Mendelian theory (the most valid in science to-day) , will probably be nor- mal. A recessive trait (one present in undeveloped germ form and never becoming active in the life of the individual) may remain recessive for genera- tiers (atavism), but will very likely become active wLt .?. it meets a like trait, recessive or otherwise. The marriage of cousins is not in itself bad. if both families are of sound stock. But such mar- riages will naturally bring out any common un- toward traits and will intensify mutual weaknesses. Thus will the children born of consanguineous mar- riages tend to have more or less pronounced stig- mata (signs of imperfect mental or bodily condi- tions), to be abnormal in one way or another, to be deaf mutes or albinos, or to have very irregular and early decaying teeth, or to have harelip, or squint, or to stammer or lisp. Their parents have the mutual physical and moral characteristics which tend to become exaggerated in the children, and this because those traits are not balanced by other and diverse ones. Sometimes a very slight disorder may grow and become intensified through several generations, 4 INFANCY until it becomes a thing really dreadful. It is when we come to the nervous system and its diseases that we find a wide range of abnormalities. This we readily understand when we consider that the central nervous system has for its function both the bringing of every organ and tissue of the body into harmonious interrelation, and the adjusting of the body as a whole to its environment — that is, to the universe outside it. 1 Children will not by any means always suffer the nervous maladies of their parents or other forbears; what they will inherit is an untoward predisposition, a tendency. And the kind of nervous aberrations which the child will manifest will depend largely on the bane- ful influences the child may be subjected to after birth. Such an unfortunate child may thus de- velop epilepsy, or alcoholism, or sexual perversity, and so on. THE ALCOHOLIC TAINT The alcoholic taint is certainly the most unfor- tunate that can be bequeathed; yet even this, like all the others, can be fought and lived down by the heroic soul. The offspring of chronic inebri- ates are badly developed; they are likely to be undersized, morose or melancholy in disposition, or hysterical and acutely sensitive. Or they may be wonderfully precocious and manifest the highest genius, perverse though it is likely to be. They lack especially poise, these unhappy children, and are weak in attention and will power. Their be- havior is apt to be odd, tending even to the demi- 1 Normal living is the right adjustment of internal relations to ex- ternal relations. — Herbert Spencer. 2 5 WHY DIE SO YOUNG? fouSy the half -mad state. The weakness of their nervous systems may express itself in a deficient moral sense and in irresistible impulses to do wicked things. Sometimes such pathetic children become downright insane. GOOD BLOOD How delightful a volume, on the other hand, could be written on the wholesome aspects of heredity! How pleasant it would be to dwell on the splendid and exquisite qualities of mind and heart and body that are transmitted; on how in- tellectual and romantic and finely emotional apti- tudes are intensified in those fortunately born! We would turn gratefully from the consideration of baneful heredity to books of biography, which tell on every page of families through which, for several generations, there have been born great scientists, physicians, jurists, statesmen, humani- tarians, merchants, sailors, soldiers, beautiful and dear women, writers of lovely verse, painters, and the like. For but one instance among thousands — that of Sebastian Bach, whose music is so noble and so satisfying; his family, beginning with Weit Bach, in 1550, continued through eight generations to produce musicians, twenty-nine of whom at- tained real and solid eminence, the fame and the beneficence of one of whom, at least, shall never die! Marriage with an individual of bad blood, then, will tend to drag down an inheritance of good blood ; imbecility is thus often introduced into "bloodlines" that have hitherto been good. One's inheritance cannot always be judged from a consideration of 6 INFANCY the parents alone, for normal parents may have abnormal, even criminal, children; the inheritance must be traced back for generations and the records of cousins, aunts, brothers, and sisters must be examined. One does not inherit from his parents, but from the "germ protoplasm." There seems to be no hereditary danger with regard to cancer except when the disease has been on both sides of the family ancestry. Certain of the disease tendencies we are born with do not manifest themselves in infancy, or in childhood, or even in youth. Tuberculosis, as we shall pres- ently see, is here an exception. They may be latent, some of those tendencies, until past two- score, when they take their part in the degenerations and abnormalities which we shall consider in the latter part of this book. It remains now to consider the possible parental transmission of infectious diseases, such as have germs for their specific or essential causes. Of these we must here emphasize two, by reason of their enormously deterrent effect on the happiness and the well-being of mankind. "blood disease" Perhaps the most dreadful of all hereditary diseases is that which is probably referred to in the Scriptural commandment relating to the sins of the fathers that shall be visited upon the children unto the third and fourth generation. Children thus miserably affected oftentimes die sadly enough — and yet fortunately — in infancy. If they con- tinue to live they are likely to be weaklings, to WHY DIE SO YOUNG? grow up with poor constitutions, to develop slowly in both mind and body; their teeth are likely to be very poor and late in coming; they may be born deaf and they may have eye troubles, may even be born blind. They may be deformed; they may have the various stigmata I have thus far men- tioned; and others which were better stated by the family doctor than dwelt on here. Nor may such stigmata appear until the child, in its turn, has reached maturity, becomes venerable even. And then, instead of a hale and hearty old age, spent with ease and dignity, these stigmata may, all belated, appear and bear the gray head in sorrow to a premature grave. 1 Anyone who wants to get the full force of these observations should go to see Ibsen's "Ghosts," a play perfectly well founded on fact. TUBERCULOSIS The parent almost never transmits the germ of tuberculosis, or consumption, to the offspring; but the tendency, the predisposition to consumption, is often transmitted. Such being the case, marriage of the tuberculous should be most earnestly depre- cated, certainly while the disease is active in the system. Especially for her own sake, without respect to possible offspring, should no tuberculous woman be permitted to marry. In her case there is ever the possibility of death in childbirth, the probability — should that crisis be survived— of physical wreck and death by lingering stages sub- sequent to the birth. When consumption is hang- 1 1 should have been called in this case fifty years ago. — An eminent consultant. 8 INFANCY ing about a girl the distance between the marriage bed and the grave is usually short with her; the husband, if he does not become a widower soon after the birth of the first child, may count upon a perpetually ailing wife. And as to the other side of the distressing picture, "Many a young man has sacrificed his chance of recovery on the altar of Hymen." A consumptive should not marry a person in health, especially if this disease has existed a long time and is progressive; besides, a latent and com- paratively innocuous tuberculous "spot" or area in the body may, through marital stresses, develop into an active and fatal lesion. But should no one who has ever had consumption marry? May no one who has been consumptive and who does not thereafter evidence the disease venture upon this blessed step? Emphatically, there should be no marriage while the disease is in the slightest evidence. However, after there has been what the doctors term a relative recovery, after the disease has been for two or three years arrested — that is, practically cured — if there are no discoverable symptoms and a satisfactory gen- eral condition is manifest, marriage need not be objected to. If a man be financially fortified against the possibility of poverty or of undue worldly stress, and if his wife make no undue hymeneal demands upon him, he may be better off married than a bachelor with all the unhappi- ness contingent upon that lugubrious state. On the other hand, a woman may be much more seri- ously harmed by marriage than a man, because of the greater taxes upon the feminine physique. WHY DIE SO YOUNG? For wifehood a woman should ever be strong and fit, not only for her own sake, but also for that of her offspring, and we are at present especially concerned with the latter. The disease in the mother is very likely to assume its most acute form after her confinement; and it then proves rapidly fatal. Multiple births should especially be dis- couraged for such mothers. During the months before birth the infant's body cells are becoming differentiated for their several offices, and the organs are formed, increase in size, and begin to take on their allotted functions. It is during this season that the organism of the coming babe is most acutely sensitive to its own and peculiar environmental impressions — such as variations in the oxygen sup- ply, or in the warmth and constitution of the mother's blood. Several months before the birth, therefore, the mother should be safeguarded even more than ordinarily; she should be assured whole- some diet, sensible and hygienic clothing; should rest well at night, and for an hour after lunch; have frequent baths in tepid water — and like familiar measures should obtain; especially should she be subjected to no unusual mental strain or excitement. SCROFULA Even so, the child may be born with the tendency to tuberculosis; it may be scrofulous, as the older medical writers used to term the condition. The child, be it understood, is not tuberculous — not yet; because parental transmission of the tubercle bacillus — the essential germ of tuberculosis — is most rare; the tissues of such a scrofulous child, however, 10 INFANCY provide an all too congenial soil for the post- natal implantation of the specific germ. Such scrofulous children are born weak and sickly. Their skin is pallid, their flesh flabby; inflamma- tions which tend to a sluggish course and are diffi- cult to heal occur on the slightest provocation in the mucous membranes. And so they have sore eyes, these poor infants, coryza, sore lips, mouth eruptions, congested and unhealthy throats, ob- stinate bronchitis, stomach and intestinal dis- orders. The lymphatic vessels and glands are easily involved; the glands in the neck become prominent; there are adenoids, and enlarged or otherwise diseased tonsils. Such infants are slow teethers; ansemic (weak-blooded), mouth breath- ers, starved for oxygen; all the bodily processes are torpid and inadequate for the needs of the frail economy. There may be scrofulous chest malfor- mations, pigeon or keel breast; bone disease re- sulting in hunchback; stunted and wizened growth; breathing capacity below the average; deficient de- velopment of the circulatory apparatus; perhaps an undersized heart. THE RECTIFICATION OF CONGENITAL DEFECTS Rectification to the normal average may be im- possible. Nevertheless, very much indeed can be done by the steadfast co-operation of the parent, the doctor, and the nurse to mitigate abnormal conditions, not only for the child itself, but also in order to avoid baneful effects upon future gen- erations. Here we have for our comfort the dictum of the evolutionists that Nature does her best to 11 WHY DIE SO YOUNG? compensate for the sins that are committed against her beneficent courses, and to bring the abnormal individual back to the normal of its type. Nature does also what may appear a cruel thing, but which is in reality a very blessed course, both for the de- generately born infant and for the whole race as well. The unions of depraved parents are for the most part unproductive, while most of the off- spring of epileptics, imbeciles, and the like are either stillborn or they die within their first year. Thus does Nature attend to our devolutionary mis- adventures without the help of reformers and legis- latures. It is also encouraging to recall that func- tional aberrations from the normal, while more likely to be transmitted than anatomical stigmata, are nevertheless more amenable to treatment. Although there may be, fortunately, no definite anatomical stigmata, the "pernicious nutritive habit" may be transmitted; and this it is the business of the physician, the parent, and the humanitarian to detect and to combat. Such in- fantile sufferers will have to be kept under con- stant observation, not for weeks or months, but for years. These statements, while applicable directly to tuberculosis, are pertinent also to other diseases and disease tendencies transmitted by the parent. I, for my part, feel very strongly regarding the aspects of heredity I have thus far dwelt upon. What physician of long practice and experience, have he but a minimum of humanity and of sympathy for his kind, can be callous in these premises? And therefore I dwell a little further on the subject. Long before Galton and Darwin and Mendel 12 INFANCY has abnormal psychology fiction been, with fair accuracy, based on such facts as we have here been considering. As in The House of the Seven Gables, "We sleep in dead men's houses; we are sick of dead men's diseases; we live in dead men's lives. The past lies upon the present like a dead giant's body; and it is as if a young giant were compelled to waste his strength in carrying about the corpse of an old, an atavistic giant." Read also the novel, Archibald Malmaison, by Julian, Nathaniel Hawthorne's equally gifted son. And as, on the other side of the picture, the ancients maintained their Three Fates, whom no child born of woman could hope to withstand, we moderns have also our Three Fates — Heredity, Environment, and Function — all three most power- ful factors in shaping our individual destinies for better or for worse. But we recognize also the divine gift of the human will. Is the heredity bad? Marvels may be, are every day, performed, when the will to live well, seeking and finding the right environment, determines furthermore upon a wise subordination and a steadfast regulation of, the bodily functions. Thus will the resolute will, the prayerful will, fight down successfully almost any vicious inherited tendency. IMITATION The question of the proportionate relations of heredity, environment, function, will, and other factors in the development of the individual, fur- nishes never-ending controversy. Some tell us that heredity counts for everything, and that, not J? WHY DIE SO YOUNG? being blessed with the superlative brand, one is as good — or as bad — as foreordained to perdition. Others lay all stress on environment; others are altogether for other factors. "When doctors dis- agree who shall decide?" and the doctor who is writing this has neither a valid position to advance nor an inclination to further befuddle the issues. I am wondering, however, if the factor of imitation may not have something to do with the case. I talked recently with an orthodontist who main- tained that heredity had very little to do with queer features and homely jaws and crooked teeth. I reminded him that families are known through many generations to have had family character- istics — the Hapsburg chin, for example, which is as typical in the present king of Spain as it was in his forbear, Philip the Second, several centuries ago. I have seen a book on that subject which gives many portraits of men and women in the Hapsburg family, every one of them big chinned. But my friend declared that my instance proved nothing; that imitation was here at work and not heredity. WHiat infant, seeing big-chinned people constantly about it, would not exercise its basic faculty of imitation, would not be constantly working its plastic baby chin, so as to have it cor- respond with the biologic chin scheme constantly presented for its observation and becoming part and parcel of its experience? Give a baby a bull- dog for a companion and it will sit for hours trying to imitate the ugly, though amiable and sociable, jaw of its pet. The same with the Teddy bear, which is so perverse a substitute for the girl baby's doll. Thus contended my orthodontist friend. And 14 INFANCY if he is right as to facial expression, may not his view be equally valid for the thousand and one characteristics babies are maintained by many facile scientists to be born with. WHO ARE THE FIT? Another consideration in this place. The ques- tion is proposed by some: "Would it not be better for the race in general if its weaklings were left to die off — humanely, of course — soon after their birth? Are not the efforts of doctors and nurses, of parents and humanitarians, to preserve the lives of sickly infants really misdirected, in that they violate the Darwinian law of the survival of the fittest? Is not the presence among us of the weakling an additional, an unfair, and a useless burden upon the strong, and a handicap upon the fit in their development, and their progress? Were not the Spartans wiser than we in throwing to the wolves their unhealthily born babes? Were they not right in considering that the claims of the individual and of the race involved a contradiction that could be wisely disposed of in but one way; that to save a sickly infant would be contrary to communal hygiene, the ultimate object of which should be the improvement cf the race? The error in such argument appears to be in considering that this tenet of the survival of the fittest is to be taken only in the physical sense; whereas, if it is to have the slightest value in philosophy, it must be indicative of evolution in all its aspects. Evolution, to be a philosophy worthy the name, 15 WHY DIE SO YOUNG? must be an all -comprehending system, upon which consistent living can be based; it has got to con- sider not only the merely material, but all other phases of life as well — the mental, the moral, the emotional, and the spiritual — an evolution inclusive of the humanities. For no philosophic doctrine is surer than that the physical, the mental, and all other phases of existence are inseparable and mutually affecting and affected parts of the in- dividual being. The coldest political economists, the most practical statesmen, will grant this, as well as those most susceptible to the emotional — at least they will if they are men experienced in dealing with human conditions at first hand. On such basis, then, a sympathy for the weak and the afflicted, and a helpful endeavor for their return to health and strength, is altogether logical; other- wise the conclusion were inevitable that civiliza- tion, the iville zum guten, altruism, and, of course, Christianity, have been and are now colossal blunders, and worse. Who would indeed have the hardihood to take it upon himself to discriminate, or to select from among his fellow humans the "fittest" for survival? How many a man, how many a woman, who has later in life given substantial comfort to others, has yet been unhealthily born, and has had his or her infant life hanging, month by month, by a thread, until the scale has been turned existence- ward, with results most beneficial to our kind! How many a weakling, having triumphantly grown to manhood and womanhood, has made great im- pression upon our civilization, to the universal good and profit! 16 INFANCY Dr. Elizabeth Blackwell, who never married, and who desired to adopt a child, visited an asylum to this end. They showed her many children. She looked them all over very carefully, and finally selected the most unpromising and an apparently vicious little girl, explaining her choice thus, "I will take this one because I think she needs me the most." And it would make your eyes well up to read how superabundantly she was repaid with the undying affection and devotion of the "out- cast," who grew up into splendid and most service- able womanhood under the fostering care of that "beloved physician." Have you ever heard of Smiling Joe, who, having Pott's disease of the spine, lay for two years on his back, strapped to a surgical frame, so that he might not die of bone consumption; so that, in any event, he might not grow up a hunchback? Had not this sick tenement child better have been left to perish; or, speaking by the book, had he not best have undergone elimination in the process of the survival of the fittest? Well, by just lying on his little back, and smiling unflinchingly through all his sufferings, by keeping on smiling the smile that just would not and could not come off, tenement Joe effected more than most of the able-bodied among us have ever hoped to do or have ever achieved. Principally by pub- lication throughout practically the whole of civil- ization, of a picture of his winsome little face, of his enduring smile, and cf his patient little body strapped to that frame, a quarter of a million dollars was collected, with which a hospital for 17 WHY DIE SO YOUNG? tuberculous children was built, down by the sea- shore, within the metropolitan bounds. AN ARISTOCRACY And yet the infant should start life as little handi- capped as possible. Most true is it that every child has the inalienable right to be born pure- blooded, and disease and deformity free. Its hered- ity and its environment cannot be any too much in its favor. And from its first cry its functions should be as well ordered as possible, if it is to live rightly throughout its Seven Ages. The situation has its social aspects. And it is most refreshing to observe the efforts that are now making for the welfare — ab initio — of the children of our people: for example, the work of the Children's Bureau of the Department of Labor at Washington, which reports the existence of an aristocracy at Brockton, Massachusetts — one into which one may not hope to climb — into which one has to be born. Only babies who can meet five requirements can boast of belonging to that inner circle. First point: The baby's father must have been earning, and must be earning, a comfortable living wage. In this circumstance alone are one's chances of healthful longevity — an essential to any aris- tocracy worth while — greatly improved. And de- spite all that may be advanced to the contrary, poverty and want are dreadful restrictives of mental and physical completeness. Fifty -five per cent of Brockton's babies were blacklisted because their fathers' earnings were below the admission stand- ard, according to which one's layettes must be of 18 INFANCY a certain prescribed quality; according to which the perambulator in which one is chauffered to five-o'clock milks must be of something above the H. F. or common make of car. The Children's Bureau shows that when fathers earn above $1,000 a year, the deaths of the babies average 60 per 1,000; when they earn from $850 to $1,000 the average is 95; when they earn from $550 to $850 the average is 120, and with those who earn under $550 the average baby death is 160 per 1,000. Second point: The baby's mother must not have been gainfully employed during either the year before or the year after its advent. Of course, this is to give up the fundamental woman's right to contend with the mere male in his own field, regardless of her so manifest physical disqualifica- tions, or of the race's bitter cry for the natural development of its individuals. And yet, if we are to avert universal disaster, we have got, once and for all, to reach a decision: Which is it to be, natural mothering or race degeneration? mother love or a rotting civilization? Well, any baby in this aristocracy (and there is in all the cosmos no tyrant that demands and will have so much as a baby) has the right to cast the aspirant into outer darkness, saying: "Your mother has no business working in a factory or wearing herself out over boarders. She should be as my mother, who gives all her time to taking care of me. And goodness knows, she is at it day and night — and sometimes father, too — at night, any- way. No, clearly, you are not eligible to our set." The Children's Bureau notes that the mothers of less than one-fifth of the Brockton babies were 19 WHY DIE SO YOUNG? gainfully employed during some part of their babies' first year, though none of them should have had to work that way. The count is better than in neighboring New Bedford, forty among one hundred of whose mothers worked away from home to sup- plement the family income. On the other hand, New Bedford must be presumed to boast with pride of considerably more hard-cash prosperity to offset her Gradgrinding of maternal flesh and blood. Third point: The baby's mother must have had at least fair medical care when it was born and during her confinement. The care of the new- comer must have been foreseem and its nurture arranged for long before its advent. Expectant motherhood must have been honored and its just dues provided for. Fourth point: Both father and mother must have been able to read and write. Of course, the illiteracy test for the parents will, at first sight, ap- pear in itself to be about as absurd as if we were to expect the baby to be born reading the Commen- taries of Julius Caesar. And, of course, wonder- fully fine babies were born some several hundred thousand years before anybody ever knew how to read and write. And yet modern social and eco- nomic conditions are such that this requisite estab- lished by the Children's Bureau for inclusion in any baby aristocracy is justified by reason that invaluable sources of sanitary and hygienic in- formation are likely to be closed to illiterate parents. Fifth point: The house the baby is to live in must have been and be well- ventilated, clean, sani- 20 INFANCY tary, and not overcrowded. The greatest Brockton infant mortality was found in the most squalid and congested homes. The baby who would qualify for the Brockton aristocracy must not be of a family the whole of which occupies but one room and which takes in others beside the family to live with them. These five considerations have been required cf any baby who would be of the infantile haul ton, because the Bureau's study of some 25,000 babies has proven their worth in saving babies' lives. SICKLY INFANTS A weak and consumptive mother should not nurse her infant. There is little likelihood of her milk itself being infected; there is much more likelihood of the infant being infected by the mother's cough as it lies upon the breast. But the milk of such a mother is not, in general, sufficiently nutritious; besides, lactation is a great drain upon her already depleted strength. Recourse must then reluctantly be made, for the reasons we shall note, to modified milk of the cow. Such modifications should conform to the individual infant's needs; the proportions of the various ingredients, milk, limewater, sugar of milk, cream, and perhaps cereals, must be proportioned according to the "symptom complex" presented by each infant. The matter is thus pre-eminently within the family physician's province; wherefore it is not dwelt on here. Artificially fed infants — that is, babies fed on the bottle — are specially prone, in the hot and humid 3 21 WHY DIE SO YOUNG? summer months, to dysenteries, to inflammations of the digestive tract; for these ailments the germs multiplying in cow's milk are almost entirely responsible. For such ailing infants and, indeed, for most suffering babies and little children, of whatever infection, and the convalescent from disease, sea air is most beneficial. Infants and children are indeed peculiarly bene- fited at the seashore. Children having the kind of tuberculosis peculiar to their months and years, the conditions we have mentioned, and also the bone, joint, and gland tuberculosis — the white swellings, or cold abscesses of bone and joint — are especially apt to get well, in most cases, without operation. Many an infant you would not believe had another hour to live improves within that very hour of its arrival, and is cured as by a miracle. Thus there are many blessed hospitals for such children along our coasts. Not only are the winds of the sea germ free (most diseases are germ- induced), but this air of heaven is also saturated with the iodine, the sodium, and the other halogen, healing salts, from the breaking of the waves and the dashing of the spray upon the beaches. The crisp saline odor from the evaporation of the ex- tractives in sea water is strongest during a storm, when the billows dash tumultuously upon the sea- weeded rocks. Besides, the shore air, being under more pressure than at high altitudes, contains more oxygen in its more concentrated form of ozone. And the effect of sunlight on animal life, when not abnormally intense, is directly invigorating. When, then, with this is combined the constant inhalation of salt air, and salt water to the whole body in the 22 INFANCY bathing of the infant and child, nothing but health- ful results are likely to be forthcoming. DIET OF THE NURSING MOTHER The diet of the nursing mother should at all times include abundant fluids, in order that the breast secretion may be active. The amount of fluids needed is much larger than that furnished by the ordinary diet, and their administration should be begun as soon after childbirth as the stomach will retain them. They add to the moth- er's comfort and flush the body, through the kid- neys and the skin, of much effete matter that would otherwise pass into the mother's milk, disturbing the child. On the first day the mother should have at frequent intervals, water, milk, and gruels, and, if necessary, mutton or chicken broth. On the second day, nutritious fluids and simple semi- solid foods. On the third day, when there are no complications, digestible solid food may be added. There may now be given a small amount of meat once a day. And the mother should eat abundantly of these simple, nutritious foods which experience has taught she can comfortably digest — milk, eggs, meats, cereals, fruits, and green vegetables. Tea and coffee sparingly, if at all; they are stimulants which have no milk-making properties. Tea, es- pecially, may disturb the mother's digestion and affect the child untowardly through the milk. Cocoa is excellent. Beer has little nutritive value, and this and other alcoholic beverages are pretty sure to disturb the infant. Malt extracts have some value, chiefly in increasing the fat in the 23 WHY DIE SO YOUNG? milk; at times also they increase the flow of the milk. At least one quart of milk should be drunk daily; in cases of faulty digestion it may be given heated, peptonized, or as kumiss and other fer- mented milks. Corn meal gruel has no equal in restoring deficient secretion of breast milk. It should be cooked at least four hours in a double boiler, and well salted to taste, thinned with water or milk so that it can be drunk, not eaten with a spoon. Two or three bowlfuls should be taken in the twenty-four hours. If there is any trouble in digesting it, it may be dextrinized. The latter is done as follows: Take three-quarters cupful of yellow corn meal, one quart cold water, two tablespoonfuls cereo, and sufficient salt to flavor; mix in a double boiler, bring slowly to a boil (to allow the cereo to act) and cook for two or three hours; strain, and take plain, or mix with equal parts of milk, as preferred. WEANING The infant is weaned about the twelfth month; or a month or two later, in the cool of the autumn if it has attained its first birthday in the hot summer. Cow's milk must then become the child's chief pabulum. It has become, therefore, the earnest task of physicians, municipal authorities, and philanthropists to secure the purest possible cow's milk for family consumption. Thus in some cities milk for infants is required to be certified. Or there are specified grades, A, B, and C, the first grade only being proper for infants and little children. And like methods of assuring milk purity are for- u INFANCY mulated in other communities. 1 Practically all milk intended for family use is now pasteurized. This is likely to become a process universally re- quired for rendering milk a safe fluid. PURE MILK No one who could afford to do otherwise should buy loose milk — that is, from the can, or taken home in pitchers. Bottles of milk should be wiped or washed as soon as received from the wagon and placed directly in the refrigerator. The latter should never be without ice nor allowed to become warm. Milk should at all times be covered as a protection against dust and insects. It should be kept in some part of the ice box where there are no strong-smelling foods, like onions, cheese, or substances from which odors might be absorbed. The object of such precautions as these is to keep the milk clean and to retard the growth of germs in this fluid. "What measures are necessary to safeguard the purity and safety of milk? (1) The cow should be healthy, and the milk of any animal which seems indisposed should not be mixed with that from the healthy cows. (2) Cows must not be fed upon swill, or the refuse from breweries or glucose fac- tories, or upon any other fermented food. (3) Milch cows must have access to fresh, pure water. (4) The pasture must be kept free from noxious 1 Most dairy concerns now pasteurize their milk before vending it. Or this can very easily be done in the house by means of the -Straus Pasteurizer, which can be bought, if not in a hardware store or depart- ment store, of the Straus laboratories in New York City, at a reason- able charge. 25 WHY DIE SO YOUNG? weeds, and the barn and yard must be kept clean, (5) The udders should be washed and then wiped dry before each milking. (6) The milk must be at once thoroughly cooled. This is best done in the summer by placing the milk can in a tank of cold water or ice water, the water being of the same depth as the milk in the can. It would be well if the water in the tank could be kept flowing; and this will indeed be necessary unless ice water is used. The tank should be thoroughly cleaned each day to prevent bad odors. The can should remain uncovered during the cooling, and the milk should be gently stirred. The temperature should be reduced to 60 degrees F., or lower, within an hour. The can should remain in cold water until ready for delivery. (7) The milk should be delivered, during the summer, in refrigerated cans or bottles about which ice is packed during transportation. (8) When received by the consumer it should be kept in a clean place and at a temperature below 60 degrees F. * BOTTLE FEEDING IS UNNATURAL FEEDING From humankind's beginning, up to about the middle of the last century, infants were entirely breast nurtured; there was no other way. Nothing could have been more of an eternal verity than this. Some mothers, however (and the exceptions, such as the consumptive mother, were very rare, indeed), could not and cannot, by reason of disease or other abnormality, fulfill this ideal Madonna function. And it was in behalf of those mothers, thus bereft of their blessed sex right, that earnest 26 INFANCY physicians and chemists, about 1850, began to seek in cow's milk some adequate approximation to mother's milk, which would serve somehow to nourish the infant during the first year of its ex- istence. An ideal, a perfect substitute was not hoped for; and in point of truth, far from achieving any such substitute, there has been elaborated, during all these sixty -odd years, not even an ade- quate substitute. I believe that all physicians especially able in the diseases of children are of this opinion. Nor in all probability will there ever be such a substitute, by reason of the insur- mountable difficulties which nature has put in the way of the essay, by reason of the irreconcilable differences there are in the milk of various living species. Wherefore pediatrists tell us that, as a rule, bottle-fed babies get their teeth later than those nurtured on the breast — a most momentous fact, since teething goes -pari passu with the nervous system (especially brain development), with speak- ing, with jreeping, and walking. The former infants are prone to convulsions and to such aberrations from health as are likely to develop later in life into hysteria and other nervous disorders; they are listless, sallow, tending to weak-bloodedness (by reason of their calcium starvation) ; they are prone to rickets; they need far more air space than nursing infants — as much, at least, as do adults, because their bodily temperature is likely to be below the normal; nor are their organs and tissues so well developed. And they are more prone to infectious disease by reason that no substitute milk can sup- ply certain subtle immunizing principles which are 27 WHY DIE SO YOUNG? inherent in mother's milk. Nor is it possible ever to get absolutely germ-free cow's milk, even under the most favorable circumstances. But artificially fed infants are oftentimes fat. So are beer drinkers fat — unhealthily fat, too. An infant fattened on artificial food may be actually starving with a body that may be likened "to a large showy house built with very light timbers, all ready to collapse under the slightest strain." These things and many more to the same effect do earnest and anxious children's doctors tell us. Think of it! Twenty times as many bottle-fed babies than breast fed are prone to the "summer complaints" and the dysenteries; among the former ten times as many such pitiful little sufferers die. During the first year of their helpless lives three times as many die of the various diseases to which infancy is subject. In a comparative study made in one city, a very small percentage of those who had in infancy been artificially fed were found alive after their twenty-first year. Dr. Thomas South- worth, so devoted and so able in pediatrics, has stated, before a medical society, that nowadays 60 per cent, of all mothers cannot, or think they cannot, or are led to imagine that they cannot, or just crassly and obstinately will not, yield to the yearning of the infant, with no language but a cry, for the breast of the mother who bore it. Such a mother bewailed to a great physician — whose temperament was a trifle short as to diplomacy — that it had pleased Providence to take her infant from her. He told her bluntly that she had no right nor reason to lay the blame on Providence. Providence had had nothing at all to do with the 28 INFANCY wretched business. It was not the Deity, but her own abominable perversity, aided and abetted by bad milk, that had killed her baby. And yet there are people so blind, iso fatuous as to expect that this twentieth century of ours is going to evolute a super race! Think deeply for a moment of the relation in which maternal nursing stands to the welfare and the future of our kind. The mother's organism is in the most intimate union with that of her infant. The normal exercise of the nursing function does indeed not only develop the infant normally, but the fortunate mother as well and as beneficently, emotionally, spiritually, intellectu- ally, in every possible way that is natural and ra- tional. And all this through the warmth and the close bodily contact, the caresses, and the constant play of mother and child, the tiny hand creeping confidently about the mother's neck. Who can, who dare estimate the part played in the molding of the child's character, to the infinite benefit of the individual and of the race, by the sweetness of the mother's smile, which her infant's first visual impressions receive, by the comfortableness, the lovingness, the cherishing, expressed in the maternal countenance? A PRECIOUS POSSESSION And what possession has a really human mother more precious than the babe at her breast; what more dreadful to such a mother than its loss? There is a picture — everybody has seen it in print shops — representing a young mother of the poor, clad in a cheap shawl, weeping over the corpse of 29 WHY DIE SO YOUNG? her firstborn. I have myself seen that picture in the very life — and death — a haunting memory in- deed. It was in a squalid tenement. There was nothing in the room save a kitchen table on which the dead baby lay; and close to the table was a rickety chair on which the mother sat. Absolutely nothing else. I had knocked several times at the door and had received no answer. Then I went in. Just as in the painting sat the young mother, hugging that rigid little body, its baby head so endearingly shaped, constantly kissing its thin, waxen hands, crying convulsively so that the tears ran down her cheeks and upon her baby's face, while she talked to, even crooned to, the little creature she had borne, for which she had so willingly suffered; cuddling it to her breast and begging it to smile, as she had coaxed it to in the life, doing the things good mothers love to do with their infants. The tragedies of the ancient Greeks and all others im- agined since paled in significance before the one before me, while I stood speechless, reverential, and, to speak truthfully, frightened. And I turned away unnoticed, and left the room, closing the door upon that profoundest and most mysterious of all human tragedies. n CHILDHOOD "Then the whining schoolboy, with his satchel And shining morning face, creeping like snail Unwillingly to school." THE UNIVERSAL PARAMOUNT I NOW beg to introduce the most important sub- ject in the universe, barring none. By giving it the respect to which its momentous nature entitles it, by maintaining the standards it connotes, the superman and the superwoman will be assured, most of the physical evils suffered by mankind will be abolished; and since practically all the world's miseries come about by reason of individual departures from the normal, most of the dreadful perversities we read of every day in our news- papers will disappear, along with the need of courts — children's courts, domestic relations courts, crim- inal courts; and life from the beginning to its end, a century or near a century off, would be for all of us, anyway for most of us, just one grand, sweet song ! I am of course referring to baby's right, normal and healthy development from its birth up to its fortieth month. This assured, the baby, thus hardened and rendered resistant to evil, both as to its mind and to its body, is likely to journey along life's path not in sorrow and in travail, but safely 31 WHY DIE SO YOUNG? and pleasantly (tute et jucunde, as the physicians of another generation used to say), until it reaches its second childhood, at least. And if this is not the most important subject in existence, I would be obliged to any philosopher, political economist, socialist, feminist, or mere man on the street, who could convince me that there is one more so. Let us, then, consider baby's development, month by month, beginning with the first so pathetic and so momentous cry by which it takes into its several pounds of body the physical breath of life. First month: Baby is sensitive to light the first or second day; about the eleventh day it takes pleasure in candlelight and in bright objects; the fourth day it hears; during the second fortnight it discriminates sounds; it starts at gentle touches the second and third days; it shows sensibility to taste about the end of the first week; strong- smelling substances produce mimetic, grimacing movements of the face the first day; during the first few days it evinces pleasure in nursing, in its bath, in the sight of agreeable objects; on the other hand, it can evidence discomfort from cold, wet, and tight clothing, nor can any words be more unmistakable nor more eloquent than the expres- sion of its sense of outrage by reason of delayed alimentation; on the twenty-third day it can ex- hibit tears; on the twenty-sixth day — mark that blessed date in the calendar — it smiles; within the first month it can utter vowel sounds; the memory as to taste and smell is first active, then, in order, come touch, sight, and hearing; the movements of the eyes are not as yet co-ordinated, and no mother need worry at this time if there is squint; the re- 3i CHILDHOOD flexes begin to be active; baby sleeps two hours at a time and sixteen out of the twenty -four. Thus far sleep and pabulum make up its main interest in the universal scheme in which it will later play so important a part. Second month: Squint is occasional until the end of the month; baby now recognizes human voices, turns its head toward sounds, is pleased with music and with human faces in general; sleeps three, sometimes six hours at a stretch; laughs from tickling at eighth week; clasps with its fore- fingers at eighth week; first consonants about the fiftieth day, as am-ma, ta-hu, gooo, ara. Third month : Cry of joy at sight of mother and father, about sixtieth day; eyelids not completely raised when it looks up ; accommodates its eyesight to light and distance at ninth week; notes the tick- ing of a watch at ninth week; listens with absorbed attention. Fourth month: Eye movements are perfect; objects seized are moved toward the eyes; grasps at objects too distant; enjoys seeing itself in mir- ror (girl babies exhibit this phenomenon earlier than do boy babies); can grasp with thumb and contrapose to hand at fourteen weeks; can hold up head by itself; sits with back supported at four- teenth week; begins to imitate. Fifth month: Discriminates strangers; looks in- quiringly; takes pleasure in crumpling and tearing newspapers; rings a bell with zest; likes to pull hair; has been known to pretty nearly 1 , if not altogether, eviscerate an adult ear, or uproot a mustache; can sleep ten to twelve hours without food; desire shown by stretching out hands and arms; seizes 33 WHY DIE SO YOUNG? and carries objects to mouth; enlarges its vocabu- lary with the consonants I and k. Sixth month: Raises itself into sitting posture; laughs and raises itself and drops arms when pleasure is great; crows with pleasure; compares image of father with original. Seventh month: Astonishment shown by open mouth and eyes; recognizes nurse after four weeks absence; sighs; imitates movements of head and of pursing lips; averts head as sign of refusal; places itself upright on the lap. Eighth month: Is astonished at new sounds and sights at imitations of cries of animals. Ninth month: Stands without support; shows increasing interest in things in general or, in evo- lutionary parlance, begins to get in touch with its environment; strikes hands with joy; shuts eyes and turns head away when something disagreeable is to be endured; fears a dog; turns over when laid face downward; turns head to light when asked where it is; understands questions before it can speak; its voice becomes more modulated, though losing none of its potency or carrying power. Tenth month: Sits up without support in bath and carriage; first attempts at walking in forty -first week; beckoning imitated; misses parents in their absence; will miss a single ninepin in a set; cannot yet repeat a syllable heard, but exhibits no little talent as a monologist, as: Maa, pappa, tatta, apappa, baba, tataa, rrrrrr rrrrraa. Eleventh month : Screaming is quieted by " Sh " ; sitting becomes a habit; stands without support; stamps; repeats syllables correctly; begins to whis- per; enlarges its vocabulary; can utter b, p. t, d, m, 34 CHILDHOOD n, r, I, g, k; vowel a most used; u and o rarely; % very rarely. Twelfth month: Pushes chair; cannot as yet raise itself or walk without help; obeys the com- mand, "Give me your hand." Thirteenth month: Creeps; shakes head in de- nial; says "papa" and "mama"; understands some spoken words. Fourteenth month: Can walk without support; raises itself by chair; imitates coughing and swing- ing of arms. Fifteenth month : Walks without support; laughs, smiles, gives a kiss by request; repeats syllables; understands ten words. Sixteenth month: Runs alone; falls rarely. Seventeenth through nineteenth month: Sleeps ten hours consecutively; associates words with ob- jects and movements; blows horn; strikes with hand or foot; waters flowers; puts stick of wood in stove; washes hands; combs and brushes hair, with other imitative movements. Twentieth to twenty-fourth month : Marks with pencil on paper; whispers; executes orders with surprising accuracy; dances to music; likes to sing and beat time. Twenty-fifth to thirtieth month: Distinguishes colors correctly; makes sentences of several words; begins to climb, jump, and ask questions. Thirty -fifth to fortieth month: Goes upstairs without help; applies sentences correctly; forms clauses; speaks words distinctly, but the influence of dialect is apparent; approximates its manner of speech more and more to that of the family; ques- tions and questions and questions until the fond 35 WHY DIE SO YOUNG? parent is like to succumb to psychasthenia, if not prematurely to senile dementia. The parent, by comparing this schedule of the ordinary, the average child's development with that of his or her own will, of course, find the latter far the more advanced. Possibly, however, there may appear here and there traits a trifle backward. But such backwardness has frequently been ob- served in infants which later in life have developed normally enough and with perhaps more sure and solid growth than the ordinary. And yet, if there are any definite departures from the normal as to sensations, perceptions, ideation, and speech, it would be well to draw these to the family doctor's attention, so that right development may be se- cured without delay. THE HEALTHFUL HOME Something now as to the home in which the child is to be brought up. It is not so much money as it is intelligence and determined action that make for safe, sanitary, wholesome dwellings, housing contented and healthy families. The first consideration in choosing a home should be as to its salubrity; convenience and other items should be secondary. Especially to be chosen is a locality where pure air and sunshine can be had, where there is no marsh, no damp cellar or bad smell. Pure water must, above all, be assured. When Abraham went down to live among the Philistines his first step was to dig a well; before everything else he provided that he and those for 36 CHILDHOOD whose lives he held himself responsible should have an abundance of pure drinking water. Sunshine colors the cheeks of children as surely as it does the skins of apples. It shows up dirt, so that frequent cleansing is necessary. And with fresh air, it is the best of all disinfectants, destroy- ing the dirt the mother cannot see, the microscopic dirt — that is, the disease germs. Sunshine and sanitation go ever hand in hand. Sunshine saves fuel, too. Rugs, by reason that they can be fre- quently renovated, should be substituted for carpets. We make laws for factories, shops, schools, and lodging houses with regard to fresh air, ventilation, the amount of space for each occupant. Are we going to do any less for our children than the police enforce in behalf of the lodging-house vagrant? Other vital home sanitation matters are drainage, plumbing, the disposal of garbage and of domestic waste, dust, insect enemies, ventilation, kitchen and other arrangements. Having moved into a healthful home, the average citizen needs to inform himself about ordinary sanitation, and that sufficiently to avoid for his family the risks of suffering and disease. The best homes speedily become unheal thful if their inmates are unclean in their personal habits. Unless the question of cleanliness is courageously dealt with in families, by sanitary authorities and by legal methods, no great headway can be made in securing the prime need of our time, healthful housing conditions. THE AIR WE BREATHE A plenitude of pure air is essential to right living, from the cradle to the last respiration. For 4 37 WHY DIE SO YOUNG? weeks we may live without food, days without drink; but no more than a minute or two without oxygen, the essential ingredient of air. This life- maintaining gas, when combined with food and water, makes heat; and that is why the sentient body is generally warmer than the atmosphere. All animal and vegetable life depends on oxygen. Under the sun's benignant influence plants give out this gas, which, thus freed, is respired by animal life. Our blood capillaries carry it to our organs, to our uttermost tissues and cells; and thus do we receive power and warmth and health — in fact, life itself. The Almighty " breathed into his nostrils the breath of life, and man became a living soul." Every room, therefore, in the home, living and sleeping rooms alike, should be thoroughly venti- lated. Air motion, its coolness, purity, and fresh- ness, with a moderate degree of humidity, are the essentials. A gentle draft should always be aimed for; Nature generally arranges for the right cross currents outdoors. And we would have them naturally in our houses if we but allowed her freedom of action by opening wide our windows all the time in temperate weather, and some of the time, at least, in very inclement weather. A strong draught is deleterious to the health of the most of us, cave dwellers as we are; those inured to draughts suffer no harm from them. A famous physician who had achieved his cure from the tuberculosis he had suf- fered, while visiting a college where he was to give a lecture, sat in his shirt sleeves before an open window on a very cold night, welcoming the blasts, until one by one his entertainers, abjuring their 38 CHILDHOOD host duties, left him in ultimate and magnificent isolation. Moderate coolness of the air is most desirable. Air in motion is cooler than stagnant; at any rate, it seems so. Pure air is as dust smoke and germ free as possible. Fresh air is changed air; air that is constantly rebreathed soon becomes poisonous. And indoor air, by the way, is not necessarily pure because it is cold. In the wintertime house air is likely to be unduly dry. A moderate amount of moisture is salutary and may be attained, to some extent at least, by heating water in large pans or in open vessels. To have rooms constantly supplied with fresh air there should be an arrangement by which oxygen from outdoors is supplied all the time. A current from room to room will not suffice. Stoves, cer- tainly in bedrooms, are pernicious, being ravenous of oxygen and often emitting gases which result from imperfect combustion. An open grate or a register may afford sufficient current. We may raise the lower sash of one window several inches — never less than one inch — and lower the upper part of a window adjacent. Or the window board is advisable. The edge of this board rests on the edge of the window sill, the ends being attached firmly to the window frame. This affords a vertical surface three or four inches high and situated three or four inches in front of the window, so as to deflect the cold air upward when the window is slightly opened. It is considered that the air will then reach the breathing zone instead of flowing on to the floor and chilling the feet. WHY DIE SO YOUNG? There should be a current in the sleeping room all night long; and there will never be a night so cold that this could not be done. We could raise the lower sash six inches and fit a board beneath it, so that air will pass between the sashes. Dust- excluding nets, and like contrivances, are made cheaply to fit into these spaces. The indoor temper- ature should be between sixty and seventy degrees, never more than the latter; at night it should be much lower. Of course, draughts should be avoided until one becomes accustomed to them; this can be done by means of screens or blankets hung up. There will be no draughts when the air comes from one side only. PURE WATER The best drinking water is such as comes down to us in springs and rills from the hilltops, sparkling, cascading, silvering in the sunshine, and taking up in its passage, from the rocks and the soil through which it flows, the gases that make it the most delicious beverage ever invented. But water supplies have been known to come, in part at least, from contaminated sources; and there have been cases in which the old oaken bucket, the babbling brook, and the sylvan springs of the poet have occasioned some very prosaic suffering and death from typhoid fever and like ingestion infections. Of course, it is the duty of governments — town, city, and state — to keep water supplies pure and germ-free; but every one knows of places and times in which this function has been cruelly neglected. In many localities householders must still do what 40 CHILDHOOD they can for themselves and their children, to keep their drinking water wholesome. Boiling water will make all the germs in it harm- less, though it may remain as muddy as ever. From the sanitation viewpoint, the latter is not objectionable, but boiled water is insipid, because all the natural gases that make Adam's ale so precious a drink bubble out in the boiling. The palatability of boiled water can be restored by aerating it; water is also purified by distillation followed by aeration. When and where there are epidemics of water- born diseases and no guaranteed system of water filtration exists, the water for drinking and cooking purposes must, for the average citizen, be boiled (with or without aeration), or passed through domestic filters of assured efficiency. The most perfect of domestic filters are only making the best of a bad state of things. The small sand, animal-charcoal, wire-cloth, filter-paper, sponge, and cotton contrivances which are screwed on to the faucet and which let much water pass rapidly through them, are not filters at all, but simply strainers, which give a murderously false sense of security. Hypochlorite of lime (calcium; will sterilize water and make it safely potable, though it will not re- move turbidity or queer odors — which latter are best removed by filtration, and are, in any event, harmless. Our government at Washington has per- fected for our soldiers an arrangement by which the smallest convenient amount of calcium hypo- chlorite (1 gram, 15 grains) is hermetically sealed in a glass tube about the size of a fountain pen, 41 WHY DIE SO YOUNG? so that the chlorine, the sterilizing element in the compound, will remain active and potent for at least ten months, if kept in the dark, and at a moderate, ordinary temperature. The specifica- tions call for a chlorine content of 30 to 32 per cent. Such a tube can be prepared by any chemist, and should be obtainable for domestic use of most druggists at a cost, for the material, of about five cents. The contents of such a tube should sterilize from forty to sixty gallons of water. Of course, water used for cooking, being boiled, need not be thus treated; only that for drinking. The tube is easily split, at the point marked, by a file. The contents may be shaken directly on the surface of the water, or it may be added to a small cup of water and then poured directly into the large container. No stir- ring is necessary. The water is rendered typhoid, dysentery, and cholera safe in five minutes; but thirty minutes will assure a 100-per-cent bacteri- cidal efficiency. A water supply thus treated will continue potable for ten days. FOOD Next in importance after air and water comes food. Food is material which supplies energy for the bodily activities, which enters into its structure, and which so regulates the vital processes as to pro- duce and maintain health. Calories represent the energy vahie of food and the energy requirements of our bodies. One adult's requirements vary from 2,300 to 3,500 calories the 42 CHILDHOOD day — less for the desk worker, more for the manual laborer. Vitamines are substances existing in whole-grain cereals, fruits, vegetables, brown rice, milk, etc. They are essential for the growth and the regula- tion of the bodily processes. They are found in cereals and vegetables in or near the husk or skin; hence the importance of not wasting those essential food parts. Protein is the foodstuff necessary for building the muscular tissue. It abounds in lean meat, milk, white of egg, wheat, cheese, beans, etc. Protein also furnishes heat and energy, but not to so great extent as the carbohydrates and fats. Carbohydrates are starches and sugars; they are found mostly in cereals, vegetables, and fruits. Fats are found in butter, cream, oils, and bacon; they also supply energy and heat. An excess of them helps for an energy reserve in the body. Under Appendix A will be found the right dietary for a child from the time of weaning on. HARDENING In our concern for the right development of child life do not let us fall into the error of the naturalist who, while studying the difficulty a butter- fly has in breaking from the chrysalis, determined to help along its will-to-live by cutting through some impediments it had to contend with, so that it could the more easily free itself. And what had that unusually tender-hearted scientist accomplished by his helping? Instead of coming out strong and beautiful, the butterfly was a frail thing indeed. 43 WHY DIE SO YOUNG? The struggle of which mistaken kindness had re- lieved it was the very source of the strength of body and the iridescence of wing it should have begun life with. Ducklings also that are helped from their shells differ from those which just have to struggle out, in being stunted and puny, if indeed they do not die at once, or soon after the too kindly hand had helped them out of the egg-shell stage of their development. Dr. Abraham Jacobi, who recently passed away at eighty-nine, the Nestor of American Medicine, and whose special life work was in children's dis- eases, was very insistent on the hardening of the infant and the child; and he left directions to this end which I here epitomize: What is meant by hardening? Nothing but this; that the resistance of the child to the effect of ex- ternal influences should be strengthened. Is there a uniform method applicable to every child, no matter of what age or constitution? Certainly not; but there is one object which should be accomplished for every infant and child — the invigoration of ex- ternal circulation. The surface of a child from two to ten years measures from three to ten square feet. In and under the surface there is a lake of blood. In vigorous health this blood is in constant and rapid circulation. Within two minutes it en- ters and leaves the surface, comes from and leaves the center of circulation, the heart. Slow circula- tion in the surface retards the flow of blood in the whole body and impairs nutrition of the heart and of every organ, causing congestion, insufficient function, and, in time, disease. Rapid circulation in and under the skin, causing rapid circulation 44 CHILDHOOD elsewhere, propels the totality of blood in the child's body (from two to six pounds, according to age — from two to twelve years) into and through the lungs, in which the contact with and the ab- sorption of the oxygen in the atmosphere takes place. Now the best stimulant of the circulation in general is, besides muscular action — exercise — the stimulation of the skin by friction and cold water. A child of two or three years should have a daily cold wash, either after a warm bath, or standing in cold water which covers the feet, or lying on the attendant's lap, or on a mattress. A brisk rubbing with a wet towel one or two minutes, and with a dry towel until the surface is dry and warm, is sufficient. Older children may have a wet sponge squeezed out over them, this procedure being followed by the same effective friction; or they may be plunged into cold water — in the winter a single moment, in the summer several minutes. While in any bath the skin should be thoroughly rubbed. This rule must not become a routine, or applicable to every child. Cold water and friction require a healthy heart and a certain degree of strength. They only facilitate the reaction that should be looked for in every instance. The same healthy child, when taken sick or when convales- cent from a disease, lacks the necessary vigor, and the routine must be interrupted. A child under size and under weight requires warmer water and friction. That is why a newly born baby or an infant of less than one or two years should be spared a low temperature. That is why, also, a child whose feet, after a bath or washing, do not get so warm as the rest of the body, should be rubbed down, not 45 WHY DIE SO YOUNG? with cold, but with warm water, or with an equal mixture of alcohol and water, until the constitution is gradually improved and fortified. Adenoids and enlarged tonsils we shall presently consider. Sleeping children must have plenty of air; sleeping garments of the grain-bag construction may be provided for those who kick their bed- clothes off. All heart and lung affections should, if possible, be nipped in the bud or coped with in their weedy incipiency. Children convalescent from diphtheria, whooping cough, measles, and the like, should be carefully nurtured and sent, if pos- sible, from town — to the seashore preferably, or to rural districts, until they are fully restored. Acci- dents involving bones and joints should cause peculiar anxiety, because tuberculosis all too often results from such hurts. All young structures are less firm, less organized, and more vulnerable to disease than those of adults. The child must as early as possible be taught not to swallow its nose and throat excretions; these latter are frequently germ-laden, and may thus engender intestinal tuber- culosis, infantile paralysis, and other infections. THE SCHOOL CHILD "Give a child in my keeping, put it under my influence up to its sixth year, and though you may then take it from me forever, though I may never see its face again, I shall be content. For it will throughout its life and to its dying day abide steadfast by the training I have given it." If the religious teacher who spoke thus had doubled this formative period, the child would of a certainty 46 CHILDHOOD not depart from the path laid out for it during those dozen years. I believe the principle is tre- mendous; and of most vital consideration in this most chaotic twentieth -century civilization of ours, when all evil is supposed to be avoided and rectified by laws or through paternalism (governmental or otherwise) rather than through reverence for the home and for the family ideal. The first dozen years are the most impressionable in human ex- istence; which means that the child's destiny is developed essentially in the home, and that it were well-nigh hopeless to assure its right develop- ment anywhere else. Of course, the school and the religious teacher must play their adjuvant part. Childhood is the formative period for both the mind and the body. The ancients were right in insisting on the sane mind in the sound body; and we to-day have come to recognize fully how right they were. It is superb the things that are done nowadays to assure health- ful living in all its aspects for our school children. And many of the schools now building are remark- able for salubrity and sanitation. THE SCHOOL Dr. L. L. La Fetra eloquently maintains that the school must cultivate first, health, strength, and energy. After that should come honesty, cour- age, and patriotism. And then the ability to speak, read, and write at least the English language, to- gether with a thorough assimilation of the essentials of arithmetic. Upon this foundation all else must be built. 47 WHY DIE SO YOUNG? The most important material part of any school — public, private, or boarding — is the schoolroom, which should be well lighted, the desks so arranged that the light comes preferably from the left side and the rear, so that the shadows shall not fall upon the writing. A north light is more uniform, and is therefore desirable. The ventilation should be ample, not only through the windows, but also by means of inlets high up on the walls and by outlets low down on the same wall. There must be a good gymnasium, at least a large playground, in which the nervous system is normal- ized and the muscles toned up. If possible, there should also be shower baths and a swimming tank. The indoor temperature is 62-64 degrees for older children, and from 66 to 70 degrees for smaller children. The best method of heating is considered to be that by indirect radiation. An ideal location would be on some commanding knoll, with a grove to one side, and sufficient grounds for games and athletics. Thus would the aesthetic instincts and the love of the beautiful in nature be fostered. In cities the schools are, when possible, built facing a park. Their roofs may be used as playgrounds. There should be cloak rooms and individual lockers, so that parasitic diseases may not be communicated by clothing. Everything possible must be done by means of games, sports, and manual training to develop sound physiques. Many problems in moral and intellectual training must be referred to the play- grounds for their solution. Much physical weakness and much deformity may be relieved and corrected in the gymnasium. 43 CHILDHOOD But there must be regulation of exercise. The amount of study or muscular exertion which pro- duces normal fatigue in a healthy child may produce serious exhaustion in a child physically below par. The offspring of alcoholic or neurotic parents, the anaemic children, the mouth breathers, and those who have defects of sight and hearing, or who grow rapidly, and especially young girls who are entering the adolescent period, are very susceptible to col- lapse from overwork. Such abnormal strains are most apt to show themselves in spring, after the indoor life of the winter. Awakening unrefreshed in the morning, inability to concentrate the atten- tion, loss of memory, irritability, morbid introspec- tion, and worry are early signs of abnormal fatigue. 1 St. Vitus's dance indicates a very advanced stage of overfatigue. The arrangement of studies should be such that those requiring more mental power, as mathematics and grammar, should be taken up in the morning, when the mind is fresher. EXERCISE Dr. J. Stanley Hall strongly favors muscle culture. He finds physical training good not for the body only, but also that the very growth of the brain depends upon the right development and use of the muscular system; that our mental and moral na- tures have developed as our accessory muscles have increased in number and have grown in use; that human progress, indeed, lies in increasing the ca- pabilities of both our fundamental and our acces- 1 The days of brutally whipping children are gone; we now instead refine and whip their brains to death. — Caille. 49 WHY DIE SO YOUNG? sory muscles. And his ideas are right. The mus- cular system is best developed by exercise, and when this is judicious the child has the best chance of reaching normal adulthood. Children get such exercise naturally if they are assured plenty of time for play and decent playgrounds. And our schools and municipalities are making full allow- ance for these imperative childhood needs. SENSE TRAINING I am myself a strong advocate of accurate sense training in the school child. Any philosopher will tell you that our senses are at best not an infallible guide. And yet they are the only means by which the individual can gauge his internal relations to the cosmos environing him. Also at their very best they can appreciate only phenomena — that is, appearances. Their perceptions must constantly be corrected by innate reason, which must in its turn learn what it can from experience. "Seeing is believing;" but the belief thus founded is sometimes proved to be erroneous. Seeing, hearing, touching, smelling, and tasting, reviewed, and if necessary, having their reports revised by the reasoning faculty, will then be fairly veridical. Only from such process can facts be born — facts, the sole building material upon which valid knowledge can be constructed. The stick appears broken in the pail of water; reason, which has learned something from experi- ence, assures us it is not. Using a bright spoon for a mirror, one appears variously grotesque and outre according as he holds the spoon inside or 50 CHILDHOOD outside, up or down or sideways; but it is to be hoped one's looking that way is only appearance and not reality. Cross the middle over the index finger, roll their tips over a bread pellet in the palm of the other hand, and the sense of touch will convey the impression of two pellets; but reason, assisted by the contrary assurance of the sense of sight, corrects the impression and convinces us there is but one. A schoolboy friend of mine, desiring to kodak me, placed me on the porch of a cottage on the side of a hill, and snapped me from a dozen feet or so below. I appeared in the photograph to have elephantiasis as to my legs, a Taftian girth, and the head of a Papuan dwarf. All of which is, I hope, not true to nature. Reason must ever bring judgment, memory, and experience to bear upon the perceptions which the senses convey to the brain; by these means reason must constantly be rectifying false sense. The right sense training, during elementary education, will relieve the adult thinking faculty of much unnecessary labor. Every adult reader will recall occasions when he has been tricked by his senses. Hundreds of instances might here be cited of delusions, illusions, hallucinations, experienced by the unscientific, the unsophisticated, the highly emotional; people in whom such aberrations are not without excuse, but who might have avoided such absurdities had their mental processes been properly trained in childhood. And scientists — that is, knowers, people whose business is to know (for science means just knowing and nothing else), men proud of their powers of observation and of their wonderful at- 51 WHY DIE SO YOUNG? tainments, men prone to consider delusions, auto- suggestions, and the like, the exclusive property of geniuses, spiritualists, and people whose imagi- nations have a way of working overtime, even eminent scientists — have been the victims of psychic perturbations. As, for instance, when the tele- phone was invented, a lecturer who was giving a public demonstration of the apparatus clearly and repeatedly heard the notes of a cornet which he had arranged to be played at the other end of the wire. He declared that he heard; nor need the record be doubted. Yet none of his audience could hear the clarion notes; and for the all- sufficient reason that the cornetist had made a mistake in the date of his appointment and was not at the place agreed upon. MEDICAL SCHOOL INSPECTIONS Medical school inspections are now a matter of course in most American communities, as well as in the Philippines and in Hawaii. Physicians engaged by health boards or by departments of education, or by those agencies co-operating, call in the morning, examine such children as are found ailing by the teachers, and exclude from the school children having any kind of infection. Thus is much danger of disease to other children in the school, and of epidemics in the community averted. Childhood infections — mumps, contagious eye affections, measles, scarlet fever, and other eruptive maladies, whooping cough, diphtheria, grippe, infantile paralysis, and the parasitic skin and hair diseases are thus oftentimes discovered 52 CHILDHOOD before it has occurred to the parent at home to call in the family doctor. More than this, however; such physicians now, by periodic examination of all the children attend- ing a school, undertake to discover defects of all kinds, quite apart from any consideration of contagiousness. They search especially for un- toward nutritional conditions, heart and pulmonary disease, deformities, defective hearing, vision, and teeth, obstructed nasal breathing, adenoids and diseased tonsils, nervous disorders, and defective mentality. A card index is kept; and the parents are notified and are earnestly advised to have their family physicians correct or at least treat the children for the deficiencies or the diseases noted. Medical school inspections have given some really startling results. A Committee on Physical Welfare of School Children found that among 1,400 children 12 per cent were suffering from malnutrition; 48 per cent from bad teeth; 14 per cent from eye defects; 27 per cent from breath- ing difficulties; and much other abnormality. And upon the basis of such figures, these recom- mendations were made: There should be periodic examinations of all school children; notification to all parents, followed when necessary by a second notice and visits to inform and to persuade parents to take proper action; the enforcement of existing laws and a securing of proper authority, where this is now lacking, to compel parents who refuse to do so to take necessary steps; physical exami- nation of children when they apply for work certificates; enforcement of health, tenement-house, 5 53 WHY DIE SO YOUNG? and child-labor laws. Departments of school hygiene should be established whose duty it should be to see that school buildings are so con- structed and so conducted that they cannot of themselves produce or aggravate physical defects, and that the school curriculum should be so devised and executed as neither to produce nor to aggravate physical and mental defects. The effect of school environment upon the child — curriculum, the school building, home study, physical training — should ever be taken into account. And children should be taught hygiene, so that they will themselves cultivate habits of health and see clearly the relation of health and vitality to present happiness and future efficiency. Not only should such medical inspections be established in public schools — city, town, and village, but also in all others — private, parochial, and the like. It is a truism that the welfare and the prosperity of any nation must depend upon the health and the stamina of its people; and such health, vigor, and morale are in turn conditioned upon the well-being of the nation's school children. Nor can it be doubted that the right period and place in which to detect and, if possible, to eradicate abnormalities and degeneracies in the coming citizen are in childhood, and methodically in the schools. Such examinations are logically within the scope and the province of the governmental authorities. NUTRITIONAL DISORDERS Many school children are starved; they actually have not enough food to sustain their immature 54 CHILDHOOD bodies. Thus results anaemia — blood poverty. Many others lack the food suitable for children. Dr. Harry Campbell, a London physician, learn- ing that many children of the poor in that city were starving, determined to investigate. And he indeed found some such cases. But in most of the families he visited he found the children suffer- ing not so much from lack of food as from too much sweets and starches. Their appetites were disturbed, their digestions deranged; consequently they evidenced much anaemia and their teeth were as a rule very bad indeed. Candy is good as far as it goes, in moderation; but it provides only heat units and is not a tissue builder. Candy develops energy; it is mostly carbon, and if we were to eat candy alone we would be like a fire that must sooner or later burn itself up into nothingness. In moderation, as dessert after a good meal, candies are in their proper place. Cakes and other sweet foods are usually com- pounded of flour and eggs, butter or other fat — and plenty of sugar. They are more nutritious than candy alone, and many can consume them without digestive disturbance. But in other cases there are much heartburn and other evidences of indigestion, by reason mostly of sugar excess. Especially should children thus affected eat little of sugar, jam, marmalade, sirups, sweet cakes, and other food sweetened with sugar. Less likely to cause dyspepsia are honey, molasses, and maple sirup. In many public schools the children must either take from home a cold lunch, or they must go home, gulp down a warm meal in the good old 55 WHY DIE SO YOUNG? American fashion, and then run back to their les- sons. This is baneful during the period of active growth, when there should be plenty of wholesome food eaten, with a decent regard for the capabilities and the limitations of the digestive tract. In many schools the civic authorities have pro- vided hot lunches for the children. In some schools the children pay the cost price for those lunches. In others they either pay or, if they have not brought the money with them, the food is given them free. I personally am adverse to the latter practice; but that's another story. THE APPENDIX In a few cases the appendix is responsible for nutritional disturbances. I am not precisely urging that every infant should have its appendix removed, along with having drops instilled at its birth within its lids, so that it will not develop sore eyes, and being vaccinated against smallpox, and being inoculated against possible typhoid fever, and getting a preventive dose of anti- meningitis serum, also one against whooping cough, and having a prophylactic dose of diphtheria antitoxin, and undergoing a lumbar puncture against the contingency of infantile paralysis, and having its tonsils clipped off and its adenoids scooped out, and so on and so on. I should, however, just like to observe that infants have had appendicitis before they have been born. Nor is the disease so very infrequent in children under two years. That pre-eminent surgeon, Dr. William T. Bull, 56 CHILDHOOD took no chances. He removed the appendix of his six-days-old baby. There was nothing in particular the matter with it — not as yet. He simply did not care to have that useless rudiment remain where it might possibly make trouble later in life. HEAET DISEASE IN CHILDREN Robert Louis Stevenson's "Pity Sick Children" springs at once to mind when one comes upon a blue-lipped, dropsy-faced, panting child, its blue jugulars pulsating prominently against its white neck and its heart beating tumultuously against its ribs, like a frightened little bird quivering against its cage. It is most gratifying to realize that such suffering, when it is not of congenital origin, is now in large part preventable, because it has been found in most cases to be of germ origin. Rheumatic heart disease is the most serious and the most frequent of the organic heart affections, in children as in adults; and the germ of rheu- matism, the streptococcus rheumaticus, the essen- tial cause of that disease has been discovered. RHEUMATISM IN CHILDREN During the first four years of life, rheumatism is fortunately rare; probably because infants and little children are not so much exposed. After four years, however, when children get about, often in unseasonable weather, come in contact with other children in perhaps crowded and un- hygienic schools, are in the streets inhaling germ- laden dust — then it is that the rheumatism incidence 57 WHY DIE SO YOUNG? rises steadily to the tenth year. The child's body also becomes susceptible to the infection by reason of ansemia, especially in rapidly growing children; imperfect convalescence after other dis- seases; overstrain at play. Thus are the bodily tissues rendered congenial soil for the rheumatism germ to implant itself and to thrive and multiply in. Favorite spots for such weedy growth are unhealthy tonsils and upper air passages; neglected teeth and gums, very frequently; inflamed or running middle ears. Other predisposing agencies are cold and damp and the insanitation obtaining in stuffy and crowded quarters. From such in- fection centers the germ finds its way through the lymph and blood channels, not only to the joints, but to the heart valves, the muscular tissue, and the interior of that most vital organ; to the pericardium, also, in which the heart lies. And the baneful infec- tion comes about by reason not only of the presence of the germs themselves, but also of the poisons, the toxins, which those rheumatism streptococci gener- ate in the vulnerable tissues. The prevention of rheumatism, or of the re- currence of the disease, in children, requires our taking into account the untoward influence of crowded towns, damp houses, poor sanitation, unhealthful soils and climates. The child's dwelling should be thoroughly dry indoors; cold, damp, crowded, and stuffy rooms are especially to be avoided, predisposing, as they do, to chills and sore throats. Damp clothes and damp beds have proved even fatal to a rheumatic child. The soil about the house should be gravel rather than clay. A warm and equable atmosphere, as 58 CHILDHOOD devoid as possible of bleak winds, sultry heats, and germ-laden dust, would be ideal. Occasional change of air and scene is good for such children. Rheumatic children are likely to be more than usually bright, emotional, and energetic; they tire their bodies before they tire their minds; where- fore discipline, rest after the midday meal, and early bedtime hours must be enforced, especially when such children are nervous and emaciated. The digestive organs need careful supervision, for they are often disordered, night terrors, hives, and migrainous sick headaches resulting. Such children should be constantly under the family doctor's supervision. The gums and teeth must be most carefully looked after. The throat will need especial care; for, as we have seen, a very usual path of invasion of the rheumatism germ is by way of the tonsils. Children should be taught as early as possible to gargle; half a teaspoonful of table salt to a tumblerful of hot water makes a good solution. The diet should be plain and varied — meat once a day for a child of seven. Warm clothing is very necessary; woolen undergarments for winter; the best possible quality of interwoven wool and silk for summer; good boots and warm socks. Children prone to rheumatism should not be forced to much study, which tends to lower the child's resistance. If we can tide the rheumatic child over his youth he will become later in life less susceptible to cardiac rheumatism. The logic of the situation requires first the safeguarding of the child against the rheumatic infection, precisely as against the scarlet fever or 59 WHY DIE SO YOUNG? the measles or any other infection; and secondly, the child's constitution must be hardened, must be fortified against any such infection by hygienic measures, by maintaining the child in a sanitary environment, and by having such reachable in- fection centers as we have indicated cleared up. These observations may apply equally well to diphtheria, pneumonia, tuberculosis, grippe, ty- phoid — in fact, to any of the infections to which infancy and childhood are prone. TUBERCULOSIS IN CHILDHOOD We have dwelt on tuberculosis in infants. During the first four years of life this disease claims many victims; from then on, however, and up to ado- lescence, the list of those slain by the Captain of the Men of Death — as John Bunyan characterized consumption — is lessened. But with the fifteenth year and up to the forty -fifth, every fourth or more among our white race, and every other adult among our negroes, succumbs to the Great White Plague. Yet in childhood, from the fifth year on, exposure to the tuberculous infection is manifestly no less than in other eras; indeed, it is generally greater than during later life. There is, then, a latency during those earlier years, remaining until tuberculous centers in the body become irritated and weak spots become manifest, by reason of the unusual stresses and perturbations which the youthful organism has to undergo. There is, therefore, the extremest necessity to examine children in their school-going period for the detection and removal, as far as possible, of 60 CHILDHOOD all causes and agencies which may lead to con- sumption. We must try ever to understand why a child of generally agreeable disposition becomes fretful, irritable, nervous, easily fatigued, unable to concentrate the attention; why it is pale, feverish and chilly by turns; why it has headache, nausea, or loss of appetite, difficulty in swallowing; whether it has a persistent dry cough; pain in the back, especially when the spinal bones are pressed on; girdle sensations; difficulty with its kidneys or its digestion. We must learn why such a child is below the average weight, or if it has suffered some very weakening constitutional disease; if there are nasal or throat obstructions leading to mouth breathing; ear trouble or muscular spasms; tender or swollen joints or a painful or distended abdomen. By such careful consideration of symptoms and by scientific preventive measures we may eliminate a vast deal of suffering, a vast deal of tuberculosis, the most melancholy of all diseases. DEFORMITIES Spinal curvature may be due to real disease (mostly tuberculosis) of the vertebra?, or weak back muscles may be at fault. Bad posturing is responsible for most of the lesser grades of spinal curvature, as also of other structural abnormalities. The teaching of proper standing, walking, and sitting is now a part of all school discipline, and a most grateful one. Especially to be appreciated in this regard are the military schools. - Lateral curvature — scoliosis — may result from malposition of the pelvis, one-sided position of the 61 WHY DIE SO YOUNG? body, or the contraction of one side of the body, following a bad attack of pleurisy. Or there is a contraction of the spinal muscles of one side, following paralysis of the opposing muscles. All spinal deformities are greatly influenced by hered- ity, general weakness, a sickly or scrofulous bodily condition. Children who grow very rapidly, assum- ing the while faulty positions at their school desks, may become "scoliotic." Those who have lateral curvature either develop- ing or obvious are prone to pain, a feeling of weakness in the back, general lassitude, a stooping gait, a prominence of the shoulder blade, and perhaps also of the hip, on the affected side. The affection can be cured if too great deformity has not developed. Muscular exercises are in most cases beneficial; or a suitable support may be worn. As to these matters a family doctor must decide. Kyphosis is an undue bulging backward of the spine. This results from muscular weakness, rickets, slouchy habits, or too much stooping. Children having this deformity (hunchback) very marked, may have been let to fall in infancy. In others there has been Potts's disease (tuberculosis) of the spine. Lordosis is an undue curving forward of the spine — the very hollow back. Hip disease (tuberculosis of that joint) and other joint abnormalities should be brought as early as possible to the attention of the orthopaedic surgeon. INFANTILE PARALYSIS Among joint deformities, surely none are more melancholy than those which are a part of the 62 CHILDHOOD disease infantile paralysis. This is called by physicians, acute anterior poliomylitis, because this infectious inflammation invades mostly the anterior nerve roots, the telegraph stations, as it were, in the gray marrow or matter (polio, myel) of the spinal cord. It is from these roots or ganglia that muscular movements, especially those of the extremities, are normally directed, controlled, and co-ordinated. During several years past, devoted and zealous physicians have been laying the chain in which the germ origin of infantile paralysis has become established. Dr. Simon Flexner, and his associates of the Rockefeller Institute in New York, have demonstrated that a specific, an essential virus, is, in the last analysis, responsible for this disease. Blows, accidents, falls, previous weakening ailments, are but predisposing, making the body susceptible, vulnerable to the inroads of the virus. The latter is "a minute, filterable micro-organism which has now been secured in artificial culture," and as such is distinctly visible under the higher powers of the microscope. It enters the body by way of the nose and throat, whence it traverses, in the blood and lymph channels, the honeycomb — like bony tissue at and about the base of the brain, thence to invade the anterior nerve roots. Sometimes also the inflammation ascends from the anterior nerve roots to the neck and the brain, producing respiratory paralysis and death. Happily, however, in most cases, the brain and the mind are un- affected, though the bodily deformities may be dreadful in extent. As with diphtheria and other infections, there may 63 WHY DIE SO YOUNG? be carriers of the infantile paralysis virus or germ — people who may not themselves come down with the disease. The virus is communicated from the sick to the well, either directly or through a third person, by contact with the nasal, throat, or buccal discharges of the afflicted on handkerchiefs, towels, eating utensils, toys, and the like, or by kissing, coughing, or sneezing. And so an infant of perhaps no more than nine months may be put to bed seemingly well, to awaken in the morning with a high fever, vomiting, and convulsions. Or, if the child be old enough to tell of its sufferings, it will complain of headache, of pain and tenderness in the neck and back along the spine. It will be restless, irritable, and sleep- less; or it will be drowsy and stupid. In from twelve hours to two or four days will ensue flaccid paralysis of one or more members, and in time wasting away of the affected muscles. Children of from one to five years are most frequently attacked, but adults also may suffer. The summer months are the favorable season for this disease, but cold is no bar to it. There have been epidemics in the arctics. No antitoxic serum, either preventive or curative, is as yet assured, nor is any positive cure, medicinal or otherwise, as yet perfected. The incubation, the hatching period, during which the toxin of the infection is developing in the system, is from three to twenty-one days. Much good is accomplished for the sufferer by rest in bed, diet, medicines addressed to the fever, the pain, and other symptoms, with electricity and massage, after the acute manifestations have subsided, and other means familiar to the 64 CHILDHOOD physician. Much may be accomplished to prevent the crippling and deforming of children who do not die. Even so, more than half the survivors are likely to suffer afterward from paralysis; and in the recovered ones the affected muscles are likely to remain small, with retarded bone development, poor circulation, and impaired constitutions. Obviously, then, since there is no certain cure, our efforts are most wisely directed to preventive measures. The sick of infantile paralysis must be quarantined for a period of six weeks. The disease must be managed as any infectious disease, and according to the directions of one's physician and health department. Especially must healthy children be debarred, during the period of any epidemic, from parties, picnics, movie shows, outings, and the like; nor may they play with children in whose homes there is sickness. Here, as in disease prevention generally, the basic factor is personal hygiene. IMMUNITY "What is immunity? The knowledge is at least as old as the history of medicine that a single attack of an infectious disease makes the survivor, at least probably, and in most cases absolutely, immune to further attacks of that particular disease. That is why so many infections — diphtheria, measles, scarlet fever, whooping cough — are childhood dis- eases, suffered during that period once and for all, in life. This so ancient knowledge has been at the bottom of the search for immunizing agents, which humankind has ever been making. To-day 65 WHY DIE SO YOUNG? we use antivenins, substances extracted from snake bodies, quite as Galen (the doctor of that Nero who fiddled when Rome burned) gave his patients viper flesh and viper blood for the same purpose. We read that the Persian king, Mithri- dates, immunized himself against poison by taking all the antidotes known in his time, experimenting on condemned prisoners until he found the doses he could safely take. He did this because ambitious members of the royal family, wanting the king's throne, were likely to resort to poisoning to that end. Those bitten by rabid dogs were advised by mediaeval doctors to eat the liver and drink the blood of the guilty canines; and the Pasteur treatment for hydrophobia is but a modern and more elegant refinement based on the same princi- ple. The idea is the same as "eating a hair of the dog that bit you"; and this is the basis of the only but real hydrophobia cure there is to-day. Doctor Jenner observed, about the time of our American Revolution, how dairy folk that got the matter of the udder sores of cows (cowpox) into cuts in their hands were immune to smallpox; by his inoculations, then, of such cow virus (vaccine) he assured protection against the much more dreadful and fatal smallpox. Thus began vaccination in the modern sense, for Pasteur developed into a scientific working principle Jenner 's demonstration of a mild form, protecting against a severe form, of a given infection. In precise terms immunity is an individual's resistance to an infectious disease to which the race in general is susceptible. Such immunity depends on the defensive reaction of the body's resisting force CHILDHOOD to the poison — toxin — either of the disease itself or to such minute portions of that poison as are contained in the immunizing agent. There may be acquired, or natural, or active, or passive immunity. Immunity is acquired on recovery from an attack of a given infection — as of scarlet fever. Negroes are practically safe from yellow fever; theirs is a natural immunity, resulting from their having, through countless generations in their native Africa, been "up against yellow jack." Call this racial immunity if you like. Our very good friend the horse is actively im- munized against diphtheria when we inject into him the poison of that disease; then we take the serum from his blood and use it to confer passive immunity on those of our kind who are in danger of diphtheria. Besides the diseases mentioned we have antitoxins (immunizing agents) against te- tanus (lockjaw), meningitis, typhoid fever, typhus fever, cholera, and other infections. DEFECTIVE HEARING Many a dunce, many a vicious child, in the old days of the little red schoolhouse, has been just a child whose hearing has not been up to par. A simple test is to have the child put his hand over one ear and then to whisper to it a few words at ten feet distance. If the child cannot repeat your words there is some difficulty with his aural appa- ratus. Having thus tested one ear, try the other in the same way. If there is no hearing at ten feet you approach the child foot by foot and repeat the whisper each time. If he hears you at 67 WHY DIE SO YOUNG? only three feet, then his hearing is only three- tenths normal. Or there is the watch test: The average-sized watch should be heard by the normal ear of a young person at forty to fifty inches. At thirty inches the hearing is fair. (As age advances the watch-hearing distance gradually diminishes; after sixty years it may be completely lost in those who may, nevertheless, hear sufficiently for the ordinary purposes of life.) Possibly the child's difficulty is by reason of wax, or some foreign body, which, being removed from the external canal, the hearing is restored. In most cases, however, the difficulty lies in in- flammation of some sort. AURAL DISEASE An aural catarrh is the first stage of practically all the diseases of the ear and of their complications, and such acute middle-ear inflammation is in turn very often caused by infection extending through the Eustachian tube, which latter tunnels the region between the throat and the middle ear. Thus the ear trouble starts as a local manifestation of such diseases as coryza, diphtheria, measles, bronchitis, scarlet fever, whooping cough, mumps, grippe, pneumonia — all infections ushered in by inflamed noses and throats. Whenever these diseases have not been prevented, symptoms refer- able to the ear must be constantly watched for, so that the hearing sense may not be imperiled. There may appear simply a dry catarrh, ac- companied by an obstructed sensation, not always 6S CHILDHOOD painful, in one or both ears; upon which suppura- tion (abscess) all too often supervenes. And then, all too often again, either directly through the tissues or by way of the blood and lymph vessels, will be involved the mastoid process, that bony projection felt immediately behind the ear. This process is made up of spongy bone tissue, through which inflammation easily travels and which soon becomes pus soaked. Nor in many cases will the trouble rest here; it will become by extension an infectious meningitis, or a brain abscess, or a plugging up of the great veins within the skull, with corrupted brain tissue as a result, and all too often death. Or the middle-ear suppuration may become chronic — that is, a child may for months have "running ears," which become a focus of infection, the pus of which is like so much dynamite, ready to explode at any time when some super- vening bodily predisposition becomes the igniting spark. The baneful effects of "matter" found in the middle ear will vary according to the nature of its miscroscopic elements. Sometimes the most viru- lent ear discharges have no odor; the deadliest may have a sweetish odor, like that of new-mown hay; or it may have considerable fetor like that of a decayed egg. Here the bony tissue is certainly breaking down. No such cases must be neglected. By a laboratory examination under the microscope (so easy of accomplishment in our day when, besides private laboratories, public, state, county, and municipal facilities are, if need be, at the family physician's disposal), we can detect in each case the respective disease germ that has to be 6 69 WHY DIE SO YOUNG? feared, be it the grippe, or the typhoid, or the meningitis, or the rheumatism germ, or the pus germ. And how many a case of tuberculosis in childhood has developed from the germs of that disease found in the aural discharges ! EYE DEFECTS If a child is to learn, it must, of course, have good eyesight. Except hearing difficulty, little can be more distressing to the school child than errors of refraction — especially myopia, near- sightedness. How many a child accounted stupid and perverse has become amiable and a bright scholar on the fitting to the eyes of the right glasses. For children who squint to be taunted by their companions as being "goggle eyed" constitutes one of child life's near tragedies. Such children should receive the eye specialist's most skillful attention. Indeed, it is a very wise rule to have every child's eyes examined before its entrance on school life. Squint in children that is caused by paralysis of one or more of the six eye muscles should be rectified (the earlier the better) , either by suitable prism glasses or by operation (by which the muscles at fault are either shortened or ad- vanced). The squint (which doctors call stra- bismus) being rectified, we have to consider next the poor vision, which may be due either to far or to nearsightedness; and then along with one or the other of these errors of refraction there may be astigmatism (deviation from the normal curve of the cornea, the circular part immediately in 70 CHILDHOOD front of the pupil). I am assuming that there are no white spots on the cornea, which are due to diphtheria or scarlet fever or measles or any grievous childhood inflammation. Many a very young child squints when it is ill. Physical weak- ness may temporarily cause this; and there are children that grow up with a squint and lose it in their teens, to have it reappear only when they are tired, in the evening, and when they have over- worked at their studies. Here may be a warning of the existence of a weak brain control, and a hint to be watchful against the effects of over- study. Medicines are of no use; electricity should not be used except by expert direction; gentle massage over the closed lids is a splendid tonic for weak eye muscles. THE TEETH A great deal of suffering, a great deal of real disease, and of systematic infection can be avoided by the habit of attending to the hygiene of the teeth. I do not know of any subject in personal hygiene to which I would attach more importance. Digestion does not begin in the stomach; it begins in the mouth. If this truth were realized a great many — though far from all — cases of dyspepsia would "fold their tents, like the Arab, and as silently steal away," never more to affect the sufferer. The first thing necessary to good digestion is to have the food thoroughly chewed, so that it is in a condition to be readily mixed with the digestive juices, the first of which is the saliva in the mouth. How necessary, then, is it to keep the mouth, the teeth, and the gums in good condi- 71 WHY DIE SO YOUNG? tion! How salutary to this end is the advice to go to the dentist at least once a year, and have those precious masticators overhauled and kept right! The teeth should be brushed at least on rising and at bedtime; and the mouth should be rinsed with water after each meal. Any one of the many dentifrices now in the market is right. Also clean the spaces between the teeth with dental floss. Soft wooden toothpicks are well enough, but picks made of hard substances are apt to injure the precious enamel. You would be surprised to hear how much tooth irregularity in children is due to the mouth-breathing habit; see, therefore, that any possible adenoids or enlarged tonsils in your child's throat are attended to. Have your children get the teeth -preserving habit in early childhood. By beginning with childhood the hygiene cf the mouth we shall avoid the danger of incurring Riggs's disease. This most chronic ailment, Pyor- rhoea alveolaris, is a process destructive of the supporting structures of the human tooth. What are the causes? The proper hygiene of the teeth and mouth has been neglected; or, in the dentist's phrase, there has been "absence of the normal contacts" between the upper and lower teeth; or the teeth have grown very irregularly. Mercu- rial, lead, arsenic, phosphorous, and other metallic poisoning in dangerous trades is often a cause; also rickets in children and diabetes in adults. Worst of all, various disease germs deposited in tooth cavities or in decayed roots pass thence through the lymph and blood channels to other parts of the body, such as the joints, setting up rheumatism and other serious diseases. When 72 CHILDHOOD there is lodgment of decaying food in the spaces between the teeth, the mouth becomes unclean, there is bad breath and bad taste, autotoxemia (self-poisoning) by such impurities, and conse- quently general ill health. In Riggs's disease there is a dull gnawing pain in and about the teeth, the gums, and the tooth sockets. While chewing food the mouth feels tender and sore. There- is dark red discoloration of the gums and bleeding of the spongy ulcerated gums on the slightest irritation. In advanced cases pus can be forced around the necks of the teeth involved, from practically all the pockets found. X-rays are now taken of the jaws which in many cases show startling abscess formations not only in the teeth, but also in the jaws around the teeth. The hygiene of the teeth begun early in childhood will prevent most cases of Riggs's disease. SNUFFLES "Cold in the head" prevails more in children than in older folk. It comes on of itself; or it accompanies many diseases such as measles, scarlet fever, diphtheria, mumps, and the like; and then the nasal discharges are very "catching." Such secretions of the little sufferer, when put under the microscope, will show various germs, those of grippe or bronchitis or even pneumonia. The child catches its acute nasal catarrh in two ways — because of the lowering of the natural resistance through exposure to cold or damp, or by reason of unnutrition; or the catarrh may have passed by personal contact of the infectious material so that it becomes a "household cold." 73 WHY DIE SO YOUNG? The child may at the outset suffer with chilliness and headache, and give evidence of being out of sorts. Then the nose "runs," a watery secretion appearing; with this the nose gets clogged up and the child snuffles, breathes with difficulty, and has to keep its mouth open to breathe at all. The obstruction is worse when the child is lying down on its back, causing much discomfort at night; in infants, indeed, attacks of suffocation may result and breast feeding be interfered with. After a time the watery secretion increases and at the end of a day or two becomes considerable in quantity, the swelling of the mucous membranes of the nose at the same time lessening, so that the nose breathing becomes easier. The discharge, while it becomes less in quantity, becomes also thicker, and finally dries up* altogether after a week or two. The child is at first languid and unfit for any exertion, but brightens up somewhat after the first two or three days. There is a great tendency for the catarrh to pass downward to the bronchi and the lungs; and this constitutes the chief danger of nasal catarrh in childhood. Recurring colds must, therefore, not be treated lightly; they may lead to bronchitis or pneumonia. A cause must be carefully sought in ill-ventilated and overheated nurseries, in stomach troubles, in cold extremities, in injudicious exposure. And the discovered cause must be removed before any treatment will avail. ADENOIDS Some years ago, on the metropolitan East Side, where sixty-odd languages are represented and 74 CHILDHOOD where are the most crowded blocks of houses in the whole world, including such places as Peking and Calcutta, there was a riot among the mothers and aunts and grandmothers of the school children. Those women had somehow got it into their heads that the "school doctors" were cutting the throats of their children. Here was a notion which the thirteenth century would have been ashamed to entertain; and yet, when a crowd of women get together, any idea, however absurd, is likely to lead to extremes such as no mere man can foresee. And if you do not believe this, read Le Bon's book, The Crowd, A Study of the Popular Mind. Here is just what those physicians were doing. They were examining the throats of the children and they were writing on cards : Mrs. Hasenpfeffer or Mrs. O'Shaughnessey or Mrs. Bacigalupo or Mrs. Rosenstein, or whatever the mother's name might be, "Your child has adenoids. You should have this ailment attended to. If you cannot afford to go to a doctor of your own, you should take your child to a hospital." And that brought on the riot. All of which goes to show how doctors are misunderstood in this world, and why, even though they do write books on how to live longer, they die younger — much younger — than clergymen and bankers and publishers and other people like that. Adenoids are soft "lymphoid" vegetations or overgrowths, bleeding readily. They lie far back of the nose and in the vault of the throat; some- times they come down so far that they can be seen as gelatinous masses at the back of the mouth, behind the "tab" or uvula. They are found in the "post nasal space" in all ages, even in the 75 WHY DIE SO YOUNG? newly born. The infant snuffles loudly and there is often considerable nasal discharge. The trouble may interfere greatly with suckling, and the poor infant, older children as well, are liable to attacks of suffocation during sleep and to night terrors. Indeed, a lot of "grinding or gritting of the teeth," which is generally attributed to other causes, may really be due to adenoids. Such children are prone to vomiting. The expression on the face of a child suffering from adenoids is un- mistakable. The child has constantly either to blow its nose or to hawk and spit out; the nostrils are round and dilated (or in older children flattened across — just mere slits); the face is pale; the child is manifestly poor blooded; and, of course, he is a mouth -breather, his jaw is dropped; his expression is dull and vacant, even idiotic. These symptoms may appear only after an attack of any childhood infection. The lips and tongue are dry. There is much earache, and in consequence "running ears." The eyes are watery and in- flamed, and the nasal discharges may cause sores of the upper lip. The taste and smell are deficient. And there is likely to be bronchitis with a barking cough. Habit spasm is observed in some cases. The consequences of adenoids are: mouth breath- ing and narrow-chestedness, and thus poor lung expansion, by which the child becomes starved for oxygen and an easy candidate for consumption; snoring; open-mouthedness, or vacant, dull ex- pression of the face; unpleasant, toneless modifi- cations of a naturally pleasant voice, such as the "nasal twang"; inability to pronounce certain letters; earache and other ear infections, even 70 CHILDHOOD deafness, by shutting up the Eustachian tube, which should in health always be open; mental deficiency, making a dunce of a naturally bright child; frequent attacks of coryza (nasal catarrh); nosebleed; irregular tooth and jaw formation; stunted growth; convulsions, and a general nervous and perturbed condition, so that an ordinarily good child is unjustly accused of wanton mis- behavior or of crass perversity. Deformities may appear. The natural and uniform development of the face is hindered, leading to the narrow jaw with crowded teeth and the high-arched palate. And it takes the highest skill of the orthodontist to correct those jaw deformities. In the chest there is likely to be alteration of shape; in some cases the pigeon, or the keel breast, but in most cases the formation of a hollow at the lower end of a breastplate, which the child makes obvious when the parts are sucked in with each inspiration. ENLARGED TONSILS When enlarged tonsils are found in children, adenoids are sure to be present also in 90 per cent of the cases. Tonsils are sometimes en- larged from birth; but they usually become so by reason of successive attacks of tonsillitis or quinsy or diphtheria, scarlet fever, measles, or in fact any nose and throat inflammation. Some- times the tonsils become so enormous that they actually touch in the act of swallowing; also in such children there is the "throaty" voice, as if the mouth were full of food; and in some cases there is a dry cough, in which much stuttering 77 WHY DIE SO YOUNG? begins. The glands in the neck beneath the skin are also liable to become swollen, and tuberculosis all too often follows. Besides the evil due to the mechanical obstruction of the tonsils there is a tendency to repeated inflammations. Also the tonsils, being thus in a state of chronic unhealthi- ness, become rich soil for many germs, and most especially for the rheumatism germs, to grow and multiply in. These germs get from the tonsils to the lymph channels, thence into the circulation, and so invade the heart, the joints, and many other precious tissues of the body. Such poor children are always catching cold. Almost all deafness begins that way. Taking it all in all, then, by far the best thing to do with adenoids and enlarged tonsils is an operation (or pair of operations) . These are quickly performed, and the relief is so great, so immediate, so salutary that a parent who would think twice about having it done would be blameworthy in the extreme. The child breathes freely at once and is again able to enjoy its food without choking. Opera- tion as early as the third month in infancy is usual. In addition to the removal of the adenoids and the enlarged tonsils the doctor may later have to remove polypi from the nose, to straighten a per- haps crooked septum, or the like. , ST. VITUS S DANCE Of the nervous disorders of children, the most frequent is chorea or St. Vitus's dance. The child shows local or general irregular twitching and other peculiar muscular movements. Some of these lat- ter are volitional; others are involuntary and can- 78 CHILDHOOD not be controlled. Many involuntary movements are imitative. One child sees another twitching its eyelids or twisting its head in an odd way; and such is the power of suggestion that it, in turn, displays the same movements, and then communi- cates these to other children, until a veritable psychic epidemic is on. The peculiar movements which can be controlled are absent when the affected child is at rest, as in sleep or when its attention can be successfully averted. Fright, injury, worry, eyestrain are real causes. Chorea often complicates or follows in- fectious fevers, especially heart disease and rheu- matism. Irritability of temper, anaemia, poor ap- petite, and difficulty with the digestive tract may accompany the ailment. A child who has had convulsions becomes easily prone. Choreic move- ments due to suggestion can be corrected and done away with by discipline and removal of the suggestions. Real St. Vitus's dance, due to struc- tural lesions, is remediable within two months, but it is likely to recur. The outlook for such a child is usually good. A child suffering thus must have rest; over- exertion must be avoided. The fitting of proper glasses may be necessary. Tea, coffee, candy, and sweets in general must be interdicted. Compli- cations must be well considered. Most cases need the building up of the general health and the right disciplinary regime. NIGHT TERRORS Night terrors in children may be the forerunner of mild epilepsy or St. Vitus's dance. Such little 79 WHY DIE SO YOUNG? sufferers awake in vague, wild alarm, scream, cling to the mother, but apparently fail to recognize anyone and cannot at once be quieted and re- assured. After a few minutes the excitement spontaneously subsides and the child returns to sleep, without recollecting the attack in the morn- ing. During its terror it may run from the room or climb upon the furniture in a wild attempt to escape the figment of its dreams. Often the cry implies a fear of being caught by some hideous person or by some wild animal. True night terrors are of somewhat serious import. They certainly indicate an unstable constitution. Sometimes they are induced by difficulty in breathing because of adenoids or bronchitis or laryngitis or weak heart or general weakness. They may, however, mean only night- mare — a kind of vivid dream usually traceable to indigestion, to bad ventilation, to some previous terrifying experience, or to mental shock. The child has a feeling of great weight on the chest, of suffocation, or of falling; it then suspends respira- tion or makes distressing inspiration sounds and awakes with a start or in a wild fright. TANTRUMS Children have tantrums either on account of poor training or of some physical ailment. The first of these causes is not in the physician's prov- ince, although in many such cases the family doctor is supposed to act in the place of the father, mother, nurse, half a dozen relatives, and not a few neighbors besides. To be quite frank, when 80 CHILDHOOD we come upon a child violent or resorting to naughtiness to gain its ends, we, in many cases, find that the parent, especially the mother, is herself nervous and lacking in self-control, cannot endure having the child cry, and thinks that affection is best expressed in terms of unlimited indulgence; there has been failure to teach the baby, from its birth, obedience to law and order, and the child soon learns that all it has to do to attract attention is to kick, scream, or hold its breath, and that then it will get what it wants. Such a child should be taken to the family doctor for careful examination and removal of the causes in the given case. Thus will a vast amount of perversity later in life be avoided. Other physical defects that might make a child irritable, neurotic, and perhaps ungovernable are eyestrain, adenoids, enlarged and unhealthy tonsils, imperfect teeth, poor nutrition, and un- hygienic living generally. It will not do just to say the child has nerves and ask the doctor to give him something for them. The reason for tantrums must be found in each case; and then intelligent remediable action must be taken. MENTAL DEFECTS The feeble-minded are graded as follows: Idiots (those of least mentality) ; imbeciles (those of next higher grade); and morons (those coming pretty nearly to the normal type of mind). In general terms the idiot never reaches the plane of spoken language; the imbecile understands spoken language and talks in various degrees of fluency; 81 WHY DIE SO YOUNG? the moron can speak and is capable of learning to read and write. There was, however, up to the use of the system devised by Doctor Binet of Paris, no way of clearly defining these types of feeble-mindedness. His tests were based on exami- nations of groups of children aged from three up to twelve years. The idiots have only the intelli- gence of an infant of one to two years; their intelligence may be practically nil and they are not classified on the Binet scale. The imbeciles corre- spond to the age groups from three to seven. The morons to the age groups from eight to twelve years, inclusive. One may speak also of the low-, the middle-, and the high-grade moron; and of the low-grade, middle, average, and high-grade normal. Most of the abnormal mentality which so grievously troubles civilization lies, not so much with idiocy and imbecility (mental conditions obviously dis- eased), as with the cases that align themselves on the border line between the high-grade moron (in the Greek "a silly person") and the low grade normal — the demifous — of which more in another place. Take any feeble-minded person, adult or child, and apply to him the following five tests for a normal child of three: Point to his nose and mouth; repeat two digits (as 7 and 9); enumerate objects in a picture (as dog or cat, lady, house); give family name (Smith or Jones); repeat a sentence of five or six syllables ("I am cold and hungry"). If a feeble-minded person can go correctly through these tests, but no more, then his intelligence, his mental age, is that of a child of three years. 82 CHILDHOOD The examiner of school children considers a child regular of intelligence if its mental capacity is equal to its age; advanced (precocious), if it has an intelligence one or two years greater than its age; retarded, if it has an intelligence one or two years inferior to its age. No child is called de- fective unless his retardation of intelligence amounts to more than two years. By means of the Binet scale, then, one can pick out retarded children, give them special training, and make of them, before they reach adult years, fairly normal citizens, fit to take up life's duties and responsibilities. By doing this civilization will not have to cope with a vast amount of viciousness, will not have to make vast expenditures for charitable and reformatory pur- poses. Can we help the feeble-minded? We cannot do so in the case of the idiot, who has not developed normally, in whom the cells composing the brain are not normally arranged or constructed, or when by reason of some grave disease brain tissue has been destroyed, especially brain cortex, which is made up for the most part of brain cells, its gray matter. The brain is the machinery by means of which thought is produced; it is not in itself mind; it is the vehicle by which mind manifests itself. What mind itself is who shall say? When the thought machinery is wholly destroyed, its prod- uct must cease; when it is partly destroyed, its product must be deficient in quantity, or in quality, or in both. And unfortunately the brain is the only part of the human mechanism which cannot be regenerated or replaced either in whole or in part. 83 WHY DIE SO YOUNG? But when the mental deficiency is due to the improper response of the central nervous system to the impressions from without the body, to functional and not to structural impairment, the brain being anatomically well enough, we may hope to cure the mental deficiency. All living is indeed the right adjustment of internal relations to our external relations. From the materialistic point of view, anyway, life is a matter of our adaptability to our environment. And when that is right, good health and long life are in great measure assured. MORALITY AND PHYSICAL DEFECTS Much consideration has of recent years been given to the relation which physical abnormalities may bear to juvenile delinquencies. A child's antisocial tendencies may have been due to parental neglect or to hopelessly adverse environment; or it may be generally undeveloped, or suffering from patent physical defects, or grossly undernourished, or its special senses may be most grievously at fault. If we accept the definition of morality as being the crystallization of natural law we have to conclude that many a child, unfortunate as to its physical departures from nature's norm, will have to be considered irresponsible should it have committed offenses against the moral law. In any event it has been justly concluded that juvenile offenders, before they are branded real criminals, should undergo exhaustive medical examination. Many a perverse child, by the rectification of physical defects, found at such examinations, has been 84 CHILDHOOD rescued for splendid manhood and virtuous woman- hood and from the pauperism, the vagrancy, the social degradation, and the jail, which would in other eras have been its life portion. I happened one day to have accompanied an eminent alienist to a religious service conducted in a prison chapel. My colleague unobtrusively indicated one prisoner, whispering to me: "That man has no business in jail; he is a pronounced microcephalic and has not the remotest notion of the difference between right and wrong. This other is a scaphocephaly, wherefore he is unjustly suffering confinement in a prison. That woman has a tower-shaped head and is irresponsible." And so on. Whatever institution they should have been in, the prison should not have housed them; for they were so born that their normal natures were either absent or perverted. For example, a boy was sentenced to a long term in Sing Sing prison — the worst boy, the judge declared, that had ever come before him. Certainly he had a bad enough record and was not at all a pleasing youth. He had served nine times in various reformatories for boys. Among the long list of his offenses was a savage attack on his mother and the heaving of a lighted lamp at his father. Yet there may have been at least mitigat- ing circumstances — the law is always supposed to make allowances for such — of a physical sort. Some hereditary anatomical and functional stigmata may have completely blunted the moral sense. The first incarceration of such perverse boys all too frequently means practically lifelong imprisonment, with intermittent periods of freedom, which are 7 85 WHY DIE SO YOUNG? punctuated by fresh crimes. In such a boy marked refractive errors may have made study a torture rather than a pleasure, the acquisition of sub- stantial knowledge a sheer impossibility; he may have seemed inattentive when in reality his hearing was hopelessly defective, or when adenoids were inducing oxygen starvation and abnormal metab- olism. There may have been depressed fracture, inducing the petit mat or slight epilepsy. We have found that, quite apart from criminal tendencies, defects in children are all too frequent. And fortunately the most of them are remediable. Society should and does now, in its acquired wisdom, recognize its duty toward the physically defective child; its own welfare demands that it should, and the duty is not difficult to fulfill. By eradicating palpable and manifest defects it enlists the unblamable vicious among its useful and grateful members. This course is better from a merely utilitarian viewpoint than making enemies of them by unjust imprisonments, during which they will brood upon the world's injustices and will invent ways of promoting social upheavals and of destroying our civilization. Ill YOUTH "And then the lover, Sighing like a furnace, with a woeful ballad Made to his mistress* eyebrows." "the soul's awakening" THERE are two paintings which in my mind's eye, long ago, I placed side by side, by reason that they glorify each a complemental, a reciprocal phase in life — man's and woman's third stage. They are both very familiar pictures and the reader will at once recognize my sketch of them. They have to do with early manhood and with maidenhood; with the time when poetry, music, flowers, perfumes, the blessed sunshine, and the heretofore latent instinct to love, and the power to inspire love, are gloriously dominant; when sentiments ring true; when the fingers are snapped contemptuously in the face of fate; when circum- stance has not yet affected character; when there is — as yet — never a thought of subordinating youth's precious ideals to civilization's mean and mercenary interests. The one of these pictures is called "The Soul's Awakening." I do not know whether Zant, the painter, named it thus. Perhaps it is in this respect, like the "Moonlight Sonata" or the "Spring 87 WHY DIE SO YOUNG? Song," to neither of which Beethoven or Men- delssohn gave those titles. Anyway, Zant's painting is to my mind wonderfully well entitled. We contemplate a very young girl, whose family and friends had but a little while before been speaking of her as a child. She is now a woman. But she has thus far hardly passed through the gateway into that marvelous field. Its wonders are very new to her; its strangeness very entrancing. Clearly she has entered on ways most lovely. Such a field she dreamed of in childhood; in her little-girl day musings there were vague foreshadow- ings of its beauties and of its rich comfortableness. But her dreamings never reached the realization now vouchsafed her. Yet even with her hand, tremulous as the body of a little bird, on the gate opening into that field, she can comprehend that, with all things wholesome and pleasurable, there must come responsibilities and compensating cares. And although she has no fear, courageous emotions are certainly aroused in her; dimly, perhaps only subconsciously, she appreciates that the heritage of anxiety and suffering which her mother experi- enced in her behalf must now soon become her own. Wifehood and motherhood are now, in her turn, to become her portion. In Zant's exquisite picture the courage and the trust lie mostly in the eyes, which are large and clear, liquid and deep and most frank; in them all the fearlessness that will be needed is to be found. Then, besides those organs, that superb painter has presented other and most ingratiating and winsome features, all with infinitely gentle 88 YOUTH touch. And the as yet immature figure is most delicately protrayed; and last of all the luxuriant hair caressing softly the head and shoulders. What poet's heart this Zant must have, if he still lives among us; what a veritable seer he must be, to have been able to grasp, as he does, the inner- most, the fundamental in life. The other painting which I have in mind is Abbey's "Sir Galahad," whose ideal was "To love one maiden only, cleave to her, And worship her by years of noble deeds." We are all familiar with the painting and the sentiment. And it is an ideal which I have found realized hundreds of times during my professional life, but never before so manifestly as during the recent demobilization period, when I had the great good fortune to examine, before their return to civil life, several hundred men, the most of them still in Uncle Sam's khaki or in his navy blue. I was able to form with these young men most pleasant and sympathetic relations, and a fine feeling of camaraderie. How grateful was my task! And these Sir Galahads, those younger brothers, in spirit and in truth, of that chevalier sans peur et sans reproche, those young men who came back from their epic heroisms, from their soarings into the empyrean, those strong and healthy youths had army and navy experiences back of them richer than most men of threescore and ten could boast. Those splendid young fellows had well-nigh perfect physiques — held themselves straight, shoulders back, clear eyes, magnificent specimens. Let us 89 WHY DIE SO YOUNG? take the sweet with the bitter. The war was horrible, soaked in suffering. But on the other hand the training for it and the actual fighting for it made real men. Captains of their own souls were they; but especially so in the determi- nation to keep themselves straight for the marriage relation. And I can do no better than to hope that the splendid average of health which the war has produced may be perpetuated, that in order for a vigorous maturity and a hale old age, three pitfalls may at least be avoided. THOSE YELLOW FINGER TIPS Tobacco has been in immense favor with our soldiers and our sailors. It has been a comfort indeed during hardship; the wounded have found unspeakable solace in it. Who would have spoken an untoward word that has seen the cigarette being inserted between the anguished lips of the "side- swiped" hero, the match applied and then the contentment evidenced in what was left of his countenance. Who would have withheld such alleviation where there was so great need of com- fort. But now the war, with its altogether un- precedented sufferings, is over, and one may write something about tobacco without appearing to be a spoilsport. For adults tobacco may be wholesome, though personally I doubt it, for most men. But there can be no question about its unfortunate effect on the as yet immature organism — that of the man under twenty-one. Take the nervous system, for instance. 90 YOUTH Youths who smoke no more than a pipeful or two a day will tell of their vertigo, their giddiness and trembling, the leg weariness they experience. They forget words ; their memory plays them queer tricks. Their power of concentration and of associating their ideas, their ability for sustained mental application — these faculties are impaired. The nicotine has been poisoning their spinal cords and their brain centers, also the sympathetic nerve centers; and so they have cold and moist extremities and their faces are suffused with a clammy pallor. Then the nicotine at first powerfully increases the blood pressure, and so slows the circulation. But soon the heart and vessels grow tired of the unwonted strain and then come rapid and inter- mittent pulse, palpitation, and pain about the heart, oftentimes severe, and sharp smoker's angi- na. The blood pressure is found to be subnormal, indicating bodily weakness. And a blood test will demonstrate ansemia — blood poverty. Digestion is often impaired. One doesn't, of course, feel quite so badly as after "that first smoke." It is just that the agony is now attenuated and spread over months and years. Much saliva is perhaps subconsciously swallowed by smokers who do not spit, and by chewers of tobacco. Upon all this flatulence, nausea, and heartburn supervene. Tobacco induces catarrh of the nose and throat; and no catarrh, from whatever cause, is curable in a smoker. Asthma is not rare in under-age smokers, who become markedly short-winded. The most injurious way of using tobacco is the cigarette, 91 WHY DIE SO YOUNG? largely because the fumes are inhaled and also because of the temptation to use many cigarettes and to do so incessantly, sometimes only to be companionable. As I have observed, tobacco may be wholesome for the man in the prime of life. But the body of the youth is fresh and rich in reserve forces, in the factors of safety about which I shall write later; and it really needs neither tobacco nor any other stimulant. Y^oung men, certainly those under age, had better cut it out. JOHN BARLEYCORN It is easily within the recollection of any adult how, years before the war just ended, sailors on shore leave from our ships in port were reeling through our thoroughfares, making themselves most obnoxious, quarrelsome, if not fighting, and terror- izingly drunk. During an evening's enjoyment of the movies I found myself sitting behind some half a dozen boys in blue. A more prepossessing, a more likable lot of youngsters — clean shaven, hair neatly combed, nattily uniformed — it would be hard to find together in any town, in any club- room, at any church sociable. Oh, the adorable young men the war has been responsible for! They sat complacent, did those boys, while the audience grew hoarse over the naval pictures. They were feeling, no doubt, "Oh yes, we did it, just as you are seeing it; but it was all in the day's work, so what's the use in making a fuss about it?" They appreciated the topical reviews; they chortled 92 YOUTH over the comics ; and they snuffled, pulled out their handkerchiefs, and surreptitiously wiped the corners of their eyes, along with everybody else (the writer included) when a movie queen "turned on the sob stuff." A lady seated in front of these boys had some trouble adjusting her cloak over her shoulders. One of them leaned forward and helped her as deftly and as gently as could any other cavalier, and was graciously, in the like good spirit, thanked by her. And those wholly admirable gentlemen were constantly passing among themselves — a flask? No. A plug? No. A box of bonbons. How marvelous a change from the not distant past! From the days when intemperance was so rife among soldiers and sailors everywhere, when the intemperate man in unifrom was so frequently a public scandal, "a curse to his companions, the first in a mutiny, the last in a battle." It is most gratifying to observe how alcoholism has been going down and out of fashion since the war. And what indeed has been the effect of alcohol on youthful organisms? There are many substances to be found in nature which some doctor has well termed the "paratriptics," the savings bank of the bodily tissues. Probably every tribe or people that discoverers or explorers have ever visited has found its use for one or another of these: For instance, the Calabar bean, cocoa, moxie, the arsenic of the Tyrol, strychnine, the gentian of the Alps, the Peruvian cinchona, India hemp, alcohol, tea, coffee, tobacco. The best reason for saying that these things are beneficial when judiciously 93 WHY DIE SO YOUNG? used is that the demand for them is not to be denied, is world wide, and not wholly explainable on the basis of human depravity; and they certainly do tide an exhausted or misused organism over physical and mental crises. And since our human civilization seems to be such that abnormal wear and tear is often unavoidable, there is a logical place for the paratriptics. Most of them are unpalatable and have to be got used to. Doctors are constantly prescribing them for their tonic effects; their use is certainly "indicated" for the elderly and the debilitated. However, the body of the growing boy, the youth, and the young man are fresh and rich in reserves, quick in and of themselves, and without the aid of paratriptics, or any rehabilitating agency to restore themselves. Especially in these periods of life is alcohol altogether unnecessary, even "contraindicated" as the doctors say. And it is most gratifying to observe that this fact is becoming very generally accepted by athletic organizations and college students. To this effect are reports from Yale, Harvard, Princeton, Cornell, the Universities of Minnesota, Wisconsin, Chicago, California. Connie Mack, manager of the Phila- delphia Athletics, the year his team won the world's championship, said that fifteen of his twenty-five players "did not even know the taste of liquor." Ted Coy, a Yale captain of a few years ago, put the ban on all forms of alcoholic drinks for his team. And now, by way of introducing my third point, I have to state the well-established fact that in the past fully 70 per cent of the ghastly venereal 94 YOUTH diseases (having for their aftermath more than half of all the suffering and surgical intervention which married women have later in their lives to endure) have been contracted under the influence of alcohol and by young men under twenty-five. HE THAT RULETH HIS SPIRIT One of the most grateful of the war's by-products is the proof it has furnished that sexual intercourse is not essential to the young man's health. Of course, there are those who have fallen by the wayside. But by far the most of Uncle Sam's boys, I am convinced, have during their training been clean hearted and have come back from "over there" bearmg upon their bodies no scars save those earned in honorable warfare. This has been largely because of the fine spirit among those men of ours, aided by the education given by our army surgeons; and by reason of the inexorable military discipline with regard to sexual diseases that was instituted and was throughout constantly maintained. And yet it has always been the truth that, although continence is harder for the male by reason that nature has made him the aggressive factor, yet there is no essential occasion for a double standard. And although doctors have treated uncountable young men for disease the result of incontinence, they have yet to treat anyone for a disease by reason of continence. The trainers of college athletes, of professional and club contesters, have ever required their charges to "keep straight," at least during train- 95 WHY DIE SO YOUNG? ing; this has made them superlative specimens of manhood. Soldiers, hunters, sailors, explorers, for many months, for years together, never know any woman; and they are the noblest as well as the most virile of mankind. Alexander the Great was in nothing else so great as that, in his youth, at least, he despised and renounced courtesans. Ruling his spirit, he was consequently able for the lesser business of taking cities. Our men of the greatest stamina and intellectual vigor — scholars, statesmen, world compellers, thinkers of epic thoughts — have ever felt fitter for their monumental works when entirely free of sexual bondage. Sexual restraint makes for strong and noble, men. There is no manlier body of men than the Roman Catholic clergy, who vow and practice chastity. Every man that striveth for the mastery is temperate in all things, but es- pecially in this relation. The main factor which distinguishes us from other creations is the Almighty's precious gift of the human will. Those who are content to hold this gift without value, who will not be king of all that is under their own hats, have in the past brought so much extreme suffering and shame, not only upon themselves, but also upon others altogether innocent, that the venereal plagues have rightly been termed by physicians the familial diseases. And as we who read this book are all for the healthful and the long life, we may here anticipate our Seventh Age by considering the following, which Shakespeare put into the mouth of "Old Adam": 96 YOUTH 'Though I look old, yet I am strong and lusty; For in my youth I never did apply Hot and rebellious liquors in my blood, Nor did I with unbashful forehead woo The means of weakness and debility; Therefore mine age is as a lusty winter, Frosty, but kindly." THE COMMON COLD "Could the sum total of suffering, inconvenience, sequelae, and economic loss resulting from common colds be obtained, those infections would at once be promoted from the trivial into the ranks of the serious diseases." Two of these sequela? alone, pneumonia and tuberculosis, account between them for more than half of human mortality; and of all the causes of tuberculosis the most frequent is the common cold, the neglected cold, of which one so carelessly says, "It is nothing but a cold." Among other derivatives of the common cold (in itself the most frequent of all human ailments) are rheumatism, mastoid abscess, and kidney, heart, and other grave organic diseases. The common cold is more than a congestion, more than a catarrh, more than an inflammation. It is an infection, the specific, the essential cause of which is one or other of several germs, among which are the pneumonia, the rheumatism germ, the influenza bacillus, or a mixture of bacteria, a "mixed infection." And what is called the "cold" is in reality the infection which has incubated through the implantation of these germs on the congested, the unhealthful, and predisposed mucous membranes of the nose, the tonsils, and the upper 97 WHY DIE SO YOUNG? air passages. Those tissues can become congested and inflamed by other than germinal irritations, as by chemical fumes or by inhaled metal and fiber particles, or there may be obstructions, as adenoids or enlarged tonsils. A deflected septum in the nose will occasion a catarrh; irritant exuda- tions of gas from the stomach in dyspeptics will produce nose and throat catarrh; while increased acidity of the blood (acidosis) may inflame the mucous membranes. Congestions and catarrhs come about reflexly in people of nervous tempera- ments and in neurasthenics — those in whom the nervous system is exhausted. Such are likely to get catarrh simply from the apprehension of catching cold. But these causes, not being bac- terial, not being germinal, do not constitute the infectious and consequently communicable cold. The common cold may, however, be developed from them, as they provide a rich soil for the micro- scopic weed to thrive in. Exposure to draughts; to dust, which is generally germ-laden; to high winds, which are generally dust-laden; to sudden changes of temperature, such as obtain in our Northern states in the early and late winter weeks; getting chilled and wet feet (by far the worst of all predispositions) — these factors depress the vitality and thus make the body a receptive germ host. Arctic explorers rarely come down with colds until they return to civilization, where the germs are, and become cave dwellers like the rest of us. Colds seem, indeed, the exclusive privilege of civilization. Our race, in all likelihood, did not snuffle much until it began to build houses, to 98 YOUTH heat these houses, and to wear germ-harboring clothes. Then, instead of a wholesome coping with the elements, people crowded into super- heated houses, with the windows nailed down, and missed the blessed sunshine, the best of all purifiers, of all disinfectants. "The stove is a mesmerist that plays no small part in the reduction of human beings to a state of idiocy. The mephitic vapors in the atmosphere of a crowded room contribute in no small degree to bring about a gradual deterioration of intelli- gence." This is not a quotation from an up-to- date book on hygiene. Balzac wrote it in a novel some seventy years ago. Hibernating in their comfortable though devitalizing houses, people constantly rebreathe their own poisonous and germ-laden exhalations, mingled with those of the family, the visitors, and such animal friends as they cannot bear to expose to the raging elements without. Those who would certainly revolt against bathing in polluted water are not at all squeamish about inhaling polluted atmospheres. Nor is it "the engine drivers and the firemen who catch cold, but the passengers in the stuffy Pullmans and the reeking coaches." A poor digestion has much to do with germ- breeding catarrhs. Eating indigestible food (shell- fish, Welsh rabbits, and the like), overeating, or not eating enough, foster the catarrhal habit, either directly by the eructation of gases, or by the absorption into the blood of poisonous proteids in unsuitable or undigested food. How often has a too generous meal, washed down by fiery and more generous potations, been the forerunner of a cold! 99 WHY DIE SO YOUNG? Bad teeth and carelessness regarding the toilet of the mouth are large factors in the development of the common cold, by reason of the germs in- habiting the buccal cavity. Many of the bacteria mentioned as the basis of the common cold are found also in the mucous membranes of the upper air passages in health and between attacks; this explains reinfections, which occur when predisposition diminishes bodily resistance to germinal activity. Colds are caught from other persons having colds, just as diphtheria is contracted from diphtheria sufferers; and common colds are quite as likely to come in epidemics, affecting whole households, schools, factories, communities. From one case alone practically the whole force of an office or a workshop may presently be suffering, even acutely. The employee who reports for work sneezing, sniveling, and with thickness of speech had far better be sent home until he has recovered, no matter at what sacrifice. It will be found to pay in the end. The common cold is most catching in its early manifestations, when the germ laden discharge from the nose and throat is sneezed and coughed and spat out in profusion. Such sufferers should isolate themselves as far as possible and should go to bed the first three days, or at least while there is fever. The contagiousness and the severity of colds vary greatly in different epidemics, according to the particular germ most in evidence or the nature of the mixed infections when these exist. The prevention of colds consists in avoiding the infection and in fortifying oneself against the 100 YOUTH predisposing factors. During epidemics contact with the sufferers should be avoided, especially in street cars, offices, and all badly ventilated places — wherever one must risk having one's face coughed or sneezed into (droplet infection). The germ is also transmitted, directly or indirectly, through inappreciation of hygienic and sanitary usage, as by kissing, the common drinking cup, the roller towel, 1 pipes, toys, pencils, fingers, food, and other means of contamination through the fresh secretions. Besides avoiding all those sources of infection, one must not overwork nor lose sleep during epidemics. As to draughts: the robust need not fear them. The very young, the aged, the coddled, and the weak had best avoid them. Yet the draught does not produce the infectious cold. We speak of colds, and I have here used the term, because the first symptom of the infection thus named is a chill; but the initial chill characterizes many fevers — pneumonia and the like. The chill is the effect and not the cause of the infection, which has for several days before been latent, incubating in the system. Most such chills are accompanied by fever, as the clinical thermometer demonstrates; the suffering is therefore rather from heat than from cold. The "cold" is caught before and not with the appearance of the chill. Cold baths, by which the skin is helped in its function of throwing off daily its two pounds of bodily waste; exercise, to which the cold air gives 1 Mark Twain wrote of a hotel in which he objected to the manager regarding a roller towel: "You are the fiftieth man who has used that towel," answered the manager, "and the first to kick about it." 8 101 WHY DIE SO YOUNG? zest; sunshine; wholesome food, by which the body is properly nourished — one should accustom oneself to all these. He who does will have his metabolism (his bodily chemistry) stimulated, his blood enriched, not only his voluntary muscles, but also his heart musculature strengthened, and will keep his nervous system in healthy, vigorous condition. Such a one is practically immune to the common cold. INFLUENZA Influenza, or grippe, is an epidemic disease which extends with extraordinary rapidity. It is likely to "get" some 40 per cent of the population it visits, and to be epidemic from six to eight weeks. Its specific germ, without which, of course, its existence were impossible, is the Bacillus influenzae. "Cold in the head" (coryza); pains all over, "in the bones"; chills and fevers; suffering, oftentimes severe enough to prostrate — are the distinctive features. In the respiratory, the most common, form of the grippe, the eyes are watery and in- flamed; the handkerchief is — or ought to be — in constant requisition to keep the germ from others as it is sneezed, coughed, or spit out. Sore throat, bronchitis, pain in the chest, and profuse perspira- tion are in evidence. Or the digestive apparatus may suffer most; nausea, vomiting, collapse, colic, jaundice perhaps, debility invariably. Or the nervous symptoms may be most manifest: intense headache and backache, pain in the eyes, a racing pulse, inflammation of particular nerves or a group of nerves, depressed spirits, and a profound prostration. The suffering may be so great that 102 YOUTH the diagnosis of meningitis may be made. Or there will be the fourth, the peculiarly febrile form, in which the temperature may go up to the dangerous height of 105 degrees; this febrile form has to be differentiated from typhoid fever. Complications of grippe, heart, and kidney disease, middle-ear disease, and mastoid abscess have to be feared; also pleurisy and pneumonia and, in young children, bronchial pneumonia. Too often, also, grippe leaves in its train chronic ill health, a wabbly heart, and a pathetic listless- ness in erstwhile strong and virile men; and many a case of latent tuberculosis has thus become no longer dormant. Influenza does not defer to climate, wind, or weather. Cases are, however, more frequent in the winter months. There have been in the past great pandemics of grippe, since the sixteenth century at least; that, for example, of 1889-90, which spread from east to west, over all civilization, with very considerable mortality and a grievous aftermath of chronic malaise and suffering in those who survived the attack. Indeed, it was the fashion long after to date various ailments from this 1890 visitation. Such mortality, such morbid sequelae, are not likely, however, to attend present-day epidemics, because with succes- sive experiences of any infection its virulence and destructiveness are likely to be progressively modified. Even now, however, for the very young and the very old, grippe is likely to prove serious. Nor is influenza one of those infections which, like smallpox or measles, confers complete im- 103 WHY DIE SO YOUNG? munity with its initial attack. Any kind of im- munity to influenza is indeed but slight. Second and third individual attacks are common. And the carriers of the influenza germs are probably numerous; like typhoid carriers, they may not suffer at all themselves, but they may be walking germ granaries, conserving the infection for future epidemics to feed upon. By reason of the bread- winner's greater exposure, males and the robust are likely to be most susceptible. Exhaustion predisposes to grippe, for it makes the bodily tissue a congenial soil for germ implantation and morbid activity. For instance, a military corps detailed for railroad construction had been in constant general good health until the men had to work hard for two days in the rain; more than a hundred then developed sore throat and bronchi- tis, and of these thirty-seven presented typical influenza. Influenza is highly contagious, being spread from person to person by immediate contact, as in kissing, or by indirect contact, as from handker- chiefs, towels, cups, and other objects contami- nated with the fresh secretions. The germ exists, especially in the early stages, in the secretions of the nose, throat, and lungs. Mass meetings, theaters, closed and crowded cars, and public buildings should, as far as possible, be avoided during these epidemics. Persons with a tendency to catarrh should avoid undue ex- posure. Keep the feet warm and dry and the bodily functions normal. Influenza is one of those diseases the control of which rests with the public and not with the doctors, except so far as it is 104 YOUTH their province to prescribe, to instruct the laity, and to urge communal support of perfectly definite and reasonable health department measures. BRONCHITIS One becomes susceptible to, predisposed to, "cold on the chest" by getting the feet wet, by exposure, fatigue, overwork, by previous weakening diseases, by food that is indigestible or scanty or, on the other hand, excessive for the bodily needs. "Catching cold," which very frequently results in bronchitis, comes also from living in overheated rooms, especially when oxygen-consuming gas is constantly in use in offices and workrooms, and in places where the poisonous exhalations of many people together is being rebreathed hour by hour and day by day — where, in short, there is bad ventilation. Those whose occupations keep them outdoors are not nearly so prone to bronchitis as are sedentary workers. In most cases bronchitis is infectious, a germ disease; the germs of catarrh, of pneumonia, of grippe are frequently found in the spittle coughed out by bronchitis sufferers. It seems that bronchitis is rare among fisherfolk, by reason of the germ-free sea air. Besides being a germ disease, bronchitis comes also in such oc- cupations as lead to the breathing in of chemical fumes and of irritating particles of steel, stone dust, cotton fiber, and the like. Bronchitis is also a natural accompaniment of many diseases — measles, typhoid fever, malaria, asthma, whooping cough, and so on. The trouble usually begins with a cold in the nose, which works down through 105 WHY DIE SO YOUNG? the throat, past the Adam's apple, then along the windpipe and so to the mucous membrane of the bronchial tubes, which thus become inflamed. PNEUMONIA For generations doctors sensed that pneumonia is "catching" — that is, a germ disease — because they found it present regularly in certain houses, in soldiers' barracks, in jails, and in schools; they easily traced direct infection in hospital wards; and they recognized epidemics of pneumonia, as of measles and scarlet fever. But not until recent years was the germ of pneumonia (the "pneumococeus") discovered. In this as in all germ diseases two kinds of causes have to be taken into account: first the presence of the germ which is peculiar to the disease and is its specific cause; and then the predisposition, which weakens the body and makes it the right kind of soil for the germ to thrive in. You will understand this better by taking the example of a family of half a dozen people. One or two of them will come down with pneumonia, while the others will escape. But why do they not all suffer, since in the family relation they must all have been about equally subject to the germinal attack? The reason is that the bodies of those who have come down were predisposed — their resisting power to the germ of the disease was diminished. But in the bodies of those who escaped the organs were sufficiently healthy to triumph over the infection; and those fortunate members of the family had 106 YOUTH in their blood agencies fighting the pneumococci, rendering them harmless, and even consuming and destroying them. Predispositions loom up very large indeed in the doctor's practice; it is a great deal of his duty to find them out and rectify them, if this is possible to be done. The sad thing, however, is that in the dreadful stress of modern life it is impossible always to avoid them. What are some of them, with especial reference to pneumonia? Men have a greater tendency to pneumonia than women because of the greater hardships the family breadwinner has to endure. In the change- able and unsettled months, such as December and March, there is much pneumonia; such months are windy and dusty, too, and that has a great deal to do with the spread of the pneumonia germs. Cold and wet, especially as to the feet, predispose by lowering the bodily resistance. Then of a cold day a man will go into a stuffy place to get himself a hot whisky punch, and will go right out into the cold again. This will make him perspire and have the effect to open the pores of his skin to the cold; so comes the deadly chill that starts the attack of pneumonia. But cold itself is not responsible for pneumonia; during the continuous cold of January and February there is not so much of this disease as in changeable December and March. Arctic explorers never have pneumonia — anyway, not in the Arctic, because the germ does not exist in that pure air; but when they get back to civilization, where the germ abounds, they are just as likely as anybody to succumb. 107 WHY DIE SO YOUNG? Fatigue very decidedly predisposes the body to pneumonia; men who must work hard through long hours and in inclement weather are very apt to come down with it. Unhealthy conditions of the upper air passages — catarrhs — tend to "lung fever." There are chronic diseases of the heart, the liver, the kidney, and the stomach to which pneumonia is a "terminal infection" — that is, one dies of pneumonia, to which those other diseases have predisposed. An injury to the chest wall may predispose. Alcoholism is at fault in a sad number of cases; and an alcoholic pneumonia is well-nigh hopeless. There is more pneumonia in the cities than in the country, for obvious reasons, but especially because the germ has a better chance to thrive in insanitary conditions; besides, city people are more irregular in their living and they are over- crowded in ill-ventilated tenements. As to the prevention of pneumonia. In the first place, the predisposition to this disease has to be removed — an easy saying this, a hard one to put in practice. For in this workaday world the struggle for existence is so intense that it is im- possible to remove all the agencies that weaken the body and lay it open to germinal attack. As for the germ of pneumonia, the pneumococcus, we must act pretty much as we should against the germ of consumption, as we shall see. The sputum is disinfected; those who nurse pneumonia patients must keep their mouths and throats very clean by means of dentifrices and gargles; they must wash their hands very often and then lave them in disinfecting solutions. After the patient's recovery 108 YOUTH or removal his house is thoroughly cleansed, aired, and opened up to the sunshine. Those who need not be with pneumonia patients had best not visit them; though, of course, there is no occasion for the fright that is often evinced, as if such sufferers had the plague. However, people worn out or otherwise susceptible to infection should not unnecessarily expose themselves in these premises. A CASE OF TUBERCULOSIS I have intimated, in these pages, how, with adolescence, begins the dreadful consumption mortality of every fourth or more among us. Here is one of the most melancholy facts in all medical experience. I do not know how more forcibly to present the matter than by the narration of a "case history," the like of which comes almost daily under the observation of every family doctor. A young working girl had caught cold, beginning in the familiar way; sneezing, the nose stopped up; headache; at first dryness in the throat, then difficulty in swallowing and in speaking; cough; chills and feverish sensations; pains in the chest (where presently the cold settled), and in the bones and joints (from the infection — the toxemia — in the blood). Now this poor girl paid little attention to these symptoms; she considered that she could not afford to, because she had to work for her living. She would not, or she could not, in the cruel economic conditions which bound her, stay at home and nurse her cold until her health could be fully restored. She neglected this really serious condi- 109 WHY DIE SO YOUNG? tion until her deplorable illness took on a tragic phase. Instead of resting at home she kept on working in a shop where she was employed, next another girl who had consumption. Now this other girl, a very conscientious girl, of course, but who was ignorant or untrained in the prophylaxis of consumption, coughed into the air about her working place and was careless as to the disposi- tion of her sputum. The germ of her disease (the bacillus of tuberculosis) became thus disseminated, so that any predisposed person working near by her, day after day, would certainly become subject to the tuberculous infection. And this pitiable result is precisely what came to pass. The poor young woman first referred to had become run down, predisposed, by reason of her neglected cold; and her tissues now provided an ideal soil for the implantation of the tubercle bacilli. So then, her lassitude and her weakness, her "tired feeling" increased day by day, she felt none of her former eagerness for work, she had none of her former ability to concentrate her ener- gies upon her task, for in truth she had but little energy left in reserve; she was easily becoming exhausted; her appetite was poor; she was losing flesh; she was becoming pale except for an un- wonted pink flush; she felt her heart beat rapidly and that she was beginning to breathe with dif- ficulty on exertion. Chills became very marked, also fever; she perspired all too easily, especially at night; she was becoming hoarse; her cough, which she with pathetic optimism called a stomach cough and attributed to indigestion, was becoming no YOUTH so persistent that she got no relief, despite the sirups and the patent medicines she was using, and which were worse than useless, because they were "turning her stomach." Finally, she found a streak of blood in her sputum; and then, in a dreadful fright, she did what she should, of course, have done months before — she went to her doctor, who had then, all too late, to tell her the truth — that she had consumption. Now this girl was one of a family of six. She died of her disease. Her father was addicted to alcohol; John Barleycorn and the Captain of the Men of Death are a team there is little use in resisting; the alcohol easily predisposed him to the consumption which he contracted from his daughter. And so he too died. The mother also came down with tuberculosis, and succumbed as did her daughter and her husband; and a strong son of eighteen soon suffered the same fate — death from consumption. And so on until all that was left of that family was a little boy of six years, who had a tuberculous, a cold abscess formation, a white swelling of the knee joint, from which he fortunately recovered. Such is the history which began with "nothing but a cold." Nearly every day the practicing physician comes upon like neglected cases. I will recapitulate here, by reason of the vast importance of the subject, the early signs of tuberculosis. 1. A cough lasting more than a month (except whooping cough, in which the cough lasts six weeks or more). Such a cough may not, of course, mean consumption, but it ill WHY DIE SO YOUNG? certainly calls for a thorough medical exami- nation. 2. Hoarseness lasting several weeks. 3. Poor appetite (especially in the morning), indi- gestion, loss of weight and strength, paleness, and a generally run down condition ("that tired feeling"). 4. Hawking and spitting, especially in the morning. 5. Night sweats. 6. A streak of blood in the sputum. 7. Afternoon fever, shown by flushed face and alternating with chilly sensa- tions. The spittle has to be examined for the tubercle bacillus, the consumption germ. But it must not be concluded that there is no tuberculosis if this germ is not found, even after several exami- nations. The test is absolute if it is positive; not so if it is found negative. Many doubtful cases will be cleared up by X-ray examination of the chest. THE PHYSIOLOGICAL PRINCIPLES Following are the modern principles of con- sumption treatment, by which most early cases can be cured, many even advanced cases arrested in their development; and by which comfort and relief can always be assured. These principles can be pointed off on the thumb and fingers of one hand. First, there must be careful disposal of the sputum of the consumptive — practically the only means by which the disease is conveyed from one person to another. The handkerchief or a cloth must be always held before the patient's face when he coughs, sneezes, or spits out; thus is droplet, or spraying, or atomizing infection avoided. The patient's handkerchiefs, towels, linen, bed 112 YOUTH sheets, and the like must be boiled by themselves before being added to the general wash. What- ever can be must be burned. The spittoon must contain some fluid (water will suffice) in order that the sputum may not dry and become incorporated with the dust. And the spittoon, when cleaned, must be scalded; this will kill the tubercle bacilli, the consumption germs. Secondly, there must be rest. There is otherwise no hope for the consumptive's emaciated body, an organism ever on the verge of bankruptcy. Here is, of course, a factor difficult of management, especially among the poor (who furnish the ma- jority of the consumption cases), many of whom feel that they must somehow work in order to maintain themselves and their own. Nor what, indeed, can be more pathetic than that the con- sumptive is, more likely than not, the family breadwinner? And yet there has to be rest, es- pecially when there is fever, and at least until the sufferer has recuperated from the exhaustion which has been the prime predisposition to the disease. For the consumptive germ battens on devitalized tissues. The rest has got to be absolute if the bodily temperature reaches 100 degrees by the clinical thermometer; and the bed inexorably when the fever has gone above this. The rest should be, if possible, out of doors — at least with open windows. When the air is cold warm headgear is to be worn; or the woolen "helmet" which comes down over the collar bone. And the footwear must be at least as ample and as comfortable as the headgear. The body must be abundantly clothed; there are 113 WHY DIE SO YOUNG? sleeping bags made for such patients. The idea of sleep is involved in that of rest. Nowhere else should nature's soft nurse be so sedulously wooed. Insomnia is most exhausting in such a disease as this, when it is so necessary to build up and con- serve the strength. Nor has any restorative even been invented to compare with sleep. Insomnia with fatigue and overexertion have predisposed to many a case of tuberculosis. We strive for sleep without medication if possible; it may, among other ways, be induced by the drinking of hot milk after the patient has been tucked away for the night. The third principle underlies what is called the "twenty-four hour cure." It is that the patient should every possible moment, day and night, twenty-three hours, anyway, breathe fresh air and be in the sunshine so long as there is a ray of it. (Of course, the excessive heat of the summer sun must be avoided.) At night, no matter how cold, the windows are to be open; nailed up, not down, if there has to be any nailing to be done. The colder the air, the surer the cure; more patients recover in the winter than in the summer. Draughts are, however, to be avoided. This can be done by means of a screen or a blanket-decked clotheshorse appropriately placed. Only twice, from day to day, should the windows be closed. A member of the family comes in half an hour before dressing time and shuts the windows; and at bedtime the patient undresses with closed windows. Then when he is snugly in bed for the night, some one opens his windows for him. The fourth principle calls for plenty of nutritious 114 YOUTH foodstuffs, coupled with good digestion, so that all the fuel taken into the body may be converted into healthy, germ-resisting tissues. The doctor must decide details for individual cases; but, in general terms, we try for the largest amount of nourishment with the least amount of labor for the digestive tract. Thus the patient should eat roasted or broiled meats (beef, mutton, or lamb), fowl, fresh vegetables, and fruits, cereals liberally mixed with cream, plenty of sugar, good butter, a generous admixture of table salt and, at or between meals (if the appetite will stand for it), from six to eight eggs, and from one to three quarts of milk daily. Such indigestibles as in- nutritious sweets, pastries, and dainties, must be avoided; these interfere with normal metabolism (the perfect conversion of oxygen, fluid, and food into healthy organs and tissues). Between meals, at any rate, plenty of water should be drunk, for no food is absorbed that is not ultimately in fluid form. No alcohol, except by the doctor's prescription. Finally comes the fifth principle. No patient shall use medicine without the direction of his doctor. Patent medicines (which have an alcohol content sometimes as large as whisky) must be avoided. Avoid the nauseating sirups. These physiological principles, under the physi- cian's direction, are applicable to many other dis- eased states. THE CONSUMPTIVE PATIENT Upon being told of his malady the patient is likely to become dreadfully affected; will look the 115 WHY DIE SO YOUNG? doctor anxiously in the face. But the latter has composed his features to clear-eyed, calm, and gmtle sympathy; and his voice is both firm and kindly while he is meeting the patient's quivering lips, his white, tense, dilated nostrils, and his swim- ming eyes, over which he presently puts his trembling fingers. Following on this initial shock, however, the patient's psychology is pretty much that of the soldier. When the prospect of going into battle first confronts the recruit, he will have a sense of terror, no matter how well established his courage ; but his emotion is certain presently to give way to that of exultation and to a belief that the fight which has to be made will ultimately be a victorious one. The patient must be obedient to his physician, and persistent in every detail of the treatment enjoined upon him. He will be for the most part confident of his recovery — a state of mind (the spes phtkisicorum) happily prevalent among con- sumptives. He must understand that his im- provement and final recovery will depend largely on his own conduct. He must consider, before he undertakes any business or other matter, how his chance of getting well will be affected thereby. He must make it a habit to converse with no one except his physician or his nurse about his disease. He must absolutely not adopt the prescriptions of solicitous friends. However well he may imagine himself, he must continue under this doctor's care until he has been dismissed. As we have considered, there is no routine medicine, no set prescription for the cure of consumption. And 116 YOUTH medicines are now held subsidiary to hygienic measures. The doctor individualizes in treating the consumptive, as he must, indeed, for all patients of whatever disease. The various organic functions have to be regulated, according to the peculiar conditions and necessity and the complex relations of the organs and tissues. THE CONSUMPTIVE'S DOCTOR The consumptive's doctor will take every possible means to recognize the disease in its early stages : for every week's, indeed, every day's, delay in establish- ing the treatment jeopardizes progressively the pa- tient's chances of regaining health. The generalship, the recognition of many elements to be considered, the material at hand with which the disease may be fought — such are within the doctor's province. The sufferer must be made to rest confidently upon his strength, his judgment, and his latent resourcefulness. The consultations must unvary- ingly and unfailingly be an inspiration. There has got to be something of a subconscious bond or compact, in which earnest solicitude will be the doctor's contribution, and loyal obedience that of the patient. The latter is physically weak and lacking in nerve energy; his psychic, his mental stamina, is like to be correspondingly below par. He will consequently need constant suggestioning of health and vigor, not only when he realizes that he needs these things, but even more so when he imagines that he does not — like so many who need to pray, not so much when they are un- fortunate as when they are becoming prosperous. 9 117 WHY DIE SO YOUNG? For it is in the latter season that the "bad breaks" are made. The doctor will study the patient's mental condition; he will recognize that in many consumptives, especially women, the emotions and the will are apt to be unstable. He will deal severely with the frivolous (strange, outre, indeed, how many consumptives are that way); he will en- courage the despondent; he will with redundant patience instruct the ignorant. His directions must be clear and definite; concerning them the patient must never be left in doubt. He has to explain the nature of the disease, not only to the patient's family, but also to the patient himself. It is very wrong to speak mildly of a pulmonary catarrh, of a little trouble at the top of the lung, to soothe the patient's feelings (with a kind of sugar- of-lead sweetness) with the result — how often has this been so! — that the latter may, through not understanding the gravity of the situation, be negligent, with fatal outcome. There are physicians of whom consumptives have said, in dying, "If my doctor had but told me the truth I might have been well to-day." For an evasive diagnosis no consumptive will observe the rigid regimen essential to recovery, nor will such a one renounce his favorite habits and pleasures; nor his vocation, if need be; nor the time and money to achieve his cure; nor will he leave his own people and his familiars. BATHING No one can be really healthy who does not consider carefully the emunctories, the eliminative organs, among which we now consider the skin. 118 YOUTH Science has proved that the varnished frog croaks its last croak when the air it breathes becomes warmer than 96 degrees — which is hot for frogs, but which the unvarnished frog will survive. The frog must use the pores of its skin to radiate the extra heat, which it cannot do when it is varnish-coated. Moreover, disease germs make short work of varnished frogs that are already weakened through sweltering. There are humans who, although they are not varnished, yet take on coats of other material quite as deleterious to health; as in the case of the individual who, in overweening pride, boasted of his bathing regularly every Fourth of July, whether he needed it or not. Also, improper, too long unchanged, and too much clothing disturbs the functions of the skin, some- times seriously. The skin is an organ of respiration, and as such is a part of the body's breathing mechanism. And the skin secretes, as when its sebaceous oil glands keep it from becoming dry; and it excretes, as in perspiration. He who bathes o' mornings gets his blood elements enriched, and avoids blood stagnation — a very evil thing; has his lung power and area increased; his appetite and nutri- tion enhanced, and the food elements better stowed away in those parts of the body where they belong; is assured a sense of mental as well as physical well-being; and in cases where such improvement is desirable has his morals decidedly improved. The skin is the peripheral — that is, the surface — heart. As we noted in our first part, a child from two to ten years old has a skin surface up to ten square feet; and underneath this is a 119 WHY DIE SO YOUNG? stream of blood and lymph that should be in constant and rapid circulation. If such circu- lation takes longer, or if there are pools, eddies, and pockets by the way, the bodily organs and tissues will get clogged up with impure blood, and will become most hospitable to all kinds of disease germs. The whole bodily machinery will become clinkered up, and sooner or later that body will suffer disease. The grown-up who has several yards of peripheral heart and a veritable sea of blood flowing through it should bathe regularly. Let him not be as the varnished frog. SKIN CANCER A word here to young women about birthmarks and the beauty doctor. Later we shall discuss cancer. This, a disease usually of middle and advanced life, is now come upon, in the form of skin cancer, with unprecedented frequency, in women as young as eighteen years. How explain this most sad state of things? Almost all cancers are the result of "precancerous conditions" in the body, plus irritation. Among such conditions are moles and certain warts from which, when they are irritated, cancer develops. Every wise grandmother will tell you that moles and birthmarks that are giving no trouble had far better not be meddled with, lest malignant disease result from disturbing them. Time was when women considered birthmarks to be beauty spots; if they did not have these marks by natural right, they put black court plaster imitations of them on their faces. But the fashion is now changed, and many foolish women 120 YOUTH resort to beauty parlors for the removal of moles and the like, oftentimes by utterly inexperienced operators, who realize nothing of the danger lurking in their proceedings. They will remove what they can see of a mole or of a warty growth or other so-called blemish, leaving behind a micro- scopic portion; and thus have they irritated the tissues at the site of their imperfect operation, have incited part of the growth not visible to the naked eye, to cancer development. Most certainly moles and the like, which have already suffered irritation — birthmarks on the neck, for instance, that have been rubbed to inflam- mation by those boned collars that reach to the ears and above; sores that will not readily heal; or any warts and moles that show swelling and give pain — all such must indeed be attended to. But this only by doctors and surgeons of tried skill, experience, and reputation. The black or red mole raised from the face, either smooth or rough, and perhaps containing hairs, is the most dangerous to irritate or to operate on; and many a fatal cancer has resulted from tampering with them. In any event what do you get from your visit to the beauty doctor? In place of a comely mole, a scar looking like a vaccination mark, or a pitting, or a parchment like a blotch. Do not, therefore, take any chances with a natural growth with which you are blessed and which is resting peacefully in the skin. GREAT ACHES FROM LITTLE TOE CORNS GROW The doctor writing this, being no medical fledgling, knows better than to try instruction 121 WHY DIE SO YOUNG? wherever fashion has a contrary voice. And it does not matter that, like most men, I like a comely foot, a natural, anatomic foot, such as Grecian women, the most beautiful in the world, had — an ample, generous foot, if the woman's architectural proportions called for it; and a small foot, so long as it was symmetrical and proportioned to the small woman. But in Greece they never aimed for an unnaturally small foot, a monstrous foot; for monstrosities are things out of proportion, too small as well as too large. If fashion decrees that feet shall be incased in ugly gear, by which they shall ever after remain distorted, which shall, besides, give constant pain, which shall, by making difficult walking and exer- cise in the open air, prevent women from living the physiological life — why, then, fashion is going to triumph and nothing any male person, doctor or no doctor, can say is going to avail. And yet there have, of late years, been rather successful efforts made to bring Dame Fashion, even though she goes to extremities, into working relations with hygiene. Many of the great shoe manufacturers now consult surgeons in their shoe-construction plans, try to learn a little some- thing about the anatomy and the mechanics of the human foot. The most common fault in a shoe is that the instep is too narrow, and the point of the shoe slopes forward equally from both sides, coming to a point midway between the two margins of the heel of the shoe. A natural foot undistorted by fashion or misuse has the great toe in a nearly straight line with the inner border of the foot, so 122 YOUTH that a shoe made on the plan mentioned throws the toes together in a bunch, especially if those abominations, French heels, have been built in. Thus results the unromantic bunion which, unlike the corn, is a bony displacement outward and an ugly one — where the first bone of the great toe joins the rest of the foot on the inside. And the same applies to the outside of the foot if the little toe is misused in the same way. Then, in the course of time, friction and irrita- tion produce a thickening and hardening of the skin over the bunion. Then the great toe gets pushed under the other toes. And in gouty or rheumatic people the bone of the foot joining the big toe also becomes enlarged and twisted. Thus is the natural elasticity of the foot altered, the movements restricted, and much intense suffering caused — so bad that surgery may have to be done. The best way to avoid all this malformation and torture is to start life, and keep up throughout life, using a shoe with a straight inner edge. Shoes are also made with divisions between the big, and the other toes. Stockings with a pocket for each toe, the same as gloves, are also to be had. The toe mark of civilization is the corn, which, indeed, may appear in any part of the skin of the foot that is constantly pressed upon. The conse- quences are sometimes singularly remote. Even curvature of the spine has resulted from the sufferer's efforts to relieve the foot in walking. And the corn may, in men, interfere with exercise and business, and be productive of nervousness, dyspepsia, insomnia, and profanity. Indeed, ab- 123 WHY DIE SO YOUNG? scesses and gangrene may result from an inflamed corn. Of course, the way to avoid such troubles is to get rid of the pressure which has caused the corn, by wearing the right kind of shoe. Corns appear even on babies' feet. Therefore, the wearing of sensible shoes should begin with the wearing of any kind of shoes at all. A splendid rule is to buy shoes you can, with perfect ease and comfort, walk out of the store in, and buy no other. There are several other troubles — ingrowing toenails, flesh growing over nails, calluses that may become as thick as leather, hammer toes, and so on, all caused in most cases by not wear- ing the right footgear, and, if permitted to grow worse, resulting in malformation and ugliness in what ought to be one of the handsomest parts of the body. EXERCISE The right development of the muscular system, along with good food, pure air, and the living of the hygienic life in general, is essential to human efficiency and longevity. A muscle unused for any period diminishes in bulk and degenerates in quality. I recall one of my fellow internes in hospital, a man at that time of magnificent physique, strength, and stamina, as well as of superior intellect, and, by the way, an expert boxer. Tradition has it that he actually, while on a holiday at Coney Island, toppled over the renowned John L. Sullivan, for a rudeness the latter had offered a lady. And 124 YOUTH it is, I am sure, in no wise a detraction from my friend's heroism that John L. had previously had any number of rounds with John Barleycorn and was consequently not up to his fighting form. In a moment of epic indiscretion, during an after- noon's relaxation in the hospital, I "took on a go" with my athletic friend; and all I have to do this day, may years after, is to close my eyes and I can see again those very same stars. Some years after our hospital service I was astonished and pained to meet my friend and to find him gaunt and feeble. He had had typhoid, he told me, and for months after recovery from the disease itself he could not ride a bicycle a block without having to desist, exhausted, winded, and sweating "like one in a tertian"; he could not concentrate his mind through to the bottom of a single page in any book. After a month of illness and at the beginning of his convalescence he wanted to get out of bed. His nurse told him he was not strong enough for that. Vexed and hurt by such an assertion, he did get up and at once fell to the floor in a heap; for his muscles, unused during his illness, had become flabby and the legs of that erstwhile Hercules had become pathetically spindle-shanked. Exercise, to be salutary, must be judicious. Taken to the point of extreme fatigue, day after day, it may do harm. When a muscle is worked, some of its substance is used up. At the same time and afterward more blood flows into it, and if the exercise is not too violent and the rest intervals are long enough the repair and growth will keep pace with or exceed the wasting. But 125 WHY DIE SO YOUNG? excessive work and too short rest, like too little exercise, will tend to muscle diminution and enfeeblement. Few persons among us can profitably work hard daily with both brain and muscle; but we should all regularly use both, choosing which to work with and which merely to exercise. For persons of average physique whose occupations are sedentary — clerking and the like — the minimum of daily exercise should be an amount equivalent to a five-mile walk. Since extra muscle work means extra muscle waste, and should be accompanied by an abundant supply of food material to the muscles, violent exercise should not be taken after a long fast, nor immediately after a meal — for much blood is then needed in the digestive organs to provide material for metabojism. Hearty young people may take a long walk before breakfast; but others should wait until after eating before engaging in any kind of exertion. WALKING I am, for my part, very strong for walking. The exercise has many most notable exemplars. Samuel Johnson tramped through the Hebrides, for all his scrofula. Oliver Goldsmith (himself a physician, though, it is to be feared, an indifferent one) was for years a wayfarer along the courses of the lazy Scheld and wandering Po, and, fiddle under his arm, through much else of Europe. Mark Twain tramped abroad — when he could not get a hitch or take a boat. Blaikie, in his immortal book, How to Get Strong and How to Stay So, in the last 126 YOUTH of many editions as well as in the first, maintained the best of all exercises to be walking. "Give me," enthused Hazlitt, "the clear sky over my head and the green turf beneath my feet, a winding road before me, and a three hours' march; and then to thinking"; whereat Stevenson, "And he must have a winding road, the epicure." Poor Stevenson, who could so well appreciate, but latterly had to give up this blessed recreation, by reason of his consumption! In other and more virile generations men thought nothing of a thirty- mile jaunt. For Dickens it would have been just a freshener — just one hearty meal of divine air, with wondrous landscapes and conversations with his rural countrymen on the side. Lily Langtry in her prime frequently did her twenty miles a day; no wonder she was handsome. A young woman, by the way, recently asked her physician to prescribe for her a complexion im- prover. Being no beauty doctor, he did what he thought the best for her and advised: "Get one pot of rouge (any kind of rouge) and one rabbit's foot (not necessarily a left hind foot). Bury them together two miles from home (or from the line of any trolley or other means of conveyance), and walk out and back (in any and every kind of weather, wearing, if necessary, arctics or rubbers in rain or snow) * so as to be sure those articles are still where you have buried them. Besides this, go to bed so that you will be sure to sleep eight hours; lie down, if possible, half an hour after lunch; bathe in water as cold as possible within 1 There is no bad weather; there are only different kinds of good weather. — Ruskin. 127 WHY DIE SO YOUNG? comfortable limits, giving yourself a good rub down after the bath; eat three square meals of wholesome food daily, cutting out the sweets and the indigestive and innutritive pastry; drink six glasses of water, at least, during the day; see that the body's emunctories are functioning properly. And I guarantee you will then have a complexion that will stop the traffic on any thoroughfare you will choose to grace with your presence." Nor, in our own supine day of the enervating motor car and the all too ubiquitous trolley, is the magnificent art of walking altogether neglected. Has not Dr. John Finley, formerly president of the College of the City of New York, now Com- missioner of Education of the Empire State, and at any time writer of fine verse, done his thirty miles in nine hours, in the nighttime too, when most of the rest of us were sleeping, beginning with Elizabeth, New Jersey, and ending up at Princeton for breakfast! Starting at In wood on Manhattan Island, walking along the Hudson front to the Battery, and thence up along the East River (most picturesque of urban shores), to the Harlem, was just one stroll for that plain liver and great thinker. And my friend, Dr. Richard Cole Newton, who admits threescore and perhaps a year or two more, is a very energetic walker, who keeps on throwing off such little stunts as a ninety-mile jaunt in the twenty-four hours, starting, say, from Newark, New Jersey, making stops at Elizabeth, New Brunswick, Princeton, and Trenton, and ending up at North Philadelphia. Superb harkings back, these, to the very efficient footwork times when the news of Marathon was brought to Athens, 128 YOUTH when Caesar's legions traversed Gaul, and Hannibal •crossed the Alps and Lucknow was relieved! Those not accustomed to long walks and who want to get the fine habit should take some pre- cautions. The strength must not be overtaxed in the beginning. In going for a day's tramp, on a Sunday or a holiday, there is no harm in getting stiff and wholesomely tired; a warm bath at bedtime will set that right. But when there is to be a walking trip there should be no more than five miles the first day, ten the next, fifteen the third; after which breaking-in one may begin at dawn and foot it until he is canopied by the stars. Nor will any harm come to him, but much good and happiness and promise of length of days. The way to walk is to throw back your shoulders military fashion, the chest out, the pectorals expanding, the nostrils dilating, the mouth closed, the head erect, the arms swinging halfway, but not like a windmill. Let your mind be diverted by the ever-changing scenery along the road; talk to the farmer of his fields, praise his pigs, ask his good wife for a drink from her spring, give her some of the news, for which she is so hungry, of what is going on in the world. Nothing else will so surely get the cobwebs out of the brain, nothing else will so liberally broaden your sense of humanity. The clear sky, the bracing breeze, the rustling boughs, the laughing waters, the birds, their throats simply bursting with melody — these our brethren, who should be our familiars, are calling. Go forth, brother, and walk among them; go, sister, out into the sunshine and mingle with them. 129 WHY DIE SO YOUNG? For a walking trip very little paraphernalia is necessary. A stout, easy pair of shoes is essential — such as have been tried out at least a week before- hand. The feet must be well nursed, bathed, and vaselined if need be, at the end of the day, so that one shall not become a tenderfoot. Many a walking trip has gone to pieces the first day or two by reason of blistered feet. A real wayfarer who is not too fussy and of reasonably democratic tendencies can find a good lunch almost anywhere on the road. A favorite refreshment of Weston's was an egg beaten up in a cup of coffee. A cake of chocolate — a most sustaining food — hi the pocket will never be amiss. And be sure to take along a foot or so of tubing through which you can quaff delicious Adam's ale from any pure wayside stream. Some of my own most agreeable recollections are of my seat atop a convenient barrel in any crossroad or country store, crackers and cheese in one hand and a bottle of tonic (ginger ale or sarsaparilla with a straw in it) in the other hand, w T ith discus- sions of the perversities of our political system with the congregated rural citizenry. As to companions on the walk. In a party one can always find a congenial companion of either sex. But if there are only two of you be sure your man is agreeable; otherwise there is no torture so exquisite as a day's walk in his company. If you are not absolutely certain on this point, go alone; you will be surprised what a good sort of fellow you will then become acquainted with. More than this; after hours of social com- munion with nature you may, come twilight, find 130 YOUTH yourself, Enoch-like, walking in most comfortable intimacy with the Almighty. PHYSICAL TRAINING While thus extolling walking I am not decrying other exercises and sports — boating, boxing, tennis, baseball, cricket, and the like; nor am I forgetting croquet. When judiciously taken these are all most salutary. Exercise develops and strengthens the mental processes; Hazlitt appreciated that fact. The brain out of which thought is evolved (we know not precisely how) is as much a bodily organ as is the liver or the lungs. Much of our thinking (we do not know how much) is really a physical process during which the vital stores of every organ are drawn upon. The energy which makes clear thinking possible depends largely on the bodily vigor. When physical disease impairs the tissues the mental processes suffer. We have noted how muscular activity develops both the nervous and the muscular systems. The muscles are the special organs of volition, the one part of the body which the brain can directly command and act on. The feeble-minded child is clumsy in the use of his muscles; the right development of the normal child is indicated by increased accuracy and delicacy of muscular control. Physical training is, then, to a considerable degree, mental training as well. Much thought (of course not all) that we used to call reason is just feeling; and much of our conduct, many of out activities, are due more to desire, sentiment, and habit, than to innate reason. We lead to a 131 WHY DIE SO YOUNG? very considerable extent a cerebrumless existence. The youth well trained all around, physically and mentally, has his activities well organized for his mature needs. The same is, of course, true for the schoolgirl and the young woman. Many intellectual men fail for lack of staying stuff. Many are timid and irresolute because they lack the physical driving power; theirs is a shoddy nervous system, a melancholy handicap, as we shall see. Much loose thinking, much rabid and false thinking, is due to loose drilling of the bodily forces in childhood and youth. Enthusiasm, self-confidence, the spirit of adventure, alertness, promptness, unselfishness, quick judgment, are all qualities to be attained on the field of games and sports. THE MILITIA Military drill makes splendidly for the sane mind in the sound body. The war just ended, so fraught with suffering and so death-dealing, has in any event turned many a slouching, mediocre, useless apology of a man into a superb specimen in whom we have now reason to glory — every fiber of his body trained to the finger tips, and from the toes up to every eye muscle trained and habituated to prompt obedience, to team work, to courage and right living of the noblest sort. Now that the war is over it is to be hoped that our before-the-war National Guard of citizen soldiery will be redeveloped and restored to its fine old status, its fresh nucleus our boys returned from "over there," every community in the land having its militia body. 132 YOUTH Young men, go into the militia. It is really amazing the amount of health, physical and mental — yes, and spiritual, too — and what fun you can get out of a good regiment. I write from experience, having been a National Guardsman. In the awkward squad you are introduced to a fine system of gymnastics, in which nearly every muscle, every organ and cell in your make-up, gets a chance. You assume the position of a soldier, and then perhaps for the first time in your life, you enjoy a delicious sense of anatomical symmetry and completeness. Never again the ignoble shuffle, the stooping shoulders, the hands in the trousers pockets. And the drills ! For an hour and a half you stand to the limit of your inches — shoulders back, head up, chin straight out, eyes to the front; your movements are timed and measured and rhythmed for you; you enjoy the mental relaxation of having no initiative of your own, of doing precisely what you are told and of having some one else for the time being order your movements for you. You learn discipline. How valuable the lesson! You come to realize that he who would, in mature life, direct others must himself first learn how to obey. Soon you are given your piece to carry; this seems to you to have the weight of a young pine tree, and at the start you manipulate your weapon with the airy grace of a dancing bear balancing his pole. After the drill you go home, bathe, sleep — the sleep of the more or less righteous, but sound, at any rate — and you awake with an appetite, a sense of physical well-being, and a clearness of mind such as are perhaps entirely novel and 10 133 WHY DIE SO YOUNG? certainly most happy experiences. You become one of a hundred splendid fellows — sound, clean, manly, wholesome. Among such your mind and body, your morals, too, have got to be right. And, what is in itself worth all the rest of the game, you will learn also why the hat has got to be removed when the flag passes. THE HYGIENIC LIFE I am here most earnestly urging youth to get the habit of living the physiological, the hygienic, the healthful life. To live this one must bathe well, eat slowly and not excessively three meals of wholesome food daily; one should be in the sunshine a great deal; should drink at least half a dozen glasses of water the day; should avoid dusty, damp, and foul air; go to bed so as to be sure of eight hours' sleep. One should wear underclothing that is all wool or as near all wool as possible, all the year round; thick in winter, thin in summer. Warm footwear and stout, water-tight shoes are essential. Tobacco had best be let alone — by the young, anyway. Alcohol should be taken very moderately, if at all, and never without a bite of food at the time of drinking. The well, indeed, never need alcohol; the elderly and the feeble may have occasional use for it. Fresh air and lots of it are necessary to the hygienic life. Rise early; go to bed early; and in the mean time keep yourself occupied. W r ater and bread sustain life, but pure air and sunlight are indispensable to health. Frugality and sobriety 134 YOUTH are the best assurance for a long life. Cleanliness preserves from rust; the best kept machines last the longest. A sufficiency of rest repairs and strengthens; too much rest weakens and makes for flabbiness. He is well clothed who keeps his body sufficiently warm, safeguarding it from all abrupt temperature changes, while at the same time preserving perfect freedom of motion. Live in a house that is clean and cheerful; this makes for a happy and a healthful home. The mind reposes and resumes its edge by means of relaxa- tion and wholesome amusement; but excess opens the door to the passions and these attract the vices. Judicious pleasures conduce to love cf life, and love of life is the half of health; on the other hand, sadness and gloom help on old age. If it is your brain that feeds you, do not allow your arms and legs to become stiffened beyond the possibility of use. Do you dig for a livelihood? Do not then omit to burnish your intellect by good reading and thereby to elevate your thoughts. I cannot imagine a finer ideal of the healthful life to set before young people than this of Huxley: "That man, I think, has a liberal education whose body has been so trained in youth that it is the ready servant of his will and does with ease and pleasure all that as a mechanism it is capable of; whose intellect is a clear, cold logic machine, with all its parts of equal strength and in smooth running order; ready, like a steam engine, to be turned to any kind of work and to spin the gossamers as well as to forge the anchors of the mind; whose mind is stored with the knowl- edge of the great fundamental truths of Nature 135 WHY DIE SO YOUNG? and the laws of her operations; one who, no stunted ascetic, is full of life and fire, but whose passions have been trained to come to heel by a vigorous will, the servant of a tender conscience; one who has learned to love all beauty, whether of nature or of art, to hate all vileness, and to esteem others as himself." BACK TO THE LAND It is most depressing, in the country region where I am summering, to ride past countless acres of abandoned farm land, the bosom of Mother Earth, whence come all our material blessings, the source of all our wealth, all un- touched. Our former Secretary of the Interior, Franklin K. Lane, would have our government provide land settlements for our soldiers and sailors who served in the war. Millions of acres are planned to be irrigated; other millions of acres of swamp land are to be reclaimed; still other millions of acres of arid land are to be cleared off for agricultural purposes; and land not fit for plowing is to be used for stock raising. Our honorably discharged soldiers and sailors would work at good pay on this vast reclamation scheme; and afterward to those good men would be sold, to be paid for on installments, the land they are working and all necessary farm implements and paraphernalia. He who works for a wage is indeed honorably occupied. And yet it is hardly possible for any man, however sincere his intentions, to do for another or for a corporation all that he would and m YOUTH could do for himself. It is simply not m human nature. More than a century ago this social and economic fact was recognized by the traveler, Arthur Young, when he wrote of a certain district in France: An activity has been here that has swept away all difficulties before it and has clothed the very rocks with verdure. It would be a disgrace to common sense to ask the cause; the enjoyment of property has done it. Give a man the secure possession of a bleak rock and he will turn it into a garden; give him a nine-year lease of a garden and he will turn it into a desert. Many of the vineyards which greet the traveler's eye have for their entire soil earth which has been carried in baskets up the mountain side by the laborious owner of those vineyards. When I used to open my casement, between four and five in the morning, to look out upon the lake and the distant Alps, I saw the laborer in his fields; and when I re- turned from an evening walk long after the sunset, there was the laborer still mowing his grass or tying up his vines. He that owns no more than an acre ("ten are ample") and a cow, under just and equal laws, knows that every stroke of his arm is creating values which he and his family will enjoy to the uttermost. Long is his day's work; but its close does not find him exhausted. He takes care to prevent the injury and the waste of what is his own. He stores and houses his crops. And with the oncoming of the snows he is busy repairing his farm tools and his implements, putting to order his barn and his chicken houses, is occupied contentedly with a thousand things that need attention by way of preparation for the spring plowing. And during the winter nights there is the helmet with the bullet hole through it, taken from the 137 WHY DIE SO YOUNG? Boche in the Argonne, and above it Old Glory that was carried wherever the fighting was done. And in the hearth below, the crackling logs are lighting up the wife's winsome face; and surround- ing them that scale of olive branches constantly ascending as the blessed years go on! Such is the life for the returned doughboy; the life so conducive to health, to happiness, and to length of days; the life for the real man. Go to it, brother! MARRIAGE And the wife. When should a man take unto himself a wife; and — with precipitate haste I add — when should a woman take unto herself a husband? There is hardly any subject more fraught with diversity of opinion. At the one extreme there is the monosyllabic advice of Punch: "To those about to marry, Don't." At the other stands the dear old Vicar of Wakefield, whose homilies were so insistently for early marriage, the earlier the better. From the physician's view- point there are weighty considerations in favor of fairly early marriages. "At eighteen under the canopy," states the Talmud; and all forms of re- ligion may well respect a saying out of the wisdom accumulated during forty centuries by the teachers of the Jewish faith. One must, however, note that the Jewish teaching had its origin in or near the East, where physical development is more rapid than in the Occident, and where very early marriages have from time immemorial been the custom. Among us it were, in most cases, best for a man not to marry under twenty-five nor a 133 YOUTH woman under twenty-one. The strain, both physical and emotional, upon the immature is like to be very great, sometimes to be grave; undoubtedly from this cause some men and women become old before there is need. No girl certainly is ever physically mature until her twenty-first year; and it were cruel indeed to impose upon her, before that age, the perils and the physical stresses of motherhood. The present tendency in civilization seems to be for very late marriages, the man at forty, the woman at thirty — a tendency sought to be justified for social and economic reasons. A deplorable status, in my opinion, which, I believe, is that of most medical men. There has been no more sympathetic or pro- found observer of human nature and of human conduct than Lecky, who considered, in his Map of Life, that the age suitable for marriage depends largely on individual circumstances. The ancients placed it far back in the man's case; and they desired a great difference in the ages of the man and the woman. Plato would have the man marry between thirty and thirty-five; Aristotle was for thirty-seven; girls those philosophers advised to be married at eighteen or twenty. Their viewpoint, however, was exclusively that of the state. They looked upon marriage solely as a means of providing healthy citizens and a powerful body politic; and they recognized but little the sentimental and lovely aspects of the marriage relation. "Yet few things," observed Lecky, "are so important in marriage as that the man should bring into it the freshness and the purity of an 139 WHY DIE SO YOUNG? untried nature; and that the early poetry and enthusiasm of life should to some degree at least blend with the married state. Nor is it desirable that a relation in which the formation of habit plays so large a part should be deferred until character has lost its flexibility and until habits have been irretrievably hardened." On the other hand, marriage should not be entered into at an age when neither partner has any real knowledge of the world; only too often do such marriages involve illusions and leave regrets. Some kind of knowledge, such as that given by extended travel, are far more easily acquired before than after marriage. Usually very early marriages are improvident, made with no sufficient provision for the children, and im- mature, bringing with them serious physical ills. Thus can no general or fixed rule be laid down; and what's more, if there were, it would be pretty generally disregarded. Moralists have chiefly dilated on the dangers of deferred marriages; economists on the evils of improvident unions. Each man's and woman's circumstances must de- termine the course. In most civilized countries the prevailing tendency is now for postponement. Among the rich the higher standards of luxury and of requirements, the bachelor men's 1 apart- ments and the bachelor girls' clubs; the "business necessity" by which women become engaged in pursuits which from the race's beginning have been natural only to masculinity; and the diminished place which the normal emotions and tendernesses are taking in life — are considerations which would 1 Bachelors, "those pirates of love that know no duty." — Fincr, HO YOUTH account for this setting forward the time of marriage. The poor, as has always been the case, are unaffected by such considerations. To- day, as ever, they marry fairly early; being un- sophisticated, it remains for them only to be natural, to fall in love, and to practice the dear old homely and domestic virtues. Nor do they con- template divorces, or sex rights, or feministic aspirations, or domestic relations courts, or tempera- mental differences. Such luxuries, fortunately for them, are beyond their resources, either of pocket or of disposition. For most, the marriage of the man at twenty- five, of the woman at twenty-one or thereabouts, would appear to be the part of wisdom. IV MATURITY "Then the soldier, Full of strange oaths, and bearded like the pard, Jealous in honor, sudden and quick in quarrel, Seeking the bubble reputation Even in the cannon's mouth." HUMAN WEAR AND TEAR BEFORE the war a woeful number of our young men were, as to their physical makeup, most inefficient machines, poorly constructed, working badly, and in danger, in the saddest way, of landing upon the scrap heap long before the allotted human span. The surgeons who examined our drafted men (also those far more numerous men unfit for any military service) emphasized this deplorable situation; long before the war they established such facts, which no one would consider. Long before the war it was known, for instance, that of twenty thousand men and women who applied for life insurance, imagining themselves in sufficiently good health to get policies, 43 per cent were found to have some kidney or heart or arterial ailment, and were either turned down absolutely or were assessed higher premiums than ordinarily; that some seven hundred thousand working people — and who among us is not a 142 MATURITY worker — die when there is no occasion, long before their time, of preventable diseases. Recently four hundred persons were examined, about one- third of them women. Ninety-eight per cent of them showed some physical imperfection; 51 per cent were in actual need of doctoring; 33 per cent were unaware of any physical impairment — theirs were masked symptoms. The simple truth is that, as a whole, we Ameri- cans are the most extravagant lot on the planet, and in nothing more so than as to our flesh-and- blood resources. It is precisely as if many thousands of our people were falling blindly over a dreadful precipice, at the bottom of which are the best equipped ambulances in the world, to take them off to the most magnificent and best surgeoned hospitals in the world, after they have been hurt. So far as the limits of this book will permit, I am now going to help put a railing around this precipice and to hoist the necessary danger signals. And this to the end that the finest piece of ma- chinery in the cosmos, the superb human body, shall not fall over, either to be smashed beyond repair or to be mended to 70 or 50 or 30 per cent of its former efficiency — with a much shorter time to run than if it had remained whole and unimpaired. What is such a railing? What are the danger signals? They are manufactured, as we shall see, according to specifications prepared in the most beneficent of all sciences, that of disease prevention. And they are based on the principle that an ounce of prevention is worth tons of regret, of most unnecessary suffering, of vast material loss. And I will beg to disregard 143 WHY DIE SO YOUNG? the protests of certain ostrichlike folk who would not have such danger signals hoisted because they would frighten people so. As if one should say, "Don't, in the name of mercy, put a lighthouse on that reef; it would show the people aboard ship what dreadful peril they are in!" Efficiency has been the great twentieth-century slogan. But doctors have realized full well that any efficiency worth talking about is not to be attained unless the human machine is sound in all its parts, its organs and tissues well adjusted to one another, properly fueled with wholesome meat and drink, not strained beyond its factors of safety, and running smoothly. I will now indicate a few of the thirty-odd places in the human machinery where doctors are accustomed to find loose cogs, rusted plates, clogging clinkers, and adjustments out of gear. THE STOUT AND THE LEAN Any marked discrepancy in the weight, as compared with one's height and years, should give concern. Weight much above the average, especially when associated with that bay-window style of architecture, should invite consideration of the condition of the liver, the kidneys, the arteries, the heart, and the digestive apparatus. The tendency to obesity should be successfully com- bated, although it almost never is, especially if there is a family temperament that way. Weight is indeed oftentimes reduced successfully enough, but generally not for long, and in many cases because "the sufferer" will not exercise the will 144 MATURITY power to stay reduced by keeping away from the flesh pot and by persevering in the banting regime. More of this in another place. In those under weight, before they are thirty, we have to think of the possibility of tuberculosis. Very many such people will go to a doctor with a history of having had frequent and neglected colds. Or there are those who have been weakened by some such serious disease as typhoid fever or malaria or pneumonia, and they have not been willing or perhaps, sad to say, able to take the time for a proper convalescence. Others are exhausted from overwork, or have blood poverty, or suffer from indigestion, or do not eat enough. For such reasons people are thin. How can such as are otherwise in good health take on enough weight, in a perfectly natural way, to bring them up to the normal for their age and height? Assume such a one takes for breakfast a cup of coffee, an egg, and a roll. Instead of mostly coffee, let him take two parts of milk and one of coffee; also a great deal of butter on his bread; two eggs instead of one, and butter with them. Lunch in like manner, taking more cream and more sugar. And let him make his drinks more nutritious; instead of alcohol, which decreases rather than adds to weight, egg lemonades and milk shakes are best. Three good meals a day with a cup of cocoa, bread and butter (sugar on the butter) between meals. Let him aim for a quarter pound of butter a day — butter on oatmeal, other cereals, bread, with eggs — everything. Sugar is fattening, too; be sure, however, to take the sweets at the end of the meal. Potatoes and all 145 WHY DIE SO YOUNG? starchy foods, well chewed, are also fattening. Moderate exercise, deep breathing, and sleeping eight hours the night (in the fresh air), with a twenty-minute siesta in the afternoon — these agencies also conduce to the taking on of weight. THE BLOOD PRESSURE The blood pressure, taken by means of the sphygmomanometer, gives most valuable infor- mation. The doctor by using this instrument is able to ascertain with accuracy (such as his finger on the pulse could not approach) the systolic and the diastolic pressures. Roughly speaking, the normal systolic approximates 100 plus one's age; and the diastolic in health registers from 30 to 50 points below the systolic. The systolic being 120 and the diastolic 80, one then has a pressure pulse of 40 — that is, the difference between the upper and lower points. Such 1, 2, 3 relation (40, 80, 120) should obtain for most healthy people. If this does not hold fairly well, imperfect circulation and poor bodily hose pipe are in evidence. A high diastolic pressure is especially serious as to the heart. Over 100 is significant of that precious organ being overworked by reason of its having to force blood through hardened arteries. A diastolic of 110 is a menace; a figure above that a grave indication of hypertension. One of the commonest causes of heightened blood pressure is excess in eating and drinking. The toxins from excess food are irritating and poisonous to the system; therefore the first step we have to take toward improving and lowering excessive blood pressure is to diminish the meats 146 MATURITY and eggs in the dietary, or, if the pressure is serious, to remove these substances entirely from one's food. Alcohol affects the appetite by increas- ing the amount of food taken; also, by interfering with normal digestion it indirectly disturbs the orderly working of the bodily processes; it should, therefore, be cut out. Drugs and other substances taken injudiciously or without medical advice often act injuriously. Caffein, thein, and nicotine, are found in coffee, tea, and tobacco; when taken excessively, they have a bad effect on the blood pressure. They must either be given up or taken in great moderation — one cup of coffee at break- fast, one cup of tea or coffee at supper, tobacco best not at all. There is a distinct relation between hard work and great anxiety, on the one hand, and high blood pres- sure on the other. Workers in lead and sometimes diabetics are likely to suffer thus. Hardened arteries and kidney disease make a bad combination. Hypertension sufferers must, therefore, be cau- tioned against the tendency to go the pace that kills, severe athletic competition, recreation ex- cesses, overwork, overeating, overdrinking, and other untoward factors above mentioned, so that their hypertension may not become pro- longed and increased with the months and the years, and so that they may be guarded especially against apoplexy. Patients having suffered in- fectious diseases should have a slow convalescence, during which they are carefully watched against too great strain on their weakened organs. On the other hand, the doctor can, by means of that instrument with the unpronounceably long name, 147 WHY DIE SO YOUNG? discern when hypotension (lowered blood pressure) is registered. Then latent tuberculosis is to be examined for, also "blood disease," neurasthenia, and the like. Also the effects of hemorrhage can thus be gauged. But our management of hypertension must be judicious. We must not, all of a sudden, change radically the patient's whole manner of life. We must in the first place thoroughly cleanse out the digestive tract, to get rid of as much of the toxins as possible. The eliminative organs must work right. The drinking of milk should be encouraged, at least a quart a day. Hot baths from time to time are good. For insomnia a glass of hot milk, with perhaps a dose of sodium bromide (15 grains) in it. W T hen there is a sense of fullness in the head with marked headache, general distress, and perhaps tingling of the fingers, get the doctor at once, especially for a sufferer past forty. If the doctor wants to blood-let in such a case, do not interfere with him. He knows his business. A patient with moderate hypertension, but otherwise feeling himself in fair health, should rest, if possible, on his back an hour in the after- noon, and Sunday should be absolutely a day of rest for him. Drugging for hypertension is a matter no layman should attempt; only the doctor should prescribe, deciding for each case on the individual merits. AUTO-INTOXICATION Autotoxemia is the poisoning of the bodily tissues through the absorption of and circulation in the blood of the toxic (poisonous) products of 148 MATURITY putrefaction in the intestines. This putrefaction comes chiefly from the excess of proteid elements or the imperfect digestion of those elements in the food. The proteids are mainly meats, fish, eggs, oysters, and the like. The autotoxemia sufferer should not forgo entirely such proteid foods, but he should eat them in great moderation The torpid or the slow liver (hepatic insufficiency) is a considerable factor in the development of autotoxemia; such a liver fails to secrete enough bile, so that intestinal fermentation and putre- faction result. The toxins thus formed and thus absorbed occasion impaired digestion, constipation, the muddy complexion, frequent headache, oc- casional dizziness, mental dullness, depression, abdominal distress; more indirectly lumbago, rheumatism, heart palpitation, hives, eczema, neu- ralgia, and disorders of special organs. If the condition continues unattended to, anaemia (poor- bloodedness) , neurasthenia, Bright's disease, or hardening of the arteries have to be feared. Tests for autotoxemia are familiar to the physician. THE ATHLETE'S HEART The athlete's heart comes about by reason of incomplete closure of the cusps of the aortic valve, that through which the heart pumps its blood into the aorta, the largest artery in the body. In con- sequence of this valvular defect part of the blood returns to the heart instead of passing on through the aorta to the other arteries of the body. The cusps are ruptured by violent muscular efforts, as in lifting, running, bicycling, ski-jumping, boxing, wrestling, and more especially the tug-of-war. 11 149 WHY DIE SO YOUNG? In most such cases, however, the valve has been weakened through some previous ailment, such as rheumatism, malaria, typhoid fever, or alcoholism. The returning — regurgitating — blood clogs up the heart chamber; wherefore overgrowth — hyper- trophy and dilation of that precious organ — occurs. The heart muscle may reach so great a degree of hypertrophy that doctors speak of the cor bovinum, the bull's heart. The water hammer is character- istic of this malady, a pulse strong and jerky, but collapsing immediately under the doctor's fingers at the wrist. This phenomenon is by reason that the heart pumps the blood into the arteries with much force, while the blood come-back is almost instantaneous. There is suffered distressing and acute pain, with flashes of light, ringing in the ears, and faint- ness on rising suddenly. Even the slightest exer- tion causes palpitation and shortness of breath. The neck vessels throb. The sleep is disturbed by dreams and nervous startings, with sensations of suffocation. No wonder such a sufferer, perhaps the erstwhile idol of his college by reason of his athletic prowess, and one naturally rejoicing in his strength, goes to pieces in a pathetic way in mature life and becomes morose and morbid. Such men do well enough if they are content to lead the quiet life, not to overstrain nor to get excited, not to take the chances other men do as to alcohol, late hours, and the bright lights — a blessing in disguise, if you look at it in the right way. Athletic training, then, though admirable within bounds, is harmless only when the heart muscle 150 MATURITY has not already been damaged by some infection, or intoxication, or serious general disease. And all training should be stopped at once in the event of any indisposition, such as we have considered, in the candidate's past. THE USE AND ABUSE OF DRUGS Drugs are oftentimes used with so little dis- crimination, with results so unhoped for, in some cases even fatal, that many people, some of them doctors, have come to believe it would be better for our race, far better, if there were no such things as drugs at all. This is, however, manifestly a wrong opinion. The benevolent friar in "Romeo and Juliet" was right when he went forth at dawn to gather his healing simples from out the dear bosom of Mother Earth, which sustains us through ill as well as good. He had the reasonable idea, did this sensible man of God, which he no doubt also had the skill rightly to apply. Henry Ward Beecher was as wise when he declared that near by many a grave are vegetable and mineral substances, by the virtues of which, had they been rightly applied, had they been used scientifically — that is, with knowledge — the occupant's obsequies would have been considerably postponed. Here is sound sense, conforming well with the fundamental facts of existence. As good sense as when that mediaeval mental healer, Carlstadt, declared that "whoso falls sick shall take no physic, but shall commit his case to God." To which the more prescient, yes, and the godlier Luther rejoined, "Do you eat when you are hungry?" And the answer being affirmative — 151 WHY DIE SO YOUNG? as, indeed, what else could it have been — Luther continued, "Even so you may use physic, which is God's gift, just as meat and drink are, or what- ever else we use for the preservation of life." Drugs must be used with discrimination and with definite application to given ills. Herein lies, except for the half a dozen household remedies, to the use of which we are all accustomed, the doctor's province and no one else's. Drugs have, as much as anything in life can be certain, their good purpose in nature. From time immemorial they have been taken into the body for no other conceivable reason than that they have been needed and found salutary and corrective. Many of the drugs are repugnant to the taste, but have all the same been persevered in, obviously because experience has shown them to be beneficial. The wisdom of the ages attests their efficacy. Medical science has studied throughout many centuries these medicaments; has formulated and crystal- lized the world's accumulated knowledge of them, has gathered them from whatsoever remotest re- gions of the earth the reputation of them has come. Unquestionably they are dangerous weapons, these drugs, in the hands of those unfamiliar with the uses of them, in the hands of those who have not learned their properties. But their wise adjustment to individual needs is basic to the rational practice of medicine. For an instance of the misuse of drugs. At lunch one day the maid, who for a stipend spared my family the inconvenience of doing its own reaching, appeared with the face of a corpse; her eyes, by contrast, of a ghastly luminance, and 152 MATURITY her lips as blue as ink. The reason for this illness was that I had that morning received a package advertising a coal-tar product, and containing sample products which I was asked to use in my practice. I threw all this into the wastebasket. The maid, in tidying up my office, found these tablets in the box, labeled as being a headache sure cure. She took not one, but several, on the some- what popular theory that if one dose is good for a given trouble, reduplications are just so much the better. We got her to bed at once and, had I not restored her, she might have been fatally poisoned. Nor would hers have been the first case — far from it — of people throwing dice with Death, the dice being loaded in favor of that grim personage. There are many books on human gullibility, on human folly. In these, however, one will rarely come upon matter dealing with the considerable human propensity to take drugs haphazard. There is absolutely nothing else which people buy for their personal use the nature and ingredients of which they do not closely examine into — nothing except the substance they take into their bodies when they are sick; sick perhaps unto death. TEA AND COFFEE Coffee and tea are generally drunk for the pleasure and sense of wellbeing they give; yet both these aromatic beverages are stimulants ; they are not food. When a tired woman refuses food, prefers instead cup after cup of strong tea, she is cheered and exhilarated — yes. and sometimes inebriated; and this to the jeopardy of nerves and muscles, 153 WHY DIE SO YOUNG? which must sooner or later break down, if the habit of "tea tippling" is persisted in. Then there is a case of neurasthenia or hysteria for the doctor; possibly even a case for the domestic relations courts, by reason of temperamental incompatibility thus induced. In like manner, when a man under stress of business, or who is going "the pace that kills" drinks anywhere up to a dozen cups a day of strong black coffee, to keep up under the unnatural strain, he is going to pay the penalty for the intoxication — for that is what it amounts to — some way or other, sooner or later. The natural forces of the human body are able to do normally a certain amount of work; and their ability to do this work is directly in proportion to the energy derived from the food supply taken into the body. A machine is kept going by the fuel in the engine; the machine may be made to go faster by means of bellows. Coal is the fuel; the bellows stimulate the flame. In the man machine food (meat, vegetables, cereals) is the fuel; tea, coffee, alcohol are as the bellows — they are not the fuel. No amount of these stimulants adds to the living tissues (the nerves, the muscles, and the organs) of the body; they merely goad the nerves, muscles, and organs to undue effort, however tired and unwilling these tissues may be. When the stimulant is stopped, or if, after a time, in spite of the stimulant, the exhausted tissues refuse to do their work, then the weakened body rebels and refuses to work again until it has been fully restored, recreated, by rest, sleep, change, fresh 154 MATURITY air, abundance of nutritious food, and hygienic living in general. If these salutary means are not now forthcoming disease, perhaps fatal, is inevitable. A certain amount of stimulant at rare intervals, when there is much unusual stress or for particular occasions, may do no harm. At such times we may consider the stimulants the savings banks of the tissues. But the pity of it is that if the habit is once started the ultimate bad effects are ignored in the apparent relief of the moment. Besides the baneful stimulative effects of tea, tannin is developed in the brewing, and this is really harmful on account of its strong astringent property, which tends to injure the delicate gastric membrane. Thus tired housewives, without know- ing it, may really be drinking ink, which is a solution of iron and tannin. The tea may be brewed in an iron kettle and left standing to "take a drop of" from time to time throughout the day. Such tea left standing is sure to be strong in tannin, and with the iron from the kettle makes the ink. Or the water in which the tea is brewed may be strong in iron (chalybeate) salts. The bitter taste of the tannin is disguised when milk is used with the tea; tea without milk or cream may be safer than tea with milk, because without the milk the bitter taste would make the tea being boiled so long unpalatable and undrinkable. NERVE TESTS People are tested for mental exhaustion (psy- chasthenia) ; for exhaustion of the nervous system as a whole (neurasthenia); for real structural malady of the nervous mechanism. The bodily 155 WHY DIE SO YOUNG? reflexes are taken; also the reactions of the eyes (those windows of the soul) to light and accommo- dation. And tremors, inco-ordinations, and the like are ascertained. Particularly impressive are found the relations between eyestrain and refractive errors on the one hand and headaches, stomach troubles, and other considerable physical distress on the other. Not a few gastric " cancers," though, sad to note, far from all, have vanished on the fitting of the right glasses. THE SHODDY NERVOUS SYSTEM We must now consider some of the nervous affections of mature life. Dr. Guernsey Rankin, an English physician, has aptly written of neu- rasthenia patients as having "the shoddy nervous system." Women may be supposed to be the greater sufferers; and yet, in a series of ten cases taken at random by Doctor Rankin from his files, nine were of men and but one of a woman. The basis of neurasthenia is generally a neuro- pathic tendency, either hereditary or acquired. The ordinary stresses and strains of life are too much for such people. The tasks the most of us rejoice in are insurmountable to them; they cannot endure the hardships we glory in over- coming. They have no "get up and go" to them. If now with such a weakened nervous condition they attempt overwork or excessive exertion of any kind, or if they take to dissipation, or if they have been grievously injured, or a sudden fright or shock has seized upon them, or if they have come down with some serious disease from which they have recovered perhaps only in part, then 156 MATURITY their nervous system gives out entirely and they become sufferers from nervous prostration. These poor folk, who are greatly to be sympa- thized with, as greatly as if they had some profound organic disease, have headaches, especially in the back of the head and neck; backache; they have fatigue dyspepsia (of which more presently) and are emotionally very irritable. Things that most of us would laugh at will at the moment send them "up in the air." Neurasthenia is a very chronic trouble; the sufferers are sometimes as well up to par as the rest of is; and then again they are 'way down in the dumps. Before forty the ailment can always be recovered from; after twoscore not so easily. The Weir Mitchell cure is the best for many of the far-advanced cases — for many others what might be called the "get-up-and-hustle cure" is appropriate. Spinal douches at bedtime are excellent and induce sleep. Baths, massage, electricity, exercise in the open, are all needful measures. At least six tumblers of water should be drunk during the day. The emunctories must be strictly attended to, and the diet must be light and easily digested. Medicines have no place whatever in the treatment of such patients. Pro- miscuous tonics and "pick-me-ups," especially alcoholic, have induced many a case of neurasthenia. A normal nervous system is indeed funda- mentally essential to right mental and physical living. No harder problem perhaps presents itself to medical practice than the normalizing of a below-par nervous system. In such cases it is for the sympathetic physician to direct the cam- 157 WHY DIE SO YOUNG? paign; but the actual fighting must be done by- team work, the doctor, the nurse, and the patient all pulling loyally together. The chief difficulty is that the patient's will power has become sub- verted. In another place I have observed, regard- ing the Three Fates, that we moderns are not content that finality shall lie altogether in their hands. We realize that humankind is endowed also with that most momentous of all gifts, the noble will, by which we become coefficient at least in the working out of our own individual destinies. It is in no person's power to change his heredity, should this have been such an unfortunate one. And yet it is abundantly in medical experience that enormous things can be done in the way of nulli- fying an untoward heredity, such as the shoddy nervous system all too often is. The difficulties attending a vicious environment are still easier to overcome; most of us can get away from any vicinity or condition that is not good for us to be in. And wonders are done in medical science in the rectification of bad functioning. The most difficult task of all is the normalizing of a perverse, a perturbed human will; and such unruliness underlies many cases of neurasthenia. Yet by education, training, good management, with some assimilation of the spirit of religion (not of the letter which killeth), the will can certainly be restored to its rightful ownership. Therein lies the cure of neurasthenia. FATIGUE DYSPEPSIA Most "psychasthenics" suffer thus. Such dys- peptics are in the main of two sorts; sedentary peo- 158 MATURITY pie or workers rather intellectual than manual ; and those who are not hard workers of any kind, but who, being affluent and therefore relieved of any necessity for active effort, are free livers, and also, either from inheritance or acquisition, worriers. Sooner or later the general nutrition of these patients begins to decrease, their appetite becomes capricious, they lose weight, they lose sleep, or their sleep is broken and dream-disturbed; they have a constant sense of physical fatigue (as we would say, they have "that tired feeling"); their memory plays tricks on them; they become irritable, introspective, lacking in self-mastery; are dismayed in the face of the least discomfiture, become ignobly cautious, of uncertain courage, pessimistic, firmly convinced in only one respect, as was Hamlet (that typical neurasthenic), that both the world and the times are out of joint. In short, they have become neurasthenic (deprived of nervous strength), in which condition they are unable to do concentrated work, either mental or manual, and life becomes for them a veritable burden. To this fatigue dyspepsia, then, are prone either those who have called upon a normal nervous system for efforts beyond its limitations, or those born with a shoddy nervous system. The end is the same in both instances — a breakdown, more or less complete, of nervous stability, the break falling for the most part on the digestive apparatus. And the sufferer, come to this pass, gets so obsessed with the increasing evidence of his failing health that he is unfit for any successful participation in life's duties and responsibilities; subordinates 159 WHY DIE SO YOUNG? all other considerations to anxieties about his seemingly desperate bad health; fears cancer or some other dreadul explanation of his condition, and is reduced to the inglorious status of the hypochondriac. In fiction one finds this type wonderfully well portrayed in the earlier chapters of David Harum. The remedies are dietetic, medicinal, and disciplinary. Among the latter are bathing on rising, and thorough toweling; after which a few simple exercises such as will make supple the voluntary muscles and provide for the thorough expansion of the chest. The day's work should be so ordered that no undue demand is put on the energies, mental or physical. It is imperative that no work of any kind be done after the evening meal — some kind of game should be played instead. There should be eight hours' sleep in the twenty -four, and one day once a month in bed. Holidays are essential, week-ends, and once a year a long vacation away from the usual routine of business or professional work. HYSTERIA Hysteria is suffered mainly by women, sometimes by children, occasionally by males. The ailment is characterized by lack of control over emotions and acts. To vary my expression regarding men of unstable wills, they are not kings of all that is under their own hats, one may with equal truth say of hysterical women that they are not queens of all that is under their own bonnets. The principal causes of hysteria are poor 160 MATURITY heredity; the having at one time received a severe physical blow, or a profound mental or moral shock; the indiscriminate use without the advice of a wise physician of drugs and of medicines which contain a considerable alcohol content; acute and chronic diseases attended by much pain and exhaustion; chronic inattention to the emunctories; and errors in education. It is not for me, in this place, to dilate on what is to-day the most prolific cause of hysteria in women. But in mercy to womankind (not to say, in justice to us all) it is my positive duty to allude, at least, to the many abnormal notions prevailing nowadays, notions political, social, and economic, such as, if they are going to prevail and to endure, will work great woe to our civilization and will be most destructive of the feminine physi- cal, emotional, and mental well-being. Imitation hysteria is a well recognized phenome- non. Many people domiciled or gathered together in boarding schools, prisons, homes, and barracks may, through the force of suggestion, come to be affected by the example of a single case of hysteria. Thus do many become victims of imitation chorea or St. Vitus's dance, though they have no physical or organic abnormality to account for the condition. And hysterical patients in hospitals may very closely mimic all the physical and other symptoms of patients in the same ward, until the hysterics would actually appear to be suffering from the afflictions they have come in contact with. The symptoms of hysteria are paroxysmal or inter- paroxysmal; the latter appearing between attacks. The paroxysmal symptoms are convulsive in 161 WHY DIE SO YOUNG? character, and are preceded generally by an in- tense circumscribed pain in the head — the imagi- nary tight band which has been called the Helmet of Minerva; and by the sensation as of a ball rising in the throat (the globus hystericus); or great pain in and about the female organs of generation. The ancient physicians, Hippocrates and others, considered the last named the chief reason for this malady, and so named the disease hysteria from the Greek word meaning "the womb." The hysterical paroxysm may simulate the epileptic fit, although the hysterical woman will not bite her tongue or fall so as to hurt herself. She is likely, in falling, to assume a graceful attitude and will murmur, "Where am I?" in melodramatic tones, and so on. All sorts of erratic movements are made. And various passionate manifestations, as of anger or fright, are evidenced. In many cases there is downright delirium. The interparoxysmal symptoms may be sensory or motor or psychic. The psychic are either localized anaesthesia (pins stuck way into the skin are not felt) or hyperesthesia (excessive sensation); or paresthesia (numbness or tingling or a sensation as of ants crawling). The motor symptoms are of paralysis, contractions of joints, tremors, and inco-ordinations. Even fractures and dislocations have been imitated to the point of creating deception. The psychic (that is, the mental) symptoms vary from mere oddity of thought to downright insanity. The treatment requires the removal, if possible, of the agencies which have brought on the hysteria, the services of a wise and determined doctor, an 162 MATURITY efficient nurse, the use mainly of physiological means of cure (baths, massage, electricity, diet), and above all isolation from oversympathetic relatives and friends. The Weir Mitchell rest cure works wonders in many cases. In most others simply leading the hygienic lif e will achieve the cure. THE EMOTIONS Most people, I am sure, have no idea of the extent to which our emotions are "mirrored in the flesh." "I remember," wrote Oliver Wendell Holmes, "a young wife who had to part with her husband for a time. She did not write a mournful psean. Indeed, she was a silent person, and hardly said a word about it. But she quietly turned to a deep orange color with jaundice." If that young wife had just gone off somewhere by herself and had had a good, out-and-out convulsive cry — an in- dividual electric storm, with plenty of raindrops out of those lachrymal ducts of hers — her emotions would have been relieved, and she would probably not have had that jaundice. Then there is the fine fear of which Kipling wrote, the great cowardice which must be felt to be appreciated, the quivering dread of something you cannot see, a fear that dries the inside of the mouth and half the throat, that makes you sweat on the palms of the hands, and gulp. Nor need one-half humankind — the lesser half — be reminded here of those sensations experienced when, Cu- pid having shot straight, one had felt, like the Hi- bernian, about to address his soul mate, "all 163 WHY DIE SO YOUNG? of a-thrimble." It is the physician's everyday experience to see terror of fatal disease raise a normal pulse of 72 to beyond 120 — all of which pitiable and excess palpitation subsides with the assurance that no such disease is suffered. Thus have the emotions ever been mirrored in the flesh. But now the scientist, armed with his Rbntgen rays, demonstrates unquestionably to the eye the very fact — in laboratory experiments with animals, at any rate. By such means has paralysis of the muscular movements of the in- testines been observed — while Professor Cannon of Harvard has shown rage, fright, and anxiety in the very act of abolishing the movements of the stomach and also of its secretory and digestive functions. The reader who will come upon Dr. Hack Tuke's book, The Influence of the Mind on the Body, will learn much to his advantage as to such phenomena. PHOBIAS The emotion of fear is in many cases "tempera- mental" — that is, no matter how good the health is, fear is an emotion peculiar to them; in other cases neurasthenia and fear are associated. Fear is in most cases a natural result of lessened personal force; it may amount only to a general and constant feeling of uneasiness or anxiety, or there may be occasional spontaneous attacks of fear. The most frequent form of fear is probably agrophobia, in which the victims, the moment they come into an open space — literally fear of the marketplace — are oppressed by an exaggerated feeling of anxiety; they seem frightened to death, 164 MATURITY begin to tremble all over, and complain of faintness, a smothered feeling, and heart palpitation. They are then likely to break into profuse palpitation and to declare that they feel as if chained to the ground and that they cannot move a step. It is remarkable that the sufferer is likely to be able, without trepidation, to cross the open space when accompanied by some one, even a little child, or if he carry a stick. The origin of this phenomenon has been explained in this way: Our primordial ancestors were arboreal. From the treetops they could without fear of reprisal pelt their foes in the jungles below with cocoanuts and the like. But when they ventured on the open spaces below, the swifter and more powerful jaguar, lion, and other felines could "get them if they didn't watch out." People who fear society, who blush and are exceedingly nervous when spoken to, may be called anthrophobics; very many youths are gynephobics. Then there are those who have the fear that things will fall upon them from on high (batophobia) ; and those afraid of everything and everyone (pantaphobia). The fear that here con- cerns us most is pathophobia — the fear of disease. The best way to dissipate this fear is to get thoroughly examined and to find out definitely if there is any occasion or no occasion to be dis- turbed. This subject of fears is many-sided, and we must take it as seriously and as sympathetically as we would any material illness. HOW TO REST One reason why people suffer nervous prostration is that they are unacquainted with the science and 12 165 WHY DIE SO YOUNG? art of resting, than which nothing should be more elementary — as elementary as eating, which latter, however, the most of us do not to-day understand. Prof. William James (that philosopher who wrote like a novelist, whereas his brother Henry, the novelist, wrote like a philosopher) had a class of tense American women to whom he was teaching practical psychology. They were just one bunch of human strenuosity (there is nothing more potential, either for better or for worse, in the cosmos), and he was explaining to them how to relax. Thereupon that composite feminine electric battery immediately applied itself, at the utmost high tension, to the task — of relaxing. I have just read the following in that wonderful book of Henry Drummond's, The Greatest Thing in the World: I heard the other morning a sermon by a distinguished preacher upon "Rest." It was full of beautiful thoughts; but when I came to ask myself, "How does he say I can rest?" there was no answer. The sermon was sincerely meant to be practical, yet it contained no experience that seemed to me to be tangible, nor any advice which could help me to find the thing itself as I went about the world that afternoon. Yet this omission of the only important problem was not the fault of the preacher. The whole popular religion is in the twilight here. And when pressed for really working specifics, for the experiences with which it deals, it falters and seems to lose itself in mist. Of course Drummond was writing about the spiritual aspect of life. But in its physical aspect the difficulty is about the same. Most people do not know how to rest. Dr. Mary Sutton Macy has had considerable service — her patients all woman — in a metropolitan 166 MATURITY neurological clinic. She has found that if those patients are to be cured they have first got to be rested, mentally and physically, in order that the physiological balance be restored. Medicines might meanwhile relieve symptoms, but drugs are not expected in most cases to effect the cure, which can come about only through giving nature a chance to recreate a healthy organism. Experience taught Doctor Macy that merely to send those patients home, with orders to rest for a week, and then return for treatment, would not do; they had to be trained in the science and art of resting. She undertook to instruct personally, and with actual demonstration, those nervous women. Far best of all, she taught the most of them how to get well without drugs — not all, because in some cases of organic disease medication is "indicated." The patient had to report three times a week; during every visit she was directed how to fel- low this instruction at home daily and frequently for from ten-minute to half-hour stretches. Each woman's progress was noted from visit to visit, and the instructions given her were amplified and continued until she knew how to relax, completely and immediately, from any position. She was made to understand that her ability thus to relax enabled her to acquire in a few minutes an amount of rest equivalent to that ordinarily attained — or unattained — in several hours' "lying down," and that, once having become adept, a night's sleep in a relaxed manner can give a remarkable amount of restorative vitality. Here is a detail of Doctor Macy's procedure: She has her patient lie down comfortably and, 167 WHY DIE SO YOUNG? closing her eyes, give her thoughts to relaxing all her arm and leg muscles, allowing her extremities to lie as sodden, heavy, and inert as dead weights or water-soaked logs; in order to test the relaxation and to demonstrate to the patient its success or failure, she raises an arm by grasping the wrist, or a leg by the ankle, and suddenly lets it go; the completely relaxed limb will instantly fall limp; the least enervation is shown by a hesitation in the fall of the limb or by a slightly continued rise after cessation of the motive power as applied by the physician. This procedure has been found beneficial in several neurotic manifestations. NEURITIS Neuritis, either local or general, may follow exposure to cold or overexertion, a blow involving a nerve, or it may occur in the course of such diseases as typhoid fever, typhus, scarlet fever, measles, malaria, smallpox, erysipelas, grippe, diphtheria, tuberculosis, diabetes, and syphilis — the toxins, in the blood, of those diseases, causing the nerve inflammation. Alcoholism is frequently to blame. In some instances it may come on quite spontaneously, all of a sudden and without dis- coverable cause — and quite like any acute infectious fever — chill, headache, loss of appetite, pains in the back or joints or limbs, so that one thinks of rheumatism. There is intense pain in the nerves, of an entire limb, perhaps — but this is not constant. There are certain metallic poisons used in the trades and in other ways that may cause neuritis. The trouble has, for instance, followed the too 168 MATURITY prolonged medicinal use of Fowler's solution of arsenic. Neuritis occurred in the case of a young woman who had been accidentally poisoned by Rough-on-rats. Neuritis has also resulted from the accidental or intentional contamination of food and drink, as when chrome yellow has been used to color cakes. Also from beer containing arsenic or from the sulphuric acid used in the making of glucose. Lead as used in the industries is a more frequent cause of neuritis than arsenic. Mercury, phosphorus, and zinc have also been causative. Tea, coffee, and tobacco are causes — though rarely so; also coal gas and coal-tar drugs. On consulting the physician for the cure of neuritis one must tell him the truth as to the cause, in order that he may not be blamed for a mistaken diagnosis, in order that the neighbors may not afterward learn what a poor doctor he was. And now, I warrant, I shall make my reader sit up and take notice. Rushing in where angels fear to tread, I am going to dwell on alcoholic neuritis in women. "Women don't drink," cer- tainly not as men do. And yet they suffer more than men do from what is really a form of alcoholism. Women assuredly take, in the form of "tonics," proprietary medicines, and nostrums, enormous quantities of alcohol. The content of the latter in a remedy, or alleged remedy, must now by law be printed on labels. And one finds thus an alcohol content almost always exceeding 15 per cent, that of wines. Before the establishment of the Federal law requiring such explicit statement on labels, the Massachusetts Board of Health 169 WHY DIE SO YOUNG? had some sixty of the most widely advertised tonics and bitters examined for their alcohol strength and content; and this latter varied from not less than 6 per cent to more than 49 per cent. Thus were very many millions of dollars spent for drug mixtures containing, everyone of them, more alcohol than beer, many of them more than wine, and several of them as much as or more than whisky. And the doses of those "harmless" remedies were labeled as from a teaspoonful to a wineglassful, from one to four times a day, "in- creased as needed." How can the condition of such an imbiber differ from that of the frank alcoholic — anyway, from that of the steady, quiet tippler, who is never really intoxicated, but who in the course of the years becomes alcohol saturated? What effects are to be expected other than such as result from the habitual use of whisky or brandy or other frankly spirituous liquors — in the cases of women, who, perhaps unconsciously, drink spirits thus disguised, in small quantities, over long periods, with, at the same time, little or no exercise in the open air? Thus comes about many a case history such as this: A woman has become run down, has had for long periods "that tired feeling"; malnutrition of various organs has been causing her considerable suffering, or she has not rightly convalesced from such serious malady as typhoid fever, rheumatism, or malaria; she has been without appetite, has not been able to sleep soundly; she has been taking little or no exercise in the open air. She is now attracted to some advertised remedy, good for a 170 MATURITY long train of printed symptoms and untoward conditions — a remedy recommended, perhaps, by a sister sufferer who "has been helped by it." Or a regular physician's prescription calling for alcohol as an ingredient, has, without his knowledge, been renewed many times. In the course of months, years, perhaps, there supervene other kinds of suffering: odd tingling in the feet or hands, or numbness, or a sensation as if ants were crawling over the skin. Then one or both forearms or legs come to be affected in that way and to manifest swelling and redness. Next there appear real neuralgias in those parts — boring or burning pain, the muscles very sore when grasped, the sufferer crying out when touched or moved in the gentlest way. Now comes loss of power in those members, and the paralysis, slight at first, but developing to wrist-drop or the "slapping gait." Ultimately there may be most distressing contractions of the extremities. All this is pathetic enough. But the mental symptoms — well, they are of a part with straight alcoholism. A natural charming disposition has become perverse. There are delirium, the waking dream state, aberrations of the senses, especially of the vision. The most extravagant ideas are expressed; illusions, hallucinations are exhibited, especially toward evening and at night. There is, by now, practically complete loss of memory, inability to concentrate the attention, utter loss of appreciation of time and place, utter irresponsi- bility. The poor sufferer, now a frank alcoholic, is likely to conjure up all sorts of impossible events, to make the loosest accusations, the most injurious 171 WHY DIE SO YOUNG? reflections — baseless, of course. She will narrate with the most circumstantial detail how she has taken long trips from home, with purely visionary descriptions of people she has met — and all at a time when she has been bedridden. There is the wildest conceivable romancing. The morale is most deplorably lowered; the most flagrantly un- truthful and hurtful things are said. How much of domestic infelicity is here connoted, how much of neighborly misunderstanding ! The course of such alcoholic neuritis is generally favorable; the one absolute essential in restoration, however, is the cutting out, inexorably, of every form of alcohol. CATARRH "Chronic cold" is a persistent inflammation of the nose, extending to the throat and all too often through the Eustachian tube to the middle ear, causing eventual deafness, ringing in the ears, dizziness, and much other distress. It is generally the result of uncured acute catarrh. The discharge from the nose is continuous; the handkerchief is constantly in requisition. There is always a feeling of fullness about the nose. The sufferer is continually catching colds, one after another; and with time his ailment increases in severity. The mucous membranes of the whole upper respiratory tract become thickened and obstructed, making the breathing labored and difficult. This characteristic American affliction, besides following uncured acute catarrh, is more an ac- companiment of some other chronic constitutional ailment than it is a disease in itself; upon the 172 MATURITY cure of which ailment the catarrh will get well of itself. The simple truth about catarrh is twofold: Every acute catarrh must be cured as it occurs, so that it will not get into the chronic stage; and only the experienced doctor can manage success- fully cases of chronic catarrh. He must find out in each individual the essential, underlying condi- tions that are responsible for the catarrh, that are keeping it up; and he must so treat the patient that those underlying conditions will be removed. Then he has to attack the local conditions that are peculiar to each case. He has to use caustic for the thickenings, the hypertrophies (as the doctor calls these unhealthy growths), which stop up the nose and make life so uncomfortable for the sufferer and sometimes also for his family and his neighbors. TYPHOID FEVER The boys recently returned to us had, of course, been inoculated against typhoid fever by their Uncle Sam. And if this had not been done for the embattled millions in all the European armies, and if like preventive measures had not been instituted against the other camp infections — typhus, cholera, the plague, malaria, and small- pox — the war, instead of lasting several years could not have endured beyond several months. For the vast majority of the soldiery would either have been dead of disease or have been too sick to fight. That, however, is another story. Typhoid fever has fourth or fifth place in Ameri- can mortality lists, coming only after tuberculosis, 173 WHY DIE SO YOUNG? pneumonia, cancer, and perhaps heart disease. It takes largely among us the place of cholera, that "Asiatic guest" which European peoples have from time immemorial so constantly and so un- necessarily entertained. Both these diseases are "ingestion infections" contracted in absolutely no other way than by swallowing food and drink (the latter mostly impure water and milk) contam- inated in various disgusting ways, with either the cholera or the typhoid bacillus. Dirty fingers take the center of the stage in the gruesome drama which so often ends tragically. Scientifically speaking, nothing can be simpler than the prevention of these infections; the application of the prophylactic principles is, how- ever, of considerable practical difficulty, by reason solely of human obstinacy and supineness. For example, there is the cook, Typhoid Mary, a carrier of the typhoid germ, who, although she declared, and probably correctly, that she had never had the disease, had, nevertheless, in those migrations from family to family peculiar to her caste, through a number of years, disseminated the infection to some score or more of sufferers. There have indeed been typhoid carriers who have had the disease forty years previously, and have continued through all that time being a menace. It is computed that one-fourth of the people who have had typhoid are carriers, that, disease or no disease, one in every one thousand of us is such a carrier, a typhoid-bacillus distributor. Most infections are self -limited ; their quarantin- ing period is fixed. But you cannot quarantine a carrier a whole lifetime, any more than you can 174 MATURITY frame an indictment against a whole people. The great trouble with Typhoid Mary has been her perversity, exceeding that characteristic of her most temperamental of callings. She has never conceded herself a menace; she has not obeyed the sanitary directions given her by the authorities; she would not wash and disinfect her hands as required; she would not change her occupation for one in which she will not endanger the lives of others; under an assumed name she emulated the Wandering Jew, who scattered the seeds of cholera in his path. Typhoid carriers who are amenable to reason, humane, conscientious, care- ful, and scrupulously clean need endanger nobody's existence. The best insurance against typhoid is, after all, to get inoculated against the disease, as all sensible people are now vaccinated against smallpox. Especially is this well to do when there are typhoid epidemics about; and for commercial travelers, motorists, tourists, and vacationists who may, in the most subterranean ways, contract typhoid and become typhoid carriers. And since here is a disease largely of early manhood and womanhood, our young people going to boarding school and colleges should certainly submit to this preventive measure before leaving home. Typhoid, which in other wars slew several fold as many as became Kanonenj utter, was practically unknown in the war just ended, by reason of the obligatory anti- typhoid inoculations. It is considered that this protection, thus afforded, is effective for at least two years; the immunization may indeed be for life. When the inoculations are made in the 175 WHY DIE SO YOUNG? afternoon untoward sensations are likely to have disappeared by the following noon. A series of three successive inoculations are made a week apart. Death has been attributed to them; but in every case I have been able to look up the death has been found by the authorities, on autopsy, to have been due, not at all to the inoculations, but to some disease in no wise related to or affected by this wonderful preventive measure. MALARIA People do not often die directly of malaria (except perhaps in the comparatively rare cases of "pernicious malaria"); but this disease generally weakens the body so much that it becomes anaemic and easily predisposed to other and more fatal diseases. Here is a most unusually miserable affection, both as to its immediate symptoms and as to the spirit- and energy-destroying effect (the chronic malaria cachexia) it often has, perhaps for many years. It is perhaps the most occasion- less of diseases, because it comes about solely through the bite of the Anopheles mosquito. With this bite that insect conveys to the fresh victim the Plasmodium malarias, the malaria germ, which has been abstracted with the blood of a previous and an active sufferer. This mosquito bites generally only after sundown. I must refer the reader to his health department or to the Bureau of Entomology at Washington for the necessary and adequate information for the eradi- cation of that insect pest. Suffice it to say here that any body of water, indeed no more than an ounce, that has been stagnating for ten days 176 MATURITY (the birth cycle of the Anopheles) is a potential malaria granary. Also, drainage and filling up of wet places solid are the surer ways of mosquito elimination; while the use of petroleum oil (semi- refined) is a fair temporary expedient. Oil destroys the larvae by plugging up their breathing apparatus. One ounce of oil will cover fifteen square feet of water surface and will remain effective ten days. The wind may blow this oil aside, to return generally when the wind changes; and though eggs may have been deposited meanwhile, the returning oil will suffocate the new larvae. An ordinary garden sprinkler may be used, or a knapsack sprinkler from which oil may be projected several yards from shore or from a boat. All malaria patients should be cured as soon as possible, so that the mosquito cannot abstract the germ with its bite and transfer it to other human beings. VACCINATION The main smallpox preventive is vaccination. This may be done in time of epidemics at the second or third month of babyhood. All persons should be vaccinated at least at seven-year intervals, and always after exposure to the disease or during epidemics. If one is vaccinated within three days after exposure to a case he need not worry about contracting it. For this slight operation reliable, government-tested calf lymph should be used. The skin of the arm above the deltoid muscle, at its insertion, is cleansed by means of soap and water, and then by alcohol (but no stronger anti- septic, lest the virus be deprived of its effect). Then the skin is scarified deep enough to let 177 WHY DIE SO YOUNG? serum exude, but no blood; a sterile needle or lancet is used. The vaccine point is rubbed into the wound and allowed to dry. A piece of sterile gauze may be used as a protective dressing. There are people even nowadays who are averse to vaccination against smallpox. They wonder if this dreadful infection cannot be prevented by other means. They fear that vaccination may be dan- gerous and ask if it is needed nowadays, when there is so little smallpox. Let us take up these considerations. 1. Before Doctor Jenner, now more than a century ago, put vaccination on, and showed how to put smallpox off, the map of civilization, whole cities were decimated, whole towns and villages wiped out of existence, by this most virulent pestilence. Public officials divided the people into those who have had, those having, those going to have smallpox. One of four sufferers died; of the survivors many were blinded, and in Johnson's and his Boswell's day every other adult was pock-marked. Nor did this hideous infection respect royalty any more than it did the common people. Such is the picture before Jenner. Look now at the after picture. Com- pulsory vaccination has done this for Germany; during long periods before the present war she had not had a single death among her sixty-odd million of people. And greater New York, which has been having an inexorably efficient health department, had in 1913, despite its fifty -seven varieties of immigrants, just one smallpox death. Tomes of statistics are to the same effect. Iso- lation, notification, disinfection, quarantine — yes, 178 MATURITY these measures help; but a superabundance of fateful experience has shown that they simply will not take the place of vaccination. 2. The dangers are infinitesimal by comparison with those this measure shields us from. All surgery has elements of danger; so has a pin prick or a razor scratch. Walking along a country road these " devil- wagon " days is much more dangerous than vaccination. Our doctors vacci- nated three and a half million Filipinos, not all of them overcleanly, without a single death or any post-vaccinal complication. Practically all con- ceivable danger comes after this slight operation, from the lack of proper precautions. Obey your doctor and there will be absolutely no danger. 3. There is so little smallpox nowadays because our health boards, being eternally vigilant, are constantly demonstrating the efficiency of vacci- nation, especially when epidemics threaten. Be- sides, one of the most gruesome facts about small- pox is its periodicity. It has had its lessened prevalence when the supply of susceptible human material was exhausted; then it has thriven anew with the coming of fresh generations. Thus, from 1893 to 1897 smallpox killed off 346,520 persons in sixteen countries — 275,000 in Russia alone; simply because vaccination was no longer deemed necessary. Let us, then, not be bold against an absent danger; nor "despise the antidote while one has no painful experience of the bane." THE BODY'S SENTINELS If, as Dr. Woods Hutchinson observes, a man is known by the teeth that he keeps, then the 179 WHY DIE SO YOUNG? most of us are quite unfit for even moderately high society. In not one of a hundred cases is the doctor able to record a perfect, nor even nearly perfect, set of teeth. Good old Sancbo Panza observed that a diamond is not worth so much as a tooth. We all read, when Colonel Roosevelt died, of how the rheumatism, of which during his life he suffered much, originated in a tooth which had been ulcerated twenty years before. The care of the teeth we have already considered. In very many cases dead teeth from which the nerves have been removed, the roots of capped teeth, or decayed teeth and diseased gums, are in reality infection focuses from which auto-intoxication, rheumatism, goiter, stomach ulcer, heart and kidney disease, head infections, brain abscesses, neuritis, and many other serious inflammations have been traced by competent physicians. Among such infection centers tooth cavities come first in the order of danger; next diseased tonsils, catarrhs of the upper air passages, ear inflam- mations, inflamed gall bladders, and appendixes gone wrong. By X-raying the teeth any infection focus is now easily detected. INFECTION CENTERS Most notable studies have of recent years been made of "weak spots" in the human body; of the kinds of disease-engendering germs found in such susceptible tissues; of the ways in which the infections thus arising affect the rest of the body; how those infections are likely to put various organs, quite remote, perhaps, from the original 180 MATURITY infection focus, out of action, or to break them down utterly. Many of the diseases of mature life have their origin in this fact of focal infection. There may be such a focus in a child's "running ear," in and around tonsils that have over and over again been inflamed, in a nasal or throat catarrh, among diseased teeth, in an appendix that has from time to time given trouble, in a gall bladder irritated by stones or which has become a typhoid-fever granary, in the tops of a pair of lungs not expanding as well as they might and should, in the pleura, in the pancreas, and in literally dozens of other vulnerable localities. There may be more than one infection focus — the primary focus and secondary ones, the infec- tious material having been conveyed from the former to the latter by way of the blood and lymph channels. And then those secondary centers may occasion others with prolonged and all too often serious results. And all kinds of germs are found in those foci, such as produce abscess, pneumonia, tuberculosis, diphtheria, heart, kidney, liver, and other infections. A very frequent type of focal infection is rheumatism, which disease we will later consider. And some of the specific germs found in those baneful centers will be found mixed with the germs of other diseases. This is "mixed infection," a much graver condition than a straight out and out infection. That is why, for instance, some people die of pneumonia, no matter how skillfully they may have been treated and nursed; in such cases suppuration germs have been combined malignly with the pneumococcus. Mixed infection 13 181 WHY DIE SO YOUNG? is what makes tuberculosis the fatal malady consumption; a pure out and out tuberculosis is rarely fatal. Practically every case of pleurisy that is not promptly and properly healed is followed by pulmonary tuberculosis. The man with a de- ranged pancreas is pretty sure to develop diabetes. A boy had his thumb crushed in an accident; pus developed in the wound; ten days after he suffered rheumatism, which "went to the heart." The pus from that boy's wound produced rheu- matism in a guinea-pig. A girl suffering from chorea (St. Vitus's dance) had been treated by medicines, and ineffectually, for weeks; she also had an infected tonsil; five weeks after this latter was extirpated she was cured of her chorea. An eminent physician writes me: "Little over two years ago I was very ill — a septic thrombus of dental origin in my right brain. This knocked me out for the better part of a year, but fortunately resolution occurred without leaving a single trace of the lesion. When I explained this to and called his attention to the fact that this thrombus (an arterial plug) had given me the choice between a suppurating artery and an apoplexy, on the one hand, or a brain abscess, on the other — and that I declined both, he replied, 'Some people are damned hard to please.' " These are very scientific — that is, reliable — facts, and they are based on most logical premises. The natural conclusion is that if one is to be cured of any disease arising out of an infection focus, that focus has, like the canker in the fruit, 182 MATURITY to be sought out and, if possible, got rid of, by surgery if necessary, as the first step to any sensible treatment. That is why all people, in mature life, anyway, should go to their doctors as they go, or ought to go, to their dentists, at least once a year for a thorough overhauling. Only thus can the doctor, and perhaps also the surgeon he calls into consultation, learn how properly to remove any disease that has taken hold in the system. THE PERFECT HUMAN BEING? Thus it is that medical examiners and diagnosti- cians generally become skeptical of the existence anywhere on this mundane sphere of a perfect human being. Which recalls the pleasantry about the clergyman who asked at Wednesday evening prayer meeting, "Does anyone in the congregation know of a perfect human being?" W T hereupon a poor little woman piped up, "I know all about a perfect human being. But she's dead now. She was my husband's first wife." The fact is, when we have come upon anyone 90 per cent physically right, we have met a speci- men above the average. And much better results could be recorded if people would undergo the thorough overhauling I have advised and would have any weedy growth extracted betimes from that most precious of cosmic soils, the human body. By thus taking thought for the only sentient machine we shall during this life possess, we may all of us safely, and pleasantly, attain our four- score at least, or perhaps our century mark. This book is individualistic in its trend. But, 183 WHY DIE SO YOUNG? just as no truth can be absolutely isolated, so can no one among us exist absolutely independent of the rest of us or of the world about him. And we should consider here, for a few pages, how the human unit's well-being is related to the world's work. One of the weightiest questions of our time is that of everyone's adaptability to his calling, be it that of banker or of merchant, of bricklayer, iron molder, cobbler, clerk. And, as the vast preponderance of our labor is to-day congregated in large corporations, many of the latter have wisely required their employees to demonstrate their physical fitness before they go on their jobs. And such corporations have (not as a matter of philanthropy, but strictly as a business proposition) required their men to be periodically re-examined while they are working for their respective concerns. THE INDUSTRIAL SURGEON The duties of that twentieth-century product, the industrial surgeon, are in the main: 1. To make physical examinations of all prospective employees and to advise corrective measures. 2. To treat accidents immediately after they have occurred and to give subsequent treatments. 3. To make examinations and to give advice in cases of sickness. 4. To formulate and control sanitation measures throughout the works. 5. To promote health education among employees. How is the employer advantaged? The best time to examine a man is before he is hired. This enables the manager of the works to place a man 184 MATURITY at the kind of work for which he is best fitted physically. Also it enables the doctor to advise the employee regarding any defects that he may have and of which he may not be aware. It gives the doctor opportunity to enlist the man's co-operation in making effort to overcome his defects, when possible, and thus increase his physical efficiency. It prevents the introduction into the factory of men undesirable because of serious defects. It prevents contagious diseases entering the factory and becoming established there. How does all this affect the employee? He is informed of any defects the doctor finds and is helped in obtaining relief. He is not given work to do for which he is not physically fitted. He knows that every other man in the factory has had a similar examination and appreciates the fact that he is safeguarded from contagious diseases. He feels that his employer is taking a personal interest in his condition and that he can go to the plant doctor for further advice at any time. Objection has been made to the physical exami- nations of employees by the industrial surgeon, on the ground that it infringes on the liberty of the individual. The United States government has, however, established the precedent, in ex- amining all candidates for army, navy, and civil- service positions, and it is a fair and good precedent. It would seem again to be feared that information of defects in certain men might be passed from employer to employer, thus making it possible to blacklist a man; but to fear this is to fail in the realization that such information is of a professional 185 WHY DIE SO YOUNG? nature and secrets thus obtained are as carefully guarded as in a family doctor's office. The industrial surgeon's examination should be as thorough as that required for a life-insurance policy, because in many departments of factories the work is of a hazardous nature. The physical examination would prevent a defective man from being put to work in a department where hazardous work is done. This benefits the employee because it enables him to secure adequate protection at the most reasonable rates. Rejections, states Dr. John F. Curran of Worcester, Massachusetts, are few — contrary to the general opinion. Statistics show 3 per cent. The surgeons actually make no rejec- tions. They merely note the man's defects, classify him as an A, B, C, or D risk, and refer him to the employment department, which accepts or rejects him according to his probable value. Sometimes the employment manager finds a man too old or physically unfit for the work for which he applies; but instead of rejecting him arbitrarily, work is found for him suitable to his age and physical condition. A man is definitely rejected who is blind in one eye, because work on grinding wheels, for instance, is very hazardous to those precious organs, even when goggles are worn — total blindness being a possibility, perhaps indeed a probability. All cases of contagious disease, including tuberculosis, debar a man from em- ployment. It is a fact/ that the consumptive workman will endanger his fellow workmen more than he will his own family at home. Hernia is the bane of industrial surgery, and men with second-degree rupture are not recommended for 186 MATURITY employment. Workmen of the Latin and Asiatic races are most prone to hernia because their diet "in the old country" has included very little muscle-building food. Hernias are curable by operation. All cases of heart disease with "dis- turbed compensation" (as evidenced by extreme shortness of breath, swelling of the extremities and palpitation) are rejected. Varicose ulcer is a menace because a man working on his feet will grow worse with it; only in a reclining position can one be cured of such a leg ulcer. Cases of marked high blood pressure are rejected because certain kinds of work might increase the already high tension and lead to apoplexy. All men presenting these defects are re-examined every three months, and engaged, should their improved condition warrant. Almost no man is thrown out of any corporation unless he is absolutely unfit for any work at all. But the man with a heart leakage has that fact determined to begin with; and then, instead of being sent up to clean windows forty stories above the street, he is given some light and unexciting occupation on the safe bosom of Mother Earth. Has a man a tendency to tuberculosis? It is more fortunate for him than it is for his employer that the fact has been ascertained at the beginning. Then instead of being put to work in a close and dusty shop he could be sent out to canvass or to do some ether outdoor work, or be even put into a sanatorium maintained by his employer company. By such rational measures has business efficiency been enormously increased, to the great good of the unfit worker (with whom we are here 187 WHY DIE SO YOUNG? chiefly concerned), of the business enterpriser, and of the country in general. FATIGUE AND EFFICIENCY The conservation of the human machine has many aspects. Consider, for instance, the relation of fatigue to efficiency. The latter decreases as fatigue begins, and it ends far short of exhaustion. Enterprisers find that it pays to alternate judi- ciously work and rest; to eliminate all unnecessary motions; to guard the worker against molestation or interruption; to have light, ventilation, and other sanitary factors agreeable; and to take counsel of the physician, the sanitarian, and the psycholo- gist. There is, in the worker's tired brain, nerves, and muscles, danger not only to himself, but to others. The number of accidents increases pro- gressively during the morning, as fatigue comes on; drops after the noon recess; rises hour after hour until the end of the working day. The same obtains with brain work as with muscle work; there is in science really no difference. Bank managers long ago recognized the relation of fatigue to efficiency, and have therefore closed their tellers' windows at three; less expensive this than the mistakes of tired employees. How often has the overwrought dispatcher sent trains into collision! Fatigue, nerve tension, and worry are perverse and uneconomic factors. ALCOHOL AND EFFICIENCY Those who are charged with the conduct of great commercial and industrial enterprises must 188 MATURITY seriously consider the degenerating part which alcohol plays. For example, managers of railways are insisting on total abstinence. Intemperate railway employees have been found unable to recognize green and red, the two colors most used in operating trains. So hidden might this fault in vision be that only an accident, with loss of human life, would reveal the engineer's inability to recognize signals. Such "toxic amblyopia" (which comes also from the excessive use of tobacco) varies in degree from slight dimness of vision, through the inability to recognize colors, to seeing everything gray — and then to total blindness. Those who are every day responsible for the lives of thousands of passengers would themselves be most perverse were they to take the risk of engaging such men. , Among 138 cases of "visual defects," 64 in- dividuals were found to be hard drinkers; 45 used both alcohol and tobacco to excess; and 23 were inveterate smokers — leaving but 6 cases to diabetes and other causes. It is the nerve cell (with its fibers) which is the physical basis of all mental processes — memory, will, judgment, divine reason; and it is this cell and its fibers (the telegraph wires transmitting the cell's signals to all the tissues, organs, and muscles in the body) which are the most affected of all the bodily parts by alcoholism and especially by the drinking of fusel oil, or wood-alcohol whisky. Thus the nerve cell, progressively shrinking, becomes in time a mere shell, with degenerate debris, in the place of a once virile servant of the body and soul. No one doubts that alcohol, in large quantities, 189 WHY DIE SO YOUNG? is a poison. In another place we shall consider its effects on the so-called moderate drinker. For many, also, alcohol, even in small quantities, may be harmful; such is the opinion of Prof. Irving Fisher of Yale. Benjamin Franklin in his Auto- biography gives his own experience (an individual one, which in science must perforce have limited value) that in his printer's trade he, a total ab- stainer, was stronger, clearer-headed and could do more work and for longer periods than could his spirit-drinking fellows. Certainly alcohol taken in any form during a day's work or in the midst of a task (either mental or manual) increases fatigue (after possibly a momentary and slight increase of power); and though it may stimulate and for a brief space make one unconscious of its power, alcohol ends up by being a depressant. Army marching tests, Marathon races, walking contests, have proven alcohol to be a decided hindrance to muscular or athletic power. It is said that in the Arctics he who takes any alcohol at all must inevitably succumb to their elemental rigors. Also, Dr. Richard M. Cabot declares that alcohol harms the mind and the brain more than it does the bodily musculature; that the brilliancy which alcohol has long been supposed to give to mental work is a popular fallacy. Its seemingly exhila- ratory effects are a delusion because they depend on the blunting, the inhibition of the higher brain centers (those most recently developed, and the initial step in the evolution of the possible super- man). Dr. Harvey W. Wiley considers it doubtful whether a single brilliant thought or poetic or 190 MATURITY elegant expression lias owed its origin to alcohol in any form: It is true that alcohol seems to take the bridle off the tongue and to give free rein to conversation; but this effect is by a paralyzing influence on the sense of responsibility rather than by a stimulating influence on the general flow of ideas. Even a pint of beer will lower intellectual power, impair memory, retard simple mental processes, produce interference in the habitual association of ideas. To be below par is almost as disgusting to a bright, modern man as drunkenness — and almost as dangerous. Mere weakness of body and mind, lassitude, lack of brightness, energy, and self-control are often brought on and made permanent by even a mild use of alcohol. From 10 to 30 per cent of all mental illness is due, in part, at least, to alcohol. We have noted how the most of venereal disease is contracted by young men under the alcoholic in- fluence. Crime is generally a manifestation of mental aberration — temporary or chronic — and this aberration is in a great number of cases due to alcohol. THE BENEFIT OF ALCOHOL All of which is no doubt true enough. But while we are dealing John Barleycorn all sorts of good and well-deserved head and body blows, let us deal him none below the belt. Let us eschew prejudice and admit, not only frankly, but also gratefully, that there are, as in all things cosmic, some good points about alcohol. The demand for it exists and persists all over the world; for it is, as I have stated, one of the body's paratriptics. And all the fanatic hypocrisy- 191 WHY DIE SO YOUNG? saturated enactments, so subversive as they are of the personal liberty for which our fathers fought, so abhorrent as they are to the fundamental spirit of all good law — any number of prohibition amendments never have, will never now, never can, remove a taste so legitimate when temperately in- dulged and so fortified in human experience. For alcohol has had, since the beginning of human history, has to-day, its righteous and justified uses. A single point in its favor is overwhelming — the sense of well-being it gives, its restorative influence after the cares and the stresses of the workday; and the incentive to geniality it then offers. Those (and there are many such) who will not grant this humanizing influence in alcohol should be excom- municate and deprived forever of the comfort and solace there is in human companionship and of the benefits which lie in the support and sympathy of all generous and mellow souls. Also, for the sick, the debilitated, and the elderly, wholesome wines and pure spirits are indicated to be prescribed according to the doctor's judg- ment; this is the opinion of a practitioner of some quarter of a century's experience. Read here also the views expressed by my dear colleague and most wise physician, Dr. William H. Porter, in his book, Food as an Aid to Long Life. Undoubtedly there has lain in the abuse of alcohol more of sorrow, crime, poverty, vice, and misery than can be justly ascribed to any other agent ever used by human beings. But the physician interested only in saving life and in helping those sorely tried by unhealthful processes has often- times to use a readily convertible heat and energy producer for those who, lacking this stimulus, must inevitably die. 192 MATURITY Such sufferers cannot, in their extremity, in their pitiful debility, get this stimulus out of ordinar}' food. Nothing so far known can take the place of alcohol in such crises where life hangs by the slenderest of frayed threads. In serious pulmonary diseases, such as pneumonia, in many infectious states, in conditions where there is much depression, and where much tonic material has been absorbed, alcohol has helped the physician to save many lives which would otherwise have ended long before the human span. The dif- ference in the results, as compared with the same type of patient to whom alcohol was denied in the treatment, speaks for itself in the records of hospital mortality statistics. The fact is, in treatment of the kind of diseases here mentioned, the doctor could not do justice to his stricken patient if he should withhold good whisky and good brandy; nor is there anything to take the place of such readily oxidizable stimulus. No other agent at the command of the doctor is as dependable; many years of experience with thousands of most desperate cases demonstrate beyond peradventure the therapeutic value of alcohol in grave and toxic conditions. It is, in sickness, the one product which yields force without taxing the digestion, without which the patient simply dies from nerve exhaustion and uneliminated toxins. THE PUBLIC HEALTH The adult individual should manifest real interest in public health matters. In fulfilling this funda- mental citizen obligation, not only will the body politic be served, but the health of the political unit and of the family will also be in very large part assured. Mr. Elihu Root has in nothing else so well shown his genius for statesmanship as in his observation that what we, after all, have govern- ment for is primarily the protection of the home against spoliation; for the protection of the lives 193 WHY DIE SO YOUNG? of its inmates against violence and the assassin. This principle of government is truly basic in civilization, has been so these many centuries past. But only of recent years has the equally fundamental principle been recognized that it is, or should be, the government's duty to safeguard the home and to protect the lives of the citizen and of his family against suffering and death from infectious disease. It is here no more in the individual's power, of and by himself, to protect himself and his own, than it is for him to do his own policing. If there is a case of scarlet fever on the floor above, or of typhus in the opposite apartment on the same floor, or of small- pox in the next house, or if there is pestilence- breeding filth in the next yard, the individual has not of himself the power, does not of himself know how, to compel the isolation of the sufferer, to compel his neighbor to do things necessary to prevent the spread of the infection. The individual cannot of himself prevent the contamination by another of a place which they both occupy. And when he changes his habitation he has no assurance, save through the health authorities, as to the sanitary or the unsanitary condition of the place into which he designs to move. If there is a diphtheria epidemic in the public schools he cannot of himself guard his child against that disease. In short, it is the constituted health authorities in whom must lie the conservation of the communal health. It is they who are civilization's sanitary police. It is by reason that we have been coming, since the birth of the science of preventive medicine, 194 MATURITY to appreciate the supreme importance of this principle of communal sanitation, that almost every village, town, county, and state in the nation has now its health committee or board or department. Many of these, the majority of them, no doubt, are bodies adequately fitted for their duties. The health department cannot, however, be supremely serviceable unless the citizen body in all loyalty hold up its hands. And this support can only be assured through the development, among our people, of THE SANITARY CONSCIENCE Professor Rosenau of Harvard has observed among us hundred million odd the awakening of a sanitary conscience, a concomitant of the sanitary renaissance nurtured by Pasteur, Koch, and their coworkers these several decades back. The modern science of disease prevention "teaches the lesson of the unselfishness of community interests and has been a potent biological factor underlying the present trend toward socialism." The idea of conscience is pretty sure to connote that of religion; and in this relation one inevitably recalls Doctor Eliot's observation that in the religion of the future preventive medicine must as a matter of course find high place. "Preventive medicine is capable in the future of doing away with poverty and misery, of remedying industrial disputes, of removing those causes of human misery, poverty, and sorrow which lead to internal rebellion and disorder and, among nations, to war and strife. We are going to get, through preventive 195 WHY DIE SO YOUNG? medicine, relief from frictions which arise out of immigration, among the leading nations of the world." The driving force in any religion, the one thing about it which gives it such potency as it may have, is the conscience of its devotees. And, indeed, it can be said, with confidence and with gratification, that the sanitary conscience is becoming woven into the woof of our twentieth-century civilization, to the considerable furtherance of the Kingdom of Heaven upon earth. To be a working and potent force this kind of conscience has got to interest itself in the general health, that of the community in which the individual is the social unit. Just as the individual contracts infection by reason of two factors — the predispositions making the body vulnerable, and the specific cause — so with regard to the communal morbidity everyone who has the sanitary conscience in robust working order will consider both the general conditions predisposing to disease and the specific epidemics that may endanger the body politic. THE PRIME OF LIFE "And then the justice In fair round belly with good capon lined, With eyes severe and beard of formal cut, Full of ivise saws and modern instances; And so he plays his part." LIFE EXPECTANCY AFTER FORTY SINCE the middle of the nineteenth century, and wherever the modern science of disease prevention has been permitted to exert its benefi- cent influence, the average span of human life has been much prolonged. In fatalistic India, where the faithful Mohammedan still heeds the Koran's adjuration not to flee from the wrath of Allah, life's duration remains pretty much what it has been for centuries past — that is, about twenty-five years. In Sweden, on the other hand, where our God-bestowed faculties are exer- cised in the furtherance of human health and well- being, life in general now endures to past fifty years. In Europe as a whole length of days is now double that of three centuries ago. The rate of increase between the seventeenth and eighteenth centuries was about four years. It was about nine years during the first half of the nineteenth century — the "human pigsty era" in England, 14 197 WHY DIE SO YOUNG? when Dickens declared, in a public meeting in 1850, that he knew of "many places in London unsurpassed in the accumulated horrors of their long neglect by the filthiest old spots in the dirtiest old towns under the worst old governments in Europe." In the latter half of the nineteenth century, however, a truly epochal sanitary renaissance took place, the genesis having been due to Pasteur's discovery that germs are the essential causes of the infectious diseases, and to the great French- man's dictum that "it is within human power to banish all parasitic diseases from the face of the earth." Consequently life throughout civilization has, since 1860, been prolonged seventeen years. And yet, though length of days, counting from babyhood to old age, has been prolonged, by reason of the wonderful advances in the prevention and treatment of the childhood infections, the duration of life expectancy after forty has been diminished. Three decades ago, forty-one years longer could be expected for a child under five; while for a child of that age an additional fifty-two years may now be anticipated — that is, eleven years more may be added to its life. A person aged twenty-five had, three decades ago, an expectancy of thirty-two years more — that is, he could hope to live to be fifty-seven years old. While such a one may now, because of improved management of the ailments to which early maturity is prone, hope for thirty-four years more — that is, he can live to be fifty-nine years old. He will thus have two more precious years added to the latter end 198 THE PRIME OF LIFE of his life, when there are so many things undone one wants to complete; when one wants so much to keep on enjoying the sunshine and the leafy shade, the breezes and the sunsets, the perfume of the flowers, and the song of birds; when one, above all, yearns to bask still a little longer in the dear companionship of one's own, in this life, all too brief at the longest and which is all so pathetically rounded in a sleep. But whereas, those who three decades ago had reached forty years could hope for twenty-three and nine- tenths years more of life, such expectancy is now twenty-three and four-tenths years, or five months less of life. And thence the diminu- tion has come to be almost steadily progressive with each succeeding five-year period, as any life insurance actuary will demonstrate. And apart from one's interest in himself the losses of men past forty are peculiarly unfortunate for their communities. Because, after all is said and done, of such men in the main are the world's real achievers and compellers, its most influential realizers of ideals. How important, then, to take into account the untoward factors that tend to endanger the physique and the psychism of the man turned twoscore! The expectancy of life is now greater among females than among males before forty; but after forty the reverse obtains — among males at all ages the increased expectancy up to forty is almost twenty-five years, among females twenty-nine years; after forty the di- minished expectancy among males is now fifteen years and among females eighteen years. No doubt the modern increase in cancer, a 199 WHY DIE SO YOUNG? disease of later life and one form of which women suffer exclusively, will account for some of this diminished expectancy. But the factory work of women, and which they seem to do in our era to an unprecedented degree, must surely explain a great deal of diminished female expectancy after forty. Here is a form of slavery peculiarly pitiful, when one considers that much of the work, in itself terribly exhausting, is done by prospective mothers, and by those whose strength should be conserved for giving their infants the breast. It has been demonstrated that the cotton-mill in- dustry, which employs more women and children than does any other, exhibits a grievously high female death rate; and it especially subjects its workers to inhalations of irritant vegetable dust — a fact very conducive in the underfed and the over- worked to pulmonary diseases. Within a score of years, indeed, the degenerative diseases have been taking more lives than formerly; there has been a great increase in the mortality from affections especially of the vital organs — heart, kidney, stomach, liver, intestines. Pari passu there has been an increase in the consumption of spirituous liquors and of nitrogenous articles of food (meats) . The wear and tear of the strenuous life is also a factor in this increase of the death rate. The introduction of easy, comfortable and rapid means of transportation has seduced to his undoing the average individual from his daily exer- cise in the open air. Unquestionably the mortality from the diseases common to middle life and old age has increased within a generation. For New York State alone 200 THE PRIME OF LIFE the increase in kidney disease has been estimated at 73 per cent; in heart disease 84 per cent; in apoplexy 34 per cent; in pneumonia 24 per cent. It has been questioned if bachelors have not a still further diminished life expectancy after forty than married men. Anyone perturbed in these premises may be assured that the expectancy is about the same. In proof of which is the conclusion of a German scientist (whose proverbial Teutonic thoroughness and profundity in investigation was as usual offset by lack of humor) that "married men really do not live longer than single men — it only seems longer." One consideration appears to me the most vital of all, and it is one that few indeed in this materialistic age ever bother about — in fact, rather scorn — and that is the psychic element. Physio- logically all work is brain work, all life stress is brain stress. "The spirit," declared Schopenhauer, "has all matter to choose from"; and a perverse, perverted spirit is bound to choose cancer cells rather than healthy ones, is likely in the course of time to substitute a hobnailed liver for one that should in old age functionate aright (so that a life which depends on so debauched a liver will, indeed, not be worth living). It were indeed difficult, though, as we have seen, some such things have been done, to gauge the psychic influence on the physical tissues, to compute the extent to which thought can effect the development of a white blood corpuscle, the making of a drop of lymph, or the behavior of an excretory cell. The process is hardly susceptible of investigation by the microscope. Yet what is more obvious than the 201 WHY DIE SO YOUNG? influence of the mind over the body? Is it not in every one's experience that mental perturbations — as acute shock from sudden grief or bad news — gravely derange the functions of the various organs? And will not chronic shock, such as through years accompanies exhaustion, or overwork or anxiety, predispose to graver affections in later life? The soul, for many Americans, before the war ennobled us, was too much for the things of lesser importance, too little for the real things of life. Money getting has been the game played day and night, and, like that of the athlete, always to win. All the waking hours have been given to this game, while the soul has been starving for the things really worth while, the intellectual pleasures, the cultivation of music and the arts, for whole- some hobbies, for the rich humanities; for these the soul — the psyche — has hungered and has been all unsatisfied and flouted. What wonder, then, that in later life such a soul acts like Poe's Imp of the Perverse and plunges the body to destruction, all before its natural limit has been reached. CANCER The most sinister among the physical degen- erations which one in his prime must consider is cancer. Some "knocker" has observed that doctors now save the lives of young people from consumption in order that they may die later of cancer. But this is hardly so. While the Captain of the Men of Death — the pregnant phrase is John Bunyan's — has been claiming his victims mostly from humanity's submerged strata, the 202 THE PRIME OF LIFE "down and out," the exhausted in body and soul, the starved and the wretched; cancer, "the crab," on the other hand, is like to reach out its tentacles rather for the fortunate, those accustomed to generous and eupeptic existence. This does not invariably hold, of course, for many very poor people have cancer. And yet the conditions condu- cive to good living would seem really congenial to this disease, which thrives quite companionably with gout. Patrician cancer aims for the shining mark — the illustrious, those whom nationalities even can ill spare. Cancer is like to strike at those who have through many useful years earned a serene old age. How often is such otium cum dignitate unrealized, considering that among every ten middle-aged Americans one at least meets this "slow and agonizing death." Cancer furnishes one of the few problems remain- ing for medical science to solve. Its essential nature is not yet fully determined. We know some of the causes of cancer; we know a great deal about how cancer manifests itself; we know how a fragment of cancerous tissue looks under the microscope and can thus determine the presence of the disease in the sufferer's body; but we do not yet surely know the essential nature of this malignant growth. The study of cancer is intense; the civilization-wide field has, for a generation past, been entered by so many and experienced delvers, all in generous rivalry to be the first to bestow upon their kind the epic boon; so abundant are the material resources which the sympathetic rich have put to the service of those workers; so nobly striving and so distributed are the cancer 203 WHY DIE SO YOUNG? research institutions; so effective are such organi- zations as the American Society for the Control of Cancer; so loyal is the co-operation of govern- ments — that the unraveling of the cancer mys- stery can now, surely, be not much longer delayed. And immediately this mystery is solved we may be sanguine of some rational prophylactic, of some scientific curative agency other than the knife. At present, however, the cancer situation requires that the physician shall draw public attention to certain danger signals, by heeding which the lives of at least half those eighty thousand who succumb yearly in the United States to this disease may be saved. "What cannot be cured may be prevented"; and those who do not lack the courage to observe the signals shall not die if they will but act with promptitude before the ramifications, into regions inaccessible to the surgeon's knife, of "cancerous" offshoots, all of which must be removed, with the malign body itself, for a certain cure to be established. There is probably little danger from cancer heredity except when the disease has been on both sides of the family. In such contingency one who notices any persistent inflammation, in the mouth especially; or whose indigestions are not easily relieved ; or who has inexplicable abdom- inal pain or whose organic functions, this or that, are not working aright; whose organs, indeed, give evidence (as they ought not to) of their presence in the body — should at least yearly consult medical advisers of tried skill and experience. By such forethought may forty thousand of our people be saved annually from cancer deaths. 204 THE PRIME OF LIFE "We know this most important thing about cancer — that certain bodily conditions and ailments predispose — make one susceptible to its develop- ment. Many cancerous growths have their seat in organs that have constantly been overworked and clinkered up, with few intervals for normal rest, by their hearty-living owners. Except after blows or injuries cancer will not otherwise develop in healthy tissues. THE PRECANCEROUS STAGE In nearly half the cancer cases there has been the precancerous stage, which ought to have been detected. Weakened bodily conditions, and ailments not in themselves serious, combined with the factor of chronic irritation, make many sus- ceptible. "Benign" tumors, not in themselves death-dealing; persistent ulcerations, especially of the stomach; long-continued inflammations; un- repaired injuries, after blows, perhaps, or injuries the recovery from which has been long delayed; abnormal tissue, such as scars or stumps from old wounds or operations; dragging, gnawing, and strength-sapping adhesions within the abdomen and pelvis, especially in women — such are condi- tions which must receive the doctor's attention. Every "lump" or sore, however painless, especially of the breast, should without delay be examined by him. Every tumor, no matter how innocent it may seem, should, if operable, be referred to the surgeon for his decision as to whether cancerous infiltration has taken or may take place in it. All tumors are not cancers, happily — to the doctor 205 WHY DIE SO YOUNG? all kinds of swellings, and there are at least a score of them, are classed as tumors — and there are several kinds of cancer, differing in degree of malignancy and in their courses. Superficial cancers, as of the face and lip, are reasonably recognizable by sight, touch, and microscopic examination. Deep seated cancers are often difficult to detect. Oftentimes the only indication of them is functional disturbance of the organs involved, perhaps also of associated organs and tissues. Women, es- pecially those after forty, should go without delay for examination as to the ailments and persistent discomforts peculiar to their sex. Men past forty — especially alcoholics, constant smokers, and heavy diners, men who are family bread- winners, and those who have weighty business and communal responsibilities — should see to the preservation of their lives by yearly examinations. THE CHIEF DANGER SIGNAL One must now see that the chief danger signal by which one's active attention should be directed to the cancer peril is the factor of irritation, which, working through months or years, fosters ma- lignancy at its site. Thus there comes the pipe smoker's cancer, on the lip; there used to be the chimney sweeper's cancer; there is the cancer of the tongue from the jagged edge of an untreated tooth; the throat cancer from the inveterate smoking of strong tobacco; the cancer from radium burns. (How many a martyr in medicine, nursing, and the allied 206 THE PRIME OF LIFE professions has suffered thus! There is the cancer from prolonged exposure to the sun; that which has originated in insect bites or by the fastening of parasites upon the intestinal mucous membrane; the cancer from betel-nut chewing, in India; from eating very hot rice, in China. The Tibetan natives carry in their tunics, against the abdomen, a kind of pocket stove, the kankri, the constant use of which excites at the site of the burn the kankri cancer. Function and structure are just as inseparable as mind and matter; therefore prolonged un- healthy functioning is bound sooner or later to lead to diseased structure. That is why persistent anaemia (poor blood), nausea, change of color, indigestion, loss of weight and of strength, bleeding from the stomach, uneasiness, pain or tenderness on pressure below the breastplate, should excite apprehension. Pain is considered to indicate cancer and the absence of sensation to remove the occasion of fear; but this were indeed a broken reed to rely on, for even advanced cancers have given no pain. Another classic symptom is supposed to be the bleeding from the stomach, which has a coffee- ground appearance by reason of the corroding effect of the acid gastric juice. Here is a sign of late though not necessarily incurable cancer. And yet I know of a most heartrending case where oper- ation was utterly unavailable, in which examination of the stomach contents revealed absolutely no trace of even "occult blood," in which there was no palpable swelling, and the sufferer, so dear to her people, felt practically no pain. 207 WHY DIE SO YOUNG? Wherefore it is now sound doctrine among the faculty that in all cases of men and women over forty with stomach symptoms and rapid emacia- tion — cases in which there has not been for several weeks response to the treatment that is generally effective — exploratory opening of the abdomen be made for a settlement, beyond a peradventure, of the diagnosis; also that the surgeon should pro- ceed at the time of the operation to the extirpation of any malignant growth that may appear. The X-ray is also a most important means of diagnosis, when employed in conjunction with others. THE ONLY CURE TO-DAY The only hope to-day lies in operation, and surgeons have thus cured many patients. The disease is always localized at first; and then its prompt removal gives the best chance. If the surgeon can act during the precancerous stage, so much the better. W T hat is the percentage of such cures? Some operators have demonstrated 80 per cent. Operations early, and with extension, have given 50 per cent of cures. W T hen complete re- moval is impossible, operation will work temporary relief, but generally there will be recurrences and no absolute cure. Even in such cases, however, there has been (though very rarely) "subsidence of the growth" and an end of the disease. "But operations are such dreadful things!" Nonsense. Anaesthesia is to-day generally begun with laughing gas, so that after a few whiffs there is nothing more to it, so far as the "going under" is concerned, than when one has his tooth pulled 208 THE PRIME OF LIFE "with gas." There is a way, applicable to many cases, in which the nurse puts her patient quietly to sleep, and when the latter awakes and asks at what time the operation is to be done, she is answered, "It has been done." Surgery is nowa- days so nearly ideal that the operating table in itself is really a good deal safer in our riotous times than most other places. Though later operations are, of course, extensive, severe, and momentous, operation for the removal of early cancer has a mortality averaging 1 per cent. Let no cancer sufferer delay. Practically all the cases that are let alone end fatally. The earlier the operation the better the hope of success. Let this be known and we shall no longer have to read statements to the effect that, largely because of public ignorance and neglect, cancer now proves fatal in over 90 per cent of the cases. THE MODERATE DRINKER The effects of alcohol are really more pernicious on the so-called moderate drinker than in him who occasionally becomes bestially drunk. The moderate drinker is never — well, hardly ever — visibly intoxicated. He does not stagger about, or draw a crowd on the streets, or insult people, or otherwise make a degrading exhibition of himself; nothing so low as that, of course. Oh yes, once or twice a year, perhaps at an anniversary, or when seeing a friend off, he may talk a trifle thick, say things he is heartily ashamed of when reminded of them, and be a trifle wabbly on his pins; but surely no worse than that. The little 209 WHY DIE SO YOUNG? he takes "certainly cannot hurt." He is almost always a congenial man, a good fellow, one of the coterie that have from youth been comrades. It is the moderate drinker who oftentimes has the sadly diminished life expectancy after forty. Such a one drops out of the circle from acute indigestion, according to the death certificate; another one a year or two afterward from "Bright's disease"; another presently from a liver gone wrong; and then one most unexpectedly from pneumonia. "So strong he seemed and so florid of face." Queer how those funerals come on so soon, one after another, among men every one of whom, you would think, should have been good for at least threescore and ten. At fifty few of that once considerable company remain, and after each funeral the survivors get together and, while sympathetically and heartily recounting the bonhomie and the virtues of the deceased, take all, most fervently, a few rounds of the good old stuff in his memory. Odd, is it not, that in such circumstances alcohol is never suspected to be the underlying cause of those premature deaths ; that it has made the body susceptible to, has predisposed it to, those fatal diseases? This alcohol does by disorganizing the body's natural defenses. WE EAT TOO MUCH Any family doctor will tell you that after the summer complaints and the September typhoids have been attended to, there is a slump in practice until after Thanksgiving Day, when he is called to minister unto a lot of indigestion sufferers; 210 THE PRIME OF LIFE after which things professional are on the joyous hum throughout the winter. For how many cases of Bright's disease, rheumatism, gout, coughs and colds, pneumonia, and hardened arteries, and what not else that is agonizing are set a-going by those initial Thanksgiving orgies! How pithy a saying is it that "many of us dig our graves with out teeth." The simple fact is that all the year around we Americans eat a great deal more than we need to. The traveler visiting us is amazed at the variety and plenitude of our fare. The Englishman, especially, comes to us from his inn at home where the traditional mutton chop, eggs, marma- lade, and some half a dozen other eatables, ex- cellently prepared, are ample; in most of our hotels, on the other hand, whether rural or urban, his bewildered eyes see a hundred things on the breakfast card, many of them very badly cooked indeed. And he will find the contrast at lunch and dinner even greater. The steerage immigrant has at home fared very well indeed on his plain bread, vegetables, and his stews — a diet into which meat will enter at most but several times the week. Our overeating, especially of meat, is the con- comitant of our prosperity. The most im- portant element in meat, nitrogen, can be had also from cheese — a much-neglected and excellent food — peas, beans, nuts, eggs, and bread. Professor Chittenden, who was very authoritative, thought our present dietary standards much too high; and that better health, increased efficiency, and greater chances of longevity would certainly follow upon our reducing our nitrogenous foodstuffs at 211 WHY DIE SO YOUNG? least 50 per cent; that such organs as the liver, stomach, and the kidneys become overtaxed in the undue efforts they have to make to dispose of them. And when this overtaxing is long con- tinued these organs are bound to develop chronic diseases and too often to break down prematurely and disastrously. TEMPERANCE IN EATING By the time the average citizen has reached middle life he is supposed to have stored up suf- ficient energy to carry him through the remainder of his days in good health. Yet in many cases this is not so, because the system has been over- strained by too hearty indulgence in both foods and alcoholic drink. During early adult life the system is strong enough to counteract, up to a certain point, intemperance in eating and drinking; but by such courses the body is not storing up the energy it should. And so, when middle life is reached, health is not all it should be. For these reasons a man or a woman of forty-five should not drink and eat as heartily as during the younger years; and the less one eats when he arrives at fifty the healthier he will be. Having a splendid appetite in youth and early maturity, we indulge it, disregarding the fact that we need only a certain amount of nourish- ment, and that whatever we eat above that adds to the bulk that should be got rid of; all of which means extra and unnecessary work for our organs. Again, in middle life we are too ready to ride instead of walk; we tend to give up exercise 212 THE PRIME OF LIFE generally. We come to find our chief pleasure in eating and drinking. And so, as we grow more and more self-indulgent we become stouter, and our surplus girth becomes so pronounced that we think it quite natural to take on weight in middle life. The worst of all this is that the excess of waste matter (due to eating too much, especially of animal food and to drinking sweet alcoholics) leads to most of the headaches, backaches, rheu- matism, and gout of middle life. After fifty the food taken should be just enough to keep us going and not so much as will clinker up the system, producing the ailments just men- tioned. The middle-aged can do very well with meat once a day and no alcohol; they will actually enjoy life better in every way for such abstinence or temperance. One will have a clearer mind, a more active body, if he takes only what is re- quired to keep up a fair weight; and this should be the test. Here is in essence what Professor Chittenden considered a fair dietary for one day. Breakfast: One shredded wheat biscuit, one teacup of cream, one German water roll, two cubes of butter, three-fourths of a cup of coffee and one lump of sugar. Lunch: One teacup homemade chicken soup, one Parker House roll, two one-inch cubes of butter, one slice lean bacon, one small baked potato, one rice croquette, two ounces maple sirup, one cup of tea with a slice of lemon and one lump of sugar. Dinner: One teacup of cream of corn soup, one Parker House roll, one-inch cube of butter, a small lamb chop broiled, 15 213 WHY DIE SO YOUNG? one teacup of mashed potato, apple-celery-lettuce salad with mayonnaise dressing, one Boston cracker, one-half inch cube American cheese, one-half teacup of bread pudding, one demi-tasse of coffee and one lump of sugar. 1 GOUT Some people speak of rheumatic gout. As a little girl concluded about Santa Claus, that "there ain't no such a person," so there is no such disease as rheumatic gout. Rheumatism is an infection, due to an essential, a specific germ. The essential feature of gout is the deposition into and around joints of "chalky" sodium biurate crystals, from blood that has, by reason of abnormal metabolism, become surcharged with uric acid. Right metabolism is the conversion of inspired oxygen — the life-sustaining gas — plus the fluids and the foodstuffs that are ingested, into healthy blood and healthy bodily tissues. Not to venture into the dense mazes of organic chemistry, it will suffice to note that the "purin bodies" in food, those which contain considerable nitrogen, and which tend, therefore, to an excess of uric acid in the circulation, should be minimized (they cannot entirely be avoided) by whomsoever has a tendency to gout. Who tend to gout? For twenty-five centuries past, at least, this podagra has always paralleled, in medical annals, high and riotous living. There was no end of gout during the height and decline of the Roman Empire. Galen, Celsus (Nero's doctor) 1 Appendix B, on further dietetic observation. 214 THE PRIME OF LIFE and their colleagues, throve on this gutta, this "dropping of morbid material from the blood into the joints." Apart from high living there is a heredity in gout, there are those among us who spring from a gouty stock. The comparatively rare cases of gout in women are thus in large part explained. One may be spared this mani- festation if other causative factors are prevented from adding their weight to this factor of heredity, if anyone with such an inheritance will but live the hygienic life, will guard against excess in food and drink, will drink tea, coffee, and cocoa moder- ately, will be very temperate, abstinent, if possible, as to alcohol (port especially), will guard care- fully against sudden temperature and elemental changes — cold and wet, against chilling of the skin. There is a relation between some occupations and gout — painters are prone, also decorators, plumbers, printers, lead-pipe workers, whitesmiths, tin workers, workers in lead generally, butlers, barmen, cabmen, draymen, longshoremen, hotel servants, lobster-palace waiters, malsters, cellar- men, and the like. Among the purin-free or nearly purin-free foods are: Milk, eggs, white bread, biscuits, hominy, tapioca, cornstarch, rice, farina, sugar and sirup, jam and marmalade, cake (except with coffee or chocolate flavoring), cream soups, potatoes (eaten in moderation), cauliflower, cabbage, lettuce, egg- plant, nuts, cheese, ice cream, custard or coconut pie. Boiled meats, especially if boiled in two waters, and boiled fish, are preferable, because the purins are thus to a large degree removed 215 WHY DIE SO YOUNG? from them. From such substances as these one's physician will prescribe a dietary when one has either an acute attack or has premonitions of an attack of gout impending. The gouty must abstain from any food which they have learned from experience will not agree with them. Plenty of water must be drunk, because no food is digested or absorbed that is not ulti- mately in liquid form. No one prone to gout should eat sweetbreads, kidneys, liver, meat extracts, salt fish, roe, caviar, or highly seasoned foods. OVERWEIGHTS The tendency to obesity is almost never success- fully combated, especially if there is a family temperament that way. Weight is indeed often- times reduced successfully enough; but generally not for long, and in many cases because the sufferer will simply not exercise the will power to stay reduced by keeping away from the fleshpots and by continuing the banting regime. Obesity results from long-continued excess in the amount of food consumed over that which is metabolized. By "metabolism" we mean the conversion of the oxygen we breathe, plus food- stuffs, into our flesh and blood, our bodily heat, and the energy we manifest. Such excess may be the result of too much food with a normal metabolism; or because of a normal amount of food with a metabolism that is not in good working order; or on account of both these unheal thful conditions combined. When stoutness becomes severe, almost every . 216 THE PRIME OF LIFE bodily function is affected. And because of the many vicious circles that form, we have to deal with a self-perpetuating and self-aggravating malady which all too often ends fatally. For instance: a heart and a blood circulation overtaxed by obesity means bodily inactivity — which in its turn tends to increase the obesity. Hardening of the arteries and chronic kidney disease (Bright's) are frequently complications of obesity; in time they recoil on the heart and eventually on the obesity. Again, obesity tends to prevent the proper expansion and aeration of the lungs, which leads in time to pulmonary disease; which later induces deficient supply of oxygen, the very breath of life. Next is affected the circulation, which, in its turn, brings about diminished metabolism; and so we get back, in the vicious circle, to obesity. In like manner is obesity related to digestive, nervous, muscular, joint, and skin diseases. There are some diseases of later life which come about by reason of fat deposition in various organs, and against which the individual turned forty and inclined to stoutness should certainly guard; excessive weight is then very apt to be associated with an increasingly high death rate. After two- score, then fifteen to twenty pounds overweight should send one to his physician for examination and advice — without which no reducing measures should be undertaken. Especially is this so re- garding exercise. For the rapid throwing off of many pounds has proved disastrous, especially in cases of fatty heart when that organ becomes di- lated to well-nigh the rupturing point. Indeed, the 217 WHY DIE SO YOUNG? obese have, in general, diminished resistance to disease processes. BANTING One may here properly indicate the foods to be avoided by the obese. These are alcohol, especially beer; beer fat is pronouncedly unhealthy fat. Also sugar, fatty meats and foods in general, milk as a beverage, potatoes, salmon, lobster, crabs, sar- dines, herrings, mackerel, pork, goose, nuts, butter, cream, and water during meals. The meals should be light, regular, and frequent rather than that at any repast the stomach should be overloaded. And the eliminating organs should at all times be in good working order. The immortal Banting devised a dietary for the obese which many cannot, however, endure; they frequently collapse after using it a few days. The following, the Banting regime modified by the physician Oertel, is better borne. Breakfast: wheaten bread, one ounce; coffee, four ounces with an ounce of milk and a teaspoonful of sugar; two soft- boiled eggs. At 11 a.m., four ounces of wine, bouillon, or water; cold meat, two ounces; rye bread, one ounce. Dinner: wine, four ounces; fried beef, five ounces; salad, two ounces; pudding, four ounces; bread, one ounce; fruit, three ounces. At 4 p.m., half a cup of coffee; one ounce of milk; a teaspoonful of sugar. Supper: wine or water, eight ounces; caviar, three teaspoonfuls; venison, five ounces; cheese, half an ounce; rye bread, three to four ounces; fruit, four ounces. Hot baths and massage are considerable aids. Certain drugs have, under the physician's care, been helpful; taken hap- hazard, there have been serious consequences. The dietary can be taken for a few days at a time, until some ten pounds or so are disposed of, and when the patient can relinquish it for a while. His scheme calls for an early 218 THE PRIME OF LIFE breakfast of a cupful of tea without milk or sugar (saccharin to sweeten, if you like); an ounce and a half of ham and a dry roll (without butter). At 10 a.m., fresh fruit, and the same at noon. Then at 2 p.m., a moderate cupful of clear soup, lean meat, and plenty of green vegetables without butter or bread or milk; salad; one or two glasses of lemonade without sugar (saccharin to sweeten). At 4 p.m. a cup of tea; at 6 p.m., fruit; at 8 p.m., three ounces of lean meat, radishes, a small potato, and some pickles. When this dietary gets on one's nerves, it can be abandoned for a few days and taken up again for a few days from time to time. No obesity cure should be attempted by any woman who has an organic malady, especially in the pelvis. With especial caution must reducing be proceeded with in women ill of serious disease, or who have suffered ailments that may have left any vestige in the body. Reducing exercises are only for women in perfect health except for over- weight. And the reducing must cease, temporarily, at least, when distress or weak feeling attends it. Indeed, in any case it is much better for the aspirant, no matter how well she thinks herself, to undergo a thorough examination by a competent physician before undertaking any reducing system. THE UNDERWEIGHTS What should those who are underweight do? We have considered those who have weakened by some serious disease, and those who are exhausted from overwork or have nervous dyspepsia and do not eat enough, imagining this item or that on the bill of fare is not good for them. And so such folk remain thin. 219 WHY DIE SO YOUNG? Here is not, perhaps, so great an evil as obesity. "A lean horse for a long race." The lowest mortality at middle life is found among those a few pounds underweight. Therefore those even in advanced life who are spare of build, unless they are extremely so, or are in really impaired health, need not worry unduly. Here is a specimen "superalimentation regime" suitable for building up the system: Breakfast, before 8 a.m., oatmeal with butter, or farina with cream; two eggs; bread, or a couple of rolls and butter; one cup of coffee, half milk, with sugar. At 10.30 a.m., one cupful of milk with one raw egg beaten up in it; bread and butter. Lunch, before 1 p.m., one cup of bouillon with one egg; one or two rolls with butter; tender meat; mashed or baked potato; weak tea, half milk, with sugar. At 3.30 p.m. same as at 10.30. Dinner, before 7 p.m., cream soup; fish; tender meat; potatoes; peas or beans; bread and butter; stewed fruits; small cup of coffee. At 9.30 p.m., kumiss or cocoa and crackers and butter. FUNCTIONAL STOMACH DISORDERS I suppose there is no other country in the world where there is so vast an army of dyspeptics as we Americans can muster; and the ranks of such among us are made up of those neurotic by inheri- tance or those who have acquired their nervous dyspepsia by overwork, worry, excitement, the pace that kills, the passion for mixing in with the maddening crowd, or of getting into the social world, the get-rich-quick mania, and — last but not least — eyestrain . With such dyspepsia there is no disease of the stomach structure, no organic trouble such as exists in chronic gastritis. The ailment is func- 22Q THE PRIME OF LIFE tional and either the muscular stomach apparatus or the right secretion of gastric juice or the sensory gastric function, or two together, or perhaps all three, are at fault. In most cases of nervous dyspepsia the main element at fault is hyperacidity or superacidity. In many cases the superacidity is only occasional, independent of food, occurring perhaps at night, or early in the morning, with gnawing in the stomach and "bilious headache." Strong emotion may bring it on. On the other hand, the difficulty may be due to subacidity, not enough gastric juice, or to the entire absence of this precious substance. The only right course is for the family doctor, or the stomach specialist he will call in if he is not adept in the analysis of the gastric contents, to use the stomach tube and so ascertain the real nature of the malady, whether it be just nervous or some- thing organic. The patient's part in this procedure is jocularly known as "swallowing the hose pipe." Assuming the ailment to be nervous dyspepsia, the underlying nervous element has in each indi- vidual case to be removed. The patient's general physical and mental condition is improved by rest, change of scene and of the mode of living by regulated exercise, proper food properly eaten, and by leading in general the hygienic life. GASTKITIS Gastric catarrh is a chronic inflammation of the stomach. The causes are: 1. Habitual excessive, irregular, or hasty eating. 221 WHY DIE SO YOUNG? The most of us eat too much, anyway, and, as the saying is, "dig our graves with our teeth," and with these implements all too often notoriously broken and poor. And many of us do not eat at set hours, as we should — three meals, and, if hungry, a snack at bedtime. And many among us gulp down, instead of chewing properly, our food. We do not make of a meal a pleasant domestic cere- mony, but as if it were something to be got through with on the jump and away. 2. I am anxious to give no reader offense; I mean, if I can, to keep on the right side of my women readers; and yet I am in duty bound to state that very much of the food we eat is badly cooked. Fried food especially is indigestible, for this is coated with a layer of fat through which the gastric juice is not able to penetrate. Improper, greasy, poorly cooked food, the deadly hot bread, pastry, excessive drinking of water, too much ice cream, tea tippling, excess as to coffee, alcohol, and tobacco, such are forerunners of chronic gastritis. 3. WTierever there is cancer, or ulcer, or enlarge- ment of the stomach; whenever there is liver trouble or chronic heart disease, and in such lung diseases as are accompanied by disturbances of the circulation — in all such cases there is accompanying chronic gastritis; as also in many cases of blood poverty, chronic kidney trouble, gout, diabetes, and other serious diseases. A GOOD COOK Further consideration of maladies of the di- gestive tract lies within the province of the family 222 THE PRIME OF LIFE practitioner. I beg here, however, to dwell for a few pages on a most monstrously neglected sub- ject — the fine art of cooking. One of the amazing incongruities of our civilization — the contempla- tion of which would send any Martian visitor among us scurrying back to his own planet — is the haphazard way in which we prepare the substances designed for the nourishment of our bodies and for the upkeep of our souls. In The Service of The King, a most wise clergyman, under the pen name J. B. Dunn, has written of what happened at a religious meeting. When asked what was the greatest need in his mission field, he startled his women questioners by replying, "A missionary cook." They thought him a jester and frowned disapproval. Their astonishment was not lessened when he produced a biscuit which he asked them to examine. It was almost green in color. "This" he said, "is the food of my people and it is not Christian food. One-half the women in the insane asylum in a neighboring state are farmers' wives, suffering from melancholia, and the superintendent assures me that their infirmity is due to eating bad bread. The woman who could teach my people how to make decent bread on an open fire, and eradicate a pernicious culmary heresy known as 'fry,' would win sainthood, and her grave would become a shrine. But that woman would have to be endowed with apostolic common sense and must have received the unction of tact, for the saddest feature of the condition I have depicted is that my people think their way is the best way in the world. The poor woman who made that biscuit told me herself that she was a born cook. 223 WHY DIE SO YOUNG? Her husband beats her, but, alas! finds no fault with her cooking. He has never known any better." How grave a sin of omission has been committed in that no niche in any Hall of Fame has been prepared to commemorate that apostle of light, of joy, of health, and of longevity, Brillat-Savarin, the immortal author of the book entitled The Physiology of Taste. This great man was born in the latter half of the eighteenth century, and died some eighty years ago. full of honors and having the universal respect of his community and era. And the book here noted, which he is said to have left at his death as a legacy of good and wholesome cheer to his friends, is saturated with the flavor and charm of many genial years. Some people have an idea that Brillat-Savarin was all for grossness and overeating; no greater libel could ever be perpetrated. The same was also said of old Epicurus; yet there was never a more temperate man. These men simply taught and practiced the wise and excellent philosophy that we human beings are entitled to — nay, that it is our duty to — enjoy the present life sanely and temperately. And to this end they insisted that discretion and moderation were essential in all things, spiritual, intellectual, and physical; to them the glutton and the debauchee were abhorrent and detestable. Brillat-Savarin comprehended well, and so taught — that he who ate or drank too much was guilty of conduct most reprehensible to the philoso- pher, to the Epicurean especially, in that the 224 THE PRIME OF LIFE subsequent condition of those thus indiscreet entailed many pangs and much suffering and illness. Therefore the enjoyment of life must be temperate; moderation in all things was his dictum. To him the business of eating was a serious one, as is attested by many a quaint aphorism, each one of which is worthy to be well pondered over. For example: "But for life the universe were nothing; and all that has life requires nourishment." "The fate of nations depends upon how they are fed." (It has been well observed, by the way, that it was not slavery nor states' rights which brought on the Civil War, but the frying pan.) "The man of sense and culture alone understands eating." "The discovery of a new dish does more for the happiness of mankind than the discovery of a new planet." "The love of good living is not merely a physical, but an intellectual and a moral quality as well, almost deserving to be ranked as a virtue." (Why not have omitted the "almost.") "The most momentous decisions of personal and of national life are made at table." "A good dinner is but little dearer than a bad one." "Di- gestion, of all the bodily functions, has most influence on the morals of the individual." "One should eat slowly and in minute portions." (We had supposed this idea was original with Fletcher.) "The great majority of us eat and drink too much." (Is not that what doctors are to-day preaching to their patients, as if it were a new thing?) Well did Balzac term Savarin's book "adorable." Besides its gracious atmosphere we find the writing of it based upon the double object, "to lay down 225 WHY DIE SO YOUNG? the fundamental theory of gastronomy, so that she will take her place among the sciences in that rank to which she has an incontestable right"; and "to define with precision what must be under- stood by the love of good living, so that for all time that social quality may be kept apart from gluttony and intemperance, with which many have absurdly confounded it." This genial lover of his kind was probably the first modern exponent of the real science and art of gastronomy. There are to-day many good books on food and dietetics; and the magazines are furnishing articles without end on practical cooking; yet none among them will be found more scientific, more useful and more entertaining in a kindly and mellow way than The Physiology of Taste. If it were read more to-day there would be less dyspepsia, less crazy and mean politics, less crime, less general cussedness, and fewer divorces — not to mention fewer doctors' bills. "What better teaching is there than is here set forth — that the education of the tastes and the appetites should be an index of the degree of any given civilization. The man of good instincts and of culture should know how to eat and drink, to converse (How nearly a lost art is this to-day?), to appreciate a beautiful landscape, to enjoy the fragrant flowers — in all things to deport himself sanely and wholesomely. Such was the philosophy of Savarin, taught in this book, which should not be lacking in any cultivated library of our day. Just one more quotation, in which we find a de- lightful picture of old-time manners: "Let the number of guests be small, that the conversation may be constantly general; of various occupations, 226 THE PRIME OF LIFE but analogous tastes; the men of wit without pretension, the women pleasant but not coquettish. Let the dishes be few but choice, and the wines of the first quality; the order from the more substantial to the lighter, the simpler to the finer flavors. Let the meal proceed without hurry or bustle; the coffee be hot, the liqueur chosen with care. Let the room to which the guests retire be large enough for cards, for those who cannot do without them, while bearing ample scope for conversation; the guests animated with the hope of still further pleasure. Then let the tea be not too strong, the toast artistically buttered, the punch skillfully made. Finally, let nobody leave before eleven, and everybody be in bed by twelve." bright's disease In Bright's disease the cells of the kidney which perform the all-important function of excreting fluid waste of the body are inflamed, either acutely or chronically; and so doctors speak of acute nephritis or acute Bright's and chronic nephritis. The most important causes of the acute inflam- mation are the infectious fevers, such as scarlet fever, measles, and diphtheria, and exposure to cold and wet. The doctor, to whom must be referred a con- sideration of the symptoms of the disease, fears especially delusional insanity (the brain being affected by the poisons retained in the circulation) and various palsies. Oftentimes there is an over- worked heart. Under appropriate treatment the patient should do well. 227 WHY DIE SO YOUNG? In chronic Bright's disease of the kidneys, the functioning cells of those precious organs have been inflamed in such a way that a great deal of breaking down of the vital kidney tissue takes place. Most cases come about through neglect of or by reason of repeated attacks of acute nephritis. We cannot, such is the nature of the ailment, cure Bright's disease, because we have no way of replacing the kidney tissue which has undergone degeneration. But very much indeed may be done by temperate living, rest, regulated diet, milk, vegetables, and rice eaten in moderation, say once a day, not altogether excluding meat, fish, and eggs. Above all, the patient must be safeguarded against uremia. This is a grave condition in which the kidneys have temporarily ceased func- tioning at all — have gone on strike, as it were, by reason of the abuse they have been subjected to, and of the unfair strain that has been put upon them. In the B right' s-disease sufferer there are premonitions of the oncoming of uremia — dizziness, nausea, indistinct or blurred vision, drowsiness, scanty kidney excretion. The uremic seizure comes on with stomach and intestinal disturbances, shortness of breath, gasping, especially at night, dry skin, and the kind of breathing known as Cheyne-Stokes respiration. Of course a doctor has got to be summoned at once in this condition. For the uremia is likely to deepen into coma and death. DIABETES In diabetes there is excess of sugar in the blood. In the chemistry of the body all starches become 228 THE PRIME OF LIFE sugar; therefore we must in so far as possible limit what is called the carbohydrate (sugar and starch) food intake. Excess of sugar is not properly digested and does not therefore contribute to the upkeep of the body; it is eliminated unchanged by the kidney. Disturbances of the orderly working of the pancreas (that organ which in animals we call the sweetbreads), of the liver, and of the nervous system have been variously held responsible for sugar sickness. In most cases we shall find the trouble fundamental in a disturbed nervous system, although in the management of the disorder we have to consider very carefully how the pancreas and the liver are working. There are also cases in which the sugar sickness is predisposed to by disease or injury of the brain or spinal cord, harden- ing of the arteries, overwork, and excessive strain, and by serious infectious diseases, such as typhoid fever and tuberculosis. Heredity frequently plays its part, many members of the same family in successive generations being thus afflicted. Along with this goes a family tendency to take on weight, so that there is a history of " diabetogenous obesity" through several generations. People of highly emotional or neu- rotic temperament, either inherited or acquired through the stress and strain of our civilization — so abnormal as it is in many respects — are prone to diabetes. Sugar sickness is commoner in the city than in the country, by reason, I am sure, of the disorganized effect the wear and tear of the city life has on the nervous system. The sedentary are more susceptible than athletes (unless the latter have developed bad hearts) and laborers, 16 229 WHY DIE SO YOUNG? who are able by reason of their muscular ex- ertions to "get away" with all their carbohy- drate intake. Gout, "blood disease," malaria, the infective fevers, the serious diseases from which proper convalescence has not been made, direct injury or disease of the spinal cord and brain, all often lead to or complicate diabetes. Oddly enough, here is a very grave and fatal disease for the young, while elderly diabetics, on the other hand, although their kidney excretion is almost never sugar free, are quite likely to live along comfortably enough, and to die of some other disease in old age, if they will but be temperate, exercising all the precautions required by their state of body, and avoiding the excesses which people who think themselves healthy feel at liberty to commit. This disease comes on very insidiously, like a thief in the night. Indeed, in many cases it is discovered accidentally, during a medical examination. Here is another among a thousand reasons why once a year, at least, people should go to their doctors, no matter how well they feel, for a thorough overhauling. What we most have to fear is the diabetes coma, which is practically never recovered from. Most adult diabetics would do well if they would obey their doctor's orders. But it is a very considerable medical experience that such patients are hard to control, are very prone to do as they please as soon as they get beyond the doctor's observation. Every diabetic must be under a doctor's constant care. Each must be treated according to his own peculiar constitution. Worry, excess, great exer- tion, exposure must in all cases be avoided. Tea, 230 THE PRIME OF LIFE coffee, and, indeed, all food must be sweetened with saccharin, instead of sugar. There are medicines appropriate to the individual case which the family doctor must prescribe, and a diabetic dietary must be faithfully adhered to. RHEUMATISM We have all read about the farmer who came home from the city with a barometer he had bought to foretell stormy weather with; and of how his better nine- tenths expostulated: "Why, Hezekiah, how extravagant you are! What did the Lord give you the rheumatiz for?" And yet this yarn hints not at all at the real cause of rheu- matism, but at only one of its predisposing causes. Inclement weather, especially exposure to cold and wet, in the changeable fall and spring months, fatigue and hardship, alcoholism — these agencies make the bodily tissues congenial soil for the essential cause, which is a specific germ, to thrive in. By themselves alone they could not bring on a rheumatism. The specific cause of that disease is the Streptococcus rheumaticus which, pearl-shaped, appears necklacelike under the microscope. Some ten thousand of this germ (coccus means a berry) would make a string (streptos) about an inch long. This coccus, implanting itself in such good soil as unhealthy tonsils and upper air passages, catarrhal middle ears, tooth cavities, or any other infection focus, gets its colonies past those insecure portals into the blood and lymph channels, and thence to the various joints, the heart membranes and musculature, the pericardial sac, the pleura, 231 WHY DIE SO YOUNG? the lungs, and other vital but vulnerable organs and tissues. Thus in a predisposed system is the rheumatic fever set up, with all the symptoms of an acute and serious infection. Recovery from such an attack leaves the sufferer far from unscathed. For the irritative inflam- mation invades the delicate membranes, the liga- ments, the smooth-faced cartilages, the tendon attachments of muscles within the joint, the nerves assigned to the joint in the bodily economy — this inflammation congests and thickens all the parts involved, abstracts much of the lubricating fluids necessary for the free and painless move- ments of the joints. With every successive rheu- matic attack fresh insult is offered, fresh injury is superimposed, until the chronic rheumatic has his joints in the irremediable condition of fibrous and thickened membranes; ossified or eroded cartilages (much like iron that is rusting after the enamel has worn away) ; gnarled, deformed, creaky joints, either grievously limited as to their motion or ankylosed — rendered incapable of any motion at all; while the muscles designed by nature for the joint's movements are atrophied and there is agonizing involvement of nerve tissue. Thus, too, what should in the normal be exquisitely smooth heart valves become successively incrusted with the infective vegetation until the cardiac murmurs sound like a miniature flood rushing through coral formation. One victim of this disease in its chronic form has, in seeking a cure, suffered many things of many physicians, some "healers," and not a few spas; has swallowed gallons of advertised "sure 232 THE PRIME OF LIFE cures"; has anointed himself with any amount of embrocations, including those "good for man and beast." This sufferer has written down his experiences in a book entitled Being Done Good, which would be vastly entertaining (evidently the writer, who is obviously no end of a "sport" has intended it to be so), if one did not discern between the lines, in a way to engage the pro- foundest sympathy, the excruciating tortures hi3 illness has occasioned him. The most important lesson here is to heed the warning of the first acute attack of rheumatism, especially if this has oc- cured in childhood or in youth, so that all future attacks may be avoided; to forestall, indeed, if possible, any attack at all. This may oftentimes be done by submitting to a thorough examina- tion by one's family physician, so that hidden or obscure foci of infection may be located and eradicated, so that, more especially, upper air passages may be rendered sound — that is, barren soil for the germinal weed to thrive and multiply in. Most important of all is an inspection by the dentist, so that such germs shall find no habitat in ulcerated teeth or unhealthy gums. (Just think of it — only 8 per cent of us have ever sat in a dentist's chair.) What many thousands of cases of rheumatism, not to speak of other infections, what a vast deal of ill health generally, will go by the board as soon as the ninety two millions of us will see and follow this light. Such is the way to deal with rheumatism. For though amelioration of symptoms is to be had, there is no medicine that will normalize the kind of joints we have considered, there is no human 233 WHY DIE SO YOUNG? power that will restore to heart valves thus affected their pristine, supervelvety smoothness. FUNCTIONAL HEART DISTURBANCES Without any real organic disease, such as would involve the heart muscle or the heart valves, there are various functional disturbances which give great anxiety. Such disturbances are in themselves seldom fatal, although the fright to which they have given rise has in some cases resulted calamitously. There are various altera- tions, either temporary or habitual, in the heart- beat as to its volume, its force or its time. A beat may here and there be dropped; there may be two or three beats in rapid succession, followed by a pause; or there is the gallop rhythm, which resembles the footfalls of a cantering horse; or the heart beats with excessive rapidity, especially in very nervous persons, sometimes as many as one hundred and twenty beats in the minute. (The normal per minute is about seventy-two in most of us.) On the other hand, the heart-beat may be very slow (Napoleon is said to have had a pulse of forty). Such alterations may be due to organic brain or kidney disease, or to digestive disturbances. Distress about the heart is especially apt to occur in cases of dyspepsia, when a good deal of gas, developed in the process of digesting sugars and starches, distends the stomach, causing "heartburn" and pressure upward of the distended stomach against the heart. Auto-intoxication — that is, the poisoning of the system by waste sub- stances that should be eliminated by the kidneys, 234 THE PRIME OF LIFE the bowels and the skin — creates impure blood, and this in turn reacts upon the heart, disturbing its function. The excessive use of tea, coffee, alcohol, and tobacco causes heart pain and distress; so do great exertion and strong emotion. The use of headache and neuralgia cures, without the doctor's prescription, weakens the heart and thus disturbs its orderly working. Blood poverty is a potent cause of functional heart disturbances; and women having chlorosis (green sickness) are apt to get up an "anaemic murmur" which may be heard several feet away from the patient. This is one of those heart murmurs which happily dis- appears with the anaemia and is due simply to the bodily weakness inherent in that disease. Pain in the region of the heart may be due to intercostal neuralgia or to pleurisy. Or there may be neuralgia of the heart itself. This is likely to be hereditary, or earlier in life the sufferer may have had some disease that had the effect to disturb the heart function. Hardening of the arteries is here a prominent cause. Sometimes only the coronary arteries, the peculiar duty of which is to supply the heart muscle with blood, are hardened or otherwise diseased. Therefore such a sufferer must be examined without fail to ascertain whether the trouble is simply neuralgia or a real heart disease. Such breast pang, angina pectoris, is called the doctor's disease, because it is suffered in that calling probably more than in any other, on account, among other things, of their being aroused from heavy sleep to go about their ministrations. In most cases of functional heart disturbance the 235 WHY DIE SO YOUNG? trouble will pass away as soon as the causative condition is remedied. This can oftentimes be done by simply stopping entirely, for a time at least, tea, coffee, alcohol, cigarettes, or other forms of tobacco. For neurotic individuals the doctor must prescribe sedatives. For these, with gastric and intestinal ailments, stomachics are right; for the anaemic, tonics. Only by a doctor's examination can it be ascertained whether the heart disturbance is functional or organic. The ascertaining of the blood pressure, by means of the sphygmomanometer, is a very material help in such examinations. VALVULAR HEART DISEASE Valvular disease of the heart is due to many and varied causes; the most frequent are harden- ing of the arteries, prolonged and excessive exertion, alcoholism, constitutional disease, a severe strain (as in piano moving), in some cases, fortunately rare, aneurism. Or there may have been an acute infective heart inflammation, perhaps many years before, in children and adolescents who have suffered rheumatism, St. Vitus's dance, scarlet fever, measles, pneumonia, or diphtheria; or in adult sufferers from erysipelas, cancer, gout, dia- betes, tuberculosis, and Bright's disease. I cannot explain here the mechanical obstruc- tions or the other physical ways in which the system suffers by reason of valvular irregularity. Suffice it to say that signs of the disease are in many cases long absent. Any such danger signal as the following should send one at once to his 236 THE PRIME OF LIFE physician. Headache, dizziness, faintness, flashes of light, shortness of breath, palpitation on exer- tion, and pain. The last is either localized in the heart region or sharp and radiating to the neck or left arm, rarely to the right arm. As time goes on, in people who willfully neglect these signs the shortness of breath becomes worse at night (the poor sufferer having to be bolstered up), there is cough, anaemia and swelling of the feet and legs. Almost all valvular heart trouble is evidenced to the examining doctor by murmurs, which are due to the roughening of the valvular surfaces; these murmurs are oftentimes discovered only accidentally, as in candidates for life insurance. The outcome of valvular heart disease will vary in the widest way, according to the general bodily condition of the individual patient, according to such previous illnesses as have led up to the heart ailments, to complicating diseases found at the time of examination, and to the peculiar character of the valvular trouble in each case. In general we may say that little children do not bear heart disease well, especially when there are recurring attacks of rheumatism and where the child is insufficiently nourished or not properly supervised. Sudden death, however, is very rare among such child sufferers. Women bear heart trouble better than men because they lead quieter and less strenuous lives; pregnancy and child bearing should indeed be avoided when possible, and yet these are not factors so disturbing as many imagine. (Here the wise counsel of the family doctor should be sought — and heeded.) 237 WHY DIE SO YOUNG? Each case of heart trouble must be judged on its merits. Sudden death is rare in such cases; some sufferers who have died thus have really succumbed to occasionless fright. We may enter- tain a favorable view of the matter when the general health is good and the habits are temperate and sensible; when there is no special liability to rheumatic or catarrhal affections; when the doctor has, by frequent examinations, found the condition of the heart valves, though abnormal, to have been for three years unchanged; when the heart sounds are of moderate frequency, and when there is little or no hardening of the arteries (as estimated by the blood-pressure apparatus); and so long as there is no evidence of venous congestion of the lungs, the liver, or the kidneys. How is valvular heart disease to be managed? In all cases the quiet life, the avoidance of excite- ment, of excess, of worry, of overexertion, and of overstrain are absolute essentials. High altitudes are for most cases not good; they make the heart labor too much. Change of climate and of scene are oftentimes most salutary. In some cases (but only by medical direction) light exercises are right. The food must be moderate in amount and easy of digestion; the bowels never clogged, nor must there ever be straining at stool. No tobacco, absolutely. Alcohol only by the doctor's orders. In appropriate cases blood letting is most beneficial and affords greatest relief. The matter of drugs must be left entirely in the doctor's hands. In many cases self-drugging is tantamount to com- mitting suicide, for the valvular lesions to which leakage is due are various. Taking a heart stimu- 238 THE PRIME OF LIFE lant for a lesion that needs an anodyne remedy, or vice versa — such proceeding is likely to result fatally. In many cases the patient is better off without drugs at all; in other cases they are essential. Every sufferer from heart disease should be under the constant care of a capable doctor, by whose directions, if they be faithfully followed, the patient will be likely to live just as long in the land as the most of his neighbors. By good manage- ment and judicious living excellent results are confidently to be expected in most valvular disease cases. THE PACE THAT KILLS Several years ago heart disease caused the highest number of deaths in the metropolis — exceeding in its record tuberculosis. And such deaths were reported from Chicago, Boston, Detroit, Philadelphia, and other great cities as being greatly on the increase. The physician may here well seize the opportu- nity to observe that, by reason of the stress and strife of our era, coupled with sheer human per- versity, many men will not take the prolonged rest imperative for convalescence from serious infections. Many such patients have been reading up their troubles in health magazines, Sunday supplements, and cyclopaedias, and they guess that they know what's what! Many others have learned from the Lydia Pinkham of the Soul, that there is no such thing as disease, anyway, since matter is nonexistent and the senses are a lie, those of doctors being especially prevaricative. 239 WHY DIE SO YOUNG P The doctor's ipse dixit has no more weight in these days than has the theologian's, although never before in human history has the medical profession performed such near-miracles and done so much beneficent work. Elderly men are pe- culiarly unmanageable, pooh-poohing doctors as such a fussy, unreasonable lot and declaring, furthermore, that an old horse that once lies down never gets up. One old man disobediently left his bed, considering a deal he had on to be paramount, went downtown, returned that afternoon in collapse, and died the next day. Another man, in his prime, convalescent from pneumonia, the toxins of which disease had sadly disintegrated his heart muscle, persisted in exercis- ing his ever-tense psychism by sitting up in bed and playing cards with his wife; of a sudden he fell back on his pillow and died of a dilated organ that had had no time or chance to return to "compensation." Unfortunately, it lies but little in the physician's power to control the spirit of the age. His warn- ings against fast living, undue indulgence in meat and drink, and against business excesses conducive to such nerve breaking as must inevit- ably wreck the organism should it be attacked by disease, all too often go unheeded. His "non- sense" about apoplexy, about heightened blood pressure and hardened arteries; his little joke about rapid living leading to premature dying — those are all too well justified by the avirile lassi- tude, the temperature changes, the weak, quick, intermittent pulse, the breath that comes with so much difficulty, the blue lips and cold finger 240 THE PRIME OF LIFE tips, the gray and dusky skin, the precordial pain, and the distended veins in the neck — all of which are like to have but one sequel. HARDENED ARTERIES The arteries are the body's hose pipes, but instead of carrying water to put out conflagration with, they supply pure blood from the body's pumping station (the heart) for the sustenance of the living tissues. Many a fire has been unsuccessfully fought, to the ruination of much property, by reason of the hose pipes having become frayed, ripping when put to use. Many a human tenement has gone to pieces by reason of the body's hose pipes, the arteries, having become hardened, "clay- piped," beaded here and there in their courses, rigid but brittle and fragile tubes. The human artery has normally a good deal of "give," to it. With each heart pumping the artery expands some, so as to equalize the pressure, as anyone can realize by feeling the pulse at the wrist. Of recent years there was a good deal of talk about a man being as old as his arteries. A man with brittle arteries would be old at forty; a man with good, well-preserved, capable hose pipes would be young at seventy. However, it has been found that in arteries, as well as elsewhere in human bodies, as in nature generally, the law of compensation obtains; that there are factors of safety for arteries, as well as for lungs, kidneys, and nervous systems, and other tissues. The meaning of this is that anybody with a moderate 241 WHY DIE SO YOUNG? degree of arteriosclerosis may, if he be but temperate, eschew certain bad habits he may have, and observe given precautions, get on com- fortably enough as long as the rest of us are likely to. The onset of arterio-sclerosis depends, in the beginning, on the quality of the arterial tissue, of vital rubber in the individual human machine, and then on the amount of wear and tear that vital rubber has been subjected to. The proof that the quality of the vital rubber counts is that arterio-sclerosis may be well developed in a man of thirty in whom there have been none of the causative factors we shall presently mention — who may, indeed, have the arteries of a man of three- score. Entire families show this early tendency to hardening of the arteries. Most such sclerosis comes, however, from bad use of good vessels. Here alcohol, tobacco, rheu- matism, gout, and diabetes have their baneful innings. Lead poisoning in the trades where this metal is used vitiates the quality of this vital rubber. And then there are poisonous — the toxic — effects of the various infections — typhoid fever, tuberculosis, and the like. "Blood disease," both early and late, work dreadful degenerative changes in the arterial vessels, especially in the aorta, the largest of the arteries, and that into which the heart, through the aortic valves, immediately pumps its blood. And then there is overeating — in many cases nothing else brings on arterio-sclerosis. It has been well said, indeed, that in this disease the cause is apt to lie in the poisoning due to undigested 242 THE PRIME OF LIFE material in the digestive canal; the evidence of this poisoning (toxemia) lies in the high arterial tension which soon becomes evident in overworked and degenerated vital rubber; while time only is necessary for change in the kidneys to take place indicative of the arterio-sclerosis that becomes generalized in the system. "The origin is alimen- tary; the lesion is arterial; the danger is renal." Nor is arterio-sclerosis uncommon in athletes, in men who at college have made their records, where muscular overexertion has, by increasing resistance, raised the blood pressure unduly. Then there are the so often stress and strain, the hurry and worry, the maddening social and eco- nomic conflicts of modern life. So there are women at fifty who have had none of the pre- disposing diseases or other factors we have men- tioned, who have eaten and drunk temperately enough. And yet they have arterio-sclerosis by reason of their high-pressure life. So it is that people with beginning arterio- sclerosis easily become pallid, or short of breath, or oppressed, or have dyspeptic symptoms, or the heart begins to palpitate on exertion or otherwise to give evidence of its presence in the body — which should not be. For an organ that makes its presence felt in the body is not acting properly. All this should naturally indicate the imperative occasion of a medical examination. The nervous danger signals, especially of the brain, are varied and always important to pay respect to. There is retinal sclerosis, by reasou of which the sight becomes impaired; there is aphasia, perhaps occasional and transient, loss of 243 WHY DIE SO YOUNG? memory, or dizziness (syncope), ringing in the ears; there are various paralyses, which may not last beyond twenty-four hours, be recovered from perfectly, but very likely recur. Thus in the course of a couple of years there may be a dozen such nervous manifestations. But most of all to be feared, after some sudden excitement or exertion or digestive disturbance, is apoplexy — that is, the fracture, the breaking of a brittle artery, and the resulting hemorrhage and clotting of blood in the brain substance. It is obvious, from what we have observed, that examination of the kidney excretion is a most important index to the presence of the degree of arterio-sclerosis. Other grave events are gangrene of the extremities. There is also much pain and loss of function in and above the foot and ankle by reason of hardened vessels in the leg — pain that has all too often been attributed to rheu- matism or to flat foot; there is here also much intermittent lameness. There is also apt to be muscular weakness after exertion, or complete disability; numbness, tightness, tingling, or a feeling as if ants were traversing the skin, in the arms. Immediately, then, there is the slightest indi- cation of arterio-sclerosis, or indeed of any occasion to foresee its approach, we guard ourselves by living the quiet, well-regulated life, avoiding especially excesses in food and drink. Particular attention is paid to the right functioning of the digestive tract, of the kidneys, and of the skin. Alcohol is cut out; tobacco were best omitted; the food is plain and wholesome — largely vegetable. 244 THE PRIME OF LIFE The Chittenden dietary I have mentioned is ample enough for any arterio-sclerosis sufferer. Much water is drunk. Vacations and change of scene are taken by those who can afford them. The best thing is to live in general the physiological life. The effects of the various diseases and un- toward organic conditions mentioned are in so far as possible eliminated. Perhaps the most pertinent observation in the premises was made by the physician Cheyne long before the disease arterio- sclerosis assumed its present dignity: "Every wise man after fifty ought to begin to lessen the quan- tity of his aliment; and if he would be free of great and dangerous distempers, and preserve his faculties clear to the last, he ought every seven years to go on abating gradually and sensibly, and at last descend out of life as he ascended into it, even into the child's diet." EXERCISE FOR THE MIDDLE AGED Some form of exercise is good for those after forty, especially for the sedentary. The more violent exercises of youth are for most of us in- appropriate to life's prime. The system of exer- cises devised by Walter Camp, the former Yale coach, are most valuable and best calculated to restore the electric juice to the middle-age life period. Mr. Camp considers that "nature never intended a man to be old at thirty, fat at forty, and dependent at fifty on a trolley or a flivver if he had to go a mile." His system takes into ac- count the proposition that a jaded man is of little use either to himself or to his community; 17 215 WHY DIE SO YOUNG? that he is a weak link in the universal scheme, and to that extent hampers the whole; that the work of the factory operative, the clerk, the executive, the salesman, the enterpriser, and the statesman is top notch only when his physical condition is right. Most systems of what may be called, as apart from golf, sailing, walking, and the like, artificial exercise, are tried for a brief period and then abandoned because the procedures have occupied too much time; or the result has been not re- freshing, but only fatiguing; or such muscles have been strained as get all the exercise in one's ordinary vocation; or in any one method too much stress has been laid on increase in the size of muscles or on the development of "stunts" which can have no practical value to any man past forty. In the Camp system the only apparatus used is the human machinery. It is preparation for the day's business and it is exhilatory; at the same time it increases the strength of the heart and lungs and the suppleness of the trunk, and it tends to keep at a superbly high point those bodily forces which are resistant to disease and to premature decay. Mr. Camp's idea, which he has so generously promulgated, is that one's legs and arms are usually good enough for his life work; that what is of most vital importance to a man, as to a motor car, is the engine, the part that is "under the hood." The heart, the lungs, and organs generally are what really count — they being right, the rest of the bodily economy can take care of itself. Given 246 THE PRIME OF LIFE true power within the torso, we shall find our efficiency, our ability for good work, and our longevity chances enormously developed. Such is the root of the matter. It appears that the Hon. John Q. Tilson of Connecticut several years ago warned his fellow representatives that too little attention has been given to the conser- vation of the nation's maturer men, who must direct our financial, economic, and industrial affairs; and }ie then referred to what Mr. Camp had been doing with a company of business and professional men in New Haven. Mr. Camp, from profoundly patriotic motives, became the head of the Committee on Physical Reserve of the National Security League; and the interested reader will be freely supplied with all the details of this system by mailing an application for the necessary information to the league at 19 West Forty-fourth Street, New York City. At the national capital, in the summer season, Mr. Camp started a sixty -day course at the house of Congressman Kemp for the benefit of Cabinet members, Senators, Representatives, foreign am- bassadors; supreme court judges, all manner of secretaries, commissioners, department directors, and such like. "Everybody was doing it." Fifteen minutes were given to the "dozen daily set ups." And at the end of the course Mr. Camp was handed many most appreciative bouquets. For instance, Secretary McAdoo said, "The work has been of great benefit to me and I can with a clear con- science recommend your course for universal use." Mr. F. A. Delano of the Federal Reserve Board: "I have worked my old machine pretty 247 WHY DIE SO YOUNG? hard these thirty-two years, and I appreciate the wisdom and the philosophy of your suggestions. The summer has been a pretty intense period and what you did contributed much to keeping me fit and able to do my bit." Secretary Lane: "The work you have done for all of us is only to be measured in kilowatts of joyousness and good cheer. I hope that your spirit may be far-reaching and that your apostles may spread the gospel throughout the land." Assistant Secretary of the Treasury Crosby, "You have organized a group here not only of men who are better for your initiative, but who recognize it and are grateful to you." Assistant Secretary of the Treasury Newton: "Your propaganda ought to be extended throughout the entire country. America is wasteful, and her greatest waste is in the sacrifice of strong men in the midst of what ought to be their period of most useful achievement." Mr. Edwin F. Sweet of the Department of Commerce: "I wish that your plan could be put in execution in every bureau in every department, in both Houses of Congress, and among the business men of every city in the United States. The habit of physical exercise which I have acquired is a permanent asset to me; we have all learned how much better the profuse perspiration, the deep breathing, and the morning baths make us feel." Mr. Louis E. Post of the Department of Labor: "I would not trade the experience of the past eight weeks at Billy Kent's on four mornings of every week for any- thing that I have experienced nor for anything that I have hoped for, except the end of the war 248 THE PRIME OF LIFE with a victory for democracy. From the first I have felt the good effects. My chest has got pretty nearly shipshape with reference to my stomach, my stride is swifter and steadier and without any of the sense of weariness I used to feel." Let us then all go to it, those of us who since thirty have been drifting into the fallacy of the undistributed middle. Let us shorten our belts and lengthen our longevity probabilities. First, however, undergoing thorough medical exami- nation to insure that no organ would be over- trained or otherwise injured. DOES GOD FIX THE DEATH RATE? I once heard a very real man of God, a broad- minded clergyman withal, during a sermon, pro- pound the above question. And he reached a decided negative. The Almighty gave us a world; also three most human gifts — reason, will power, and just plain common sense. And he expects us, whom he put on this earth, to become coefficient at least, in the working out of our own destinies. Especially have we not the right to attribute to a cruel Deity such premature death and such suffering as are actually due to crass, stubborn ignorance and to wicked, perverse inhumanity. Truly, God does not fix the death rate. Who does, then? Human kind itself, for the most part. Those theologians aid high death rates who ignore the demonstrated facts of disease pre- vention; who seek to perpetuate the mediaeval superstition that infections are merited scourges 249 WHY DIE SO YOUNG? from on high; who would teach that the forces evolving pestilence are mightier than man can hope to struggle against, too awful to be defied, which it were impious indeed to contend with; that hosts must succumb when the Angel of Death spreads his wings on the blast, when from a cloud passing over an evil-minded community a retributive hand scatters the seeds of destruction ! Those "faith curers" and "divine healers" swell the death rate who would ignore that most mani- fest of human facts, the existence of disease and of suffering, and who would have their fellow mortals close their eyes to the tremendous curative possi- bilities in material measures. Those politicians swell the death rate who spend many millions of the people's money in the investigation of hog cholera and hoof-and-mouth disease, but who would not maintain in the Presi- dent's Cabinet a Secretaryship for the centrali- zation and co-ordination of our national health activities. (For the reason, it would appear, that the interests of a somewhat nebulous but most reprehensive "medical trust" would thus be furthered.) Venders of patent medicines and of "sure cures," who fleece their victims until the latter have passed far beyond the incipient stages of their maladies, when competent physicians could have helped them to a cure — such fakers have a heavy responsibility for many thousands, every year, of occasionless deaths. Those profiteers swell the death rate whose depredations make it impossible for our people to procure essential sustenance, wherefore their 250 THE PRIME OF LIFE bodies become easily predisposed to disease and to epidemics; this is to be said also of those who sell "rots and spots," fowl several years dead in storage, and other food which is poisonous to the human system. Housewives and poor cooks whose culinary products produce dyspeptics directly, and drunkards indirectly, give far more impetus to the upward trend of the death rate than is generally imagined. And mothers who can, but will not, nurse their own children, and those other well-meaning mothers who believe they are able to raise their families in defiance of such "newfangled" hygienic notions as are expressed in this book, help greatly to keep the death rate high. Those who overwork women and children in' factories have a dreadful responsibility for holding the death rate at a shamefully high level. So also do those employers who require men to work at dangerous trades under intolerable conditions, such as in some occupations have been occasioning a tuberculosis mortality, under the thirty-fifth year, of 80 per cent. Such and many more are the agencies for which we are to blame, making for millions of occasion- less deaths before our natural span is reached. Dear reader, who has gone thus far with me, you must now surely realize that no one among us can safely ignore considerations of sanitation, hygiene, and disease prevention as being of no personal concern. One cannot, as to these, live by oneself alone. We cannot, any of us, escape some personal share of the responsibility for fixing the general death rate. But we can choose, we 251 WHY DIE SO YOUNG? can make at least the selfish choice, of being on the side of the forces that are working to bring down the death rate, instead of knowingly aligning ourselves with the forces that are jacking it up. We can, at any rate, realize that the most of us die sooner than we have any right or business to die; can so live as to forestall by many years the day or the night when we must be as he who "wraps the drapery of his couch about him and lies down to pleasant dreams." VI THREESCORE AND TEN " The sixth age shifts Into the lean and slippered pantaloon, With spectacles on nose and pouch on side; His youthful hose, well sav'd, a world too wide For his shrunk shank; and his big manly voice, Turning again toward childish treble, pipes And whistles in his sound" LAGGING SUPERFLUOUS? /T^OO frequently does one hear the elderly say A that they would be better off dead, that they are only in the way of those who are doing the World's Work. Do such dear folk ever consider how precious to their families is their mere presence, how much of benignancy they can suffuse, how potent are the counsels by which they can guide, out of their own rich experience of life, the young, whose province lies in action. In my youth I had the blessed good fortune to know an elderly gentlewoman, now since gone to her sure reward. It would be difficult to imagine anybody more necessary to her kin, to her friends, to the community in which she lived. No family matter, whether the engagement of her grand- daughter or the starting out in business of the son of her niece's husband's second cousin, was ever con- cluded without her interest being solicited. Any 253 WHY DIE SO YOUNG? friend who had ever sat at her table or had drunk a cup of tea under her roof might claim considera- tion almost as warm as was shown for those actually of the blood or who had married into it. And a made man was that tradesman who could deliver his goods at her basement door. Her home, I must be careful to add, was in that Elysium about Washington Square Park, in the metropolis. This dear lady had high tea Sunday evenings. And youths would come in of late afternoons and have their heart agonies soothed by her; while girls would just drop in and be amazed to find there sundry boys whom they could never have imagined would happen there precisely at that time — oh dear, no! The old, the young, men and women, with little children, would call, and generally would stay to tea. The men who came seemed to appear from all over the habitable globe. She was the widow of an Englishman who had been in the navy. Wherefore men who had traveled much were to be seen there. And cer- tainly no one of them who ever touched at the port of New York would dream of missing this snug haven. And what extraordinary little presents they were constantly bringing; the house seemed full of such — tea made of real tea leaves from China, hideous heathen gods, Japanese ivory miniature work, amulets from India, perfumes from Araby, laces from Ireland, flowers always. Truly you thought of Browning's tender bit of flattery that "the young women are beautiful, but the old women are still more beautiful," when you were in the presence of this genial, comforting, satisfying, and satisfied hostess, seated at the 254 THREE SCORE AND TEN head of her mahogany, clad in simple, amply draped, soft black silk with old lace about the neck and at the wrists, the dress slightly opened at the throat and filled in with that fluffy kind of stuff which I understand (mere man that I am) is called tulle, an old-time brooch (some family heirloom) pinned to and resting upon it. No cloth on the mahogany table, of course, but superb silver, sparkling cut glass and wonder- ful chinaware, with a bowl of flowers in the center of that exquisitely polished wood. The moral tone (I think, of course, only of the men) was jacked up many a peg as the eye wandered over the board groaning with cold roasts, jellied loaves of chicken or veal, cool green salad, homemade preserves and cake, while one drank of the fragrant and cheering cup of tea blended with lumpy yellow cream, poured out for you by that dear lady from her antique teapot — the while you were conversing with the fortunate company gathered there in the benign effulgence irradiating from the head of the table. "Lagging superfluous on the stage?" Well, hardly. All, how we fortunate ones have during the years since been missing that gracious presence! THE TRAGEDY OF DEAFNESS An unfortunate woman was taken in youth with an acute ear disease which rendered her slightly deaf. This condition was neglected until, eight years later, she became totally deaf. Mean- time she suffered greatly with headaches and head noises. Sbe had given birth to four childreD and had the entire care of them, doing housework 255 WHY DIE SO YOUNG? besides. Two of these children died. With them all she had been up innumerable nights, and in the daytime the efforts to hear and understand them wore her out. When they were babies and when they were asleep she had to leave her work every few minutes to see whether they were crying, falling, or climbing out of bed. Her husband having died and her two girls going out to work for the day, she kept the house alone. No one called in neighborly spirit. At times she expected messengers, expressmen, dealers. So she had to go and see whether anyone was ringing the bell or knocking at the door, hundreds of times a day. She had also lost all sense of smell. WThen she was busy with some work she had to run and see whether water was boiling over or something was cooking too fast. Whenever she turned on water she had to remain at the tub or sink lest she should forget all about it, and could not hear the overflowing. "Most deaf persons," she wrote me, "must be forgetful. A blind person is not expected to keep house alone and seems more helpless than a deaf one. Yet it would not be extremely hard for a blind person to know whether a child is crying or getting near an open window or the hot stove, or to listen whether anyone is coming up the front steps and knocking at the door. Seeing, where one should hear, is far more trying than hearing, when one should see. I am thought to be a very quiet, contented woman who does not think it dreadful to be deaf. And while others listen to music (I have heard the greatest artists who performed in the 'seventies) and to conversation, chatter and 256 THREE SCORE AND TEN laughter, I feel as though I carried constantly a humming, buzzing machine behind each ear. And I hear ringing, singing, roaring, accompanied by deep organ tones besides — about ten noises continually." Probably no other infirmity steals on one so much like a thief in the night as does deafness. Nor is there any so irreparable when once estab- lished. Relief then is always possible and some arrest of the affliction's advance, but no cure. Eyestrain and errors of refraction manifest them- selves unmistakably, especially after forty; and the presbyopes among us may get fitted with the corrective glasses. On the other hand, most people with defective hearing give little heed until they realize, by accident, perhaps, that they cannot hear the watch or the clock tick as they were wont to do, or until there is a roaring in the ears or a dizzy spell. The ear mechanism is extraordinarily complicated and delicate, pecul- iarly affected by catarrhs of the nose and throat, by inflammations extending to the middle ear via the Eustachian tube. Most chronic deafness results indeed, from oft-repeated and consecutive colds in the head, from congestions in the upper air passages, and by reason of the migration from the mouth, through the tube mentioned, of grippe, pneumonia, meningitis, tuberculosis, or other bac- teria. Or inflammation will close up that tube, thus destroying the equilibrium which ought naturally to obtain between the air inside the ear drum and the air without the drum in the external ear. Tobacco and alcohol induce and keep up catarrh, and thus play their sinister part in deafness production. And the "motor ear" has 257 WHY DIE SO YOUNG? become common by reason of the as yet abnormal speed of that modern invention and of the dust it raises, to all of which the human animal is not yet inured. And the thousand and one noises which constitute the Great American Vulgarity, and without which, it would seem, civilization cannot be maintained, tend to blunt the hearing sense. And this not only by the nervous fatigue those noises induce (which fatigue reacts on the auditory nerve), but also by the actual mechanical destruction that the noise vibrations work on the infinitely delicate and labyrinthine elements of the hearing apparatus. Nor is it generally realized how great a handicap deafness is in the modern struggle for existence — hard enough for so many, even unhandicapped by any physical impairment, but very hard indeed for the elderly. The number of those who are becoming deaf is constantly increasing — and that so gradually they hardly realize the progress of their affliction. Their efficiency lessens with their hearing. And their mental activity and acumen be- come progressively diminished because the acute- ness and the sureness of our mental processes, of our perceptions and consequently of our judg- ments, depend very largely on the sensations conveyed to our brains via our sense organs. Thus the inability to hear the human voice puts one pathetically at a disadvantage in intercourse with one's fellows and in life's occupations. VISUAL DEFECTS Among the many circumstances in modern civilization tending to impair human vision is 258 THREE SCORE AND TEN improper illumination, either natural or artificial. Too intense light is as bad as, perhaps worse than, poor lighting. Eyes are not merely optical adjuncts; they are integral parts of the body, really expanded portions of the brain. They mutually affect the functioning of most other organs. Inefficient eyes cause many chronic headaches, much depression and bodily fatigue, many indigestions, and a great deal of nervousness. Any organ exercised well within its limits tends to increase in power and facility; if persistently overworked it becomes progressively unable for any work at all. One habitually using his eyes in strong light decomposes his "visual purple" faster than it can be regenerated. Even normal eyes are ruined by overuse, especially in lowered general health; and as most eyes are abnormal, or at least not perfect as to visual machinery, many people have to cope not only with bad environ- ment and lowered health, but also with inherent optical defects. Because of the many and newly invented methods of commercial lighting, by gas and by electricity, the composition of light as well as its intensity has come to require serious con- sideration. In the days and nights of oil and candlelight the question was simply one of quantity, the quality being generally soft and benignant; but modern lighting, whether gas or electric, is often so intense as to be injurious. These latter means of illumination contain many more of the violet and ultraviolet rays of the spec- trum than our fathers were accustomed to. Such rays are useful in the treatment of disease by light in radiography; but they are certainly amiss for 259 WHY DIE SO YOUNG? illuminating the printed page or the object on which the artisan must work. Lights that can tan and sunburn the skin and perhaps induce baldness are no doubt responsible for much of the present-day visual weakness. The effect of such illumination on the deeper optical structures is certainly pernicious. It is very likely that cataract comes from this cause in many cases; certain it is that stokers, glass blowers, and other workers in intense light and heat are enormously prone to this grievous eye affection. Illumination made up of red and yellow rays of the spectrum is best for visual purposes; and such grateful light as that given by the evening lamp is best certainly for elderly folk. i CATARACT A cataract is a change in the crystalline lens of the eye, by which the transparency of the lens is diminished. The most frequent form, that known as senile cataract, comes about by reason of the natural predominance of the mineral over the animal constituents in the lens tissues. Our bodies are made up in varying proportions of animal and mineral elements. In childhood the animal predominates; the mineral in the elderly. And in many of us the eyes do not escape the natural change, wherefore cataracts form; also there is, in many elderly people, the arcus senilis, the pearly ring that forms around and in front of the pupil of the eye. Cataract may result also from blows upon the eye, from certain eye diseases, such as retinitis 260 THREE SCORE AND TEN and glaucoma, rickets, diabetes, excessive near- sightedness unrelieved by glasses, occupations in which fumes arise from the material worked on. Many people understand cataract to be a growth leading to blindness; and in cases of complicated cataract, when there is also some other eye ailment, as retinitis or glaucoma, this may be so. But the opaque crystalline lens, in most cases, only excludes images; and the operation or other means em- ployed by able eye specialists will oftentimes bring restoration of the eyesight at least in considerable part, although accommodation to light and to distance, which is a part of the function of the lens, is gone after the operation. People with cataract or impending cataract first have dimness of vision, which affects objects in all directions and which varies with the degree of illumination. There is no pain, nor are there, with uncomplicated cataract, any subjective symptoms such as headache. The cataract may remain stationary for a time or it will increase until the whole lens is opaque; then it is "ripe." The nutrition of the crystalline lens is intimately related to that of the whole eyeball, and such nutrition is deranged by any persistent eyestrain or other cause of inflammation. Cataract is very frequent in nearsighted — myopic — eyes when at the same time there is inflammation of other parts of the eye. Naturally, then, the avoidance of all eyestrain (with the fitting of proper glasses) is essential. Also senile cataract is the more liable to form or to increase during periods of impaired general health. Therefore any means by which health is preserved will delay the development of 18 261 WHY DIE SO YOUNG? cataract. Other alleged cures are at best of no avail. The physician can do much by treating the compli- cations to which part of the failure of vision may be due, and by adjusting the glasses that will relieve eyestrain and give the best vision. Operation is generally done under the local application of cocaine and is thus painless. A general anaesthetic, as chloroform or ether, is in most cases not indicated. Here, however, as in all procedures having to do with so infinitely deli- cate an organ, only the most approved attainable professional skill should be enlisted. ASTHMA Asthma is a general name that has been applied to various conditions associated with extreme and very distressing difficulty of breathing. Thus one speaks of cardiac or of renal or of hay -fever asthma, because chronic heart and kidney sufferers are often short of breath and because hay fever, which has its site mostly in the nose and throat, is characterized by the same symptoms. We are here, however, considering more especially bronchial or spasmodic asthma. No period in life is free of bronchial asthma; but elderly people are likely to suffer very cruelly by reason of it. There is probably no human affection of which the causes are more numerous or peculiar than asthma. Many of these causes act on the mucous membrane of the upper air passages; others act indirectly through the blood and the nervous system. Some unfortunate people have asthma only when they are exposed to direct 262 THREE SCORE AND TEN cause, while others have constantly recurring attacks without any apparent cause. And it is the latter which require study in each individual case, because immense relief can be afforded and even cure achieved when the underlying causative factor is discovered and perhaps eradicated. Among direct causes easily ascertained are defects in the nose and throat — polypi, bony outgrowths, de- flections of the septum, hypertrophic rhinitis, ade- noids, enlarged tonsils, and other untoward condi- tions. From the nostrils down to the dividing of the windpipe into the two largest bronchial tubes, the physician may, by careful examination find a cause the removal of which would end the distress- ing and sometimes dreadful paroxysms of this disease. Then there is dust of all kinds. Common street dust should never be examined under the micro- scope just after a meal; the process is liable to induce qualms. One sees the germs of tuberculosis, typhoid, grippe, bronchitis, etc.; in the field molds, fungi, bacteria, and many most offensive and irritating particles, both inorganic and organic; fluff from woolen clothing, the dust of mills, of foundries, thrashing floors, bakeshops; and such material as is evolved in offensive trades — which, when inspired by the susceptible, will induce asthmatic seizures. Here is a report of one specimen of city dust: "Plaster, iron rust, stone dust, cement from building operations, dust from excavations or from badly constructed tents, ash, house sweepings, dried garbage blown from barrels and cans, chimney soot, and cinder from industrial plants. 263 WHY DIE SO YOUNG? Many odors will produce paroxysms in the asthmatic — odors of pitch, phosphorus, and sulphur, of chemical vapors; the emanations of dogs, cats, 1 horses, hares; the smell of such plants as ipecac and of flowers, as, perhaps, the rose. Grasses and the pollen of plants produce asthma, which is a disease of the bronchial tubes; the difference is only in the site of the affection, which in hay fever is the nasal cavity. Climate plays a great part in the development of asthma; and here the matter is almost wholly one of idiosyncrasy in the individual. Extremes of temperature or excessive dryness or, on the other hand, excessive moisture, may induce the seizure. Thunderstorms will in some bring on attacks. But as to climate, we can fairly well differentiate two classes of victims — those who suffer from dampness combined with either heat or cold; and those who are especially affected by clear atmospheres in which there is not sufficient change of air — as in deep valleys and thick forests. In the latter cases a breeze springing up will relieve the attack. Next among direct causes are lung troubles such as bronchial inflammation or consumption, emphysema and spasm of the midriff, or tumors in the lung pressing on important nerves. For indirect causes of asthma the history of the illness has to be minutely considered. People who have had malaria, whooping cough, and measles are likely to develop asthma. Heredity and family factors have been traced in 40 per cent of asthmatics. The disease may "run in families" 1 Some men are mad when they do smell a cat. — Shtlock. 264 THREE SCORE AND TEN whose nervous machinery is characteristically un- stable; other members of such families, if they have not asthma, may instead have migraine or neuralgia, or neurasthenia, or epilepsy. Hereditary and family tendency may not manifest itself in asthma until late in life, although the children of asthmatics may give evidence of asthma during attacks of influenza or coryza. In the gouty, especially late in life, asthmatic seizures may alter- nate with joint affections. Those who have had "blood disease" in youth may have asthma later in life. 1 Improper diet — sea food, especially — and an over- loaded stomach, by which poisons from undigested material get into the blood, are very prone to induce seizures. "Nocturnal asthma" comes fre- quently by reason of late suppers. Constipation is here also a factor. Kidney disease may be accompanied by asthma, probably through the circulation in the blood of toxic substances not properly disposed of by the kidneys. Uterine and ovarian affections in women may provoke asthmatic attacks. There is an intimate relation between asthma and such skin diseases as eczema and the hives — no doubt by way of the circulation. But, after all, the disordered nervous system is fundamental in most asthma cases. The great nerves affecting respiration are disturbed; and thus are brought about the spasms of the bronchi and the swelling up of their lining mucous mem- brane. Such emotions as anger and fright may thus bring about paroxysms. So also we may 1 "His bones are full of the sins of his youth, which shall lie down with him in the dust." — Job. 265 WHY DIE SO YOUNG? understand how asthma may alternate with or be present along with such other nervous affections as neuralgia and angina (heart cramp). The outlook is good enough as to life itself. The sufferer seldom dies in the asthmatic seizure, however dreadful it appears to the affected by- stander. The question whether the asthma can be cured depends on whether we can remove the cause or the causes in the given case. The first thing that has to be done is to relieve the seizure, a matter solely within the physician's province. He will treat all catarrhs and obstructions of the upper air passages, bronchitis and other complicat- ing affections. He warns the patient against dust and any odor that has been found by experience to bring on seizure. The previous history is exhaustively gone into and every clue is followed, sometimes with most beneficent results. Various climates may have to be tried; one which is equable, fairly dry, of moderate altitude, and fairly dust free will be right in many cases, but not in all. For many, a climate of an opposite sort to that in which the patient has been living will relieve him. Thus, when the asthmatic has been living in a moist climate a dry one may help him; the asthmatic whose home has been inland may do well at the seashore. Oddly enough, the air of cities suits many sufferers better than the purer rural air. Dampness in air or soil is not favorable generally for asthmatics. For the elderly we advise outdoor life, with walking, golf, or riding in moderation, as befits advancing years. Such exercises must be stopped well within the point of fatigue. The open-air 266 THREE SCORE AND TEN life should become habitual. The body surface must never be chilled, the extremities never cold; tepid baths are made customary. The stomach must never be overloaded; light meals, with a snack between times if necessary, to dispel hunger; the dinner in the middle of the day, to avoid the nocturnal paroxysm Restrict, while not avoiding entirely, the starches and the sugars; banish the lobster, the crab, and the deadly hot bread; plainly cooked and easily digestible meats, fresh fish, cooked vegetables, and fruits are right. The elderly may take stimulants, but carefully and very moderately, if they be of established purity. Coffee is best taken black, with very little sugar. Medication helps in asthma; this, however, is entirely within the family doctor's jurisdiction. CHRONIC BRONCHITIS Many elderly people suffer from chronic bron- chitis. An attack of the grippe or of acute bronchitis has been let to run on weeks and months after it should have been cleared up, and then the inflammation of the "tubes" becomes chronic. The trouble is apt also to go along with other lung affections — asthma or consumption — heart, artery, and kidney ailments, alcoholism, indigestion, rheu- matism, and gout. Workmen in those dangerous trades where they must constantly breathe in irritating vapors are very subject to chronic bronchitis. After fifty years this disease is easily developed. It thrives in damp, cold, and change- able weather. The sufferer is short of breath on exertion, and he is easily exhausted; his chest is 267 WHY DIE SO YOUNG? apt to feel tight. He has, however, little pain, and rarely fever. His cough varies with the state of the atmosphere and with the season; in the summer there may be none at all, or only morning and evening cough. The general health is then pretty fair, but with the coming of cold weather the disease becomes prominent. At all times there will be in most cases the symptoms also of associated disease. These patients, when they can afford it, should spend their winters in a dry, warm, equable climate such as our Southland affords. They must, in any event from November to May, avoid ex- posure, and at all times fatigue. The strenuous life is not for them. The clothing, especially the footwear, must ever be warm and dry; the diet of easily digestible food; the meals regular; the stomach never overloaded. Such sufferers must not take on fat. The body's eliminative organs must receive careful attention. The physician will prescribe medicines appropriate to the individual case. His success in treating this disease will depend largely on his finding out how it originated, and what diseases (such as we have mentioned) accompany the chronic bronchitis. Although com- plete cure may not be possible, a great deal can be done to prevent extension, to avoid compli- cations, to ease the symptoms, and to prolong life. THE PNEUMONIA OF THE ELDERLY Many elderly people suffer from the "pneumonia of the aged.'* The disease may be latent and may set in without the customary chill. The cough 268 THREE SCORE AND TEN and the expectoration are slight. The physician finds it difficult to locate the part of the lung affected, but generally this is the most dependent, the lower portion of either lung as the patient lies on his side or back; the condition is then that of "hypostatic" congestion, or pneumonia. Such ailment comes about by reason of great debility, with feeble heart action; and it is generally fatal. Many an apoplexy terminates thus. Pneumonia is indeed one of the terminal af- fections such as are secondary to other serious diseases. Especially during the winter months patients with chronic tuberculosis and other pulmonary diseases, chronic liver troubles, heart disease, arteriosclerosis, diabetes, Bright's disease, malaria, typhoid fever, influenza — such patients are very likely to be carried off by a pneumonia which, until toward the end, gives very little evidence of its presence; — some little elevation of temperature, perhaps; slightly increased and labored breathing. The sufferer is, however, so near the end that adequate examination is not possible nor even, indeed, advisable. In diabetes especially the fatal issue is determined rather by pulmonary abscess or gangrene than by "straight" pneumonia. TERMINAL AFFECTIONS It is an odd kind of paradox, but a valid one, never- theless, that many people, the aged, especially, do not die of the disease from which they have suffered most. Secondary or terminal affections carry off most sufferers from incurable maladies. Besides the terminal pneumonia, pleurisy or meningitis or peritonitis or dysentery have, in their character of WHY DIE SO YOUNG? secondary or terminal affections, to be guarded against, as best we can, in the venerable. APOPLEXY Apoplexy is caused either by the rupture of a blood vessel within the skull, blood escaping, with consequent pressure on the brain; or by the plugging up of a blood vessel, the blood supply to some part of the brain being thus cut off. The rupture of a blood vessel is predisposed to by chronic alcoholism, chronic kidney and heart disease, gout, rheumatism, syphilis, and most of all arteriosclerosis. The exciting cause of such rupture may be sudden physical exertion, passion, intense mental perturbation, cold-water bathing in one unaccustomed to the cold bath, excessive eating and drinking, and straining of any sort. The symptoms will vary according to the part of the brain affected. There are likely to be pre- monitory sensations — dizziness, fullness or pain in the head, numbness of one hand or foot, loss of memory for words, bad dreams. The attack is sudden, with convulsions and coma; or there is coma alone; or there is little or no loss of conscious- ness; or the sufferer falls as if shot or struck by a heavy blow. In the conscious, speech and swallowing are difficult. The tongue is likely to protrude toward one side of the head; the mouth is drawn toward the sound side of the face. The face is flushed and the pupils are dilated; or one may be dilated and the other contracted. The breathing is slow, irregular, and snoring; the cheeks are puffed out with each expiration. The pulse is slow, full, and hard. Such a pathetic 270 THREE SCORE AND TEN condition may come on during sieep, the sufferer being found thus in the morning. In apoplexy due to a plugging up of an artery there is brain softening in the affected region. The plugging is due either to an embolus or a thrombus. An embolus is a plug of vegetating material detached from a rheumatic heart valve or elsewhere and set coursing along with the blood stream. Such plugs occur in the infectious fevers and in diseased blood states. A thrombus is a plug formed at a diseased point in the blood vessel itself of sufferers from fatty heart, syphilis, lead poisoning, gout, and other serious maladies. When there is an embolus the onset is sudden, with convulsive twitchings. When there is a thrombus there are like to be premonitions such as we mentioned for the ruptured vessel; but the onset is slow, the hearing is progressively disturbed, there are drowsiness, loss of memory, confused mentality, and dizziness. Paralysis generally accompanies apoplexy; and this will vary according to the part of the brain affected. If a paralyzed limb is raised by one's hand it will be found entirely relaxed, flaccid, and powerless. If the patient makes any movement it will be by the hand and leg of one side only. The face is usually paralyzed on the same side as the arm and leg. The mouth is drawn away from the affected side of the face, being pulled thus by the unaffected muscles. The doctor is of course sent for at once. Till he comes the most important measure in taking care of a stroke sufferer is to disturb him as little as possible. He is placed in bed or in a reclining 271 WHY DIE SO YOUNG? position, his neck freed of clothing, his head moderately elevated, his shoulders slightly raised. An ice bag or cold wet cloths are placed on his head, and hot bottles to the extremities. The latter are carefully wrapped up in cloths or towels so as not to blister. Even in the mildest cases the patient remains in bed a fortnight. The diet is light; constipation is avoided, by enemas if necessary. The paralyzed limb, if swollen, may be wrapped in cotton batting or flannel. Surgeons have of late years done wonders by trephining, removing the clot and thus removing the pressure from the brain. Apoplexy is often recovered from — the first and second strokes, anyway; and chances of course diminish with the patient's age. In any event, the hope of full recovery from complete paralysis is slight. Power is usually restored in the leg sufficient to enable the patient to get about, but in most instances the finer movements of the hand are lost. More or less mental weakness may follow an attack, and the venerable, thus recovered, may become irritable and emotional. The general health must be carefully conserved and the emunctories must be kept active. When the paralysis has persisted for more than three months the patient's relatives must understand that the condition is past relief, that medicines and electricity will not cure, though they may relieve and give comfort. SLEEP The disorders and disturbances of sleep are sometimes serious, especially in the elderly. Indi- 272 THREE SCORE AND TEN viduals vary greatly in the amount of sleep they require, and at different ages there are different needs. While some few of us can get along on less, even four hours, perhaps the most of us need at least eight, sometimes ten. There are also temperamental differences, and variations the result of habit and circumstances. Generally speaking, infants sleep most of the twenty-four hours; at four years twelve hours are needed; at fourteen, ten; at seventeen, nine and one-half hours; seven or eight during adult life. In old age continuous sleep is rare and the requirement is less ; but frequent naps and dozing by day as well as by night maintain a fair average. More sleep is required in cold than in temperate or warm climates. A cool, dark, quiet, well-ventilated room, a comfortable bed, and adequate (not excessive) covering are conducive to sleep. A preparatory period of sleepliness is natural, and in case of insomnia ought to be cultivated. Active emotions, mental worry, intense thought, cold extremities, or a chilled skin defeat the rearrangement of the circulation on which so much depends for sleep. No other physical function is so readily disturbed. If a person is awakened at an unusual hour several nights in succession, he tends to establish a habit of awakening at that hour. Habit is all powerful, both for good and for evil, here as generally in life. Regular hours for retiring and arising are most important. The causes of sleeplessness are many. Reminis- cences occasion much insomnia in many of the elderly. Then does the sympathetic Shakespeare appeal to them: 273 WHY DIE SO YOUNG? "Sleep, gentle sleep, Nature's soft nurse, how have I frighted thee, That thou no more wilt weigh mine eyelids down And steep my senses in forgetfulness." Practically every deviation from health is marked by disturbances of sleep; and once a bad sleep habit is established it tends to persist and is likely to become the sufferer's chief ailment. Many people are hereditarily poor sleepers. Every trivial sound or unusual circumstance (a light, an odor, or a jar, even the discontinuance of a customary noise or light) may put an end to the rest. Hunger, overfeeding, indigestion, gout, kidney trouble, various drug addictions, tea, tobacco, alcohol, fevers of all sorts, malaria, lead poisoning, too much or too little blood in the brain, heart maladies, discomfort, pain, nervous exhaustion, mental pre- occupation, intense study — such are among the causes inciting to sleeplessness. Some people readily fall asleep, but shortly awake and remain so the balance of the night, or they merely secure fitful periods of sleep. Others spend several hours getting to sleep, and they then rest fairly well. Still others complain of broken sleep, the night being passed in alternating sleep and wakefulness, which may be quite uniform in a given instance. As a rule patients suffering with insomnia are disposed, quite unintentionally in most cases, to exaggerate the amount of their sleeplessness; it is indeed a common experience to find such patients sleeping soundly part of or even most of the night, when one looks in to see how they are getting on. 274 THREE SCORE AND TEN Much loss of sleep manifests itself in a haggard, weary air and lessened muscular force. Appetite, digestion, energy in general, courage, and good nature are diminished. The sufferer loses weight and, in cases of absolute deprivation of sleep, the loss may equal that due to the deprivation of food. The eyes of the insomnia sufferer lose their clearness and appear dull, and the whites of the eyes may be reddened. The tongue is coated and the entire organism is deranged. If we are to manage insomnia properly we have to know in each case what are the untoward conditions of which the loss of sleep is a mani- festation. If we can remove such conditions, natural sleep will in most cases return. All heredi- tary, digestive, autotoxic, circulatory, and nervous factors have to be systematically investigated. Nothing must be omitted in the scrutiny. Very often the mode of living has to be corrected before sleep can be restored. The physical state of the sufferer has to be thoroughly improved by baths, proper diet, exercise, and the right hygiene. A warm bath taken quietly at bedtime and not followed by any stimulating frictions is effective in many cases. Many other physiologic means of inducing sleep are among the family doctor's resources. Any drug that sufficiently masters the organism to produce sleep is a dangerous remedy. No drug should be used except by the doctor's prescription. Many well-nigh incurable cases have been es- tablished by promiscuous drugging to induce sleep. There are cases which will yield only to complete change of scene. An ocean or a lake 275 WHY DIE SO YOUNG? voyage is especially valuable, as being devoid of exhausting excitement and sight-seeing. A sojourn by the seashore is in many cases a wonderful remedy, by reason of the monotonous and soothing sound of the ocean waves. One feels the very first night, as did good Nick Bottom, an exposition of sleep coming upon him. FACTORS OF SAFETY I have in this book used the phrase, factors of safety. These are our reserve forces, which avail us in time of undue stress and strain, and which keep our bodies in fairly normal condition despite the many chances we take, despite our thousand- fold violations of the obvious and natural laws of health, despite the multitudinous agencies in our environment which are inimical to human existence. By reason of these factors of safety many of us are able, safely and pleasantly, to attain our three- score and ten; were it not for their existence in our bodies, very few indeed among us could com- plete the human span. The Creator has merci- fully provided in us those latent forces. To under- stand them aright we may well make an analogy between the human machine, the finest and most superior in nature, and such mechanisms as are constructed by the hand of man. Compare, to begin with, the human body with the steam engine. The former has to be fed and must get its supply of oxygen, or it will not keep going — will not live; and an engine must be properly fired and the draught properly regulated, to the same end. The essential difference is, of 276 THREE SCORE AND TEN course, that the human machine is self-repairing, while the other is not. Consider now how the engineer and the builder, in constructing engines, bridges, houses, and the like, are careful to calculate and to allow for the margin of safety. Assume, for instance, that the tensile strength of boiler steel plates and stay bolts is 60,000 pounds to the square inch; the actual working stress to the square inch should then not be more than 10,000 pounds for the plates and 6,000 pounds for the stay bolts. That is, the stress to which the plates may be subjected in the boiler should be only one-sixth the actual strength of the steel, and the stay bolts but one- tenth. The factors of safety are here said to be six for the plates and ten for the bolts. For many functions the animal mechanism is doubled or even trebled. The functioning of one organ is oftentimes assisted by other organs. One may live with lungs reduced by disease or surgical operation to one-sixth their normal capacity. From one-half to three-fourths of the liver may be removed without jeopardy to life — indeed, we might almost say to comfortable living. The pancreas — that organ more essential to digestion than the stomach — is ten times as large as is necessary. Many of our organs are bilateral — we really need but half of them. One-half the brain would do, has had to do, after accidents or by reason of certain diseases. People have got along, are constantly getting along, as if nothing had happened, after the removal of one kidney. There is a surplusage of bones and cartilage. One gentle- man during twenty-four operations parted with a 19 277 WHY DIE SO YOUNG? hand, a leg, an appendix, an eye, several bones, and some of his liver, and seems not to have been seriously discommoded. Particularly well provided with factors of safety is that part of the human machine where our thinking is done. The seat of the mind, the brain, is protected by a bony casement within which is the most bountiful and most interrelated blood supply in the human system. We have always a good deal more blood than we really need, for nearly half of this precious fluid can be withdrawn without serious consequences. Indeed, there are diseases in which losing a pint or so of blood would be salutary. Within five days the body would recover the loss. The active tissues of most of the organs exceed greatly what is needed for the normal functioning of those organs. In some organs the surplusage is five, ten, or even fifteen times the actual requirements. Physicians never give over being astonished at post-mortem examinations by the extensive organic changes found in people who have died in advanced years and who have manifestly suffered at various times in their lives of grave diseases, living on, nevertheless, despite the ravages of the latter. And the psychic, the mental factors of safety — what a suggestive study will the psychologist find here! So there is ample scientific warrant for the statement, "The half of his strength he put not forth." Thus can we understand how in the men whom we call great there is a potential far beyond the measure of their deeds. All of us, indeed, have within ourselves a latent, an abounding potency; 278 THREE SCORE AND TEN the resources of mind and body we are able to draw on for supreme occasions are far beyond our ken. It is by reason of the amplitude of our reserve forces, both physical and mental, that we are able to preserve ourselves in fairly good condition, despite the many malign agencies en- vironing us — unexpected stresses, accidents, the diseased states we have been considering, and the far greater number of maladies for which we have not been able in these pages to find place. Philip Gibbs, who did such epic writing about the recent war, observed with astonishment the way in which the soldier recovered from the well- nigh overwhelming fatigues of battle and from the almost breaking strain on every quivering nerve during the kind of fighting that was so dreadful a part of that war. Britishers, on the last lap of their rearguard actions, were tired almost to death. Yet when they were called upon for one last effort, after six days of fighting and marching, they staggered up to their work; but like men who had been chloroformed, with dazed eyes, gray and drawn faces, speechless, deaf to the words spoken to them, blind to the menace about them, seemingly at the last gasp. Footsore and stiff-limbed were such young fighters, feeling like very old men. Yet — and this was to that splendid war corre- spondent the astounding thing — after a few days' rest these heroes were young and fresh again. "Upon my faith, it was almost impossible to believe they were the same warriors, as they stood about in the evening sunshine, like men on a village green taking their ease in times of peace. Their kilts 279 WHY DIE SO YOUNG? were dirty and stained, but they had washed off the dirt of battle, had shaved, and cleaned their steel hats, and the tiredness had gone out of their eyes and their youth had come back to them.'* Seldom, indeed, in the most awful of stresses, are we left without a few ounces of latent energy upon which recuperation may be based. We have, indeed, in our bodies, all of us, a reserve potency. Our resources of mind and body, for the most part unsuspected, and which we are able to draw on for supreme occasions and needs, are far beyond any idea we have of our capacities. And who would dare say that our factors of safety are only physical in sort. The most the materialist could claim is that the psychic aspects of our nature are based on our physical make-up. But all the phases of our nature — the physical, the intellectual, the volitional, the emotional, the spiritual, are as interdependent as they are inter- related. One may have in himself no end of physical resources; but these will remain impotent if there be in that man no will, no religious zeal, no sense of outrage that has to be resented to bring his physical reserves into action. The will-to-win is a most powerful inciter of reserve force. I have a photograph of a great intercollegiate boat race, which shows the losers painfully spent at the end; though one would have expected the winners to be the more ex- hausted, since they had to make the greater effort to win. The feeling of victory is also salutary. The mortality from wounds in a defeated army has been found to exceed greatly that in the army which has triumphed. Emerson wrote: 280 THREE SCORE AND TEN I have read that those who listened to Lord Chatham felt that there was something finer in the man than anything which he said. It has been complained of our brilliant English historian of the French Revolution that when he has told all his facts about Mirabeau they do not justify his estimates of his genius. Sir Philip Sidney, the Earl of Essex, Sir Walter Raleigh are men of great figure and of few deeds. We cannot find the smallest part of the personal weight of Washington in the narrative of his exploits. The authority of the name of Schiller is too great for his books. This inequality of the reputation to the works is not accounted for by saying that the reverberation is longer than the thunderclap; but some- what resided in these men which begot an expectation that outran all their performance. The larger part of their power was latent. Emerson called this latency character and wrote a noble essay under that title. And what the great of the earth possessed superlatively no one among us wholly lacks. 1 In every position in life the observer must surely have discerned, at one time or another, the exhibition of such reserve stamina, of power people have had but knew not of, in themselves. No day passes when the physician has not found in patients individual forces in reserve, latent potencies which come to the rescue in times of undue stress and strain, and which serve to main- tain the body through everything of evil and under conditions most antagonistic to health and well- being. Such, and many more than we can here mention, are the factors of safety in our human structures and in our living economy. If now, in addition to 1 The world is a riddle to which the keynote is character. — Dean* ROBBINS. 281 WHY DIE SO YOUNG? those divine gifts we use, more than we have ever before, those faculties which the Almighty has also so generously bestowed upon us; if we but understand, more than ever before, that we may, under divine inspiration, by just willing it, become coefficients in the working out of our own destinies; if we but live naturally and reasonably, temperately applying those most beneficent princi- ples of modern hygiene, sanitation, and disease prevention which have been so inadequately set forth in this book — what, if we but do these things, is to prevent the most of us from extending the kingdom of heaven for ourselves on this earth from threescore and ten to fivescore and more? Our kind does, indeed, rightly belong to the centenarian class. Most other creatures live to five times their periods of maturity. The genus homo is mature at twenty; it should therefore live to one hundred years at least. VII OLD AGE "Last scene of all, That ends this strange eventful history, Is second childhood and mere oblivion, Sans teeth, sans eyes, sans taste, sans everything." WHAT DOES IT MEAN TO GROW OLD? HUMANKIND'S three greatest evils are said to be disease, old age, and death. Disease certainly is an evil which could be prevented in most cases by rational hygiene and sanitation. Old age may be no evil at all, but a very happy time. And assuming death to be an evil, a propo- sition which may very well indeed be doubted, is it not entirely possible for our kind in general to postpone the meeting of that evil until long after threescore years and ten? The physiologist Haller computed that human maturity is attained by the twentieth year and that human life should endure five times that period. Buffon computed that in nature the average creature's life duration is six or seven times its period of development; that, therefore, a man's growth being generally attained at ado- lescence, his span of life should be fivescore years rather than threescore and ten. Buffon also be- lieved that longevity does not depend on habits 2S3 WHY DIE SO YOUNG? of life or on modes of living, but that long life is inherent in the individual. Anybody can see that this idea does not apply for all human beings — far from it. Yet there is a good deal in Buffon's belief. Reflect upon those we know of who have lived to great ages despite the most villainous habits, despite chronic intoxication, inveterate use of tobacco, and like disregard of the laws of health. Doctors who make post-mortem examinations never cease to be amazed by the extensive disease changes found in people who have died in advanced years and whose bodies give abundant evidence of having suffered at various times in their lives from serious maladies, living on, nevertheless, despite the ravages wrought in the organs and tissues. Experimenters, too, are amazed to observe how our organs are fortified by factors of safety both as to function and as to structure — all to the evident design that we may live on and on, not- withstanding the thousandfold strains and stresses to which we are constantly subjected, a majority of them unnatural as they occur in civilization. Metchnikoff expressed his conviction that it is very possible for human life to be greatly lengthened. In maintaining this thesis he investi- gated not only the animal, but also the vegetable kingdom — life, indeed, wherever it is manifested, and he has adduced many facts in his two books, The Nature of Man and The Prolongation of Life, which go to show that existence, in some of its manifestations at least, appears to be indefinitely prolonged; that there are forms of life which seem never to die. There are one-celled infusoria which have a continuous existence, terminable OLD AGE only by violence or accidental causes. Such a parent body lives through an indefinite series of divisions, by which it is multiplied beyond our powers of estimation; it seems never of itself to suffer natural death. This is true also of the higher plant forms, some of which attain to gigantic size. The famous dragon tree which Humboldt discovered and which was overthrown by a storm was computed by Metchnikoff to have lived several thousand years. Adanson, the French naturalist, considered that the baobab, a tree of Cape de Verde, was above five thousand years old. We all know something of the great sequoias. There is, or there was until a few years ago, a pair of tortoises in the Bronx Park the ages of which have been placed at three centuries. One recalls here the popular pleasantry about the camel who can go eight days without a drink, "but who wants to be a camel?" Or as the idea occurs in the noble fable of Pushkin, the Russian poet : "How is it," asked the eagle of the vulture, "that you live three hundred years, while I must die at thirty?" "Come with me," said the latter, "and I will show you how to live as long as I." And they went together to a place where carrion abounded. Whereat the eagle concluded he had rather live but thirty years magnificently on rich red meat than three hundred if to that end he had to eat carrion. But what is old age? What does it mean to grow old? What goes on in the body that brings its wearer to the stage of the lean and slippered pantaloon? We really do not know, but several theories 285 WHY DIE SO YOUNG? have been advanced. Of these perhaps but two are valid, those of Metchinkoff and of Nascher. The former believe that old age comes from slow self-poisoning, from auto-intoxication, from the body's absorbing gradually through the months and years of adult life toxic matter, remaining from the incomplete elimination of the bodily impurities. Most of these toxins are generated by germs which inhabit the intestinal tract. And Metcbnikoff believed that throughout life the emunctories, the eliminative organs, should never be clogged up. A clinkered-up human machine can never last as well as one that has had its waste, its ashes, as it were, constantly and regularly removed. THE BODY CELLS Dr. J. L. Nascher of New York, whose noble and peculiar work in medicine lies in geriatrics, the science of the maladies of old age, has worked out his theory of cell evolution. The human body is a vast accumulation of cells. Cell life is the origin and basis of all our physical life. And every cell comes from a cell. Existence begins in the mother's womb as one single cell from which future cells are multiplied and differentiated for their several offices in the human economy — nerve, liver, digestive, muscle, and many another kind of cell. Thus in the last analysis it is our cells which have the power of and are endowed with the properties of selection, nutrition, assimi- lation, excretion, growth, motion — and, in their turn, of reproduction. Life is really a living and a dying of cells. Our body to-day is not quite 286 OLD AGE our body of yesterday, for since yesterday many of our cells have died, and have been replaced in their duties by others that have been evolved from them. In the course of this constant destruc- tion and reproduction of cell life there is going on a constant evolution in cells. The newer cells differ slightly from those from which they have sprung. At one stage of the evolution the cells are best adapted to their surroundings, their environment, and their available nutrition; and at that time they are best fitted to perform their functions well. As life advances, however, the cells become less and less adapted to their environment, until, as they are destroyed, they produce other cells so little fitted for the conditions under which they must work that these can perform their functions practically not at all. Life, age, and natural death then are really matters of cell differentiation and capacity. Such is Doctor Nascher's theory of old age. And it appeals to me very strongly by reason of my belief that, after all is said and done, it is in the last analysis the soul which dominates ex- istence. It is the species soul which dominates the species germ plasm; it is the individual soul, or will, or mind, or spirit, as one or another may prefer to call it, which determines the course of individual life. As Schopenhauer put it, "The soul has all matter to choose from." Apply this idea to Doctor Nascher's theory. We cannot, indeed, estimate by any instrument or laboratory method the influence of the mind on the physical tissues; we cannot compute the extent to which the will and thought affect the 287 WHY DIE SO YOUNG? development of a red blood cell, the evolution of a drop of lymph, the behavior of an excretory cell; but it is every day and every hour manifest that such physical developments are affected by mental states. It is surely in everyone's experience that mental disturbances — as, acute shock from sudden grief or bad news — gravely derange the functions of the various organs. And what else can rationally be expected than that chronic shock, such as through years accompanies exhaustion or over- work or anxiety, predisposes to graver affections in later life? Will not a perverse spirit determine in time disease cells in place of healthy ones? Will not a perverted will, abjuring temperance in favor of flesh pots, determine in time the cells of the hobnail liver rather than such as would functionate normally in old age? The ancients had it that the sound mind dwells in the sound body. Given, however, the sound mind, the mind informed, temperate, cultivated, and judicious, and as a matter of course the sound body, enduring to old age in ease and dignity, will pretty surely develop and obtain. And the human body should endure to fivescore rather than to threescore and ten; our kind does indeed "jes' naturally" belong to the centenarian class. Most other creatures live to five times their period of physical maturity. The genus homo is mature at twenty; it should thus live to five times twenty. DIETARY The aged digest more slowly than the young; their bodies indeed do everything more slowly. 288 OLD AGE They should, therefore, not eat more frequently than three times a day; and, if hungry, something light at bedtime. I was asked to prepare a dietary "for an elderly lady who finds her digestion some- what weakened by advancing years," and I arranged the following, which may possibly be of service to other elderly people: Assuming that there is no real disease (for which the family physician must prescribe the "indicated" dietary), the following foods should serve well and be comfortably digested: cereals, rice, toast, bread a day old, crackers, eggs, fish, nutritious but not fatty soups, purees, milk, tripe, pork tenderloin, bacon, beef, mutton or lamb roasted or broiled, game, potatoes (preferably baked), and most fresh vegetables and fruits (except cabbage and bananas), cooked. Take very moderately peas> lentils, stews, coffee, tea, cocoa and chocolate, goose, duck, beans, sweet- breads. Avoid veal, pork, fried meats, rich pastry, and anything else which has been found by ex- perience to disagree. For one's stomach's sake and, if one's principles are not averse, a glass or two a day of light wine should at fourscore be a good servant. The observations of the physician Cheyne, which I set forth with regard to arteriosclerosis, are pertinent here. If men have been moderate smokers they should not have to give up these comforts in old age. EXERCISE AND WARMTH The old should exercise but gently. They should walk up easily graded slopes. They should 289 WHY DIE SO YOUNG? play croquet or golf, or such games as keep both the mind and the body pleasantly but not violently occupied. And they should rest often. The venerable must ever have warmth; for them, at least, life is ever a question of warmth. Their feet especially should be always warm and dry. HOBBIES It is most necessary that old people should have hobbies, which they should have begun to ride in early or middle life. Nothing so ages an elderly man who has laid down his life's vocation as to be without some equivalent occupation. There are many and most congenial hobbies to ride. For example, Gladstone was a Homeric scholar; Salisbury, an adept in electricity; Joseph Chamberlain, a cultivator of orchids; Billroth, the great surgeon, a delightful pianist. Of all hobbies, it appears to me, the most satisfying and the most comforting is the appreciation of music, with, perhaps, though by no means necessarily so, some little skill on a musical instrument. MUSIC Music is indeed a most salutary medicine, because its component tones are regular vibrations, even auditory waves, precisely so many to each note; being thus unlike cacophonies, noises that are made up of irregular dissonant conflicting vibrations. Thus is the pleasing sense of perception of good music conveyed to the brain, where its benignancy is in turn transmitted to the sympa- 290 OLD AGE thetic nervous system, which directs the functions of the heart, the lungs, the stomach, and other organs. Thus is good music not only physic for the soul, dissipating mental depression, sooth- ing emotional disturbances; but it also enhances nutrition, furthers digestion (wherefore Voltaire spoke of "liver music"), quickens the pulse, helps to restore organic unity. Indeed, the entire human machinery will run all the better for oc- casional lubrication with a stream of melody that is sweetly played in tune, and which "will help thee in thy need in sickness, grief, and all ad- versities." It is truly one of humankind's most inestimable blessings that into our stream of consciousness there may (be we so disposed) empty themselves, most mellifluously, those purling rivulets, those rippling brooks, those laughing waters, those sparkling cascades which have their springs in concords of sweet sound. A GOOD HABIT I will now touch upon a subject which I should, from a doctor's viewpoint, have considered in the beginning of this book, and for the reason that a habit, good or bad, when established in childhood, will be throughout life a dominating influence. I am thinking about the salutary, the healthful effect, of the prayer habit, one which should be instilled as soon as a child becomes sufficiently comprehending; and I want now to write about the physiological effect of this habit upon the. body as well as upon the mind and the soul. I reproduce here, as nearly as I can remember, 291 WHY DIE SO YOUNG? part of a sermon which I once heard, by a veritable man of God: "In studying the biography of any great man we are very likely to be impressed by the paucity of his deeds and sayings by comparison with the influence he has exerted upon his day and generation; we cannot, by a consideration of the former, reach any just estimate of that influence. In such study we eventually become impressed not so much by what the great man in the given instance did, or what he said, but by what he was, his character. This is so of Washington, of Julius Caesar, of Lincoln, of many another. All men, great and small, do and say, for the most part, what their environment, what the exigencies of their time, require of them; but if we are to discern the intrinsic secret of the power which they have wielded we must study not so much their words and deeds as their personal habits. "Jesus Christ preached and healed the sick with altogether peculiar power; but it is probable that his tremendous influence upon mankind since his advent has been mainly by reason of his character. And to understand this we must study his personal habits. Conspicuous among these was that of prayer. Again and again, being sought in the intervals of his benign ministrations, his disciples found him in prayer. In my own ministry I have experienced nothing so fatiguing as an afternoon spent in sick calls. I confess this leaves me utterly exhausted, and only in prayer can I find refreshment of body and soul. I cannot sufficiently extol medical men who are with the sick all day long every day and halfway into the 292 OLD AGE night. I marvel how they can endure the strain. The Archbishop of Salisbury, in a talk with medical students, advised them, by way of relaxation from their duties, to cultivate poetry. I know a better pursuit than that; it is to cultivate the habit of prayer." Why cannot science and religion collaborate as to this habit? The unquestionable trend of modern thought is monistic, its basic concept that of a cosmic oneness in which all phenomena, however diverse they may appear, are most intimately in- terrelated, quite as is now unquestionably agreed that all forms of energy are interchangeable. I here recall three papers which I read years ago by the Rev. Dr. W. R. Huntington, the Rev. Dr. Moncure Conway, and the Rev. Dr. Lyman Abbott, all on the Nature of Prayer. And, a layman as to theology, I could not fail to be impressed by the idea fundamental to the writings of these three great men, each of a different Christian denomination — that prayer is helpful not so much as to the granting of specific personal requests; not so much in that the inherently be- nignant laws of nature could be disturbed in their working in behalf of any individual suppliant; but that prayer is helpful in bringing him who prays into comfortable, salutary, and restful relation with the First Cause, known variously to humankind as the Almighty, as Jehovah, as "the power not ourselves making for righteous- ness," and so on. (I will presume here to interpret the term righteousness as meaning Tightness, orderliness, consistent interrelation, universal one- ness; and I will here repeat, as being, to my mind, 20 293 WHY DIE SO YOUNG? pertinent, the definition I have already given of all morality as being "the crystallization of natural law.") It must surely gratify the humanitarian who is not of the clergy, to observe this departure from the theology of other eras; it is gratifying es- pecially to the medical scientist by reason that this modern aspect of religious faith is much in unison with scientific faith — faith in the con- stancy of the universe, in the invariability and immutability of its wholesome laws and in that infinite, eternal, and omnipotent influence which pervades and controls the cosmos. Cannot, then, a philosophy of prayer compre- hensible to all, possible to be of reasonable ac- ceptance by all, be evolved, out of which could be developed a consistent therapeutics of prayer? Assuredly the human being needs help from without; for, though a coefficient in the working out of his own destiny, there is, when unassisted, no more pathetically helpless atom in all existence than the human unit. Surely when such world- compellers as Gladstone and Cromwell, Washing- ton, Lincoln, and Wilson, and their like, have humbly acknowledged and sought the help to be got out of prayer, lesser men and women may also seek it, and that without humiliation. Among these latter I can and do earnestly, out of my experience, indorse the sentiment that "he who rises from his knees a better man, his prayer is answered." As I have before in these pages intimated, the simple fact is that the various aspects of human nature — the physical, the intellectual, the 294 OLD AGE volitional, and the emotional — when they have been perturbed by life's stresses, are brought by prayer back to their normal co-ordination and functioning; that the prayerful individual by that act gets his relations to his environment readjusted, and finds himself restored to harmony with the eternal verities. Such, I submit, would be a reasonable conception of the act and the purpose of prayer, one which might well be set forth both from the pulpit and in the clinic. A WELCOME FRIEND There are some very comfortable opinions about old age. For instance, that grand old man of science with whose name I began this book, Francis Galton, declared in his eighty-sixth year, "I find old age to be a very happy time, on the condition of submitting frankly to its many limi- tations." Then there is "the justified mother of men," whom Walt Whitman extolled, who rests in her armchair on the porch, surrounded by her children and her children's children, while the rays of the setting sun touch warmly her whitened hair. Serene she sits, her eyes steadfast upon the westerly glow, as the twilight gathers and the evening star appears, musing of many things in the past, but mostly of memorials dearly treasured and fondly laid aside in some old cabinet: "Her hallowed bridal dress, Her little dainty gloves, Her withered flowers, her faded tress." And there was the aged aunt of Brill at-Savarin; when he was summoned to her deathbed he raised 295 WHY DIE SO YOUNG? her head and induced her to take some "most excellent and restorative wine," whereupon she thanked him and, sinking back contentedly on her pillow, said, "My dear, should you come to my years you will understand that the aged need death just as the young need sleep." APPENDIX A Following are the right materials from which the mother may safely select for the weaning of her child up to its fifteenth month. Five meals are given daily. Diet for the Child from the Time of Weaning To the fifteenth month: Five meals are given daily. 7 A.M. Corn meal, barley, rice, or wheat jelly: one or two tablespoonfuls in eight or ten ounces of milk. (The jelly is made by cooking the cereal for four hours the day before it is wanted, and straining it through a colander.) Stale bread and butter or biscuit. 9 a.m. The juice of one-hall orange. 11 a.m. Scraped rare beef: one or two teaspoonfuls mixed with an equal quantity of bread and moistened with beef juice. Or a soft-boiled egg mixed with stale bread crumbs, a piece of zweiback, and a half pint of milk. (Scraped rare beef is best obtained from round steak, cut thick, and broiled over a brisk fire sufficiently to sear the outside. The steak is then split with a sharp knife, and the pulp scraped from the fiber.) 2.30 p.m. Beef, chicken, or mutton broth, with rice or stale bread broken into the broth. Six ounces of milk, if wanted. Stale bread and butter, or zweiback and butter. Many children at the above age will take and digest apple sauce and prune pulp; when these are given milk should be omitted. 6 P.M. Two tablespoonfuls of cereal jelly in eight ounces of milk; a piece of zweiback and butter. Stale bread and butter or biscuit. 297 WHY DIE SO YOUNG? 10 p.m. A tablespoonful of cereal jelly in eight or ten ounces of milk. From fifteen to eighteen months: Four meals are given daily. 7 a.m. Choose from oatmeal, hominy, corn meal, each cooked four hours the day before they are used. When the cooking is completed the cereal should be of the consistency of thin paste. It is strained through a colander and forms, on cooling, a jelly-like mass. Two or three tablespoonfuls of this are served with milk and sugar, or butter and sugar and salt. Eight to ten ounces of milk as a drink. 9 a.m. Toast or zweiback. 11 a.m. Choose among the following foods: the juice of an orange; a soft-boiled egg mixed with stale bread crumbs or baked potato; one tablespoonful of scraped beef mixed with stale bread crumbs and moistened with beef juice; one tablespoonful of minced white meat of chicken; baked potato, a drink of milk; zweiback or bran biscuit, or stale bread and butter. Sample meal : one tablespoonful of minced chicken mixed with baked potato, a drink of milk, stale bread and butter. 2.30 p.m. Choose among chicken, beef, or mutton broth with rice or stale bread broken into it; custard, corn- starch, or plain rice pudding, junket, stewed prunes or stewed apples; bran biscuit and butter or stale bread and butter; wheatsworth biscuit. 6 p.m. Choose among farina, cream of wheat, wheatena, each cooked two hours; from one to three table- spoonfuls served with milk and sugar, or butter and sugar, or butter and salt; drink of milk; zwei- back, or stale bread and butter. From eighteen to twenty -four months: Four meals are given daily. 7 a.m. Corn meal, hominy, oatmeal with butter and sugar, or milk and sugar, or butter and salt; a soft-boiled egg every two or three days. Minced chicken on toast occasionally; a drink of milk; bran biscuit and butter, or stale bread and butter. When egg 298 APPENDIX A or minced chicken are given, cereal in smaller pro- portion or cut out. 9 a.m. The juice of an orange. 11 a.m. Rare beef, minced or scraped; the heart of a lamb chop finely cut. Minced chicken, baked potato, spinach, asparagus, squash, strained or stewed tomatoes, stewed carrots, mashed cauliflower; baked apple or apple sauce, stewed prunes; stale bread and butter. Sample dinner: Lamb chop, baked potato, stewed carrots, baked apple, stale bread, and butter. After the twenty-first month well- cooked string beans may be given. 2.30 P.M. Chicken, beef, or mutton broth with rice or with stale bread broken into the broth; custard, corn- starch, or plain rice pudding, or junket; bran biscuit and butter, or stale bread and butter. 6 P.M. Farina, or cream of wheat (each cooked two hours) : from one to three tablespoonfuls with milk and sugar, or butter and sugar, or butter and salt; drink of milk, or malted milk, or weak cocoa; zweiback, or stale bread and butter; wheatsworth biscuit. After eighteen months many children will have better appe- tite and thrive more on three full meals the day, at 7 a.m., 12 o'clock, and 5.30 p.m. At about 3 p.m. a cup of broth and a cracker or toast, or a drink of milk may be given if it does not take away the appetite for the evening meal. The oatmeal, hominy, and corn meal above mentioned should each be cooked four hours the day before they are used. The cereal should then be of the consistence of thin paste. This is strained through a colander and should form, on cooling, a jelly-like mass. During the second year: Three square meals, and a little extra, as follows: Breakfast — 7 to 8 o'clock: Oatmeal, hominy, cracked wheat (each cooked four hours the day before they are used) served with milk and sugar, or butter and sugar; a soft-boiled egg, hashed chicken; stale bread and butter; bran biscuit and butter; a drink of milk. At 10 a.m. the juice of one orange may be given. 299 WHY DIE SO YOUNG? Dinner — 12 o'clock: Strained soups and broths, rare beef- steak, rare roast beef, poultry, fish; baked potato, peas, string beans, squash, mashed cauliflower, mashed peas, strained stewed tomatoes, stewed carrots, spinach, asparagus tips; bread and butter. For dessert: Plain rice, or plain bread pudding, stewed prunes, baked or stewed apple, junket, custard, or cornstarch. Supper — 5.30 to 6 o'clock : Farina, cream of wheat, wheatena (each cooked two hours): from one to three tablespoonfuls, served with milk and sugar, or butter and sugar, or butter and salt; a drink of milk, zweiback, or stale bread and butter. Twice a week custard, cornstarch, or junket may be given. Occasionally malted milk or weak cocoa. With three meals a child has a better appetite, much better digestion, and thrives far better, in consequence, than those children whose stomachs are constantly working overtime. Yet some especially delicate children cannot do without a luncheon at 3 or 3.30; then a glass of milk and a biscuit, or a cup of broth and zweiback, are right. Or a child may at this time relish instead a scraped raw apple or a pear; this is par- ticularly judicious for constipated children. Children recover- ing from serious illness will require, according to the doctor's directions, more frequent feeding. In general, good foods for children are: Cane sugar, cream, fruit pulp, mashed vegetables, clear soups, pure"e of vegetable, fish, oysters, lamb, veal, gelatin, beef, turkey, mutton, chicken, squab, beans, oatmeal, graham flour, Boston crackers, peas, graham bread, corn meal, wheat bread, barley, macaroni, arrowroot, sago, dates, tapioca, molasses, figs, corn, green peas, spinach, stewed fruits, string beans, onions, peaches, pears, tomatoes, cranberries, chocolate, bacon fat, cocoa. Here are forbidden foods for the nursery: Ham, sausage, pork, salt fish, dried beef, corned beef, goose, duck, broiled or stewed kidneys, liver and bacon, stewed liver, gravies (except dish gravy), baked tomatoes, pickled beets, fried pota- toes, carrots, pastries, griddle cakes, fresh bread, meat or fruit pies, rich cakes, hot biscuit, meat stews, raw celery, raw or fried onions, radishes, cucumbers, muffins, doughnuts, pre- serves, canned fruits, tea, coffee, liquors (unless indicated by the doctor). 300 APPENDIX B The following is an ample daily intake for an average adult, in good health, which has been arranged by my friend Dr. William H. Porter. It will be observed that many foods in general use, are not mentioned, and other common foods though not absolutely interdicted, are, nevertheless, either advised against or are advised to be taken sparingly, occasionally, and not as part of one's steady diet. For those suffering real ailments, such as diabetes, liver affections, and the like, special diets, different from such as here given, are indicated. Eggs, milk, wheat, bread and butter, and beefsteak, should be the staples. Beefsteak is mentioned as the working standard among meats, as it is the most easily digested of all. But we may eat instead, lamb, mutton, and occasionally veal; all kinds of fish, including oysters, clams, lobsters, and crabs; all kinds of poultry and game. The meats to be broiled, boiled, or baked; the fish to be broiled or baked; the oysters and clams raw or stewed; the lobsters plain boiled. A little crisp bacon from time to time; also ham and corned beef, better without cabbage. Eggs boiled, poached, or scrambled. Milk, plain, preferably warmed, with a little limewater (one tablespoonful) added. Wheat bread is taken above as the standard because it is the most easily and perfectly digested. It should be at least twenty-four hours old and preferably toasted. Rye, graham, zweiback, or the various health-food breads may at times be substituted. Weak coffee, or tea, without milk or sugar, or with a dash of milk, may be taken sparingly, two or three cups the day; either beverage, taken 301 WHY DEE SO YOUNG? clear, aids digestion, but with milk and sugar often disturbs digestion. We may enlarge the above diet by adding string beans, green peas, lima beans, spinach, lettuce, asparagus, and cauli- flower, vegetables the least likely to excite intestinal fermen- tation. They should be well cooked, only one of them at a meal; and when taken with the meal there should be a reduc- tion in the above quantities of meat or milk. We may also add boiled rice and macaroni, and occasionally boiled beets, carrots, turnips, and squash. Small quantities of cereals may be taken as part of breakfast; but cereals as the exclusive breakfast food are far from being sufficient or sustaining. The following foodstuffs should be taken sparingly, many of them not at all. All fruits, either cooked or raw, nuts, sweets, and pastries of all kinds, potatoes, onions, tomatoes, parsnips, celery, radishes, cabbage, eggplant, oysterplant, pork, except as ham or bacon, rich gravies, and most soups. Soups tend to destroy the keen appetite which makes possible the eating of plain and substantial food; also they stimulate a strong desire for highly seasoned food; also the mixed-cream and rich-stock soups tend to excite undue and putrefactive fermentation (auto-intoxication in the intestines). Rich gravies disturb digestion. Potatoes, so universally used, have these objectionable fea- tures; they have a high starch and a low proteid percentage; they are often eaten fried; the starch which they contain is rapidly digested and assimilated. The yield of this product is only animal heat; not animal blood and muscle. Such material cannot take the place of the proteid constituents of food, which are so necessary to the maintenance of perfect health. The same reasoning holds true of most of the above- mentioned articles usually employed as food. Fruits are usually picked before they are fully ripe; or they are in a state of partial putrefaction, and they are often covered with bac- terial life. Having reached the alimentary canal in one or more of these states, they excite undue and putrefactive fer- mentation and thus prevent the right digestion and assimila- tion of the proteid animal elements of the food — beef, eggs, and the like. By following the above advice a sufficiently varied diet can be secured and a high grade of nutrition can be maintained. 302 INDEX A Abbey's " Sir Galahad," 89. Abbott, Rev. Dr. Lyman, 293. Abdominal distress, 149. Abscess: in ear, 69; in brain, 69, 180; in teeth, 73; mastoid, 97, 103; pulmonary, 269. Acidity, 221. Acidosis, 98. Adanson, French naturalist, 285. Adenoids, 11, 46, 56, 72, 74-78, 80, 81, 98, 263. Air, fresh, 37, 38, 39, 40, 134. Albinos, 4. Alcohol: use of, 93, 94, 134, 209, 210, 212, 213, 218, 222, 235, 236, 242, 257; and venereal diseases, 95; and pneumonia, 108; inter- feres with digestion, 147; and efficiency, 188-191; benefits of, 191-193. Alcoholic: taint, 5, 6; neuritis, 171, 172. Alcoholism, 93, 150, 151, 168, 169, 170, 171, 172, 236, 267, 270. American Society for the Control of Cancer, 204. Anaemia (blood poverty), 11, 55, 58, 91, 149, 207, 235, 237. "Anaemic murmur," 235. Anaesthesia, 208. Aneurism, 236. Angina, 266. Anthrophobics, 165. Antitoxins, 56, 67. Anti-venines, 66. Aortic valve, 149. Aphasia, 243. Apoplexy, 187, 201, 240, 244, 270- 272. Appendicitis, in unborn, 56. Appendix, the, 56, 57, 181. Arcus senilis, 260. Arsenic: poisoning, 72; of the Ty- rol, 93; Fowler's solution of, 169. Arteries: hardening of, 146, 147, 149, 217, 229, 235, 236, 238, 241- 245, 267; plugging up of, 182, 270, 271. Arterio-sclerosis, 242-245, 269, 270. Asthma, 91, 105, 262-267. Astigmatism, 70. Athlete's heart, 149-151. Athletic training, 150, 151. Atmosphere, polluted, 99, 105. Aural diseases, 68-70. Auto-intoxication, 148, 149, 180, 234. AutotOxemia (self -poisoning), 73, 148, 149. B Babies: average of deaths, 19; sickly, 21, 22; weaning, 24, 25, 297-300; bottle-fed, 26-29. Bach, Sebastian, 6. Bach, Weit, 6. Bacillus, tubercle, transmission of, 8, 10. Baobab tree, 285. 303 WHY DIE SO YOUNG? Bathing, 118-120. Baths: shower, 48; cold, 45, 101; warm, 10, 275. Batophobia, 165. Beauty doctors, 120. Bedrooms, ventilation of, 39. Beecher, Henry Ward, 151. Beefsteak, 301. Beer: little nutritive value, 23; fat, 218. Being Done Good, 233. Betel-nut chewing, cancer from, 207. Billroth, 290. Binet, Doctor, 82, 83. Birthmarks, 120, 121. Blackwell, Dr. Elizabeth, 17. Blaikie, How to Get Strong and How to Stay So, 126. Blood: good, 6, 7; disease, 7, 8; circulation, 44, 45; acidity of, 98; stagnation, 119; pressure, 146-148, 187, 236, 238, 243; let- ting, 148, 238; supply, 278. Blood vessels, rupture, 270. Body, keep warm, 135. Bones, broken, 46. Bottle-fed babies, 26, 27, 28, 29. Brain, the, 83, 270, 277, 278. Bread: hot, 267; wheat, 301. Breast: milk, 24; soreness of, 205. Breath, shortness of, 91, 150, 187, 237, 262, 267. Bright's disease, 149, 210, 211, 217 227, 228, 236. Brillat-Savarin, The Physiology of Taste, 224; quotations from, 225, 226, 227; aged aunt, 295. Brockton, an aristocracy at, 18, 19, 20, 21. Bronchitis, 68, 73, 74, 76, 80, 105, 106, 262, 267, 268. Buccal cavity, germs in, 100. Buffon and human maturity, 283, 284. Bull, Dr. William T., 56, 57. Bunions, 123. Bunyan, John, 60. Butter, fattening, 145. Cabot, Dr. Richard M., 190. Caesar, Julius, 292. Caffein, effect of, on blood pres- sure, 147. Cakes, 55. Calabar bean, 93. Calcium hypochlorite, 41, 42. Calf lymph, government-tested, 177. Calluses, 124. Calories, 42, 43 Campbell, Dr. Harry, 55. Camp infections, preventive meas- ures against, 173, 174. Camp, Walter, system of exercise, 245-249. Cancer, 7, 120, 121, 174, 199, 200, 202-209, 236. Candy, develops energy, 55. Carbohydrates, 43. Cardiac asthma, 262. Cartilages, ossified, 232. Cataract, 260-262. Catarrh, 68-70, 73, 74, 77, 91, 98, 99, 102, 172, 173, 221, 222. Cavities, tooth, 72, 180, 231. Cell evolution, the theory of, 286, 287. Cells, the body, 286-288. Cereals, 302. Chamberlain, Joseph, 290. Cheyne, quoted, 245. Cheyne-Stokes, respiration, 228. Childhood, development, 31-36; infections, 52, 53. Children's Bureau of the Depart- ment of Labor, reports, 18, 19, 20. 304 INDEX D Child's development, the, 31-36. Chill, the, 101, 107. Chittenden, Professor, 211, £13. Darwin, 2, 12. Chlorosis (green sickness), 235. Darwinian law, 15. Cholera, Asiatic, 42, 67, 173, 174; Deafness: cause, 78, 172; the hog, 250. tragedy of, 255-258. Chorea (St. Vitus's dance), 78, 79, Death rate, the, 200, 249-252. Deaths: from tuberculosis, 60; from preventable diseases, 142, 143; from smallpox, 179; from cancer, 203, 204, 209. Deformities, 61, 62. Delano, F. A., 247. 161, 182. Cigarettes, injurious, 91, 92. Circulation of blood, 44, 45. Cloak rooms, 48. Cocaine, 262. Cocoa, for nursing mothers, 23. Coffee, use of, 93, 153-155, 222, Dental floss, 72. 235, 236, 301, 302. Dentifrices, 72, 108. Cold: in the head, 73, 74, 102, 105; Diabetes, 72, 168, 182, 222, 228- common, 97-102; neglected, 97; 231, 236, 242, 261, 269. causes of, 98, 99; catching, 100, Diastolic pressure, 146. 101; prevention of, 100, 101, Dickens, Charles, 198. 102; "chronic," 172. Dietary: for one day, 213, 214, Cold-water baths, 45, 101. 245; for gout, 215, 216; for the Complexion improver, a, 127, 128. obese, 218, 219; for building up Connor, Professor, 164. Constipation, 265. Consumption, 8, 9, 109-118, 182, 186, 267. Conway, Rev. Dr. Moncure, 293. Cooking, good, 222. Cooks, poor, 251. Consumptive patient, the, 115- 117; his doctor, 117, 118. Corn-meal gruel, for nursing moth- ers, 24. Corns, 123, 124. Coryza, 68, 77, 91, 102. Cotton-mill industry, 200. Cousins, marriage of, 4. Cowpox, 66. Cows, feeding, 25. Cromwell, 294. Crosby. Secretary, 248. Cup, common, source of infection, 101, 104. Curran, Dr. John F., 186. Curriculum, school, 54. the system, 220; for diabetics; 231; for asthmatics, 266, 267; for elderly people, 289; for the child from time of weaning to its fifteenth month, 297, 298; from eighteenth to twenty-fourth month, 298, 299; during the second year, 299, 300; daily, for average adult, 301, 302. Diet, for nursing mother, 23, 24; daily, 301, 302. Digestion, poor, 99, 302. Digestive juices, 71. Digestive: organs, 59; juices, 71; disorders, 234. Diphtheria, 52, 56, 60, 65, 67, 68, 71, 73, 77, 168, 181, 227, 236. Disease prevention, 195, 197. Diseases, germ-induced, 22; sex- ual, 95, 96; degenerative, 200. Disinfecting solutions, 108. " Divine healers," 250. Dizziness (Syncope), 244. 305 WHY DIE SO YOUNG? Dragon tree, 285. p Draughts, 38, 40, 101. Drill, military, 132, 133. Factory workers, female, 200. Drinker, the moderate, 209, 210. Fatigue: and efficiency, 108, 188; Drugs, use of, 147, 151-153, 161, dyspepsia, 158-160. 238, 239, 275. Fats, 43. Drummond, Henry, The Greatest Fattening foods, 145, 146. Thing in the World, 166. Fear, 164, 165. Dunn, J. B., 223. Feeble-minded, 81, 82, 83. Dust, germ-laden, 98; city, 263, Feeding, bottle, 26-29. 266. Feet: wet, 98, 105, 107, 290; Dysentery, 42, 269. swelling of, 237. Dyspepsia, 55, 56, 71, 158-160, Fetra, Dr. L. L. La, 47. 220, 221. Fever: Scarlet, 52, 59, 65, 67, 68, v 71, 73, 77, 106, 168, 227, 236; typhoid, 56, 60, 67, 105, 145, Earache, 76. 150, 168, 170, 173-176, 229; yel- Ear, middle: running, 58, 181; low, 67; "lung," 108; after- inflammation of, 68, 69, 70, 172; noon, 112; rheumatic, 232. 257; catarrhal, 231. Filipinos, vaccinated, 179. Ears, ringing in, 172, 244, 255, Filters, water, 41, 42. 257. Fingers, dirty, 101, 174. Eczema, 149, 265. Finley, Dr. John, 128. Eliot, Doctor, 195. Fisher, Prof. Irving, 190. Embolus, 271. Fit, epileptic, 162. Emerson, quoted, 281. Flatfoot, 244. Emotions, the, 160, 163, 164. Flexner, Dr. Simon, 53. Environment, 13, 14, 18, 158. Food, 42, 43, 99, 145, 146, 149, 213, Epidemics, 41, 64, 100, 101, 102, 214, 218, 219, 220, 222, 231, 289, 103, 104, 106, 175, 177, 194, 297-302. 251. Foods for the nursery, forbidden, Epilepsy, 265. 300. Epileptics, marriage of, 4; off- Fowler's solution of arsenic, 169. spring, 12. Franklin, Benjamin, 190. Erysipelas, 168, 236. Fried food, 222. Eugenics, science of, 1, 2, 3, 4. Fruits, 302. Examinations, physical, 142, 143, Function, 13. 165, 184-187, 206, 219, 230, 233, q 236, 243, 247, 249. Exercise, 49, 50, 124-126, 131, 146, Gall stones, 181. 245-249, 289, 290. Galton, Francis, founder science of Extremities, swelling of, 187. eugenics, 1, 3, 12, 295. Eye: defects, 70, 71; strain, 79, 81, Gangrene, 244, 269. 156, 257, 261, 263. Garbage, disposal of, 37. Eyes, inefficient, 259. Gargle, solution for, 59, 108. 306 INDEX Gas: oxygen - consuming, 105; stomach, 98, 234; laughing, 208. Gastric: juice, 221; catarrh, 99, 221, 222. Gastritis, 221, 222. Gentian of the Alps, 93. Germs, disease, 41, 57, 58, 69, 70, 73, 78, 97, 104, 105, 106, 108, 176, 180, 181, 198, 263. Gibbs, Philip, 279. Gladstone, 290, 294. Glands, enlarged, 11. Glasses, fitting of, 261, 262. Glaucoma, 261. Goiter, 180. Goldsmith, Oliver, 126. Gout, 203, 211, 214-216, 222, 230, 242, 265, 267, 270, 271. Gravies, rich, 302. Green sickness, 235. Grippe, the, 52, 60, 68, 73, 102, 103, 168, 257. Gums, neglected, 58, 59, 71; un- healthy, 180, 233. Gymnasium, in schools, 48. Gynephobics, 165. Hall, Dr. J. Stanley, 49. Haller, and human maturity, 283. Hapsburg, family characteristics, 14. Hare-lip, 4. Hawthorn, Julian, Archibald Mai' maison, 13. Hay-fever asthma, 262, 263. Hazlitt, 127, 131. Headache " cures," 153, 235. Health Department, 194, 195. Hearing, defective, 67, 68. Heartburn, 55, 91, 234. Heart: undersized, 11; disease, 57, 97, 103, 174, 180, 181, 182, 187, 201, 239, 240, 270; palpita- tion, 149,150, 165, 187; athlete's, 149, 151; muscles, 150; beats, 234; functional disturbances, 234-236; fatty, 271. Heating method for schools, 48. Heels, French, 123. Helmet of Minerva, the, 162. Helmet, woolen, 113. Hemorrhage, 244. Heredity, 1, 2, 3, 6, 12, 13, 14, 18, 158, 204, 229. Hernia, 186, 187. Hip disease, 62. Hives, 149, 265. Hobbies for the old, 290. Holmes, Oliver Wendell, 163. Hoof-and-mouth disease, 250. House of Seven Gables, The, 13. Houses, ventilated, 99; super- heated, 99, 105. Human being, perfect, 183. Human maturity, the, 282, 283, 288. Hunchback, 62. Huntington, Rev. Dr. W. R., 293. Hutchinson, Dr. Woods, 179. Huxley, quoted, 135, 136. Hydrophobia, 66. Hygiene, departments of school, 54. Hygienic life, the, 134-135. Hypertension sufferers, 147, 148. Hypochlorite of lime, 41, 42. Hysteria, 160-163; cause, 161; imi- tation, 161; symptoms, 161, 162; treatment, 162, 163. Idiots, 81, 82, 83. Illumination, improper, 259, 260. Imbeciles, marriage of, 4; off- spring, 12; grade, 81, 82. Imitation, 13, 14, 161. Immunity against infectious dis- eases, 65-67. 307 WHY DIE SO YOUNG? Immunizing agents, 67. Index card, 53. Indian hemp, 93. Indigestible food, 99. Indigestion, 55. 71, 80, 91, 99, 149, 210, 267. Industrial surgeon, the, 184-187. Inebriates, offspring of, 5, 6. Infantile paralysis, 52, 56, 62-65; Edieyr^oval of or cause of, 63; symptoms, 64; Ki lin Rudyard> 163 treatment, 64, 65; preventive measures, 65. Infants: degenerately born, 12; sickly. 15, 16, 21, 22; artificially Kumiss*24 fed, 21, 22, 26-29; benefited by sea air, 22, 23; weaning, 24, 25, 297-300; development, 31-36. Infection: centers, 180- 183; "mixed," 181. Infections, childhood, prevention and treatment, 198. Influenza, 102-106; symptoms, 102, 103; contagious, 104; im- Laryngitis, 80 munity to, 104; control of, 104, Lateral curvature, 61, 62 Kankri cancer, 207. Keel breast, 77. Kidney disease, 97, 103, 180, 181, 201, 265, 267-270. Kidney excretions, 230; examina- tion of, 244. Kissing, germs transmitted through, 101, 104. Koch, 195. Kyphosis, 62. Land settlements for soldiers and sailors, 136. Lane, Franklin K., 136, 248. Langtry, Lily, 127. 105. Infusoria, one-celled, 284, 285. Ink drinking, 155. Inoculation, typhoid, 175. Insomnia, 114, 148, 273, 274, 275. Insurance, life, 142. Lead: poisoning, 72, 242, 271 ; and neuritis, 169. Le Bon's, The Crowd, A Study of the Popular Mind, 75. Lecky, Map of Life, 139. Legs, swelling of, 237. Intestines, paralysis of muscular Life expectancy after forty, 197- movements, 164. 202. Irritation, factor of chronic, 213, Lightning, commercial, 259. 214. Lincoln, 292, 294. Lip cancer, 206. J Lisp, 4. Liver: torpid, 149; reduced by surgery, 277; hobnail, 288. Living, fast, 240. Lockers, individual, 48. Lordosis, 62. Lumbago, 149. Lung fever, 108. Lungs, reduced by surgery, 277. 308 Jacobi, Dr. Abraham, 44. James, Henry, 166. James, Prof. William, 166. Jenner, Doctor, 66, 178. Johnson, Samuel, 126. Joint affections, 265. Joints, deformed, 232, 233. INDEX j£ of. 25, 26; cooling, 25, 26; keep- ing, 26; substitute for mother's McAdoo, Secretary, 247. milk, 27, 28; hot, 114, 148. Macy, Dr. Mary Sutton, 166, 167. Moles, 120, 121. Malaria, 105, 145, 150, 168, 170, Morality, 84-86. 173, 176, 177, 230. Morons, 81, 82. Malnutrition, 53, 54, 55. Mosquito, Anopheles, 176, 177. Malt extracts, increase milk flow. Mother: medical care, 20; con- 24. sumptive, 21, 26; nursing, 23, Marriage: of blood relations, 4-6; 24. of the tuberculous, 8, 9; age Mother's milk, substitute for, 21, suitable for, 138-141. 26, 27, 28, 29. Mastoid process, 69. " Motor ear," the, 257. Maturity, periods of, 282, 283, 288. Mouth-breathing, 11, 72, 76. Measles, 52, 60, 65, 68, 71, 73, 77, Mouth, cleansing, 71, 72, 100, 108. 103, 105, 106, 168, 227, 236. Mumps, 52, 68, 73. Meat, overeating, 211. Muscle: culture, 48, 49, 50; waste, Meats, 301. 126. Meats, and blood pressure, 146. Muscular system, 48, 49, 50, 124, Medical: school inspections, 52. 131. 53, 54; examinations, 165, 184- Music, 290, 291. 187, 219, 230, 233, 236, 243, 247; Mutes, deaf, 4. trust, 250. Myopia (nearsightedness), 70. Medicine, preventive, 194, 195. Medicines, proprietary, 115, 169, jj 250. Membrane, mucous, 11, 97, 98, Nasal discharges, 73, 76, 172. 100, 172, 262. Nascher, Dr. J. L., theory of old Memory, loss of, 243, 244, 270. age, 286, 287. Mendelian theory, 4, 12. Nature of Man, The, 284. Meningitis, 67, 70, 103, 257, 269. Negroes: tuberculosis in, 60; im- Mental defects, 81-84. mune against yellow fever, 67. Mental illness, 191. Nephritis, acute, 227, 228. Mercury may cause neuritis, 169. Nerve tests, 155, 156. Mercurial poisoning, 72. Nervous system, 5, 102, 131, 132, Metabolism, 102, 126,214,216,217. 156-159, 230, 262, 265, 291. Metallic poisoning, 72, 168, 169. Neuralgia, 149, 235, 265, 266; Metchnikoff, and human life span, " cures," 235. 284, 285, 286. Neurasthenia, 98, 149, 155, 156, Militia, the, 132-134. 157, 158, 159, 164, 265. Milk, cow's: for infants, 21, 24; Neuritis, 168-172; causes, 168, germs in, 22, 25, 28; for nursing 169, 170, 180; a case history, mothers, 24; fermented, 24; 170, 171, 172. graded, 24; pasteurized, 25; Newton, Dr. Richard Cole, 128. loose, 25; safeguarding purity Newton, Secretary, 248. 21 309 WHY DIE SO YOUNG? Nicotine: poisoning, 91; effect on Physical resources, 278, 279, 280. blood pressure, 91, 147. Nightmare, 80. Night sweats, 112. " Nocturnal asthma," 265. Nose excretions, 46. Noses, inflamed, 68. Nostrums, 169. Nurseries, ill- ventilated, 74. Nursing mother, diet for, 23, 24. Nutritional disorders, 54-56. Physical training, 49, 131, 132. Plague, the, 173. Plasmodium malaria, 176. Playgrounds, 48, 50. Pleurisy, 182, 235, 269. Pneumonia, 60, 68, 73, 74, 97, 106- 109; 145, 174, 181, 201. 257. 268, 269. Poisons, metallic, 72, 168, 169. Polypi, 78, 263. Porter, Dr. William H., Food as an Aid to Long Life, 192; daily food intake arranged by, 301, 302. Obese, dietary for the, 218, 219. Post, Louis E., 248. Obesity, 216-219; "diabetoge- Post-mortem examinations, 278, nous," 229. 284. Oil, petroleum, for mosquitoes, Potatoes, 302. 176. Pott's disease, 17, 62. Old age, what is, 283-286. Prayer, 291-295. Operations: for adenoids, 78; for Prayer, Nature of, 293. enlarged tonsils, 78; for cancer, Precancerous stage, the, 205, 206, 208,209; for cataract, 262; sur- gical, 277, 278. Ovarian affections, 265. Overeating, 99, 146, 147, 210-213, 216, 242, 265, 270. Overweights, 216, 217. Oxygen, life-maintaining gas, 11, 38, 39, 45. P Pace that kills, the, 239, 240. Pancreas, the, 229, 277. Pantaphobia, 165. Paralysis, 244, 271. Paratriptics, 93, 94. Pasteurizer, Straus, 25 n. Pasteur treatment, 66, 195, 198. Patent medicines, 115, 169, 250. Pathophobia, 165. Peritonitis, 269. Peruvian cinchona, 93. Phobias, 164, 165. Phosphorus poisoning, 72. 208. Predisposition, 106, 107, 108, 110. Profiteers, 250. Prolongation of Life, The, 284. Protein, 43. Psychasthenia, 155, 158. Public health, the, 193-195. Pulse, 234. Puncture, lumbar, 56. Pyorrhoea alveolaris, 72. Quinsy, 77. R Radiography, 259. Radium burns, cancer from, 206. Rankin, Dr. Guernsey, 156. Reducing, 219. Refraction, errors of, 70, 156, 257. Renal asthma, 262. Rest, sufficiency of, 135; how to, 165-168. 310 INDEX Retinal sclerosis, 243. Retinitis, 260, 261. Rheumatic heart disease, 57. Rheumatism, 57, 58, 59, 60, 78, 97, 149, 150, 170, 180, 181, 182, 231- 233, 236, 242, 267, 270. Rheumatieus, streptococcus, germ, 57, 58. Rhinitis, hypertrophic, 263. Rickets, 72, 261. Riggs's disease, 72, 73. Rontgen rays, 164. Roosevelt, Colonel, 180. Root, Elihu, 193. Rosenau, Professor, 195. Rubbing, 45. Rugs, preferable to carpets, 37. Rupture, 186. Saccharin, 231. Safety, factors of, 276-282. Salisbury, the Archbishop of, 290, 293. Saliva, /l, 91. Sanitary conscience, 195, 196. Sanitation, home, 37. Scarlet fever, 52, 59, 65, 67, 68, 71, 73, 77, 106, 168, 227, 236. School child, the, 46, 47; sense training for, 50, 51, 52. School, the, 47-49; medical inspec- tions in, 52-54; hot lunches in, 55, 56. Sclerosis, retinal, 243. Scoliosis, 61, 62. Scrofulous children, 10, 11. Sedentary occupations, 126. Sense training, 50, 51, 52. Septum, deflected, 98, 263. Serum, anti-meningitis, 56. Sexual intercourse, 95, 96; dis- eases, 95, 96. Shoe faults, 122, 123, 124. Siesta, afternoon, 146. " Sir Galahad," by Abbey, 89. Skin: stimulating, 45; and bodily waste, 101; bathing the, 118; an organ of respiration, 119; cancer, 120, 121. Sleep, 127, 134, 146, 160, 167, 272- 276. Sleeping bags, 114. Sleeping garments, 46. Sleeping room, ventilation of, 40. Smallpox, 56, 66, 103, 168, 173, 175, 177-179. Smiling Joe, 17. Smokers, moderate, 289. Snuffles, 73, 74. Sobriety makes for long life, 134, 135. Soul, the, 287. "Soul's Awakening, The," by Zant, 87, 88, 89. Soups, 302. Southworth, Dr. Thomas, 28. Sphygmomanometer, the, 146, 147, 236, 238. Spinal curvature, 61, 62, 123. Spinal douches, 157. Spittoon, 113. Sputum, blood in, 111, 112. Squint (strabismus), 4, 70, 71. Stammer, 4. Sterilized water, 41, 42. Stevenson, Robert Louis, " Pity Sick Children," 57. Stillborn, 12. Stimulants, 153, 154, 155. Stomach: disorders, 205, 220, 221; gnawing in, 221; tube, 221; gas, 234; overloading, 265, 267. Stoves, in bedrooms, 39; in living rooms, 99. Strabismus (squint), 70, 71. Streptococcus rheumatieus, 231. Strychnine, 93. St. Vitus's dance, 49, 78, 79, 161, 182, 236. 311 WHY DIE SO YOUNG? Sugar, excess of, 55, 228, 229; fat- tening, 145; sickness, 229. Suggestion, force of, 161. Sunshine, best disinfectant, 37. " Sure Cures," 232, 233, 250. Tonsils, enlarged, 11, 46, 56, 57, 58, 72, 77, 78, 81, 98, 263; in- fected, 181, 182, 231. Tooth cavities, 72, 180, 231. Toothpicks, wooden, 72. Surgical operations, 78, 208, 209, Towel, roller, source of infection. 260, 277, 278. Sweats, night, 112. Sweet, Edwin F., 248. Sweetbreads, 229. Swimming tanks, 48. Syphilis, 168, 230, 270, 271. Systolic pressure, 146. Tannin, 155. Tantrums, 80, 81. Tea, use of, 23, 93, 153-155, 222, 235, 236, 301, 302. Teeth: decaying, 4; bad, 53, 55, 58, 59, 81, 100, 180, 181; hygiene of, 71-73; cavities in, 72, 180, 231; gritting of, 76; X-raying, 180; diseased, 181; ulcerated, 233. 101, 104. Trait, recessive, 4. Trephining, 272. Tuberculosis, 7-11, 60, 61, 97, 103, 109-115, 168, 173, 181, 182, 186, 187, 229, 236, 257. Tumors, 205, 206, 264. Tuke, Dr. Hack, The Influences of the Mind on the Body, 164. Twain, Mark, 101, 126. Typhoid carriers, 174, 175. Typhoid fever, 56, 60, 67, 105, 145, 150, 168, 170, 173-176, 229. Typhus, 168, 173. U Udders, cleaning, 26. Ulcer, teeth, 73; stomach, 180; leg, 187; varicose, 187. Temperature, indoor, 40; school- Underclothing, wool, 134. room, 48. Tenements, ill-ventilated, 108. Terminal affections, 108, 269, 270. Tetanus (lockjaw), 67. Thein, effect on blood pressure, 147. Three Fates, The, 13. Throat: excretions, 46; cancer, 206. Throats, inflamed, 68, 172. Thrombus, 182, 271. Tilson, Hon. John Q., 249. Tobacco, use of, 90, 91, 92, 93, 134, 222, 235, 236, 242, 257; effect on blood pressure, 147. Toenails, ingrowing, 124. Toes, hammer, 124. Tongue, cancer of, 206. " Tonics," 157, 169, 170. Tonsillitis, 77. Undergarments, 59. Underweights, 219, 220. Uremia, 228. Uric acid in the circulation, 214. Uterine affections, 265. Vaccination, 56, 66, 175, 177-179. Vaccine, 66, 178. Valvular disease of the heart, 149, 232, 234, 236-239. Varicose ulcer, 187. Vegetable, 302. Venereal diseases, 95, 96, 191. Ventilation, home, 37, 38, 80, 99, 105; schoolroom, 48. Vertebrae, disease of, 61. 512 INDEX Visual defects, 189, 258-260. Vitamines, 43. Voltaire, 291. W Walking, 126-131. Warmth, for the aged, 290. Warts, 120, 121. Washington, 292, 294. Water, drinking, 36, 37. 40, 41, 42 128, 134, 157, 245. Wax in ear, 68. Weaning infants, 24, 25, 297-300. Weight, reducing, 144, 145; taking on of, 145, 146. Weir-Mitchell cure, the, 157. , Whitman, Walt, 295. Whooping cough, 52, 56, 65, 68, 105, 111. Wiley, Dr. Harvey W., 190. Will, the human, 13, 96, 158, 160. 249. Wilson, 294. Window board, 39, 40. Winds, sea, germ-free, 22. X-ray examinations, 73, 112, 18G\ 208. Yellow fever, 67. Young, Arthur, quoted, 137. Zant's, " The Soul's Awakening," 87, 88. Zinc may cause neuritis, 169. THE END ^StO^c y^c VL*JU Jim rf ct xJ&,xg Ml^\>4m '^jiLJ/Witii'u p | M S^HIffiB li>g ' r. . . ii?